The Next Bacterial Concern: Legionella and Premise Plumbing

Life in 2020 has been upended by a series of turbulent events – most notably the COVID-19 pandemic and widespread social protests spreading across America – leading to widespread lockdowns and temporary abandonments of office and public infrastructure. As states across the country begin to slowly reopen amidst these once-in-a-generation circumstances, their populations may unknowingly be walking into yet another disruptive, bacterial concern within their offices, restaurants, and buildings.

Empty buildings and unattended HVAC systems, while seemingly nondescript, oftentimes unintentionally promote the unwanted consequence of harmful bacteria growth in stagnant plumbing systems running overhead. Legionella pneumophila, commonly known as legionella, is a bacterium that, when aerosolized, can be inhaled by humans and cause outbreaks of Legionnaire’s Disease within populations with weakened or compromised immune systems such as hospitals and nursing homes1. Warm stagnant water, rust, scale, and the presence of other microorganisms all correlate strongly with the rise of legionella populations, and also happen to be predominant characteristics of unattended premise plumbing fixtures and cooling towers. Legionnaire’s disease causes severe pneumonia, fever, muscle aches, and shortness of breath in individuals and populations with compromised immune systems. The disease infects 52,000 people annually in the US, resulting in the death of one in ten of those afflicted4, rendering it nearly one hundred times as deadly as typical influenza5. How has this bacterial infection, yet another unseen threat in our lives, managed to escape attention for so long?

As the US broadly begins to phase in state reopenings, the water industry, unsurprisingly, will once again play a role in making sure the US population does not forget about other threats such as legionella as they return to work. In much of the past, following outbreaks or situations that give rise to Legionnaire’s, water utilities have recommended flushing out cooling towers and plumbing systems to eliminate the risk of bacterial buildup and then, prior to allowing reentry, perform readily available legionella testing through a local or regional water quality analytical lab. Yet it is unlikely that we will see much of the US building infrastructure flush their systems as the entire nation goes back to work. In a time of increasing concern surrounding water quality and quantity throughout the country, simply flushing a system, wasting thousands of gallons of water, and starting again seems at best, inefficient, and, at worst, wasteful.

The Sylmar team works with clients to implement new premise plumbing treatment systems as a solution both for short-term, post-COVID boot-up scenarios as well as long-term mitigation of the legionella threat in buildings. Building operators and treatment system integrators work with Sylmar and established technologies to set up systems within their own buildings to prevent harmful bacteria from ever forming in the first place. These solutions are not necessarily new – companies like Nalco have been installing systems to chlorinate, disinfect, and extend the life of cooling tower and HVAC equipment for decades9. And yet, novel ionization and filtration technologies have proliferated and decreased in costs over the past decade – leading to more efficient and cost-effective methods to provide individuals living and working in these buildings with a safe working environment. This new preventative method for legionella treatment – decentralized, resilient, sustainable – is the future of premise plumbing and legionella mitigation. For far too long our buildings have believed that the far away, centralized treatment plant will solve their water quality concerns. In many cases that may be true; with legionella, the new, decentralized way is the best way.

As COVID-19 opens our eyes as to how microorganisms can impact our lives in previously unforeseen ways, it is time that the water industry similarly begin to take seriously the potential for legionella to cause an outbreak of another kind. Sylmar works with technologies, companies, and utilities that seek to deploy proven, effective, and environmentally friendly systems to replace the inefficiency and wastefulness of simply trying to flush this problem away. Sylmar is here to help make 2020 not just a year of viral infection, but one in which we begin to think more holistically about the future of our relationship with our water and protecting our most vulnerable populations from the dangers of legionella is one step in that direction.

https://www.cdc.gov/coronavirus/2019-ncov/php/building-water-system.html
AWWA Webinar: “Return to Service: Addressing Water Quality in Buildings with Low or No Use”
https://www.cdc.gov/legionella/wmp/overview/growth-and-spread.html

https://www.cdc.gov/flu/about/burden/index.html
https://www.beckershospitalreview.com/infection-control/illinois-to-pay-6-5m-to-families-of-legionnaires-victims.html
https://www.nprillinois.org/post/illinois-legionnaires-disease-more-prevalent-coronavirus#stream/0

