The time has come for definitive steps to be taken that call for pre-emptive and strategic action to help prevent outbreaks. This summer, there have been several large outbreaks of Legionnaires’ disease. Outbreaks in Quebec City, Edinburgh, and Chicago were some of the deadliest in recent years. These recent tragedies highlight the urgency that is necessary to create plans and policies that can help ensure that future outbreaks have less of a harmful impact and can be avoided altogether.
Legionella, the bacteria that can cause Legionnaires’ disease, grows in abundance in nature. However, when conditions in manmade water supplies promote Legionella growth, problems can occur. When Legionella propagate, it is more likely that people can inhale aerosolized water containing the bacteria, which can infect the lungs, causing a disease that can be severe, with mortality rates from 5 to 30%.
Currently, building owners are not legally required to test their water supplies for Legionella. While rigorous testing is generally conducted following an outbreak, building owners do not need to conduct pre-emptive diagnostic testing of any kind. The design and dimensions of a water system as well as the type of components used, the amount of chlorine in the system and the temperature all influence the risk factor for Legionella proliferation within a building. The problem is, while these issues can point to potential problems, scheduled testing specific for Legionella is the only way for building owners to know if they must act to prevent patrons and employees from becoming sick. Required testing for large water supplies is a proactive step that can directly prevent outbreaks.
Local and state health departments similarly must adjust their protocols for Legionella reporting. When notified of a cluster of cases and a potential outbreak, health departments have done exemplary work in terms of collaborating with building-owners to remedy dangerous situations. They help with remediation, post-outbreak testing, and help building management develop plans to avoid future outbreaks. However, public notification of outbreaks must improve. Health departments must make basic information about recent outbreaks readily available to the public on websites as soon as possible, so the public can feel informed about potential dangers to their health.
Overall, the emphasis should be on protecting the public from Legionnaires’ disease before outbreaks occur, and lessening the impact of outbreaks if they do come up. Instead, action is generally much less proactive, and largely seems to focus on “cleaning up the mess” if an outbreak occurs. This is the wrong approach. The solution is to create a culture where building owners seek to protect the public and are held accountable if they choose not to and where health departments seek transparency in their investigations to better inform and protect people. A national conference is a first step in finding this solution. This conference would set the stage for further action, bringing together representatives from health agencies, facilities managers, experts from the water treatment industry, microbiologists, and others from industries impacted by Legionella. The emphasis of such a conference would be to create awareness as to the dangers of Legionella and to push for standards that would create an environment where protection of the public is the top priority.