Remembering the Legionnaires’ Outbreak

Remembering the Legionnaires’ Outbreak

In the midst of a star-spangled summer in which the United States celebrated its bicentennial, more than 4,000 members of the Pennsylvania chapter of the American Legion gathered just blocks away from Independence Hall where the country’s forefathers had severed their ties with King George III two centuries earlier. While Philadelphia sweltered on July 21, 1976, the military veterans discovered an icy refuge inside the air-conditioned quarters of the elegant Bellevue-Stratford Hotel as they kicked off the organization’s annual convention. For four days Legion members mixed and mingled inside the Philadelphia landmark, dubbed “The Grand Dame of Broad Street,” before returning home after what they believed was another successful gathering.

Within days, however, the phone at the American Legion’s Pennsylvania headquarters began to ring with the distressing news of the deaths of a number of convention-goers. By August 2, however, it was clear that this was no string of bad luck as 12 members had died and three dozen more had been hospitalized with a mysterious respiratory illness. The pneumonia-like symptoms were nearly the same in every case—muscle aches, headaches, severe coughs, diarrhea, muscle and chest pains and fevers as high as 107 degrees. Many of the dead were older men and smokers, but the ages of the victims ranged from 39 to 82.

As news spread, it was revealed that not all the afflicted were American Legion members or their wives. The victims included a bank teller who worked across the street from the Bellevue-Stratford Hotel and a bus driver who had transported a group of young cadets who marched in the convention’s parade.

Although baffled as to the cause, public health officials urged calm as fears of a flu pandemic spread around Pennsylvania even more quickly than the mystery illness itself. Swine flu, which had struck a New Jersey army base earlier in the year, and parrot fever, spread by sick pigeons, were among the leading theories. The good news for investigators, however, was that it quickly became evident that the disease was not contagious. One convention-goer, for instance, exhibited no symptoms although the two men he shared a hotel room with had died suddenly. Antibiotics also proved effective in treating the sick.

In response to the medical mystery, the federal Centers for Disease Control and Prevention (CDC) launched the largest investigation in its history. “No previous scientific detective effort in history has approached the scale and intensity of the campaign now under way to track down the course, source and pattern” of the disease, reported the Boston Globe. A team of 20 CDC epidemiologists joined state health workers in scouring hospital records and poring through autopsy findings. Laboratories remained open throughout the night as helicopters flew in the latest blood and tissue samples. In hospitals across Pennsylvania, the medical sleuths interviewed patients about their every move in Philadelphia, from whether they ate the hotel’s go-getters’ breakfast to how many times they rode its elevators.

Investigators even checked into the Bellevue-Stratford Hotel and combed the premises for clues. They examined everything from the hotel’s ice machines to its toothpicks, and they crawled into its heating and cooling systems to take samples. They considered causes ranging from food poisoning to foul play by anti-war protestors who had previously threatened violence against military veterans. The only common threads the investigators could find, however, were the disease’s symptoms and the fact that the afflicted appeared to have spent some time either in the hotel lobby or outside on the sidewalk.

The outbreak of the mystery disease generated intense media coverage. Newsweek called it the “Killer Fever,” while Time dubbed it the “Philly Killer” on its front cover. Most of the media, however, settled on another name for the strange respiratory illness—“Legionnaires’ disease.” As months progressed without the identification of a cause, the medical investigators themselves came under the microscope of public scrutiny—even being forced to testify before Congress.

One frustrated CDC microbiologist, Joseph McDade, decided to redouble his efforts in the days after Christmas. Having cancelled his vacation plans, McDade spent hour upon hour in his laboratory scouring slides that had only been examined in five-minute bursts in the initial rush to find the cause. “It’s like looking for a contact lens on a basketball court with your eyes four inches above the ground,” McDade told the New York Times. After spending a half-hour examining tissue taken from the lung of one of the victims, McDade found the culprit for the disease—a previously unknown bacterium that the CDC dubbed Legionella.

Nearly six months after the outbreak, the CDC announced that it had cracked the case. The Legionella bacteria thrived in hot weather and in water such as the air-conditioning system perched on the roof of the 19-story Bellevue-Stratford Hotel. Although Legionella wasn’t found in the hotel’s cooling system because it had been cleaned by the time of its discovery, investigators surmised that the system’s powerful fans emitted a mist of contaminated water that fell on pedestrians on the sidewalk below and were sucked into the lobby through a ground-floor vent where victims breathed in the tiny, infected water droplets. Ultimately, 34 people died and more than 200 became ill from the outbreak during the American Legion convention, and the discovery led scientists to document earlier outbreaks of Legionnaires’ disease, including one that killed three members of the Independent Order of Odd Fellows who attended a convention in the same Philadelphia hotel in 1974.

Although the medical case had been solved, Legionnaires’ disease has not been confined to the history books. In fact, it has made a resurgence in recent years. According to the CDC, the number of people diagnosed has increased nearly fourfold from 1,127 in 2000 to 5,166 in 2014, with the disease proving fatal in about seven percent of cases. Just last year, an outbreak in the Bronx killed 16 while another in Flint, Michigan, claimed the lives of a dozen more. Most of the 20 outbreaks averaged each year occur in buildings with large water systems and poorly maintained air-conditioning equipment.

Read more about pandemics here

Remembering the Legionnaires’ Outbreak - HISTORY

But what is the history of this terrifying infection?

The arrival of a mysterious lung disease that killed one in five sparked terror throughout the US in the summer of 1976.

The setting was a convention of the American Legion, where thousands of the mainly elderly veterans descended on the Bellevue-Stratford Hotel in Philadelphia.

Within days of the start however, veterans began falling ill in large numbers with a previously unseen form of pneumonia.

In the days that followed, 221 patients developed the illness - and 34 eventually died.

The outbreak sparked mass panic in the media and public - the Cold War was still underway, and some believed it might even be an attack by enemy forces on the veterans.

The Centers for Disease Control launched a major investigation, interviewing all the disease survivors, and carrying out microscopic autopsy.

Soil, air, and water samples were taken from the hotel and its grounds, and eventually this yielded the bacterium.

Legionella, as it was named, had been thriving in the water cooling tower of the hotel, and had been pumped into every room in fine water vapours.

It was not long before the phenomenon emerged in the UK, with cases in 1977, followed by major outbreaks in the 1980s - also linked to water cooling systems.

One, in Stafford, claimed 23 lives, and prompted a Government Committee of Inquiry.

Even the BBC was not immune - an outbreak centred on its headquarters in 1988 made 79 people ill, and killed three.

Elsewhere in the world, massive outbreaks in Murcia, Spain, and the Netherlands also claimed lives.

The emergence of water cooling towers as the chief villain in these "explosive" outbreaks led to new efforts to make them safer.

The lukewarm water circulating around them was the perfect breeding ground for the bugs, which were then discharged into the atmosphere to scatter over the nearby area.

Engineer Geoff Brundrett was among those who looked at how Legionella may be "designed out" of such equipment.

He told BBC News Online: "Basically you have to keep the water either very hot or very cold - so the bacteria cannot breed.

"You also add biocide to keep bacteria numbers down."

Guidance was issued to factory owners - but a recent survey, coupled with sporadic outbreaks of the illness, suggested that many were simply not interested in protecting the public from the disease.

Mr Brundrett said: "Perhaps a third of people surveyed said they didn't bother."

Now the climate, however, is changing.

The Health and Safety Executive now orders quarterly lab tests on the water in these systems, along with stricter instructions to keep them clean, backed up with fines or even the power to close factories in the case of repeat offenders.

And there are signs that the police are also stepping in.

A case in which a factory owner was accused of corporate manslaughter following three deaths caused by Legionella is still in the courts.

The American Legion Hosts Its Annual Conference in Philadelphia

The three-day long national conference by the American Legion was planned for Philadelphia, Pennsylvania, to take advantage of the year-long celebration of the American Bicentennial. Many activities and events were slated for Philadelphia, the site of the signing of the Declaration of Independence. The convention, which started on July 21, 1976, took place at the Bellevue-Stratford Hotel and was attended by more than 2,000, mostly-male Legionnaires.

Legionnaires' disease has been reported in a handful of states this summer, leading to 19 deaths and more than 100 illnesses. The unrelated cases are part of a typical pattern seen with a disease that tends to appear in warm weather and is mostly dangerous for people who already are sick or weakened.

While such outbreaks have become more common in recent years, experts don't know if that's because of better reporting or surveillance, or if the disease, a type of pneumonia, is truly becoming more prevalent, said Dr. Matthew Moore, a medical epidemiologist at the federal Centers for Disease Control and Prevention.

Regardless, he said disease activity this summer is pretty much "par for the course."

Some key questions and answers about recent reports:


-In Illinois, an outbreak reported last week at the Illinois Veterans Home in Quincy, an assisted living and nursing home southwest of Chicago, has led to the deaths of seven elderly residents, all with underlying conditions. Another 32 residents have been sickened. Tests were pending Tuesday for other residents. The source has not been identified, said Ryan Yantis, a spokesman for the state's Department of Veterans Affairs.

-In California, six inmates at San Quentin State prison have been diagnosed with the disease since last week five others are hospitalized with pneumonia-like symptoms and 73 inmates are under observation and being treated for respiratory illness in a prison medical unit, said prisons spokeswoman Dana Simas. Authorities have not found the source.

-In New York, an outbreak in July and August that killed 12 people and sickened more than 100 was traced to bacteria found in an air-conditioning unit cooling tower at a Bronx hotel.

-Two isolated illnesses occurred - one at Illinois' Stateville prison last month, the other in July at West Chester University in Pennsylvania.