NYC outbreak, this one on Lower East Side


https://www.ecolab.com/nalco-water/expertise-and-innovation/water-safety
https://www.ecolab.com/nalco-water/expertise-and-innovation/water-safety/legionella-control-strategies
https://www.liquitech.com/products/
https://www.liquitech.com/products/copper-silver-ionization/

COVID-19, Epidemiology, and the Wastewater Industry

Over the last several months, the rise and spread of COVID-19 has simultaneously overrun health care systems, taken lives, and shut down the world’s most robust national economies. In the United States, many have come to realize that COVID-19 is not going to disappear anytime soon. As states begin to lift stay-at-home restrictions we’re still confronted with a daunting challenge: we still don’t know how far the virus has spread. The United States has tested just over twenty million people for COVID-19, or a little over six percent of the population. And, while epidemiologists don’t fully agree on how many tests per day are needed to adequately contact trace and begin to return to normal society, there is consensus that current levels of testing are insufficient. But there is one atypical place that presents a unique opportunity to help fill the hole that current testing has failed to address: sewage.

Those of us in the wastewater industry have known for years that you can understand a lot about a population by analyzing what comes through the municipal sewage plant. Wastewater analysis, a perhaps surprising epidemiological tool, has been used to detect influenza outbreaks and even the prevalence and types of narcotics use in a city. The field of wastewater-based epidemiology (WBE) has been at the forefront of epidemiological research for years, with experiments and technologies being developed in labs across the nation such as at Arizona State and Yale Universities.

Indeed, recent research has shown that what we flush down the toilet can be a vital tool in helping to analyze the relative prevalence of SARS-COV-2, the virus that causes COVID-19 in a population. By measuring ribonucleic acid (RNA) stemming from coronavirus infections in wastewater, epidemiologists can glean broad population-level conclusions about the outbreak in ways the six percent of testing never could provide. And just like that, this previously niche epidemiological tool with little mass value, has quickly become an invaluable resource in fighting the outbreak.

The process is relatively simple; sludge pellets formed from concentrated wastewater can be scanned for SARS-COV-2 RNA, which is itself amplified using reverse transcriptase polymerase chain reactions (PCR). In addition to simply confirming the presence of the virus within a given location, which itself won’t come as much of a surprise, this testing can also reveal relative volumes of the virus and thus, over time, can be correlated with active infections in the greater population. Most significantly, whereas coronavirus carriers may not become symptomatic for up to two weeks after contraction of the virus, these individuals will quickly begin excreting SARS-COV-2 RNA. In fact, we’re seeing that wastewater may even serve as a leading indicator of future symptomatic outbreaks and hospitalizations, giving us as much as a one week head start.

Data collected from wastewater, in combination with more traditional metrics, can help public health officials create a more comprehensive picture of population health well in advance of a major outbreak. As wastewater utilities and cities begin to realize the incredible power stemming from ongoing data collection and real-time water quality analysis, utilizing RNA to track population health over time represents an opportunity for the wastewater industry to provide yet another value-add to the population it serves. WBE for COVID-19 is a practice that has the potential to save countless lives by allowing public health officials plan for, respond to, and recover from pandemics and do so in a way that can save communities both time and money.

At Sylmar Group, we’re helping some of the leading firms and utilities put advanced WBE tools to work to protect public health. In the water and wastewater industry, we take pride in protecting human health and the natural environment and surprisingly, the 2020 COVID-19 Pandemic has given us another reason to value the stuff that flows through our pipes and, just as importantly, the people, organizations, and technologies that look after it.

https://covid.cdc.gov/covid-data-tracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fcases-in-us.html#cases_casesper100klast7days
https://www.newyorker.com/news/news-desk/how-much-coronavirus-testing-does-the-united-states-need-to-reopen
https://www.google.com/publicdata/explore?ds=kf7tgg1uo9ude_&met_y=population&idim=country:US&hl=en&dl=en
https://www.cnbc.com/2020/04/21/coronavirus-tests-rockefeller-plan-would-screen-millions-for-covid-19.html
https://www.sciencedaily.com/releases/2020/04/200423144056.htm
https://www.nhregister.com/news/coronavirus/article/Yale-research-Sewage-may-predict-coronavirus-15297365.php