Faulty Towers | The Lancet USA Blog

Faulty Towers | The Lancet USA Blog

by Rebecca Cooney

New York City is recovering from its largest and deadliest Legionnaires' disease outbreak. According to city health officials, the number of infections has grown to 124 confirmed cases. And as of the third week of August, the death toll has reached 12—all people with underlying medical conditions. With temperatures climbing over 90 on many days and air conditioners running full blast, it has had the city warily looking at every vent.

The culprit is L pneumophilia, a species of Legionella bacteria, which causes pneumonia-like symptoms and flourishes in cooling towers—heat rejection devices used for air conditioning—that are heavily relied on in the summer months. Narrowing the skyline down to a handful of units is no small task. The exact number of cooling towers in New York City is well into the thousands and includes all shapes, sizes, makes, and models. But unlike previous years where sporadic infections have been reported around the city, this outbreak has been traced to roof-top cooling towers in a geographically clustered area. Five buildings in the South Bronx, including a hotel and a medical center, have tested positive for the bacteria and hundreds of spots have been inspected.

The incubation period from Legionella infection to disease is about 2-10 days. With the first positive tests for the bacteria having been identified in mid-July and city sources reporting no new cases after August 3, it is likely that the worst has passed. Enter the next set of hurdles. Although, the “ground zero” contaminated cooling tower is probably one of the five in the high-impact South Bronx cluster previously detected, to make that determination, genetic testing is under way.

Industry standards suggest that cooling towers should be maintained and cleaned twice a year. But in response to the magnitude of the current outbreak and number of deaths, on Thursday, August 13, 2015, the City Council of New York passed aggressive new legislation governing cooling tower upkeep. Ratcheting up the urgency for building owners, all cooling towers must now be registered within 30 days of the law’s enactment (by mid-September). But the law does not stop there. Building owners must also perform quarterly inspections for Legionella bacteria and provide the Department of Health and Mental Hygiene (DOHMH) with annual certification that cooling towers have been tested, cleaned, and disinfected. Failure to comply could result in penalties of $2000 for an initial infraction to up to a year in prison and a $25 000 fine for disobeying maintenance orders from the DOHMH. While some critics have decried the new measures as being overly punitive, safety governance of cooling towers should be on par with other building-wide regulations, such as fire codes.

It is surprising that such precautions have not already been enacted in a city of skyscrapers, where air conditioning runs for months, electric bills peak, and people bring sweaters to wear in chilly offices. But before New Yorkers can breathe deeply and welcome cooler fall weather, the new measure must be firmly enforced to align building owners with the public health needs of the city. That means greater vigilance and diligence, even with a hefty price tag. There is simply no room to be complacent. We’ve already seen the tragic effects this summer of giving cooling towers a cold shoulder.