-High levels of Legionella bacteria were found last week in the water system at a substance abuse treatment unit in Arizona at the Phoenix Veterans Affairs Health Care System, leading authorities to relocate 20 patients. The bacteria were discovered during routine testing and no illnesses have been reported, spokeswoman Jean Schaefer said.

-A building at a GlaxoSmithKline drug manufacturing plant in Zebulon, N.C. was closed temporarily in August after Legionella bacteria were found in the external cooling towers there no one was sickened.


The illness is a type of pneumonia caused by bacteria that infect the lungs. Named after a 1976 outbreak among participants of an American Legion convention in Philadelphia, the disease can cause coughs, breathing trouble, fever and muscle aches. The elderly and people with chronic illnesses are most at risk. Antibiotics can treat the disease but it is fatal for between 5 percent and 30 percent of patients, Moore said.


The bacteria live in the environment and thrive in warm water. People can get sick if they inhale mist or vapor from contaminated water systems, hot tubs and other typical sources but the bacteria don't spread from person to person. New York's recent outbreak likely spread by wind blowing mist from the hotel cooling tower to surrounding areas, Moore said.


The CDC estimates that between 8,000 and 18,000 people are hospitalized with the disease each year, usually in summer and early fall.

State and local health departments are asked to report cases to the CDC, many cases aren't reported, including many hospitalizations. This year, reports totaled 3,212 through Aug. 16 last year's provisional total is 4,486, but final numbers are expected in a few weeks.

Surviving War, But Not The Veterans' Home

Gerald Kuhn spent part of his service in World War II digging into French soil and exhuming the bodies of his fellow American soldiers.

It was his job in the Army to collect their dog tags and personal belongings and ship them back home to their families in the United States. It was grim work — in later years, he shied away from talking about it to his children — but he was proud of his military service.

And so when the time came, he looked forward to moving to the Illinois Veterans Home, a state-run facility near the Mississippi River, about five hours southwest of Chicago.

“He was proud to be a veteran,” said Jana Casper, one of his daughters. “He earned that right to be able to go to live there.”

But in 2015, her father was one of 12 residents to die in an outbreak of Legionnaires’ disease at the home. That disease came back in 2016 and sickened five more people. And it came back again this past fall, sickening three and contributing to the death of another veteran.

“When’s it going to stop?” Casper said in an interview with WBEZ. “How many more people are going to have to die before they can get to the bottom of what’s causing it?”

In three straight years, legionellosis killed 13 people and sickened at least 61 residents and staff at the downstate veterans’ home, and the state has failed to stop the outbreaks and other cases despite investing millions of taxpayer dollars.

The tragic and continuing ordeal at the 210-acre facility in Quincy has heightened scrutiny over how well Gov. Bruce Rauner’s administration has managed a deadly public health crisis that started after he took office.

A WBEZ investigation is spotlighting how veterans who endured unspeakable experiences on the battlefield died at the facility after being sickened by bacteria-contaminated water. Their families contend they weren’t diagnosed nor given antibiotics quickly enough to fend off what typically is a treatable form of waterborne pneumonia.

And now, Illinois’ senior U.S. senator, Dick Durbin, is saying the facility should be shuttered until its water system is fully safe. And he said it’s a “scandal” and an “insult” to veterans that the state hasn’t been able to rid the facility’s water system of Legionella bacteria over the course of nearly 30 months.

Military equipment is scattered around the grounds of the Illinois Veterans' Home in Quincy. (Andrew Gill/WBEZ)

Eleven families are suing the state for negligence. But because those deaths occurred in a state facility, Illinois law caps any potential awards at $100,000 — well below the seven-figure outcomes Legionnaires’ cases have yielded in litigation elsewhere.

In 2015, a dozen residents at the home died in the first outbreak of Legionnaires’ disease, which can be contracted when people inhale infected water vapor through showers, sinks, and fountains. Legionellosis is a term that encompasses both Legionnaires' disease and a less-deadly infection known as Pontiac fever. Since the initial outbreak, the state has imposed new treatment protocols and spent nearly $6.4 million on emergency upgrades to the complex’s water treatment system.

Despite having plumbing more than a century old, those upgrades have left the Quincy home with “the cleanest water in the state,” the head of the Illinois Department of Veterans’ Affairs said recently.

But in 2016, five more people at the home contracted Legionnaires’ disease, though no one died. That’s when Rauner traveled to the veterans’ home and told reporters the state was closely monitoring the home’s water for the bacteria.

“We’re really on top of the situation,” he said at the time.

While the Centers for Disease Control and Prevention praised the state’s action plan in a report this year, it nonetheless found that the facility’s plumbing system still poses a “potential risk” for the disease, and given the facility’s old age, it declared that “completely eradicating Legionella is very challenging.”

Since that statement and the strong words last year from Rauner, three more cases hit the home this fall, resulting in the 13th Legionella-related death there: Roy Dehn, an 88-year-old Korean War veteran who was a longtime Chicago Tribune employee from west suburban Lisle. (The state disputes that Legionella caused Dehn’s death, but the local coroner determined it was a contributing factor.)

Speaking out now for the first time, families of the dead residents tell WBEZ they are looking for answers in a string of deaths they contend were wholly preventable.

Some of those family members also believe they are owed a greater apology than what they’ve gotten from the state so far, perhaps even an acknowledgement from the governor himself.

“Why didn’t he come and pay respects to the families that lost their families?” asked Diane McHatton, whose otherwise healthy 94-year-old father was among those to contract Legionnaires’ and die in 2015.

“We love this country. We raise the flag. We kneel down to pray. They can’t even say, ‘I’m sorry for your loss’? Don’t you think they should’ve? And I’m asking why? That’s what I want to know. Why?” she said. “That hurts.”

Living through a Nazi prison camp

McHatton’s father is Melvin Tucker, a decorated U.S. Army Air Corps tailgunner whose B-17 bomber was shot down over Nazi Germany in 1944. Everyone else aboard died, but Tucker successfully parachuted from the burning plane as it headed toward the ground. After landing in a spray of gunfire, he was captured by a Nazi soldier and held for 13 grueling months in one of Germany’s most notorious prison camps.

"I didn't want to talk about the horrors I witnessed during the war or the nightmares that still haunted my dreams,” Tucker wrote in a 2007 memoir he published about his war experience. “But I felt compelled to do so because many people were saying that they didn't believe the stories about the atrocities the Germans committed against the Jews. I had seen them with my own eyes."

Tucker survived his ordeal in World War II, but not the bacteria-laden water at the Quincy veterans’ home.

When he developed a fever at the home on Aug. 21, 2015, he was given Tylenol, according to the family. By that point, there had been five earlier confirmed cases of Legionnaires’ disease at the facility dating back to July 24 of that year, according to the CDC.

It was a detail Tucker’s family did not know at the time because the state hadn’t yet publicized the spate of illnesses.

Six days later, Tucker was still not on any kind of antibiotic and hadn’t been tested for Legionnaires’, according to his family and their lawsuit with the Illinois Court of Claims. Tucker even asked for a priest because he was “fearful he was going to die,” according to a court filing. Only then did the veterans’ home staff take a urine sample that confirmed he, too, had contracted Legionnaires’.

A day later, Tucker became unresponsive.

“That’s the hardest thing to see your daddy [like that] after all he’s gone through,” McHatton said, her voice rising and tears welling in her eyes. “For three days, he’s gasping for breath, and we couldn’t do a damn thing about it. Not a thing.”

Ten days after first getting sick, Tucker was dead.

Now, his family’s anger at state officials — about what their father went through and the continuing string of legionellosis cases — is still raw.

“What would they want done?” McHatton said. “If their dad got shot down over enemy lines, if their dad went 13 months being kicked and starved and beaten, come home, picked himself up, worked his butt off till he retired, and then have something like this happen?

“Ask them how they would feel. What would they want? We seen our dad suffer.”

‘Where our veterans come to live, not where they come to die’

As of Tuesday evening, Rauner’s office had not made the governor available for an interview with WBEZ. But Illinois Department of Veterans’ Affairs Director Erica Jeffries defended the administration’s response to the illnesses and said that veterans like Tucker got the best care possible while they were residents at Quincy.

“He was treated and cared for and loved at our home. All of our residents are, and I ask you to find a family member who says that they are not,” she said. “He succumbed to Legionnaires’ disease. It can kill you.

“We maintain and say that our homes are a place where our veterans come to live, not where they come to die.”

The state contemplated moving residents after the 2015 outbreak but decided not to, citing the strain that it could pose to frail residents in the facility’s care. The department is not currently considering plans to move residents, Jeffries said.

Her agency, which oversees all four of Illinois’ veterans’ homes, has acted on recommendations from the CDC with a series of infrastructure upgrades and protocol changes at Quincy since the Legionnaires’ outbreaks in 2015 and 2016.

Jeffries said employees at the home have been trained to better identify and respond to symptoms of pneumonia. Urine testing for Legionnaires’ and chest X-rays are now an automatic response when a patient begins showing symptoms. Health care workers at the home also get patients on antibiotics right away, even before the test results come back.

None of those protocols existed before the first outbreak in 2015 — a fact that’s evident in the negligence cases now before the state’s court of claims.

Jeffries maintained the state is doing all it reasonably can do to tamp down illnesses caused by a pervasive bacteria.

“What we have not done is remove all the piping and start again,” Jeffries said, referring to the facility’s aging plumbing system. “Short of doing that, we’ve done everything we possibly could do to ensure the safety of our residents and staff, and we’ve done everything that the CDC has recommended that we do.”

