UPDATE: 3 CASES IDENTIFIED IN ROCKLAND COUNTY, 1 TRACED BACK TO THE BRONX. IS THE OUTBREAK REGIONAL NOW?

When will the Centers for Disease Control be called in?

The Banknote Building (which half of the building is leased by NYC’s HRA department serving people on public assistance), The Bronx Detective Bureau, Daughters of Jacob Nursing Home, and Department of Homeless Services Intake Center in The Bronx were found to have tested positive for Legionella as it has crossed over into East Harlem in Manhattan and found at Taino Towers, and Brooklyn House of Detention as mandatory testing of cooling towers is now in effect. According to Pix11 News a Riker’s Island inmate is also now among the infected.

As of yesterday, it brings the total to 15 sites that have been identified and made public although for whatever reasons, 3 sites identified by New York State Department of Health that are “outside” the impact zone have yet to be identified but according to a press release by the City and State, the identities of those sites will be released shortly.

Welcome2TheBronx called the New York State Department of Health’s Press office to see when these additional sites would be released to the public and we were simply told, “We don’t know.”

We asked why is there a delay in releasing the information if the sites were identified as of yesterday and we were simply told, “We really don’t have an answer as to why they haven’t been released yet.”

This lack of timely communication of information is a problem. People want and need to know where these sites are, it is our rights as residents of New York City and New York State to know where the potential hazards are being found IMMEDIATELY. It is precisely what The Opera House Hotel is upset with—this lack of any type of information.
List of sites that have tested positive for Legionella and locations of Legionnaires’ cases as per data provided by NYC Department of Health:

A nurse who works at Lincoln Hospital for the past 8 years reached out to us because they felt that they could no longer remain silent. In order to protect the nurse’s identity they have asked to remain anonymous, however, we have known the individual for years and can vouch that they are indeed a reliable source.

The Lincoln Hospital nurse wrote to us and said:

“I am in the trenches here at Lincoln with this outbreak. I’ve treated several patients with it and during its most active time. I will admit that even I was afraid and I don’t frighten that easily. I knew something was wrong because the pneumonia numbers were growing and nobody was saying anything. I kept bringing it up to my coworker and on the third day of me talking about it, the news broke. Lincoln did not inform its employees officially until two days after the news aired it and supposedly the first case walked into the hospital on July 4th which I believe is inaccurate. I walked through the halls and it seemed like every other person had pneumonia and everyone was coughing up phlegm and blood. And the ages varied from late 30’s to late 70’s, It was truly alarming. So I am with you on not trusting what they say. I’m really hoping that they find the actual source and get this under control.”

As of August 10th, according to the NYC DOH the following is known thus far:

Highlights:

• No new deaths have been reported in the last six days.
• No new cases diagnosed since August 3.
• Health officials remain confident that the source of the outbreak is from a location in the initial round of positive test sites, and that through disinfection of the source, the outbreak has been contained.

Cases

• Reported individuals with Legionnaires’: 113
• Individuals treated and discharged: 76
• Individuals with Legionnaires’ deceased: 12
• All deceased individuals were adults with underlying medical conditions.

Safety of Water Supply and Air Conditioning

• New York City’s drinking water supply and other water features, like fountains, shower heads and pools, are safe throughout New York City and are unaffected by legionella
• Water towers are unaffected by legionella
• Home air conditioner units are unaffected and walking into air conditioned environments is safe, as well.

Locations and Remediation

• All sites will submit long-term plans as to how they will maintain the cooling towers to protect against any future growth of legionella.
• The Health Department convened a panel of experts in the field of infectious disease to discuss the work the City has done so far and to ensure that all the appropriate steps are being taken to find and eliminate the source of the outbreak.

Ongoing Actions

• Continued monitoring for new cases
• Close collaboration with area hospitals
• Disease detectives conducting epidemiological investigation
• Interviews with all individuals reported with Legionnaires’ to support source identification
• Providing updates to elected officials and Bronx residents
• Outreach to vulnerable populations – senior centers, homeless shelters, and other locations
• Monitoring of disinfection of affected cooling towers

How does NYC DOH know that our water towers and drinking supply are safe if they have not tested them? What about the teacher who passed away in April that worked in the impact zone, why is his death not being counted and researched? Approximately 7 confirmed cases of Legionella infections are located within a 2 block radius around PS 325 where the late teacher worked.

