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Health officials have yet to identify the source of the Legionnaires’ outbreak on Manhattan’s Upper East Side as the number of infected individuals has climbed over the past two weeks.
Sixty-three people have developed the severe form of pneumonia from the Legionella bacterium as of Tuesday night, health officials said. Seventy-six buildings with cooling towers have tested positive for the bacteria. Fifty-seven of them have drained, cleaned, and disinfected their building towers; and the remaining 19 will be cleaned by Thursday, Health Commissioner Dr. Alister Martin said this week.
Healthbeat spoke to Dr. Aaron Glatt, chief of infectious diseases and hospital epidemiologist at Mount Sinai South Nassau in Oceanside, New York, to get a better understanding of how someone on the Upper East Side might be at risk of falling ill with Legionnaires’.
Legionnaires’ is a severe form of pneumonia caused by the Legionella bacterium and can float through airborne water droplets before someone inhales the germs. The bacteria are not transmitted by drinking water or through person-to-person spread.
Previous Legionnaires’ outbreaks have typically affected the Bronx and Harlem, because of the high density of tall buildings with cooling towers and the high concentration of residents with chronic health conditions. One of the largest and deadliest Legionnaires’ outbreaks happened during the summer of 2015, when 138 cases and 16 deaths were linked to a single cooling tower in the South Bronx.
The current outbreak in the Upper East Side should not come as a surprise. The relatively affluent neighborhood is home to a large number of cooling towers.
The Upper East Side, which is where the mayor’s official home sits, is a core part of City Council Speaker Julie Menin’s district. At a virtual town hall meeting Monday evening, Menin reiterated her concerns on behalf of her constituents, many of whom live in the affected neighborhoods of Yorkville and Carnegie Hill and are particularly vulnerable to Legionnaires’ because they are older than 50.
“I’m hearing from a lot of constituents who are seniors,” she said. “One question they have is: Should they limit their time outside? … I’m getting that question again and again, and I’m really urging the health department to offer some kind of proactive preventative guidance.”
Menin has also criticized the Health Department for not enforcing a new law that took effect in May requiring building owners to ramp up testing for the bacteria.
Of the 63 reported cases, the majority have been hospitalized; 40 have been discharged; and 12 remain in the hospital. Eleven have not required hospitalization.
Glatt spoke by phone about how the bacterium makes the move from a benign germ to a public health hazard and whether you should make that trip to Museum Mile.
This interview has been edited for clarity and length.
How does Legionella spread in the environment?
It’s usually not present in the general environment, but where it is, if it gets aerosolized and then you breathe it in, you can unfortunately get infected. Not everybody gets a serious illness. Some people get no illness. Some people get a minor illness, and unfortunately, some people do get very sick from it, and it can even be a fatal illness, especially in people that have underlying significant illnesses besides Legionella.
What does it take to catch the Legionella bacterium and fall ill?
I can’t tell you if it’s 10 breaths, 50 breaths, 100 breaths. It depends on so many variables. But if it’s in the air, in a cooling tower that is aerosolizing Legionella and a person breathes that … any inoculum theoretically could be significant. Obviously, the larger the inoculum, the longer or prolonged the inhalation, that would increase the risk of a person getting the infection. Their underlying conditions will often determine how seriously ill they get.
New York City health officials have said there’s no evidence that masks are needed to help prevent acquisition. What would you advise to someone nervous about getting sick?
If somebody was in an extremely high-risk situation and they had to walk around in those areas, where all of these buildings are potentially spewing forth aerosols that might have Legionella in them, I can’t tell a person like that that it’s incorrect to wear a mask. But you’re asking: Is there anything somebody can do? (Wearing a mask) might be something that they can do.
Health officials have said the bacterium is ubiquitous in the built environment, particularly in the city’s cooling towers. When does it change from ambient bacterium to a public health hazard?
The cooling towers need to be appropriately cleaned, and they’re supposed to be maintained. Sometimes there’s a very small concentration of Legionella that is present. If you don’t appropriately clean the cooling tower system, it can unfortunately grow and spread. It grows in the hot water, and the potential then for aerosolizing occurs.
I imagine a lot of people are wondering if they’re walking down the street in the Upper East Side, how much are they at risk and what they should be doing to prevent illness?
People can continue to walk. It’s not something that they have to be overly concerned about. But if they have an underlying significant lung disease or other medical problems, then maybe they should consider wearing a mask. Although I don’t have evidence that that would be fully protective, this is part of life. You can’t lock yourself inside. The critical thing is, if you do get any symptoms, to be evaluated right away, because it’s a treatable disease, especially if you treat it early on.
Health officials have said 76 buildings with cooling towers in the Upper East Side have tested positive for the Legionella bacterium. The Guggenheim Museum and the Metropolitan Museum of Art are among them. What would you advise someone who wants to visit one of those museums?
That’s a choice they have to decide they wish to take. If they’re in an extremely immunocompromised state, maybe that’s not the best time to take such a visit to that area.
The Met did not immediately respond to a request for comment. A spokesperson from the Guggenheim said the museum “took immediate steps for remediation,” adding, “The city has confirmed that there is no additional action needed at this time, and this poses no risk to anyone inside the building.”
Anything you’d like to add?
People should know if they’re at high risk, and seek out your doctor if you have initial symptoms, because that would be the best time to diagnose and treat.
People at increased risk include those who are older than 50, smoke or Vape, have chronic heart, lung, kidney or liver disease or diabetes, or a weakened immune system, according to the Health Department. Symptoms include fever, chills, muscle aches, and cough. People may also have headaches, fatigue, loss of appetite, confusion or diarrhea.
Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at [email protected] or on the messaging app Signal at trentondaniel.88.
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