The entrance to the Illinois Veterans Home marks the year the long-term care facility first opened. It is the largest and oldest of four state-run veterans' homes. (Andrew Gill/WBEZ)

Jeffries said original plumbing at the nearly 132-year-old facility is “miles and miles and miles and miles long.” She said she didn’t know how much it could cost to replace, but ballparked it could be north of $500 million.

It is that network of galvanized piping — often more than a century old — that contains “extensive sedimentation and biofilm” and appears to “be associated with persistent positive Legionella culture results from point-of-use fixtures,” the CDC said in a June analysis of last year’s outbreak.

The agency described how testing showed those who were sickened in 2016 may have been exposed to the bacteria through a kitchen sprayer, a therapy tub, and, ominously, in-room sinks — all after the state had undertaken what the federal agency lauded as “significant remediation efforts.”

“In spite of the progress, the potable water system continued to pose a potential risk for Legionella growth and transmission,” the report said.

Jeffries said no water-use restrictions currently are in place at the complex, other than a prohibition on using jet sprays in whirlpools.

Durbin: Fix the water — or close the home

But Sen. Durbin tells WBEZ far more dramatic steps are necessary in light of the most recent legionellosis cases in October and November.

He said the state must move the Quincy home’s nearly 400 veterans and their spouses to a safe place until its century-old plumbing system is fully free of the waterborne bacteria that killed residents. If that isn’t possible, the state should build a new home, Durbin said.

U.S. Sen. Dick Durbin, D-Ill., appears on Capitol Hill in Washington D.C.
(Lauren Victoria Burke/AP Photo)

“This has progressed from a disastrous situation, where veterans of the state of Illinois have lost their lives because of contamination in the water supply at the veterans’ home in Quincy, to a scandal. I just don’t think there’s any other word to describe it,” he said.

“I want an admission by the governor that we have failed these veterans, and we need to do something immediately on an emergency basis to protect those who are there to make sure this never happens again and, if necessary, to replace this facility,” said Durbin, who along with fellow Democratic U.S. Sen. Tammy Duckworth, has endorsed candidate J.B. Pritzker to be their party’s nominee to challenge Rauner as the potential GOP candidate in the 2018 gubernatorial election.

“What we have now lurching from year to year is a situation that’s embarrassing, and it’s an insult to these veterans and their families,” Durbin said.

Expert: Recurring Legionnaires’ ‘very troubling’

One nationally recognized research pioneer in Legionnaires’ disease said it is not uncommon to find the bacteria in about 50 percent of all large buildings.

Janet Stout, a microbiologist who runs a Pittsburgh laboratory that specializes in Legionella remediation, said the bacteria can be controlled effectively by disinfecting the water system, and she said most long-term care facilities aren't as vigilant as the Quincy veterans’ home when it comes to testing for the bacteria. She said she is unaware of anyone ever vacating or demolishing a building because of an inability to eradicate Legionella from drinking water.

At the same time, Stout called the string of Legionella outbreaks at the Quincy home “an unusual circumstance."

“It certainly makes you scratch your head a little bit about what’s going on,” she said.

Another water safety expert went even further, saying in 30 years of studying water contamination issues across the country, he could not recall another instance where people contracted Legionnaires’ disease at the same location over three straight years.

“To see it come back year after year is unusual and very troubling,” said Erik Olson, director of the Natural Resources Defense Council’s health and environment program. “The strongest evidence they haven’t done the right thing is if you have repeated outbreaks of Legionella. Clearly something needs to be done.”

But Olson, who has studied lead- and Legionella-contaminated water in Flint, Michigan, and has testified on Capitol Hill about water safety, said he would have qualms about putting his own loved ones at Quincy given the pattern of Legionnaires’ cases.

“If I had … an elderly relative or someone that was immune-compromised in one of those facilities, I would be worried,” he said.

For her part, Jeffries, the state’s Veterans’ Affairs director, said she would have no concerns whatsoever about recommending one of her parents live there. “I would, without hesitation,” she said.

The home’s water treatment facility, she said, has been rebuilt “from the ground up,” including new water heater tanks in every building. Special $150 filters designed to screen out Legionella are attached to every shower head and sprayer and replaced monthly.

“I believe our water is probably the cleanest water in the state without hesitation,” she said.

Jeffries said one reason the facility continues to get positive test results for Legionella is because of how aggressively the state is looking for it and because it is a common, naturally occurring bacteria.

“If you look for it, you are guaranteed to find it,” she said.

Asked if it was possible the facility ever could be fully free of Legionella so long as its suspect, original plumbing system is in place, Jeffries answered, “Probably not.”

A statue of a Union Army soldier from the Civil War stands guard over the 210-acre campus of the Illinois Veterans Home about five hours southwest of Chicago. (Andrew Gill/WBEZ)

‘A picture of health’

At age 90, Gerald Kuhn walked on his own and had avoided the dementia that ravaged so many of his fellow veterans at the Quincy home. He had no trouble remembering the names of his 13 grandchildren, his family said. He liked calling out square dances, wore a prized baseball cap emblazoned with the words “World War II Veteran” and was, as his daughter Brenda Sprague recalled, “a picture of health.”

Between 1942 and 1945, Kuhn was stationed in France and Germany, and later, was proud of his service. But he didn’t much like talking about the war. Kuhn resisted his family’s repeated efforts to get him to join other veterans on an Honor Flight. That's a nonprofit veterans’ group that pays to fly aging servicemen and -women to Washington, D.C., with their former comrades to view war monuments.

“He eventually told us why, that one thing he had to do in the war was dig up bodies that were killed in action and buried in France, and he just did not want to be reminded of that so that was his reason for not wanting to go,” said his son, Wayne Kuhn.

Former U.S. Army Sgt. Gerald Kuhn, pictured here in his World War II uniform, was "the picture of health," his family says, before contracting Legionnaires' disease at the Quincy Veterans' Home. Kuhn, 90, died in August 2015. (Photo courtesy of Gerald Kuhn's family)

After being discharged, Kuhn returned to Illinois and farmed. He also was a carpenter, owned a filling station and was a handyman, helping get the fairgrounds ready each year for the Adams County Fair. When a urinary ailment cropped up in his late 80s, he readily entered the veterans’ home. Each weekend, he would leave to visit the homes of his five children in and around Quincy.

But during one of those visits on Aug. 23, 2015, one of his daughters could see he was not feeling well and thought he had a slight fever, his family said. Not until three days later, after being given Tylenol at the veterans’ home and having grown sicker as his fever reached 104 degrees, Kuhn asked to go to the hospital and tested positive there for Legionella, his family said.

‘We have a situation at the Quincy home’

On the same day Kuhn began presenting symptoms of Legionnaires’, the Illinois Department of Public Health notified the CDC of five laboratory-confirmed Legionnaires’ cases among residents and staff at the facility. The earliest known case occurred July 24, 2015, according to the CDC — more than a month before the Rauner administration put out its first press release about the outbreak.

News of the growing crisis even reached the governor’s office during Kuhn’s and Tucker’s illnesses.

A public records request to Rauner’s office for emails about the Legionnaires’ outbreak shows discussion among his communications team about the five confirmed cases at Quincy when both Tucker and Kuhn were sick, but neither had yet been tested.

In an Aug. 24, 2015 email, a state Veterans’ Affairs spokesman alerted the governor’s press staff about the test results, saying, “We have a situation at the Quincy home.” The spokesman went on to say he did not intend to publicize details of the test results that day unless “directed or in the case of wide media interest.” The first state press release announcing eight confirmed cases of Legionnaires’ disease went out Aug. 27, 2015.

But it was too late for Gerald Kuhn. On Aug. 31, he died.

Former Quincy Veterans' Home resident Gerald Kuhn sports his cherished World War II cap during a family outing. Late into his life, the farmer enjoyed calling square dances and woodworking.
(Photo courtesy of Gerald Kuhn's family)

“I think they could have been more forthcoming with their information if they knew it was an issue,” said Brenda Sprague, Kuhn’s daughter.

Another daughter, Jana Casper, said she had a sense there was a desire by the home to “not make this a public case.”

Not having information about the presence of Legionnaires’ prevented the Kuhn family from possibly bringing their father into one of their homes before he got sick.

“When we went back to remove dad’s things after he had died, there were several families who were moving their families out because then it was more of a known issue. People were pulling their loved ones out for that reason,” Sprague said. “So, it’s like they had the information to make a good decision, where we didn’t.”

Casper said afterward, she received a phone call from the Quincy facility’s administration office, saying it was “really sorry” about her father’s death and that the family needed to come “to take care of his things.”

“That was the extent of what we received to my knowledge,” Casper said during an interview in the living room of her sister’s home with her three sisters and brother present.

When asked if that was enough recognition or acknowledgement, Casper began, “I don’t know if anything would’ve been enough. How do you apologize for … ”

“ … neglect,” continued Sprague’s sister, Cindy Cassens, finishing her sibling’s sentence.

Former U.S. Army Sgt. Gerald Kuhn, pictured here in his World War II uniform, was "the picture of health," his family says, before contracting Legionnaires' disease at the Quincy Veterans' Home. Kuhn, 90, died in August 2015. (Photo courtesy of Gerald Kuhn's family)

Former Quincy Veterans' Home resident Gerald Kuhn sports his cherished World War II cap during a family outing. Late into his life, the farmer enjoyed calling square dances and woodworking.
(Photo courtesy of Gerald Kuhn's family)

‘Dead for two days, and no one knew’

An undated photo of Dolores French
(Courtesy of Dolores French's family)

When the state first made the dire situation at Quincy public in 2015, the story quickly got picked up.

Springfield resident Steve French was in his car when he got a phone call from his brother in Waukegan, who had heard a news report that the illness was spreading at the veterans’ home. Just a month earlier, their parents had become residents there.