The following are facts about Legionella and Legionnaires’ Disease which are not being disclosed by DOH and in turn the media and it is imperative that everyone is fully aware of all the facts:

Fact:

According to the CDC:

“Despite advances in water management and sanitation, waterborne disease outbreaks continue to occur in the United States. CDC collects data on waterborne disease outbreaks submitted from all states and territories* through the Waterborne Disease and Outbreak Surveillance System.† During 2009–2010, the most recent years for which finalized data are available, 33 drinking water–associated outbreaks were reported, comprising 1,040 cases of illness, 85 hospitalizations, and nine deaths. Legionella accounted for 58% of outbreaks and 7% of illnesses, and Campylobacter accounted for 12% of outbreaks and 78% of illnesses. The most commonly identified outbreak deficiencies§ in drinking water-associated outbreaks were Legionella in plumbing¶ systems (57.6%), untreated ground water (24.2%), and distribution system deficiencies (12.1%), suggesting that efforts to identify and correct these deficiencies could prevent many outbreaks and illnesses associated with drinking water. In addition to the drinking water outbreaks, 12 outbreaks associated with other nonrecreational water** were reported, comprising 234 cases of illness, 51 hospitalizations, and six deaths. Legionella accounted for 58% of these outbreaks, 42% of illnesses, 96% of hospitalizations, and all deaths. Public health, regulatory, and industry professionals can use this information to target prevention efforts against pathogens, infrastructure problems, and water sources associated with waterborne disease outbreaks.”

Fact:

According to the NYTimes:

“Legionella love water systems, particularly old, clunky and corroded ones that are not well maintained and have a little sludge,” said Dr. Glenn Morris, the director of the Emerging Pathogens Institute at the University of Florida and a specialist in infectious disease. “Cooling towers in particular are a great place to live from a legionella’s perspective, because it’s nice, warm water year-round.”

But experts said cooling towers account for a relatively small proportion of Legionnaires’ outbreaks. More often, they said, the disease spreads through the systems that supply water for drinking, cooking and bathing.”

Fact:

According to the EPA:

Legionella also grow symbiotically with the aquatic bacteria attached to the surface of biofilms (Kramer and Ford 1994). Biofilms provide the bacteria with nutrients for growth and also offer protection from adverse environmental conditions (including during water disinfection). The concentration of Legionella in biofilms depends upon water temperature; at higher temperatures, they can more effectively compete with other bacteria. Because biofilms colonize drinking water distribution systems, they provide a habitat suitable for Legionella growth in potable water, which can lead to human exposure.

The advisory went in to further state:

“Colbourne and Dennis (1989) stated that although Legionella are not thermophilic, they exhibit thermo-tolerance at temperatures between 40 and 60°C, which gives them a survival advantage over other organisms competing in man-made warm water systems. Although temperatures between 45 and 55°C are not optimal for Legionella, these temperatures enable them to reach higher concentrations than other bacteria commonly found in drinking water, thus providing Legionella with a selective advantage over
other microbes (Kramer and Ford 1994).”

Fact:

From Legionella.org:

“Public health authorities downplay the significance of Legionella infections because most originate from drinking water. It is easier to target a cooling tower and harder to discuss with the general public the implications of Legionella in the drinking water. Note that the investigators said “probably”. All you have to do is ask the investigators “Did you culture the homes of the patients and their workplaces for Legionella?” If they refuse to answer, you will have learned something.”

