© New Zealand Broadcasting School 2022

Legionnaires': The country's cut-throat killer

Micoscopic Legionella Bacteria
Microscopic Legionella Bacteria  Ashdale Engineering

It’s the middle of Winter, which means there’s one thing all New Zealanders try to avoid more than anything. Getting sick.

A common cold will leave you with a lingering headache. The flu will leave you with muscle aches and your body hitting temperatures hotter than the kettle, yet colder than water from the tap after a fresh frost. Believe it or not, there’s one disease that has all these symptoms which few people know about. It could almost be described as pneumonia’s ugly stepsister, leaving a painful effect psychologically. It definitely likes to make itself known too. A whopping 129 cases were reported in the first 5 months of this year.

21 of those in Canterbury.

It leaves people bed-ridden for weeks and it sends people to the grave. New Zealand also happens to have the highest reported incidence of the disease globally.

Legionnaires’ (LEE-JAN-EARS) has existed for many years, and was barely recognized by health professionals until around 20 years ago. There’s no doubt it’s being left misdiagnosed on a regular basis, especially given the only way to find out if someone has Legionnaires' is by coughing up some form of saliva in an already dry throat.

University of Otago (Canterbury) Professor Stephen Chambers said the only form of sampling is less than ideal, as it leaves just one very difficult option for patients to determine their health.

"One of the setbacks is that you have to give a sputum sample, and that's not that necessarily easy. If the person is elderly or very young, then there's often confusion around Legionella and they can't co-operate," Chambers said.

Don't hesitate to seek help

That’s exactly what 68-year-old George Downward stresses to the public who have never heard of Legionnaires' disease before, and feel as though they may have some of the listed symptoms.

Just 3 months ago, George finished his tenure as an Intensive Care Doctor. Before he knew it, he was back where he treated thousands of patients. Only this time, it was to be treated himself by his former colleagues.

At first, George was apprehensive to appear on camera, feeling worse for wear after what has been a grueling month of recovery.

We began the interview in a radio interview form.

And after some thought (and a cheeky remark), George agreed to be filmed on camera...

So... What is Legionnaires'?

Legionnaires’ (also known as Legionellosis) is a form of pneumonia. The disease is named after the bacteria Legionella which thrives in damp and moist environmental conditions. It can not be spread person-to-person and studies have shown that men are twice as likely to get the disease over women. It has several different strains, but the two most common which continue to attack kiwis is Legionella Longbeachae (LONG-BEACH-I), and Legionella Pneumophila (NEW-MOF-FILA).

Legionnaires'- the unknown pneumonia (Television Story)

Below, the pie graph shows what percentages of cases over the years have been treated as Longbeachae, and the same for Pneumophila. It is clear that Longbeachae is the most common, but Pneumophila may go under-diagnosed due to legislation laws in the country. One could say the absence of a legislation may contribute to New Zealand having the highest amount of reported cases globally. (explained further in the piece).

Legionella Longbeachae

If you’re an avid gardener, then there’s no doubt you’ve been exposed to Legionella Longbeachae at some point in your life. You may wonder why health professionals stress the fact of wearing gloves and face masks when gardening and washing your hands afterward. Legionnaires is exactly why you shouldn’t ignore this advice any longer.

The strain of Legionella bacteria lives within soil mixes and compost and is the most common form of obtaining the disease in New Zealand. Studies back that up, according to the New Zealand Public Health Surveillance Report in 2015, longbeachae made up 51.8% of cases found in New Zealand

Legionella Pneumophila

To simplify the term, 'Pneumophila' is just the technical term for ‘water.’ Legionella searches everywhere and anywhere for warm waters to establish itself in. It can be caught in ways you may have thought were never possible; from the water spray off your morning shower to even window wiper water. It's less common that it's big brother Longbeachae, but in 2015 made up 28.9% percent of cases, and the statistics flow in a steady stream.

Health professionals and those involved shared their concerns that Pneumophila may be going undiagnosed initially due to the lack of allowances for checking cooling towers. Here in Christchurch, previous cases of Legionella Pneumophila have been investigated after checks conducted by the CDHB and the Christchurch City Council, as many cooling towers have been left unregistered.

In their Legionnaires' fact sheet, The Canterbury District Health Board says symptoms will begin 2 to 10 days after you’ve been infected. If you’re concerned that the symptoms may be a little more serious than a common cough or cold, their advice is to seek medical attention immediately.

And don't forget George's advice, he was once apprehensive to admit just how sick he was, but stresses how important it is to put your hand up when you feel it's necessary.