Dolores French, a native Chicagoan and lifelong Cubs fan who was 79, had only one health malady: deafness. Otherwise, she was in good health and was allowed to move into the veterans’ home with her husband of 57 years, Richard French Sr., because he was a U.S. Army veteran who served during the Korean War.

She was assigned to an independent living unit at the facility, Steve French said, while her husband was placed in another residential building at Quincy because he needed care for his worsening Parkinson’s disease. Typically, French said, his mother would walk to her husband’s room and spend eight hours a day with him.

When the phone call about Legionnaires’ at Quincy arrived, Steve French said he immediately wanted to check on his parents’ well-being and tried calling his mother, who had a device that translates phone calls into text. He got no response. He tried the desk in her building and also got nothing. The next call went to the facility’s administrative offices.

“I said, ‘This is Steve French. I heard the news. I’m just checking on my dad and mom,’” he recalled. “And she just said that they’re OK, that if something happens, we’ll get a call.”

That was Friday, Aug. 28, 2015.

But it wasn’t until the next morning, as French was contemplating making the drive to Quincy from Springfield to check on her, that he was notified by the home that his mother’s neighbors had reported her missing, and staff wanted permission to enter her room, he said.

Within 10 minutes, as the Frenches sat in their basement, another call came from Quincy to report his mother had been found on the floor in her apartment, dead.

Dolores French later in life. (Courtesy of Dolores French's family)

As the news began to sink in, yet another call arrived, this time from the Adams County Coroner’s Office. French’s wife, Deann, took the phone.

“He said, ‘We found Mrs. French, and this is going to be difficult for me to tell you, but she has been dead for a significant amount of time,’” Deann French remembered. “So I’m processing that, and I said, ‘Do we know what happened to her? What happened?’ At this point, I’m not thinking Legionnaires’. I just wasn’t. And he said, ‘No, she was found on the floor in front of her recliner, pretty badly decomposed.’”

Within another hour or two, the coroner called back with confirmation that he suspected Legionnaires’, and that state law required an autopsy because an outbreak had been declared at the home. Bewildered, Steve French said he asked that his father not be informed so that he could go tell him face to face the next day.

“I didn’t think he was going to make it out of the room,” French said. “He shut it down. The first thing out of his mouth was, it should have been him. That is what he said: ‘It should’ve been me.’”

And in a moment of clarity that no one else had, French’s father also offered that he was wondering why he hadn’t seen his wife, Dolores, since the previous Wednesday. The question was a poignant one, considering that Parkinson’s sometimes robbed him of the ability to recall people’s names or recognize points in time. But on other occasions, his family said, he would be exceptionally lucid, just as he was at that painful moment upon learning of his wife’s death.

“That was the first time we had anybody put a timeframe on anything,” Deann French said. “So, when Steve called them on Friday and said, ‘I’m concerned about my mom and dad,’ and they said, ‘I can assure you they’re fine,’ his mom had been dead for two days, and no one knew it at all.”

After delivering the grim news, the Frenches insisted on a Legionella test on his father. It came back negative, but they decided on the spot they wanted him out of the Quincy veterans’ home. Steve French said the troubles didn’t end there: In checking Richard French out of the home, staff erroneously marked him as deceased, meaning he faced a cutoff in Social Security benefits as he was moving into another nursing home. It was a monumental hassle to undo, Steve French said.

Just four months after his wife’s death, Richard French died.

Richard French poses with Dolores, his wife of 57 years. Dolores was found dead of Legionnaires' disease in her room at the Quincy veterans' home during the first outbreak in 2015. (Courtesy of Dolores and Richard French's family)

“The ironic part is Steve spent the greater part of the rest of his dad’s life, trying to prove his dad was alive, only to prove he was alive and then he passed,” Deann French said.

The couple said there has been little outreach from the state, other than what Steve French characterized as a “form letter” from the head administrator at the facility offering “just a very generic, ‘sorry for the passing of your relative.’” There has not been outreach about Legionnaires’ or explanation for the home’s delayed recognition of his mother’s death, he said.

And then there was one other piece of mail.

“I remember when we opened mail after she died that came from Quincy, and we thought it was going to be some sort of apology that she was dead,” Deann French recalled. “It was a past-due notice on what was owed for her portion of living there.

“And, of course, she hadn’t paid it because she was dead,” she continued. “It was insult to injury at that point.”

In August 2016, the Frenches filed a personal injury suit against the state of Illinois with the court of claims. But their case, like the others that have been filed, has not been decided.

Jeffries, the state Veterans’ Affairs director, said Dolores French lived in the facility’s independent living section and thus was not receiving regular, skilled nursing visits from staff. Jeffries called the French case “a terrible tragedy.”

“Mr. French’s story is Mr. French’s story,” she told WBEZ, when confronted with Steve French's version of events.

Pressed if she had any reason to doubt any aspect of his account and to answer why the staff would say Dolores French was safe when she was likely dead, Jeffries said, “I really can’t answer that because I don’t have the details, and I’m not going to answer a question I don’t have the details on. I really don’t know.”

State concedes no legal responsibility

At this point, the state is accepting no legal responsibility for the 2015 Legionnaires’ outbreak, according to filings with the court of claims.

“As we move forward, we will be guided by the facts, and our focus will be to make sure that the resolution is fair,” said Annie Thompson, a spokeswoman for Democratic Attorney General Lisa Madigan, whose office is representing the state Veterans’ Affairs department in the families’ lawsuits.

None of the family members interviewed by WBEZ said they were pursuing the claims for the relatively meager award, which state law caps at just $100,000. Instead, they say want to see the problem solved. And they’re incredulous that the problem hasn’t been fixed yet by the state, with each new case forcing them to relive their own personal horror.

“You know, they were supposed to have gotten help for their water system to redo it, and now it’s showing back up again,” said Jana Casper, one of Gerald Kuhn’s daughters. “When’s it going to stop? How many more people are going to have to die before they can get to the bottom of what’s causing it?”

Casper’s sister, Brenda Sprague, then jumped in.

“These are people who served our country. They are the ones who support our freedom today, and to think this is the way they go out, it’s just really, really hard. We had an awesome dad,” Sprague said. “It was hard to watch the strong man that he was die the way he died.”

Neither the Kuhn family nor Tucker family want to see the Quincy facility permanently close, but they want a greater commitment from the state to eradicate the threat of Legionella. Steve French questioned why the facility is still open.

To date, it’s unclear whether anyone has lost their job as a result of decisions that were made from the summer of 2015 forward. The state’s Veterans’ Affairs department didn’t respond to a follow-up question.

But Sens. Durbin and Duckworth, who headed the state Veterans’ Affairs department from 2006 to 2009, have called for a “review of [state Department of Veterans’ Affairs] leadership given this troubling pattern of the presence of Legionella at IVH Quincy three years in a row.”

In an interview with WBEZ, Duckworth said, “Something needs to be done. And maybe this is the next step to figure out who has allowed this failure to continue. And at the end of the day, the state director and the governor are responsible.

“No veteran and no family member deserves to go through this,” said Duckworth, a disabled Iraq War veteran who said she hopes to live out her final days in a government-run veterans' home. “It simply is not acceptable.”

U.S. Sen. Tammy Duckworth, D-Ill., appears in Springfield in 2014.
(Seth Perlman/AP Photo)

Jeffries, who has been Veterans’ Affairs director since 2015, defended her agency’s handling of the situation at Quincy, particularly during the first outbreak when no protocols existed on how to handle Legionnaires’ cases. She said she disagrees with Duckworth’s criticism of the department.

“We had not until that time had any diagnoses of Legionnaires’,” said Jeffries, referring to the 2015 outbreak. “So, because of that, that was not the protocol that we did. So no, I don’t think it was a failing. I think our job and what we did was to provide the highest quality care that we could and that is available, and that’s what we did.”

She acknowledged the anger that some families continue to feel and said the agency is “very sorry for the loss of every single one of our residents.” She also said she sent handwritten letters to representatives of each family with a dead loved one in the 2015 outbreak and attempted calling them. Family members interviewed by WBEZ said they did not recall getting such correspondence from her personally.

She insisted the home and its staff remain highly attuned to the needs of residents there.

“Our staff members know their names. They know their children's names. They know how they like their eggs. They know whether they like to be with extra blankets or a fan. They know the ins and outs of these folks, and they care for them and they love them,” Jeffries said.

But as Legionnaires’ cases continue to accumulate, the Frenches agreed the state needs to do more to prevent further outbreaks.

“You know what he should do?” Deann French said of Gov. Rauner. “He should go back over there and he should drink some of the water. Or maybe he should take a shower. Or maybe he should eat off of one of those plates coming out of that kitchen. Maybe that would make an impact on him.”

Bottom line, Steve French said, someone has to answer for what happened — and is continuing to happen — at the Quincy veterans’ home.

“People are dying. Something’s killing them. Granted, it’s a water-treatment problem. But it’s killing people,” he said. “Shouldn’t somebody be held accountable?”

This story has been updated to change a reference to the date of the first-known case of Legionnaires' disease during the 2015 outbreak, which showed up on July 24.

Dave McKinney and Tony Arnold cover state politics for WBEZ. Follow them on Twitter at @davemckinney and @tonyjarnold.

Remembering the Legionnaires’ Outbreak - HISTORY

Washington D.C. (January 22, 2018)—In August 2015, New York recorded the worst outbreak of Legionnaires’ disease in the state’s history when 133 Bronx residents contracted the disease resulting in 16 deaths. Emergency state and city regulations were enacted and celebrated as decisive steps to address the threat. More than two years later, New York has posted a record number of cases and a significantly higher rate of Legionnaires’ disease than any other state in the country per capita.