The implication is that the actual source is not the cooling tower, but the home or workplace of the patients with Legionnaires’ disease. In order to be thorough, the health department should have cultured the drinking water that the patients had been exposed. ”

From the Centers for Disease Control:

“Despite advances in water management and sanitation, waterborne disease outbreaks continue to occur in the United States. CDC collects data on waterborne disease outbreaks submitted from all states and territories* through the Waterborne Disease and Outbreak Surveillance System.† During 2009–2010, the most recent years for which finalized data are available, 33 drinking water–associated outbreaks were reported, comprising 1,040 cases of illness, 85 hospitalizations, and nine deaths. Legionella accounted for 58% of outbreaks and 7% of illnesses, and Campylobacter accounted for 12% of outbreaks and 78% of illnesses. The most commonly identified outbreak deficiencies§ in drinking water-associated outbreaks were Legionella in plumbing¶ systems (57.6%), untreated ground water (24.2%), and distribution system deficiencies (12.1%), suggesting that efforts to identify and correct these deficiencies could prevent many outbreaks and illnesses associated with drinking water. In addition to the drinking water outbreaks, 12 outbreaks associated with other nonrecreational water** were reported, comprising 234 cases of illness, 51 hospitalizations, and six deaths. Legionella accounted for 58% of these outbreaks, 42% of illnesses, 96% of hospitalizations, and all deaths. Public health, regulatory, and industry professionals can use this information to target prevention efforts against pathogens, infrastructure problems, and water sources associated with waterborne disease outbreaks.”

As more and more sites are identified that are “outside” the impact zone, we must demand answers as to how this disease has spread so far in our communities and to what extent is it present in our everyday environments.

We’ve been through this before in The Bronx. We all know if this were happening in Manhattan, perhaps on the Upper East Side or any area below 96th Street, there would be more action and faster results than we are getting, but we’re not.

It’s still a tale of two cities when it comes to health disparities and issues.

The Bronx Museum was overflowing with concerned Bronx residents about the current Legionnaires’ outbreak in our borough—so much so that well over a hundred more could not get inside.

A city employee told an attendee of the meeting that they were not prepared for such a turn out as residents expressed frustration at using such a small space for such an important meeting.

The panel, led by New York City’s Department of Health Commissioner Dr Mary Travis Bassett, MD, provided several new insights such as the death toll having risen from 4 to 7 with a total of 86 confirmed cases.

The panel  continuously stressed that they are focusing on cooling towers because that’s where recent cases have been found to be the source and are closest to those currently infected.

This line of thinking runs counter to that of studies and even the United States Environmental Protection Agency which in 2001 stated in an advisory that the majority of cases originate with drinking water.

Legionnaires’ is transferred to humans via water vapor and mist so theoretically, if you’re taking a hot shower and the water is contaminated, it’s quite possible to become infected.

According to the Mayo Clinic, one of the most world-renowned medical research groups indicates the following:

How the infection spreads

Most people become infected when they inhale microscopic water droplets containing legionella bacteria. This might be the spray from a shower, faucet or whirlpool, or water dispersed through the ventilation system in a large building. Outbreaks have been linked to a range of sources, including:

• Hot tubs and whirlpools on cruise ships
• Cooling towers in air conditioning systems
• Decorative fountains
• Swimming pools
• Physical therapy equipment
• Water systems in hotels, hospitals and nursing homes

Although legionella bacteria primarily spread through aerosolized water droplets, the infection can be transmitted in other ways, including:

• Aspiration. This occurs when liquids accidentally enter your lungs, usually because you cough or choke while drinking. If you aspirate water containing legionella bacteria, you may develop Legionnaires’ disease.
• Soil. A few people have contracted Legionnaires’ disease after working in the garden or using contaminated potting soil.

Several healthcare sites suggest that you should boil your water and then cool it before using it for drinking purposes if you’re at high risk of getting infected such as those with respiratory ailments and compromised immune systems.

Legionella.org says:

“For patients who have an underlying disease that compromises their immune system (diabetes, kidney failure, etc.), avoid drinking tap water. Instead, bring the water to a boil, then cool it, and then store it in the refrigerator for drinking. Long boiling times are not necessary. As soon as the water starts boiling and bubbling, Legionella and other water bacteria are killed. Bottled water is less likely to contain Legionella in large numbers than tap water.

For patients who are transplant recipients, receiving cancer chemotherapy, or receiving corticosteroids (prednisone), tap water should not be used for drinking. Buildings taller than three stories are more likely to harbor Legionella.”

