A Belated Look at New York’s Cooling Towers, Prime Suspect in Legionnaires’ Outbreak
Since the outbreak that gaveLegionnaires’ disease
its name nearly four decades ago, water-cooling towers have been identified as prime breeding grounds for the deadly disease.But even as cases have increased across the nation, and experts have called for more safeguards, New York City has done little to address the risks the towers pose as they power air-conditioning systems in many large buildings
Now, as New York faces the largest outbreak of Legionnaires’ disease in the city’s history, Mayor Bill de Blasio and other officials are trying to marshal a more aggressive approach to the disease and to quell concerns raised by seven Legionnaires’ deaths since July 10, all of them in the South Bronx. At a news conference on Tuesday in the Bronx, the mayor said that the total number of cases had risen to 86 and that more cases were expected to be reported, even as the outbreak appeared to ebb
iven its name by a 1976 outbreak at an American Legion convention in Philadelphia, the airborne respiratory disease has sickened thousands of New Yorkers. The city’s first confirmed case, in 1977, was a 68-year-old Manhattan woman (who recovered), and since then, the disease has struck again and again, in apartment complexes, office buildings and even on a cruise ship. But the disease has typically come in smaller numbers and with only scattered deaths, and that has largely left the government reacting to outbreaks rather than trying to prevent them.
Often described as a severe form of pneumonia, the disease can spread through air-conditioning units mounted in windows, exposed overhead pipes and other common features of urban life.
And it can take as little as walking by one of these sources carrying the legionella bacteria and inhaling mist to contract the disease, though certain people — older adults, smokers, those with weakened immune systems — are more susceptible.
In recent years, the country has seen a spike in legionella-related illnesses. The number of cases reported to United States public health authorities rose to 4,548 in 2013 from 1,127 in 2000, according to a 2015 medical journal article.
This year, the Centers for Disease Control and Prevention has reported about 2,400 cases of Legionnaires’ disease.
Precisely how and where the 86 people with Legionnaires’ in the current South Bronx outbreak contracted remained under investigation by health authorities. But five water cooling towers — a component of the air-conditioning systems in many modern buildings — have tested positive for legionella in the affected area and are thought to be the source of the outbreak. That finding has highlighted longstanding concerns about the upkeep and oversight of the cooling towers, which provide the damp, warm environment that the bacteria need to thrive and must be cleaned regularly to prevent bacteria from taking root.
Dr. Jay Varma, deputy commissioner for disease control for the city health department, said in an interview that the city had not acted sooner to propose regulation in part because of the difficulty of identifying the cause of the disease in many cases. He said it was also not known how often cooling towers were the source. “The challenge is we don’t know where most infections normally come from,” he said.
n the South Bronx, Dr. Varma said, health officials are confident that they have identified and addressed the most likely cause of the outbreak but have not yet determined whether it was one or more of the towers. He said the city would not release the names of those who had died, citing privacy laws.
At the news conference on Tuesday, Mr. de Blasio said the city planned to tighten regulation of the towers, but in recent days, community leaders, neighborhood residents and industry experts have faulted the city for failing to have a more rigorous inspection regime in place.
In December and January, there was another outbreak of Legionnaires’ disease in the Bronx, with 12 confirmed cases. Eight involved residents of Co-op City, the sprawling complex of apartment buildings in the northeast Bronx. Cooling towers were later found with the bacteria. None of those cases were fatal.
Mr. de Blasio, in defending the city’s response on Tuesday, said the recent outbreaks in the Bronx had underscored the key role of cooling towers in spreading the disease and had prompted city officials to become more proactive. “Previously, and this is the consensus of everyone I’ve talked to who are experts in this field, there wasn’t an identified pattern that suggested these cooling towers were a problem,” he said. “Now we have a pattern.”
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But a study published last year by researchers in the city’s health department documented the rapid increase in cases of the disease and pointed to cooling towers as one of the risk factors in outbreaks. The study also noted that the disease was often concentrated in impoverished neighborhoods, saying, “If environmental issues in high-poverty neighborhoods contribute to the disparity, greater effort may be warranted, for example, on the upkeep of cooling towers and water systems in the buildings in these areas.”
The C.D.C., the New York State Department of Health and a variety of industry groups have all published guidelines for maintaining cooling towers in an effort to help health care facilities prevent the spread of legionella bacteria. In June, the American Society of Heating, Refrigerating, and Air-Conditioning Engineers, an influential engineering association, specifically addressed cooling towers in a standard published in June to reduce the risk of legionella.
But generally such standards are not binding, leaving building operators to weigh the risks of legionella with the hefty price of monitoring.
“Hindsight is 20-20, but it’s not a new disease,” said Bill Pearson, who served on the committee that wrote the recent standard. “And it’s not like we haven’t known about the risk of cooling towers, and it’s not like people in New York haven’t died of Legionnaires’ before.”
In 2000, City Councilman James S. Oddo, who represented Staten Island, proposed a resolution to determine best practices for preventing Legionnaires’ disease at hospitals in the city. The resolution, which Mr. Oddo, now the Staten Island borough president, says was inspired by a report he saw on television, ultimately failed.
A grave warning came five years later. Seven patients contracted Legionnaires’ disease, two of whom died, at NewYork-Presbyterian/Columbia hospital, and a city and state investigation traced the source to a tainted water supply in a hospital building. But no new city regulations were put in place.
Indeed, during a 2010 committee hearing on indoor air hazards that might spread legionella and other bacteria, James F. Gennaro, then a city councilman from Queens, interrupted a representative for a contractors’ association to say his testimony was “freaking me out so bad I’m putting like, you know, Purell on right now.”
One of the largest outbreaks took place in 1994 on the cruise ship Horizon, part of Celebrity Cruises, which departed from New York City. One passenger died from Legionnaires’ disease, and federal health officials found 16 other confirmed and 34 suspected cases of the illness in passengers on the Horizon between late May and mid-July of that year. The outbreak was traced to legionella found in the sand used in filters in the ship’s whirlpool baths.
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