“Unfortunately we continue to see cases of Legionnaires’ disease climb in New York,” said APLD Spokesperson Daryn Cline. “This is especially troubling since New York is holding itself out as the leader in Legionnaires’ disease prevention. The truth of the matter is their emphasis on water management inside the building has not had an impact on decreasing the rate of disease.”

“We are convinced that any meaningful reduction in Legionnaires’ disease in New York requires a focus on the complete water distribution system that supplies our homes and workplaces—from source to consumption,” added Cline.

New York led the nation again with 1,009 cases reported to the CDC—a 38 percent increase in cases compared to 2016. Of the state total, New York City recorded 441 cases—a 65 percent increase over 2016. In fact, New York City’s 2017 case total outpaced 2015—the year of the worst outbreak in New York City’s history.

“These continuous increases are exactly why more resources must be dedicated to better understand the relationship between waterborne pathogens such as Legionella and our public water supply and distribution system,” said Tonya Winders, President and CEO of Allergy & Asthma Network, and APLD member. “The fact remains that water containing Legionella bacteria from the public water supply is entering homes and buildings, and—as a result—people are getting sick. Some are dying.”

The Alliance has been critical of the New York City and State’s response to preventing cases of Legionnaires’ disease since regulations were put in place after the Bronx outbreak in 2015. The group’s main contention is that the regulations are too narrowly focused on building equipment and do not address the source problem—Legionella entering buildings from the public water supply and distribution system.

“Building equipment uses the same water source that supplies our showerheads and faucets. Without addressing the bacteria entering our buildings from the public distribution system, the issues we face with Legionella are not going to end,” said John Letson, Vice President of Plant Operations at Memorial Sloan Kettering Cancer Center. “According to the CDC, 35 percent of Legionnaires’ disease outbreaks can be attributed to conditions and disruptions to water service outside of the building. In order to keep people safe, especially those with compromised immune systems and patients receiving out-patient care, more must be done to remove the threat of Legionella in our public water.”

Another key criticism of New York’s current approach is the failure to properly address individual, sporadic cases of Legionnaires’ disease which—according to the CDC—make up approximately 96 percent of the total recorded cases nationally. By focusing only on building equipment, New York’s regulations only address a portion of the four percent of cases attributed to outbreaks—leaving hundreds of New Yorkers at continued risk of infection.

“Our public policies are being driven by outbreaks which generate news and political pressure,” added Cline. “There were only two known events in New York City that were classified as outbreaks in 2017— with the highest infecting 13 people. Yet, in 2017 an average of 19 people contracted Legionnaires’ disease each week across the New York state. During one week alone, there were 27 new cases in New York City, which went largely unnoticed. Worse yet, they were not fully investigated to understand the sudden spike or how to prevent similar spikes in the future.”

Among other things, the APLD is a staunch advocate of mandating that every case of Legionnaires’ disease undergoes a comprehensive investigation in an effort to better understand how to prevent the disease. The group also urges for more resources to be allocated to gain a better understanding of how aging infrastructure, heavy rain and flooding events, and the wider implementation of low-flow appliances are impacting the increase.

“The most important thing to remember is that Legionnaires’ disease is a waterborne illness so water must be the focus of any preventive measure,” added Winders. “Any solution that doesn’t address the bacteria entering our homes and buildings from the public water supply and distribution system is not a solution at all.”

Some say it was radiation, some say there was acid on the microphone,
Some say a combination that turned their hearts to stone,
But whatever it was, it drove them to their knees.
Oh, Legionnaires’ disease.

I wish I had a dollar for everyone that died within that year,
Got ‘em hot by the collar, plenty an old maid shed a tear,
Now within my heart, it sure put on a squeeze.
Oh, that Legionnaires’ disease.

Granddad fought in a revolutionary war, father in the War of 1812,
Uncle fought in Vietnam and then he fought a war all by himself,
But whatever it was, it came out of the trees.
Oh, that Legionnaires’ disease (“Legionnaires’ Disease,” Bob Dylan).

Bob Dylan’s song lyrics capture the feeling of confusion and conspiracy that diffused throughout the nation after an American Legion convention in Philadelphia left members with a deadly pneumonia.

The Legion members were celebrating America’s bicentennial the momentous occasion brought them all to the Bellevue Stratford Hotel on a hot weekend in July of 1976. The illness progressed in the members after they returned to their homes, all suffering from headaches, chest pains, fever, and lung congestion. Dr. Ernest Campbell, a physician from Bloomsburg, Columbia County, was the first to see a pattern in the outbreak of illness after he found that three of his patients with similar symptoms had attended the conference.

Among the 182 persons infected, 147 required hospitalization, and 29 died. It was a disheartening time for members of the American Legion. They mourned their friends who had survived wartime, only to fall ill celebrating the legacy of their homeland. Scientists at the Center for Disease Control (CDC) in Atlanta, Georgia, scrambled to identify what kind of infectious agent was responsible for such a lethal outbreak. The American public waited in anticipation. Was it bioterrorism? Foul play? Was it an infectious microorganism, or a toxin? “Sabotage is an easy possibility to consider,” said Dr. Lewis Polk, Philadelphia’s health commissioner, “but there is no evidence to lead us to that conclusion.”

TIME Magazine’s August 1976 cover story “Disease Detectives: Tracing the Philly Killer” glorified the efforts of CDC scientists on the trail, citing not only the need to determine “whodunnit”, but the noble sleuth’s responsibility of finding out how. The cover article sheds light on the elusive nature of the pathogen. Though it is now known that a microorganism caused the pneumonia outbreak, the journalist claimed the “detectives” had ruled out microorganisms and had moved on to toxicological agents - chemicals and heavy metals.

After nearly six months of head-scratching, scientists at the CDC were downright embarrassed that no one had yet found the culprit, let alone how the infection had spread. TIME Magazine ran another story in January, 1977 called “Found: The Philly Killer, Perhaps,” that reported a persistent CDC scientist Dr. Joseph McDade’s success in identifying a novel rod-shaped bacteria. He recalled later that the process by which he found the bacteria was, “like searching for a missing contact lens on a basketball court with your eyes four inches away from the floor.” After finding nothing looking like a known pathogen, McDade set out to look for something—anything—that he didn’t recognize. Although he had no idea what he was looking for, the molecular and immunological techniques he used were perfect for identifying the culprit bacterial pathogen. The bacteria were later named Legionella pneumophila.

It is now known that Legionella pneumophila thrives in warm water and warm, damp places. The month of July is hot and balmy in the city of Philadelphia and the Bellevue Stratford Hotel offered air-conditioned rooms for the comfort of their guests. Unfortunately, cooling towers are the perfect breeding ground for Legionella pneumophila, and its dissemination through the Bellevue Stratford Hotel was facilitated by the air conditioning.

Since its discovery in 1977, Legionella pneumophila has been extensively characterized. Scientists have found the pathogenic microorganism to be responsible for outbreaks since then. There are classical symptoms that set Legionnaires’ disease apart from other pneumonias. Symptoms include high fever, headache, dry cough, chest pain, difficulty breathing, diarrhea, confusion, delirium, vomiting, nausea, and failure to respond to beta-lactam antibiotics, the type of antibiotics usually used for pneumonia. If Legionnaires’ disease is suspected, beta-lactam antibiotics can be given in conjunction with another antibiotic.

L. pneumophila thrives in warm, damp places. The bacteria are ubiquitous in freshwater environments like lakes, rivers and wet soils (Phares). L. pneumophila is primarily spread via inhalation of infected aerosols. One perfect place for this bacteria to grow is cooling towers and air-conditioning systems, as was the cause of the 1976 outbreak in Philadelphia. However, L. pneumophila preference for aquatic environments has proven to be a global health issue, as it has been the major pathogen in six notable outbreaks around the world. These outbreaks have caught the attention of the World Health Organization (WHO) which has devised approaches to control cooling tower environments, and develop water safety plans.

According to the World Health Organization, “the fact that Legionellae are found in hot-water tanks or thermally polluted rivers emphasizes that water temperature is a crucial factor in the colonization of water distribution systems.” These characteristics mark Legionella pneumophila as a fastidious bacteria, which means it thrives in artificial conditions.

The World Health organization has taken initiative in the characterization of Legionnaires’ disease and its epidemiology. Epidemiology is the branch of medicine dealing with the incidence and prevalence of disease in large populations and with detection of the source and cause of epidemics of infectious disease. Common environments for Legionella pneumophila are potable water distribution systems, cooling towers and evaporative condensers, health care facilities, hotels and ships, and natural spas, hot tubs, and swimming pools. Hospitals and other health care facilities pose challenges for L. pneumophila prevention because these often have older, more complex plumbing systems, and many persons who may be highly susceptible to infection. The concern for this pathogen has spread far outside the city limits of Philadelphia, Pennsylvania.

WHO has described ways for disease surveillance and public health management of outbreaks to be possible at a national level. Though implementing surveillance systems in countries depends greatly on such factors as: infrastructure and public health laws, surveillance law, notification law, data protection, and patient confidentiality, WHO stresses that it is of great importance. Efficient identification and communication of an outbreak is essential because time is a major factor for the survival of those who become infected.

The WHO is a leading authority on disease outbreak and epidemiology. Their thorough recognition, surveillance, and regulation of Legionnaires’ disease, has surely improved the lives of many.

Thankfully, the “Philly Killer” is no longer at large in Philadelphia. Though more is known now about Legionnaires’ disease, it is still a significant health concern throughout the world. The historic event at the Bellevue Stratford Hotel inspired a race for knowledge that resulted in the ultimate characterization Legionnaires’ disease, and the identification of a novel human pathogen – Legionella pneumophila.