When Welcome2TheBronx asked the panel if the Department of Health had cultured the homes and workplaces of those infected and the victims, the answer was no.

We also, for the record, presented the data regarding that the majority of cases of Legionnaires’ originate with drinking water and drinking water systems and the panel did not refute the data but they skirted the issue saying that for this outbreak in they didn’t see any evidence for that stating that “we would see high concentrations of individuals at one building if that were the case and we didn’t see that.”

Yet one building had 8 individuals who were infected with one victim who passed away and District Leader Israel Martinez, from the 84th Assembly District which covers Carmen Arroyo’s district came forth and broke down crying because 4 of his neighbors from his building at 787 E 149th Street are in the hospital due to Legionnaires’ and another was one of the 7 victims that passed away from this outbreak.

Clearly we are being presented with evidence of clusters in buildings that have not yet been identified as contaminated which runs contrary to what Health Commissioner Dr Mary Travis Bassett, MD responded to Welcome2TheBronx’s question.

Life long resident, Nick Leshi said,  “Seven dead so far. Unacceptable. If this was anywhere else besides the South Bronx there would be a national outcry like there was for the Ebola scare. The Department of Health needs to be held accountable and so do those company landlords. They’re handing out flyers to educate the public on Legionnaires’ Disease but this happened in Co-op City too. The public has no control over this—elected officials need to step up and make sure our water infrastructure is safe.” As a commenter said, Leshi added, “The politicians are spinning this into something fairly isolated, but it’s a larger, systemic issue.”

Erin Brockovich, the legal clerk and environmental activist who gained fame after Julia Roberts portrayed her in the movie by her name, went out publicly on the Bronx outbreak and said the following on her Facebook page yesterday:

“Now 4 Dead, 71 Sickened Amid Legionnaires’ Outbreak in NYC

The Legionella bacteria has been detected across the greater Bronx area. If it were one cooling tower here – another there… maybe, but it has infected many locations.

The water system is compromised, disinfection has failed…and so has your government.”

Bronx Borough President said, “We’re not at the level of panic but anxiety is very high.” but many Bronx residents do not agree with that. People are anxious and clearly indicated they are panicking due all the uncertainties with this outbreak.

Parents are panicking about schools to which Eva Moskowitz founder and CEO of Success Academy Charter Schools sent an email stating that they are, “…in close contact with the Department of Education to make sure that all our school buildings have been tested, and remain safe.”

A parent from one of the schools called to find out whether the school had been tested and they were told yes by the school’s administration but they, “…don’t have official reports from the DOE and the City to share with the parents.”

The South Bronx and The Bronx needs the our government officials from local to the State level to step up their game and increase the speed and manpower in this investigation.

Today Mayor de Blasio announced that the number of new cases are dropping and that his administration will be working on designing legislation on halting future outbreaks. Along with the Health Commissioner Bassett, they both continue to state that the drinking water is safe but how do we know that if it hasn’t been tested? How do we know if the faucets and showers at the homes and workplaces of the cases haven’t been tested?

During today’s press conference they continue to blame the cooling towers but what about the 2 aforementioned clusters in the two buildings? Again, if these homes haven’t been tested, we cannot rule out the drinking water supplies of the buildings where these people live.

Dr Bassett also said that people with asthma and respiratory ailments are more susceptible to Legionnaires’ and Public Advocate Leticia James added that people with HIV and compromised immune systems are at greater risk.

These are two conditions which are highest in the South Bronx where the outbreak has occurred. We have 8x the national rate asthma in our population and we have 15x the rate of hospitalization from asthma.

The Bronx also has the highest rate of HIV infections in NYC mostly concentrated in The South Bronx which makes this a dangerous situation for our most vulnerable populations.

We will not sit by silently while our friends, family, and neighbors are sickened by this disease and the city hasn’t done its due diligence by testing the homes of the 81 cases thus far. It is negligent in my personal opinion that New York City’s Department of Health is not covering all bases.