The 2 most notable cases in Canterbury

There have been a number of cases of Legionnaires' here in the Garden City. Before testing was done outside of Canterbury, the region was known as the centre of the disease, but only because of the extensive research done by local specialists. Health Protection Officer Debbie Smith has investigated over 100 cases in her 17 years looking into Legionella, and of these, she highlighted 2 main outbreaks;

1) 2005: 19 cases, 3 deaths.

This was the first time anyone had seen a handful of cases in a short space of time. People were getting sick with Legionnaires' which was unfamiliar to the CDHB. Within the space of 4 months, the number of cases had grown to 19. Therefore, Debbie says they treated it as an outbreak;

"Back in May, we started investigating it as an outbreak, and the more we started looking the more we weren't finding a source."

2) 2015- 6 cases, 0 deaths.

In June of 2015, there was a fault in a cooling tower in Woolston, leaving 6 people with legionnaires' (4 men and two women). The cooling tower tested positive for Legionella Pneumophila, which as stated above is the technical term for water. The CDHB and Christchurch City Council then proceeded to investigate the cooling tower and found that it needed to be decontaminated in order to stay functioning in the industrial area it was based in.

Below, a map shows the large space in which the cooling tower contaminated with Legionella Pneumophila.

Map of legionnaires infected area
The Lyttelton Port, Magma Gallery and The Tannery are all within the area Google Maps

Is Legionella seasonal?

Based on statistics gathered by the Ministry of Health, the answer is clear. Every case across the country since 1997 was put together in the month it was diagnosed to show that the Spring and Summer months are when Legionnaires is most dormant.

A gap in the puzzle...

It's clear that people associated with Legionnaires' such as Debbie Smith and Chris Dick want to see more responsibility taken by higher powers for monitoring Legionella. Currently, the Ministry of Building, Innovation an Employment check cooling towers that fit under the Building Warrant of Fitness Act, but not cooling towers that supply our council supplied water. This ultimately means that some towers which could be infected with Legionella are being left to be checked and listed by Councils and Health Boards. 

Think about that for a moment.

The water in your glass quite possibly has legionella in it and so does every tap you turn on. When water passes through the boundary into your commercial facility or property you, the owner are now responsible for it. But there are no mandatory checks for the water you drink or shower in.

That's a lot of water. 

Debbie Smith did note that MBIE has made contact with the CDHB about the issue and changes may be made for the future, but for now, the opportunity to catch Legionnaires' is free flowing.

Chris Dick is a plumber for Laser Plumbing. He has no affiliation with researchers or health professionals, but rather heard about the problem through a colleague in Australia. He has tried to take matter into his own hands, showing the true reality of the effects Legionnaires' is having on people in New Zealand. When talking to higher powers, he drew this conclusion.

"My impression was, they had larger fish to fry, that it wasn't as important as something else. And so the downside of that of course is in the meantime, people are suffering because of it."

In a statement, MBIE said;

“Only some cooling towers are regulated under the Building Act – cooling towers that are part of an industrial manufacturing process are currently covered by health and safety legislation, as they are excluded from the definition of a building under the Building Act.”

“Councils collate cooling tower information out of their systems manually to add to their registers. Some councils liaise with their local DHBs to collect additional information to make their registers more comprehensive.”

"WorkSafe NZ produces guidelines outlining the responsibilities and duties of cooling tower owners to prevent the outbreak of legionnaires disease. The guidelines state what practicable steps owners should take, including undertaking the same tests (and at the same frequency) as those for cooling towers regulated under the Building Act."

Although guidelines are set, some businesses may not follow them thoroughly because of costs. It’s clear there’s a gap in what is needed, and there are people who know how to patch it up, but these key people on the ground need the support from higher powers. 

Looking ahead

As technology develops in the world of health, there's no doubt that Legionnaires' will become more familiar, better treated, and most importantly (in some instances), will save the lives of those who do not deserve to fall to the disease they have no way of saving themselves from.

But right now, it seems that people are waiting to sprint from the blocks, ready to save lives, but the blocks... The help those people need to get off the ground, just isn't there.

"Legionnaires'", just 4 weeks ago it was a word that had not ever entered my brain. But now, with research, statistics and personal recounts of the disease first hand, it's crystal clear that it's something that needs to be educated to many.

Aotearoa... the land of the long white cloud, known for its clean green image, has the most reported cases of Legionella worldwide. With the way laws are currently set, and the weight on Health Boards and City Council's to maintain a list of cooling towers without assistance the seat-belt of Legionella control is not yet fastened. And as Debbie Smith said...

"If you look for it, you'll find it..."