Why Reports of Legionnaires’ Disease Are on the Rise in the United States

Before her 73-year-old mom contracted Legionnaires’ disease at a nursing home earlier this year, Monique Barlow knew little about the deadly pneumonia and the waterborne pathogen that causes it.

“Until then, I didn’t give it much thought,” says Barlow. “I didn’t even really know what it was.”

Sheryll Barlow, a resident of Room 325 at Arlington Court Skilled Nursing and Rehab Center in suburban Columbus, Ohio, died in late February. Arlington Court was just one of at least five Columbus-area facilities to report an outbreak of Legionnaires’ disease, which is caused by Legionella bacteria, since May 2019.

Modern drinking water treatment in developed countries has effectively eliminated cholera, typhoid and other traditional waterborne scourges. The U.S. Safe Drinking Water Act (SDWA), passed in 1974, propelled progress by requiring water suppliers to meet national standards for monitoring contaminants and managing them through filtration, disinfection and other processes. The U.S. now has one of the world’s safest drinking water supplies. And most of the attention on drinking water safety today has shifted from microbiological to chemical, with plastics, pesticides and per- and polyfluoroalkyl substances, or PFAS, leading lists of contaminants of concern.

Yet many microorganisms also slip through the cracks of U.S. drinking water systems, sickening up to an estimated 4 million to 32 million people every year. Although most only result in mild gastrointestinal upsets, some can be deadly, as witnessed by recent reports of brain-eating amoeba in Texas municipal water supply.

That figure doesn’t include wells, which are particularly prone to pathogen problems. In 2000, some 2,300 people fell ill and seven died in Walkerton, Ontario, for example, after heavy rainwater drew E. coli and Campylobacter jejuni bacteria from cow manure into a shallow aquifer of a nearby well.

Typical concentrations of chlorine used in treatment plants can be insufficient to kill off Cryptosporidum and Giardia, which cause gastrointestinal disease. And other infectious agents, including Legionella and non-tuberculosis mycobacteria, reside beyond the reaches of the treatment plant — finding hospitable environments in the pipes that distribute water to and within hospitals, hotels, homes and other buildings.

“It’s never going to be 100%, but we have things well under control for pathogens in source waters,” says Joe Cotruvo, an environmental and public health consultant based in Washington, D.C., and formerly with the U.S. Environmental Protection Agency’s Office of Drinking Water. “The data show that those risks are going down and have been going down ever since the Safe Drinking Water Act was implemented.”

That is, Cotruvo adds, with one exception. “What has been going up has been Legionella.” Figuring out why — and what do to about it — is a major focus of efforts to combat waterborne diseases today.

Attention to Legionella has been heightened by the Covid-19 pandemic. Some health experts express concern that a prior infection with the virus that causes Covid-19 could make a person more susceptible to Legionella. But there’s an even more pressing concern connecting the two: Building shut-downs through the spring and summer have left warm water stagnant in pipes — a perfect environment for Legionella to multiply.

Many hotels, offices, schools and other buildings have been left fully or partially vacant for long periods of time, notes Chris Edens, an epidemiologist with the U.S. Centers for Disease Control and Prevention (CDC), which recently released guidance for reopening buildings. “As those kinds of communities reopen, it’s important for owners and operators to be thinking about water management.”

Leading Cause

Legionella grows naturally in the environment, especially warm freshwater lakes and streams that can be a source for drinking water. It generally only becomes a risk to human health when it enters and multiplies within human-made water and plumbing systems, and then that contaminated water becomes aerosolized.

Drinking fountains, hot tubs, sinks, toilets, sprinklers, showers and air-conditioning systems are among the common sources. It tends to flourish when temperatures are warm, water is stagnant, chemical disinfectants are insufficient, and nutrients are plentiful, such as inside corroding pipes. When inhaled at high enough levels, the bacteria can infiltrate the lungs and cause one of two forms of legionellosis, Pontiac fever or Legionnaires’ disease. The former is usually a fairly mild respiratory illness the latter is far more commonly reported and estimated to be fatal in one in 10 cases.

Now the leading cause of reported waterborne disease in the U.S., Legionella accounts for about 60% of outbreaks over the last decade. Nearly 10,000 cases of Legionnaires’ disease were reported to the CDC in 2018 — the most ever in U.S. history, and still a likely underestimate. Edens suggests the true figure is probably double that. Other scientists estimate the annual case count at between 52,000 and 70,000.

Reports of Legionnaires’ disease have climbed in recent years. No one is sure why, but factors could include improved reporting, aging people and infrastructure and climate change. (Nationally Notifiable Diseases Surveillance Systerm | U.S. CDC / Ensia)

Legionnaires’ disease was discovered in 1976 after some 200 people became ill with a mysterious type of pneumonia-like disease at an American Legion convention in Philadelphia. Dozens died. Health officials eventually identified a bacterium that had thrived in the building’s cooling towers and then spread though the air-conditioning system.

Cooling towers were also likely behind many of the more than 2,000 confirmed cases in New York City between 2006 and 2015. In the summer of 2019, the Sheraton Atlanta hotel was closed for a month after an estimated 79 people were infected from Legionella traced to the hotel’s cooling tower and decorative fountain. A variety of other plumbing issues and insufficient water management has resulted in outbreaks around the country — at nursing homes, hospitals, schools and across whole communities.

At least 87 people were infected with Legionnaires’ disease in Flint, Michigan, in 2014 and 2015 after the city switched water sources. Researchers found evidence for three likely sources of Legionella exposure: a hospital, City of Flint water and local cooling towers. Mayor Sheldon Neeley told Ensia that the city is “making critically important infrastructure improvements to move our community forward in a positive direction.”

Proliferating Pathogen

Yet such large-scale Legionnaires’ disease outbreaks are “just the tip of the iceberg,” according to Joan Rose, a water researcher at Michigan State University. Research suggests that for every case linked to a specific source and outbreak there are nine sporadic cases. For example, outbreaks only accounted for about 10% of the cases in New York City linked to cooling towers.

“We don’t have Legionella under control,” says Rose.

Why does Legionella appear to be on the rise around the U.S.? The answer is complicated, explains Edens. The larger numbers could be partly due to greater awareness and testing. But he suggests that an aging population and aging infrastructure are major drivers.

“In large part, our distribution system is very antiquated,” says Amy Pruden, a professor of civil and environmental engineering at Virginia Tech. As water travels through the distribution system and enters a building, it can lose disinfectant as well as interact with the materials, temperatures and design of the building’s plumbing. “Many things are at play that affect whether these microbes grow in the plumbing,” she adds.

Climate change, too, may be playing a role. Longer summers tax the cooling devices used by large buildings. Increased rainfall may increase the presence of Legionella in drinking water.

It’s all added up to growing concerns and heightened calls to address the risks. “The thing about Legionella is it’s a silent killer. You can’t see it or smell it. It’s just in the air floating around,” says Eric Hageman, a Minneapolis lawyer who represents the family of Sheryll Barlow in a claim against Arlington Court. “So, you have to be proactive.”

Controlling Contaminants

Arlington Court had been aware of a Legionella problem at the facility months before Monique Barlow’s mom became sick after another resident contracted Legionnaires’ disease in October 2019. “I just assumed they took care of everything. But then it popped back up, and that’s when we got the call,” says Barlow.

After learning that her mom had the disease, she says she wanted to know more. “I felt like they owed us an explanation. How are you fixing this? How is this not going to happen again?” Barlow adds.

Since February 10, Arlington Court has implemented changes, including the installation of filters in the kitchen, visitor areas, showers, bathrooms and ice machines. Such point-of-use filters are among emerging tools to control Legionella.

In a letter to residents reported on March 1 after local officials announced an investigation of an outbreak, Arlington Court said it took “very seriously the health and safety of everyone at the facility.” In a statement at the time, its parent company, Vrable, said it was working with authorities. Arlington Court and Vrable did not respond to multiple requests for comment for this article.

Flushing of the pipes is critical anytime a building, or an area of a building, is not in regular use. Edens emphasizes the importance of water management strategies such as flushing water pipes, controlling temperatures and using disinfectant within a building. “We know water in the tap is not sterile,” he says. “The purpose of water management is to ensure that if some Legionella bacteria come through the main, the bacteria have nowhere to grow and hide.” He added that, under ideal conditions, Legionella can create a biofilm that helps it survive hot water and chlorine — another thing water management should aim to prevent.

Flushing of the pipes is critical anytime a building, or an area of a building, is not in regular use. And because Legionella bacteria rapidly reproduce at temperatures between about 75 ºF (24 ºC) and nearly 120 ºF (49 ºC), it’s also important to keep hot water hot and cold water cold.

Adding chlorine or other disinfectants to water as it enters a building is yet another tactic to reduce contamination. Chlorine, which is generally applied after filtration at a drinking water treatment plant, can drop to ineffective levels by the time water reaches the point of use. Supplemental chemical treatment such as a chlorine booster can bring disinfectant levels back within a range that limits Legionella growth.

Consumers can also take steps to reduce risks in their own households. For example, the CDC recommends that hot tub or spa owners frequently test water for proper levels of chlorine, bromine and pH. Old piping and “dead legs” — altered, abandoned or capped sections of pipe — can also provide the opportunity for Legionella to grow. And precautions should always be taken for stagnant water.

“You need to consider the far reaches of the building. If you’re not using a second bathroom, for example, then flush the shower before people use it,” says Cotruvo. “And don’t inhale while flushing.” Cotruvo also recommends using hot water regularly so water doesn’t stagnate in the pipes maintaining hot water heater settings at about 130 ºF (54 ºC), blending hot and cold water at the tap to avoid scalding and not spending excessive time in the shower or bathroom.