Call NYS Governor Cuomo at 518-474-8390 and choose option #3 and demand that investigation is stepped up on both the State level along with the Federal level by calling in the CDC.

Call NYS Health Commissioner Howard A. Zucker, MD at 518-474-2011 and demand that investigation is stepped up on both the State level along with the Federal level by calling in the CDC.

Last night’s Town Hall Meeting at The Bronx Museum:

Mayor de Blasio’s Press Conference today at Lincoln Hospital:

Just days after NYC Department of Health announced a Legionnaires’ outbreak in the South Bronx, New York City’s Office of Emergency Management is rolling out its mobile office to The Bronx, tomorrow, August 4th. The Mobile office will be deployed throughout the 5 boroughs over the month of August to educate New Yorkers on preparing for emergencies and will also distribute literature on Legionnaires’ Disease.

From NYC Office of Emergency Management (OEM)

NYC EMERGENCY MANAGEMENT BRINGS MOBILE OFFICE TO THE BRONX ON AUGUST 4

NYC Emergency Management to open mobile offices throughout all five boroughs in the month of August

August 3, 2015 – New York City Emergency Management officials will visit the Bronx on Tuesday to discuss emergency preparedness, coordination, and planning with residents. NYC Emergency Management staff members will open a mobile office at Monsignor Del Valle Square in Hunts Point from 11 AM to 3 PM, and will give residents the opportunity to learn more about the agency’s role in educating and preparing New Yorkers for emergencies. Emergency managers will also distribute information about Legionnaires’ disease.

“NYC Emergency Management works tirelessly every day to keep New Yorkers safe and informed,” said NYC Emergency Management Commissioner Joseph Esposito. “Our mobile office hours are a new way for New Yorkers to meet and get to know the emergency managers coordinating emergency responses in New York City.”

NYC Emergency Management staff members will be on hand to distribute a range of emergency preparedness materials. New Yorkers are encouraged to stop by to learn how to be prepared for any emergency, including steps to make a plan, gather supplies, and stay informed. Residents will also learn how they can join New York City Community Emergency Response Teams (CERT), a program consisting of more than 2,000 volunteers dedicated to helping their communities during emergencies.

NYC Emergency Management mobile office hours will be held from 11AM to 3 PM at the following locations:

• August 4: Bronx, Hunts Point (Monsignor Del Valle Square, 163rd Street and Hunts Point Avenue)
• August 6:  Brooklyn, Red Hook (Red Hook Library, 7 Wolcott Street at Dwight Street)
• August 12: Queens, Rockaway Beach (Beach 95th Street and Rockaway Beach Boulevard)
• August 18: Staten Island, St. George (Staten Island Borough Hall, Stuyvesant Street and Borough Place)
• August 25: Manhattan, Harlem (Adam Clayton Powell Jr. State Office Building, 125th Street and Adam Clayton Powell Jr. Boulevard)

-30-

MEDIA CONTACT:           Nancy Greco Silvestri/Omar Bourne (NYCEM) (718) 422-4888

 STAY CONNECTED:        Twitter:           @NotifyNYC (emergency notifications)

@nycoem (emergency preparedness info)

Facebook:        /NYCemergencymanagement

With a 4th death, along with additional sites having been identified as contaminated with Legionella—the bacteria that causes Legionnaires disease—and additional cases of individuals who have contracted the infection, tonight’s Town Hall meeting at The Bronx Museum from 6PM – 8PM on the issue is going to have to answer a lot of questions.

Is the city doing enough? Is our drinking water really safe?

As of Sunday, the cases of Legionnaires had risen to 71 since July 10th. The 4 individuals who passed away from the disease were said to have suffered from other health ailments including heart and lung issues.

Although New York City Mayor de Blasio along with other officials have said that there is no need for panic because this is a highly treatable disease and it isn’t communicable, meaning transferred by human contact, residents are not taking any chances.

