Legionnaires' Disease and COVID-19 Dueling Diseases

Peanut butter and jelly, coffee and cream, wine and cheese. Arguably…. all of the very best things come in pairs. Sometimes, we even feel lost without the matching pairs. For example, imagine only having one earring, one sock, or one shoe.

As we turn the corner in preparation for the new year, there is one very important pair that we must pay attention to: COVID-19 and Legionnaires’ Disease (Legionella is the waterborne bacteria responsible for Legionnaire’s Disease).

Admits the wake of the coronavirus pandemic numerous statistics and facts were published warning the American population of the increasingly fatal disease. The majority of information dispersed steered the conversation towards a fabricated understanding of the reasons behind the mortality numbers.

A study recently conducted and published in September of 2020 by the highly specialized water research and policy journal, ACS ES&T Water, reported that 50% of patients with COVID-19 who died, also at one point had a secondary bacterial infection. Some of which, were linked to Legionella and COVID-19 co-infections.

The main takeaway from this research is to understand the severity of the virus paired with a secondary infection vs the virus on its own.

The research developed further dives into two key lessons taken from comparisons of outcomes during past influenza pandemics (The 1918 “Spanish Flu” 1957, 1968, and 2009).

1. Most fatalities were due to bacterial co-infections

2. Mortality rate, morbidity and hospitalization time was much higher after the pandemics.

Causes and outbreaks due to Legionella are expected to continue to rise and be a major public health burden admits the COVID-19 pandemic. Especially after building closures or reduced operations with fewer people returning to fulltime in-person work in 2021 than expected. This reduced building usage causes stagnation of water, providing the perfect conditions for the growth and spread of Legionella. The dramatic duo of COVID-19 and Legionnaires’ Disease is more than just an annoying infection or short sickness. Paired together they can produce an incredibly deadly threat to many lives.

Water management will be crucial in preventing the consequences of bacterial pneumonia co-infections and avoiding unexpected increases in mortality.

What is a Water Management Program?

Water management programs identify hazardous conditions and take steps to minimize the growth and transmission of Legionella and other waterborne pathogens in building water systems. Developing and maintaining a water management program is a multi-step process that requires continuous review. Such programs are now an industry standard for large buildings in the United States.

What are the elements to a Water Management Program?

Seven key elements of a Legionella water management program are to:

1. Establish a water management program team
2. Describe the building water systems using text and flow diagrams
3. Identify areas where Legionella could grow and spread
4. Decide where control measures should be applied and how to monitor them
5. Establish ways to intervene when control limits are not met
6. Make sure the program is running as designed and is effective
7. Document and communicate all the activities

Contact IWC to find out more about our Water Management Programs and how we can help your facility stay safe and avoid increased risk of waterborne pathogens.

Nicholas J. Ashbolt − School of Public Health and Department Medical Microbiology & Immunology, University of Alberta, Edmonton, AB T6G 1C9, Canada; Provincial Laboratory for Public Health (ProvLab), Alberta Health Services, Edmonton, AB T2N 4W4, Canada; orcid.org/0000-0002-3853-0096