Businesses Reopening During COVID Have Another Concern: Legionnaires’ Disease

Recently, an employee at a high school in Kettering, OH tested positive for Legionnaires’ disease in June after the school closed down due to COVID-19. Four water pipes, located in bathrooms and sinks, held Legionella bacteria. Legionnaires’ disease is a concern for schools, businesses, and other entities reopening after coronavirus-related closures. After 21-30 days of disuse, water in pipes becomes stagnant and the chlorinated water, which acts as a disinfectant, is no longer present. Bacteria called Legionella can form in the water system leading to lung infection.

Legionnaires’ disease was first discovered in 1976 after members of the American Legion contracted it at a convention. The disease is a potentially lethal lung disease transmitted when an individual breathes in small droplets of water that contain the bacteria Legionella. It transmits through the air and plumbing from water fountains, showers, and even hot tubs. Water pipes must be properly flushed and sanitized.

There are many similarities between COVID-19 and Legionnaires’ disease. Both are respiratory illnesses that primarily affect the lungs resulting in comparable symptoms like cough, fever, and chills. Experts are worried that a misdiagnosis of COVID-19 for those infected with Legionnaires’ could stall proper treatment. Unlike COVID-19, Legionnaires’ disease is rarely transmitted from person to person and can be cured with an antibiotic if diagnosis happens early. While most healthy individuals survive an outbreak, Legionnaires’ does have a death rate of 10%. People most at-risk of getting Legionnaires’ disease include those over 50, current or former smokers, those with diabetes, or a history of liver failure.

In particular, Legionnaires’ has been linked to cruise ships with hot tubs and swimming pools being more susceptible from a lack of regular disinfection. The CDC says 20-25% of Legionnaires’ diagnoses come from travel-related sources, including cruise ships and hotels. It is hard to pinpoint the exact point of infection on a cruise ship because people disperse across the country after these cruises are finished. In one prominent case, passengers aboard a Celebrity Cruise ship were diagnosed with Legionnaires’ disease as a result of a hot tub being improperly drained and disinfected. (Silivanch v. Celebrity Cruises, Inc., 171 F. Supp. 2d 241 (S.D.N.Y. 2001)). Hot tubs are particularly susceptible because Legionella grows best in warm water, but warm water also kills off disinfectants used to combat the disease quicker. The court found the cruise line liable to passengers for negligence and punitive damages because the defendant’s conduct constituted gross negligence or wanton or willful misconduct. Id. at 262. If a hotel, cruise ship, or care facility becomes negligent in treating its water or keeps infections from patrons, they could open themselves up to liability.

The key to prevention is to treat and disinfect water systems, particularly after the water in pipes is stagnant for more than three weeks. The CDC recommends discarding old ice from ice-makers, cleaning water fountains, hot tubs and spas, as well as showers and sinks. Even buildings that have seen a little usage since COVID-19 should be diligent in disinfecting water pipes. There is also a CDC guide to developing a water management program to reduce Legionella growth.