Local supermarkets are reporting a slight increase in bottled water sales even New York City Health Commissioner Bassett is declaring our drinking water safe and is focusing on cooling towers which led to the discovery of the 5 infected areas, yet according to the New York Times:

“Legionella love water systems, particularly old, clunky and corroded ones that are not well maintained and have a little sludge,” said Dr. Glenn Morris, the director of the Emerging Pathogens Institute at the University of Florida and a specialist in infectious disease. “Cooling towers in particular are a great place to live from a legionella’s perspective, because it’s nice, warm water year-round.”

But experts said cooling towers account for a relatively small proportion of Legionnaires’ outbreaks. More often, they said, the disease spreads through the systems that supply water for drinking, cooking and bathing.”

And this is indeed the case as the United States Environmental Protection Agency released a health advisory in 2001 on drinking water and Legionella stating (PDF FILE):

Legionella also grow symbiotically with the aquatic bacteria attached to the surface of biofilms (Kramer and Ford 1994). Biofilms provide the bacteria with nutrients for growth and also offer protection from adverse environmental conditions (including during water disinfection). The concentration of Legionella in biofilms depends upon water temperature; at higher temperatures, they can more effectively compete with other bacteria. Because biofilms colonize drinking water distribution systems, they provide a habitat suitable for Legionella growth in potable water, which can lead to human exposure.

The advisory went in to further state:

“Colbourne and Dennis (1989) stated that although Legionella are not thermophilic, they exhibit thermo-tolerance at temperatures between 40 and 60°C, which gives them a survival advantage over other organisms competing in man-made warm water systems. Although temperatures between 45 and 55°C are not optimal for Legionella, these temperatures enable them to reach higher concentrations than other bacteria commonly found in drinking water, thus providing Legionella with a selective advantage over
other microbes (Kramer and Ford 1994).”

According to Legionella.org, a website founded by healthcare professionals with over 30 years of experience with Legionairres‘, they caution the following:

“Public health authorities downplay the significance of Legionella infections because most originate from drinking water. It is easier to target a cooling tower and harder to discuss with the general public the implications of Legionella in the drinking water. Note that the investigators said “probably”. All you have to do is ask the investigators “Did you culture the homes of the patients and their workplaces for Legionella?” If they refuse to answer, you will have learned something.”

 

The implication is that the actual source is not the cooling tower, but the home or workplace of the patients with Legionnaires’ disease. In order to be thorough, the health department should have cultured the drinking water that the patients had been exposed. (‘Legionnaires’ Disease Contracted from Patient Homes: The Coming of a Third Plague?’/European Journal of Clinical Microbial Infectious Disease, ‘Cooling Towers & Legionellosis: A Conundrum and Proposed Solutions/International Journal of Environmental Health‘)

In another study conducted on Legionnaires’ in New York City between 2002-2011 and published in 2014 in the medical journal, ‘Emerging Infectious Diseases’ reported that New York City, as well as the rest of the nation, has seen an increase in Legionnaires’ infection. In NYC between 2002 and 2009 there was an increase of 230% with the highest incidents located in areas where poverty is concentrated the highest.

We already know that the South Bronx is in the poorest congressional district so this latest outbreak should not be a surprise when taking this latest study in to consideration. The study goes on to say that more research is needed to understand this link between poverty and higher incidents of the disease and states:

“Among patients with community-acquired cases, the probability of working in transportation, repair, protective services, cleaning, or construction was significantly higher for those with Legionnaires’ disease than for the general working population. Further studies are required to clarify whether neighborhood-level poverty and work in some occupations represent risk factors for this disease.”

So far none of the 4 victims and the 71 individuals with Legionnaires’ were in contact with the 5 identified contaminated water cooling sites: Lincoln Hospital, The Opera House Hotel, Concourse Plaza Multiplex, The Verizon Building on 165th Street and Streamline Plastics Company.

Would it be prudent to then begin testing our water supply of it hasn’t been tested already? Clearly the EPA has indicated that conditions in drinking water supplies are far more favorable for Legionella.

In a call we put to The Center for Disease Control, Welcome2TheBronx was told that New York State Department of Health has to formally ask the CDC to step in for assistance.

Although I am not a health care professional, I think after 4 deaths and perhaps one of the largest outbreaks in New York City history demands that the CDC becomes involved.