Regulatory Gaps

In a report published in August 2019 by the National Academies of Sciences, Engineering. and Medicine, a 13-member committee warned that current laws — even the SDWA — fail to protect the public from the spread of Legionella.

The authors, who include Rose and Pruden, lament that the bacterium is managed in water systems “on an ad hoc basis.” A handful of federal, state and local regulations require certain buildings to have water management plans that include monitoring for and treatment of Legionella. But no federal law targets Legionella contamination of water supplies and building water systems.

The committee offered several recommendations for improving Legionella management in the U.S., such as requiring a minimum disinfectant level throughout public water systems, developing clinical tools to capture more cases of Legionnaires’ disease, providing more guidance to homeowners, no longer allowing low-flow fixtures in hospitals and long-term care facilities, and addressing the longer periods of time that water sits idle and lower hot-water temperatures common in green buildings.

Pruden expresses hope that the document is a “point of reference for those motivated to take action,” but acknowledges today’s challenges: “There is also a great deal of political distraction and other issues getting priority.”

The EPA notes that it regulates Legionella in public water systems under the Surface Water Treatment Rule (SWTR), which is tied to the SDWA. The rule was originally written to control viruses and Giardia, then amended to control Cryptosporidium. The agency suggests that it is currently considering potential changes to requirements on disinfectant residuals and other measures that may provide for better control of Legionella in plumbing systems.

But many scientists argue a need for more urgent attention to and action on the issue.

For Legionella, the SWTR provides only “lip service” to the control of Legionella, says Rose. She suggests that disinfectant residual alone is inadequate to control the bacteria.

“We need some coordination at the [federal] level,” adds Pruden. “It’s a multi-stakeholder problem, but is now awkwardly being handled through the litigation system.”

This piece was originally published on Ensia, a nonprofit media outlet published by the Institute on the Environment at the University of Minnesota.

Encyclopedia of Greater Philadelphia

The Legionnaires disease outbreak was traced to the Bellevue-Stratford Hotel at Broad and Walnut Streets, where the annual American Legion convention was held in 1976. The Bellevue-Stratford opened in 1904, replacing the former Bellevue and Stratford Hotels. It was considered one of the most elegant hotels in the nation during its heyday, hosting celebrities and politicians, including nearly every U.S. president since Theodore Roosevelt, as well as local social elites. Negative publicity surrounding the Legionella outbreak forced the hotel to close in November 1976 and demolition was considered. After a $25 million renovation, the Bellevue-Stratford reopened in 1979, but struggled to fill its rooms. It closed again in 1986 and stood empty until it was reopened in 1989. After multiple owners and names, in 2010 it was renamed the Hyatt at The Bellevue and as of 2016 continued as a mixed-use commercial and hotel property that retained some cachet as a meeting place of movers and shakers.

Legionella Bacteria in Lung Tissue

In January 1977, researchers were able to identify an until-then-unknown genus of bacteria responsible for the mysterious Legionnaires’ disease, which had killed thirty-four people. Dubbed Legionella after the American Legion, whose conventioneers were afflicted, the bacteria was found to thrive in large air conditioning systems such as those used in hotels and hospitals. Legionella infects the lungs when contaminated water or soil is aerosolized and inhaled. It cannot be spread from person to person. It was found to have caused previous outbreaks in hospitals from as early as 1965. Once the disease agent was identified, a cure was found. Today, Legionnaires' disease is treated with antibiotics.

Graph at the Legionnaire's Disease Symposium

The Legionnaires’ disease outbreak began in July 1976, when the American Legion held its annual convention at the Bellevue-Stratford Hotel at Broad and Walnut Streets. Thousands of American Legion members attended the conference. After returning home on July 24, several attendees developed pneumonia and very high fevers within a week twelve had died. The disease infected a total of 221 people and its cause eluded epidemiologists for months, as tests for illnesses that caused similar symptoms came back negative in the Legionnaires. This photograph was taken at a symposium on Legionnaires’ disease in November 1976, two months before the Legionella bacteria was identified.

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Legionnaires’ Disease

The outbreak of a mysterious pneumonia-like disease in the Philadelphia region in the summer of 1976 puzzled doctors and public health officials. Many of the sick had attended an American Legion convention at the Bellevue-Stratford Hotel, giving the new illness the name “Legionnaires’ disease.” Months later, doctors discovered that bacteria in the hotel’s air conditioning system had caused the outbreak. By then, thirty-four of the 221 people who fell ill had died, and the Bellevue-Stratford Hotel had closed its doors for lack of business.

The 1976 Legionnaire’s disease outbreak centered on the Bellevue-Stratford Hotel, where the disease’s victims had gathered for an annual American Legion convention. (Library of Congress)

The outbreak occurred during the bicentennial of the Declaration of Independence. After returning home on July 24 from the three-day American Legion meeting in Philadelphia, several of the legionnaires began to fall ill with chest pains, high fevers, and lung congestion. By August 2, twelve had died. Doctors initially suspected that swine flu might be the culprit. If so, it was feared that Philadelphia could become the epicenter of an influenza pandemic, on the order of the 1918 “Spanish” flu that had killed as many as 100 million worldwide. In this light, Pennsylvania state health director Leonard Bachman (b. 1925) considered a quarantine of the city. Bachman held daily press conferences—sometimes twice a day—to update the public on the progress of the epidemic, while the city of Philadelphia set up a hotline to take reports of potential new cases.

Meanwhile, the numbers of sick continued to grow: by August 6, twenty-five had died, with 112 others hospitalized. However, tests for known viruses, bacteria, and fungi that might cause similar symptoms all came back negative. Moreover, the disease showed no evidence of secondary infection that is, the sick did not seem to pass the illness to those with whom they came into contact. There would be no deadly pandemic, but the question remained: what was killing the legionnaires?

To find out, a team of local and state health officials distributed a survey to the ten thousand people—legionnaires and their families—who had attended the meeting. Through computer analysis of their responses, epidemiologists determined that the sick had all been inside the Bellevue-Stratford Hotel, although some had stayed elsewhere. Moreover, several attendees of the International Eucharistic Conference, which took place at the hotel shortly after the American Legion Meeting, also became ill with the same mysterious pneumonia. On August 14, epidemiologists added presence at the Bellevue-Stratford to the case definition of the new disease.

Researchers scrambled to find a cause for the mysterious diseases for nearly six months. (Special Collections Research Center, Temple University Libraries)

In the absence of a clear infectious agent, doctors turned their attention to chemical toxins. The symptoms of infection roughly matched those of nickel poisoning, and some speculated that the sick might have inhaled nickel carbonyl, perhaps through fumes from burning business papers. Researchers also tested the pesticides and cleaning products used in the hotel, looking for any clue as to what might have caused the mysterious outbreak. Although answers remained elusive, the number of new cases of “legion disease” dropped off. By the end of August, officials announced that the epidemic had ended. Nevertheless, business at the Bellevue-Stratford declined precipitously. The hotel’s rate of occupancy dropped from 80 percent to 3 percent at its lowest point, while the once-bustling restaurant, bar, and coffee shop were all nearly deserted. In November, the hotel’s owners announced that the Bellevue-Stratford would have to close its doors. (It reopened in 1979, after a major renovation, under new management.)

Epidemiologists traced the mystery disease to a newly-discovered bacteria, dubbed Legionella, which was found in the air conditioning system in the Bellevue-Stratford Hotel. (Centers for Disease Control)

In January 1977, researchers finally pinpointed the source of the legionnaires’ pneumonia. It was not, after all, poisoning from nickel carbonyl or some other industrial poison, but a bacterium from a previously unknown genus, subsequently named Legionella after the first recognized outbreak. Researchers thereafter realized that Legionella bacteria thrive in large central air conditioning systems, such as that used by the Bellevue-Stratford. They also concluded that similar outbreaks had occurred going back to 1965 in hospitals and large office buildings but had escaped detection at the time. However, the names of both the disease and the bacteria remained linked to the initial outbreak in Philadelphia. A 2002 outbreak of the disease at a Jewish nursing home in suburban Horsham, Pennsylvania, killed two residents and sickened seven others, as well as an employee. In 2005, two attendees of the Pennsylvania American Legion convention in King of Prussia were sickened with Legionnaires’, reviving memories of the 1976 crisis, although both men survived. Since the discovery of the Legionella bacillus, doctors have been able to treat cases of the disease with antibiotics.

Dan Royles is Assistant Professor of History at Florida International University, in Miami. His first book, To Make the Wounded Whole: African American Responses to HIV/AIDS , is under advance contract with the University of North Carolina Press.

Copyright 2016, Rutgers University

Related Reading

“The Philadelphia Killer.” Time Magazine. August 16, 1976.

Cravens, Gwyneth, and John S. Marr. “Tracking down the Epidemic.” The New York Times Magazine. December 12, 1976.

Fraser, David W., Theodore R. Tsai, Walter Orenstein, William E. Parkin, H. James Beecham, Robert G. Sharrar, John Harris, et al. “Legionnaires’ Disease.” New England Journal of Medicine 297, no. 22 (December 1, 1977): 1189–97.

A chance discovery?

In the public health world, Legionnaires’ disease is often viewed as a classic case of the power of epidemiology, and its core tools that field investigators use to map out patterns and understand how diseases strike.

But what if McDade never went back to the lab that Christmas and meticulously reviewed his samples? Did the whole success of the Philadelphia legionnaires’ mystery come down to a chance discovery by a scientist who voluntarily decided to take a second look, following an uncomfortable encounter at a holiday party?

