The Facts Behind the Fear of Legionnaires' Disease
Scientists link energy-saving water systems to outbreak conditions, but what are the real risks?
A trend in public health that had been building quietly for years finally burst into the news in July. First, more than 100 people sickened and 12 died in July and August in the Bronx in New York City. Then, in September, another outbreak occurred in which a dozen people succumbed out of 54 who fell ill at a Quincy, Ill., veterans home. That same month, dozens more came down with the illness at San Quentin State Prison, near San Francisco.
Each outbreak of Legionnaires’ disease, a severe form of pneumonia caused by bacteria that thrive in warm water, faintly recalled the cholera epidemics of the 18th and 19th centuries. While many might assume that waterborne diseases are extinct in the U.S., the outbreaks of Legionnaires’ disease, in reality, are commonplace, though unspectacular.
The number of people affected is significant. Legionella bacteria infect between 8,000 and 18,000 people in the United States every year, according to the U.S. Centers for Disease Control and Prevention (CDCP). The number of victims has been growing, says the CDC.
Meanwhile, the growing number of people hospitalized or killed by the disease has fueled more lawsuits, say consultants and plaintiffs attorneys. “Legionnaire’s is the new asbestos,” claims Tim Keane, a consultant with Legionella Risk Management in Chalfont, Pa. “The litigation rate is very high.”
Whether those assertions are true remains to be seen. A review of cases in state circuit courts, as shown on the website Justia.com, showed that comparatively few building owners and managers are the primary targets in lawsuits on record.
Located on the roofs of buildings, evaporative cooling systems, which spread the bacteria in New York City, are just a part of the problem. A report released in August by the CDCP shows that showerheads, faucets and other sources of potable water contribute to waterbornedisease outbreaks. The report expands the public impression of Legionnaires’ disease as something exclusively contracted from a building air-conditioning system or a cooling tower’s airborne droplets, although air-conditioning and cooling towers have the potential to affect larger numbers of people.
Chemical disinfectants are the main method of controlling the Legionella bacteria, but water temperature and flow control also matter. In 2011, researchers at the Johns Hopkins University School of Medicine wrote that electronic faucets are more prone to high bacteria levels, compared to manual faucets.
In July 2014, three research scientists from Virginia Tech, Blacksburg, Va., presented a review of research on waterborne diseases and drinking water. That report focused on so-called opportunistic premise plumbing pathogens (OPPPs). These pathogens, the scientists wrote, “are now the primary source of waterborne infectious disease in developed countries.”
Keane, citing those and other related studies, said faucet and showerhead watercontrol devices effectively slow down circulation and leave water to sit, stagnant, for longer periods in tanks and plumbing systems. “Instead of turning over once a day, it might be sitting there for days,” Keane said. The sweet spot for Legionella bacteria is between 68°F and 122°F. A key issue with preventing Legionnaires’ disease is maintaining high-enough temperatures in hot-water tanks, said Michael Patton, head of international sales and regional management for Griswold Water Systems.
Building owners trying to save energy frequently turn down the heat to the 120°F range. “We understand the need to balance water and energy conservation,” said Patton. “At the same time, reducing hot-water temperature from 140° down to 120° to save energy puts your water temperature at a risk profile where it could allow colonization to begin.”
Sluggish circulation from water flow controls can be another contributing factor, said Patton. For example, if flow restrictions are put in and pipes are not insulated, the water will both cool down faster and circulate more slowly in the pipes.
No one is suggesting that green building systems are the only or even a major cause of the increasing occurrences of Legionnaires’ disease or other waterborne illnesses. As a large swath of the U.S. population gets older, they are more susceptible to—and more likely to die from— the disease; also, improved reporting and detection are adding to the total of known cases. A new standard on design guidance for legionellosis, published by ASHRAE (formerly known as the American Society of Heating, Refrigerating and Air-Conditioning Engineers), sets minimum legionellosis risk-management requirements for water systems (ENR.com 7/7).
The Virginia Tech scientists concluded there were “direct conflicts between control of OPPPs and other worthy goals, such as scalding [prevention], disinfection by-products, energy and water conservation, and corrosion control.”
Since testing is now sophisticated enough to pinpoint the source of an outbreak, lawyers are often eager to take these cases because the evidence is stronger, Keane noted.
Most settle out of court, as is typical in personal injury cases, with more than 90% finished before the trial stage, notes Thomas Bernier, a shareholder at law firm Segal McCambridge’s Baltimore office. It works on many cases involving insurance companies defending against Legionnaires’ claims.
But Bernier, Keane and other attorneys who defend building owners and companies against Legionnaires’ disease claims, say their caseloads have expanded steadily, with a corresponding increase in the number of personal injury lawyers now specializing in Legionnaires’ litigation.
Designers and contractors may be vulnerable to lawsuits over outbreaks in comparatively new buildings. When cases do go to trial, the price tag can be steep, with judgments averaging in the $2- million range, Bernier said.
A primary goal of plaintiffs’ attorneys is to prove what caused the bacteria to colonize the building, which means the lawyer for the plaintiffs will “cast as wide a net as possible,” said Susan Smith, another shareholder at Segal McCambridge.
The exact number of lawsuits hitting designers and contractors is hard to discover. Design and construction team members are more likely to be targeted when the disease strikes people in newer buildings, such as the 2010 outbreak at a Baltimore senior living complex, which had been open for only a few years. Another outbreak in which the lawsuits targeted designers and contractors occurred at an Akron, Ohio, hospital expansion.
Other lawsuits visible on Justia.com mainly involved building owners and operators as defendants. One set of lawsuits targeted the U.S. government, claiming wrongful death and negligence connected to outbreaks at veterans hospitals in the Pittsburgh area in 2011 and 2012. Six out of 22 people who became ill died. Another recent case came from the family of an Irish tourist who was visiting Chicago. They sued Marriott International in 2012, alleging that he became sick from water sprayed from a decorative fountain. The suit names the hotel chain and the owner of the specific hotel as defendants. So far, although Legionnaires’ disease shows few signs of being “the new asbestos,” it remains a persistent health problem and worry.