McDade says no, not entirely.

“There are a lot of people who think chance plays a large part in the discovery, and I suppose it does. But I think the methodology brings it all around eventually,” he said. “I think that one of the things that happens over time is that scientists peruse the same areas, and sometimes they go back and try to reproduce what other people do, and reinvestigate it. And things then come out.”

In the case of the Legionnaires’ disease discovery, Mcdade said the disease itself wasn’t new. But without a big, fatal outbreak, sporadic cases often went unnoticed.

“However when you get a very large outbreak of something, with 150 to 200 cases of disease, it cannot be ignored. It cannot be ignored,” said McDade. “Sometimes what it takes is a large outbreak of a disease to help you discover something that’s been percolating for a long time, undetected.”

Following the discovery of the legionella bacteria, he and others were then able to trace it back to previous, unsolved outbreaks.

“I still to this day continue to learn lessons,” said McDade. “Data becomes information, information becomes knowledge and hopefully someday knowledge collectively becomes wisdom.”

Applying the lessons of Legionnaires’ to a career in public health

Mcdade could have turned his life’s work into studying Legionnaires’ disease, but he didn’t.

And while he admits that many would consider his identifying the legionella bacteria as the biggest discovery of his career, he said he used what he learned from that experience to make “equally satisfying” contributions to public health throughout his life.

One of McDade’s biggest lessons from working on Philadelphia’s Legionnaires’ outbreak was the way it transformed his entire scientific approach. Up until then, he focused on making sure he ran tests well and accurately.

“I was trained as a research microbiologist and not as a public health microbiologist,” said McDade. “And the more I learned about epidemiology, the better a laboratory scientist I became. Because it’s not only about doing the right tests and doing them well, it’s knowing what to test and why. And I found that over time, I started asking the broader questions about what do we think is happening, how can we determine what that is, what tests we should perform and why,” said McDade. “If you’re not asking the right questions about it, the information won’t necessarily be useful.”

He began collaborating more with people.

After three years of working on the outbreak, he went back to the rickettsia field, where in the mid-1980s, he helped discover the first human case of ehrlichiosis, a disease which up until then, was thought to be confined to dogs. McDade recalled drawing parallels between the then mysterious human case that others thought could be rocky mountain spotted fever and an image he had seen during a military presentation years earlier of a terrible Ehrlichia infection that army dogs had contracted from ticks.

Mcdade later became deputy director of the CDC’s national infectious disease center. Pointing to the lessons from Legionnaires’ of the importance of collective knowledge and collaboration, he launched one of the first online open access journals, Emerging Infectious Diseases, in the 90s and was editor for five years.

“The idea was to improve communication around the world about emerging threats, and it worked very, very well and rapidly,” he said.

The popular journal is now monthly. McDade also taught at Berry College in Rome, Georgia. He retired in 2014 and is now a member of the National Institute of Health’s national science advisory board for biosecurity.

“That’s my only professional activity at this point. Otherwise, I find myself very busy every day. A lot of it is fun, some of it is a bit of work, but I don’t sit still well,” said Mcdade, laughing.

Bacteria And The Bellevue: The Birthplace Of Legionnaires’ Disease

On August 12th, the Philadelphia Department of Public Health issued a health advisory confirming 31 reports of Legionnaires’ disease and two fatalities among local residents, a fairly typical seasonal increase, according to the PDPH’s communications director, Jeff Moran. Although media attention this summer has focused on an outbreak of the disease at the Opera House Hotel and the Melrose Houses apartment complex in the Bronx, New York, that has killed 12 people so far, not to mention the outbreak at San Quentin prison in California where 95 inmates are currently under observation, Pennsylvania has the highest number of reported case counts across the country with 200 confirmed this year. The disease is named for the first identifiable U.S. epidemic of the disease, in 1976, when members of the American Legion fell ill after their Bicentennial convention at Broad Street’s elegant Bellevue Stratford Hotel.

The Bellevue Stratford in November of 1976. The grand hotel closed that month due to numerous cancellations in the aftermath of the Legionnaire’s disease outbreak | Source: Library of Congress, Prints & Photographs Division

The summer of 1976 was hot and humid in Philadelphia, and luxury hotels like the Bellevue Stratford made sure their guests were comfortable by keeping the air conditioning running around the clock, which proved to be fatal for some. The outbreak of the legionella bacteria infected 182 people and killed 34 during the 58th annual convention of the Pennsylvania Department of the American Legion held on July 21-24th. A CDC field investigation later found the bacteria breeding in the hotel rooftop air conditioning system’s cooling tower.

“Because legionella is ubiquitous in the environment,” Moran explains, “it is difficult to prove that a specific environmental location was the source of infection.” Which is part of the reason why it is so remarkable that CDC investigators were able to inextricably link the Bellevue Stratford Hotel to not one, but two outbreaks of Legionnaires’ disease in the 1970s. No known connections between specific Philadelphia buildings or the bacteria have been found since.

After identifying the legionella bacteria in 1976, CDC researchers were able to retroactively diagnose previous mysterious outbreaks, including one that occurred just two years prior in September 1974 that was also traced back to the Bellevue Stratford. That outbreak infected a convention of the Independent Order of Odd Fellows and killed two attendees.

According to Dr. David Fraser, the head of the CDC investigation into the 1976 outbreak, “One of the things we found later when we could do blood tests on employees was that employees who had worked in the hotel back in 󈨎 were more likely to have antibodies to legionella than those who were more recent employees. So it looks as though, from time to time, there was exposure to legionella in that area. We don’t know that it was from the hotel itself, but we have pretty good evidence from the ’76 outbreak that the source of infection was in the hotel.”

The association of the Bellevue Stratford name with a deadly disease understandably upset hotel management. “William Chadwick, who was the general manager at the time, was not happy with me,” Fraser recalls. “I was taken aside by lawyers for the Bellevue Stratford and threatened with lawsuits. The biggest gripe that they had about the investigation was that we put the Bellevue Stratford into the case definition. That is, to be a case of Legionnaires’ disease one had either to attend the American Legion convention or be in the Bellevue Stratford some time after July 1st. They thought that was unfair.”

Consumer protection sub-committee hearing on Legionnaires’ Disease in Philadelphia on November 23, 1976 | Photo: Associated Press

The historic hotel, nicknamed the “Grande Dame of Broad Street,” opened in 1904 with extravagant amenities, including two orchestras, three ballrooms, both Turkish and Swedish baths, an outdoor rose garden on the roof, and rooms decorated in colonial, French, Italian, and Greek styles. G. W. & W. D. Hewitt, the local architectural firm with an impressive list of previous projects that include the Philadelphia Bourse and a roster of renowned former partners like Frank Furness, designed the building.

After the outbreak the luxury hotel received one cancellation after another, until it was forced to close and fire 500 employees in November of 1976. The last event hosted by the Bellevue Stratford before its closure was the 48th Annual Conference of the Society of American Magicians.

Any structural changes made to the Bellevue Stratford after 1976–since 1996 the Hyatt at The Bellevue (the name was shortened from Park Hyatt Philadelphia at the Bellevue in 2010)–are more closely linked with reduced occupancy than medical precaution. “There wasn’t a need for a structural change at the Bellevue Stratford Hotel, as I recall,” says Fraser regarding CDC recommendations for physical changes made to the hotel. “There was a likely value in keeping the bacterial growth in the cooling towers under control. Clean the towers and treat them regularly.”

Center for Disease Control epidemiologist Stephen Thacker interviews Thomas Payne at Chambersburg Hospital on August 4th, 1976. Payne’s temperature rose to 107 degrees after contracting the bacteria | Photo: Public Domain

Because of lingering bad press and a declining market for luxury hotels on this scale, the Bellevue could not sustain its grand accommodations. A renovation in 1980 reduced the number of guest rooms from 1,000 to 545, and a second renovation in 1989 further reduced the number of rooms to 165. Hotel space is now confined to floors 12-19, and the rest of the building has been converted into offices, retail, and a food court. The Sporting Club, a 93,000 square foot exercise facility, was added to the hotel’s parking garage (built in 1983 on the lot where The Philadelphia Art Club once stood). A lobbying firm and a communications group now occupy the 8th floor, which once housed a spacious suite for hotel managing director William Chadwick and his family. The roof in its heyday had restaurants and gardens. It is no longer accessible to the public.

The Hyatt at the Bellevue’s website boasts visits from every U.S. president after Theodore Roosevelt and innumerable celebrity guests. It also proudly lists the few outstanding original fixtures that survived the hotel’s numerous renovations, like light fixtures designed by Thomas Edison and Tiffany stained glass. No mention of either of the two outbreaks of Legionnaires’ disease is made. Text on the hotel’s timeline quietly reports that “in 1976, the property was put up for sale and advertised around the world.”

Outbreaks of legionella continue to increase across the country, though no alarms are going off in Philadelphia. According to the Philadelphia Department of Public Health’s advisory, the summer increase in Philadelphia County is not unusual and the cases–predominately male with a median age of 62–have not been concentrated to one location in the city. Unlike the outbreak in the Bronx, where the disease can be traced back to a specific building and its cooling tower, the cases in Philadelphia “have no epidemiological association with one another”. The PDPH notes that the increase of infection is consistent with historic trends and that an upsurge in cases of legionella during summer months are common due to heat, rainfall, and humidity, which provides ideal breeding conditions for the bacteria.

About the Author

Karen Chernick Karen Chernick is an art historian and museum professional who recently moved to Philadelphia from Tel Aviv. She is excited to discover the stories that her new home has to tell through its design, architecture and urban renewal.

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