TAPE: The death toll from the outbreak of Legionnaires’ disease in the South Bronx has now risen to 7 people...

Mary Harris: One day last July, news broke that there was an outbreak in New York City.

TAPE: The bacteria that causes Legionnaires’ disease was found at five locations...

MH: At first the number of deaths seemed small, but as the days went on and the death toll grew, the story started to get national attention.

TAPE: Members of the Center for Disease Control are in the city today...

MH: Whenever we hear the word “outbreak” on the news, it taps into something primal in us. These are stories we can’t resist.

TAPE FROM CONTAGION: Have you ever seen something like this before...No.

MH: This is from the movie Contagion, about a deadly virus.

TAPE FROM CONTAGION: It’s figuring us out faster than we’re figuring it out... It doesn’t have anything else to do.

MH: The tagline for this movie was “nothing spreads like fear.” Of course most outbreaks aren’t some unknown virus sweeping the globe. But even the ones we do experience in real life cause a lot of fear.

I’m Mary Harris and this week on Only Human we’re taking a closer look at an actual outbreak, how it starts, how it spreads, how it gets contained. And what happens when a city has to practice medicine on the fly, with millions of people watching. Our reporter Amanda Aronczyk is here. And when this story broke, Amanda, you were kind of intrigued.

Amanda Aronczyk: Yeah I thought the whole thing was really confusing. Right, the number of people dying kept going up, but the city was telling us the problem was over. And I started to wonder, what is going on? So what I’m going to do, Mary, is I’m going to tell you the story as the public saw it--what happened--and then I’m going to tell you the story again--what really happened behind the scenes.

MH: Alright, I’m ready.

AA: And one more thing before we get going. When there’s big news in New York, lots of WNYC reporters get pulled in to cover it, and this is one of those times.

MH: So in this episode, you’re going to hear a few voices from our newsroom.

TAPE REPORTER: Alright we are recording, um, could I get you just to spell your name for me?

AA: In the middle of last summer’s outbreak a WNYC producer called up Annie Minguez. Annie’s cousin, Daniel Tejada, was in the ER.

MINGUEZ: He had a breathing tube, you know, an IV, several antibiotics, sedatives, medications to paralyze him...

AA: Before he was admitted he’d been home with a 104 degree fever. Even though it was summer in New York, he put on sweatpants and a sweater and he thought he could just stay home and sweat it out. Now the doctors said he was so sick they had to put him into a medically induced coma.

AM: They came back and they told him you have a lot of damage to your lungs, we need to act quickly.

AA: Annie’s family called Daniel’s parents in the Dominican Republic. They said: buy plane tickets and come now.

AM: And they got to the hospital and basically saw their son, their only son, face down with all these tubes. And the doctors continue to tell us, he’s very, very sick. Um.. his lungs are very, very infected.

AA: Daniel is a 31-year old cab driver. He’s got a 6-year old daughter. And he’d never been hospitalized before--this bacterial infection came out of nowhere.

AM: The biggest frustration for us right now, is identifying where. Because he is a cab driver, he could have inhaled it anywhere.

AA: Think about that. He could have inhaled it anywhere. The doctors have no idea where he caught the disease. But they do know what it is. It’s Legionnaires’ disease. It’s not unknown and it got its weird name in 1976. There was a conference being hosted by the American Legion.

Three days of veterans drinking and dancing and reminiscing about great wars come and gone, and then it’s over. The veterans pack up and go home. A few days later, one of a Legionnaires dies of what appears to be a heart attack. And then another man dies, and then another…

TAPE: Throughout Pennsylvania health investigators are talking to more than 100 people who have the disease, but are still alive…

AA: No one knows why these men are getting sick and dying.

TAPE: What did they do at the American Legion convention? Were they all together at a single time? Or gathered in one location? Question after question to find that common link.

AA: The CDC launches its largest investigation to date. 221 people get sick and 34 die. Doctors fear there is no cure. It takes 6 months to solve this mystery. The disease is not contagious, it wasn’t spreading from person to person. Instead, each person inhaled a very common bacteria that usually lives in water and in this case, the bacteria was festering in the hotel’s air conditioning system.

CBS TAPE: In our morning rounds, disease detective are racing to find all the sources of a widening Legionnaire outbreak right here in New York City…

AA: Back to New York last summer. On July 20th, city health officials detect a Legionnaires’ disease outbreak -- this is day 1 of their investigation. But it’s not until day 10 that the media starts to pick up the story…

CBS TAPE: New York’s health commissioner is calling the spike in cases unusual…

AA: By day 14, there are 60 cases. Four people dead. And it’s starting to seem like the outbreak is centered in the South Bronx. WNYC sends a reporter out to talk to people.

REPORTER: What have you heard, first of all?

MAN: WE have just heard in the news about a disease that is killing people, at least four people have died. Over 65 are sick of something like that. So yeah.

REPORTER: Are you worried?

MAN: Uhhhhh. A little.

AA: A quick word about this neighborhood. The South Bronx has had a rough history. There’s lots of poverty and blight. And it can be hard for people who live there to shake off all of the city’s past neglect.

WOMAN: You have to realize what area you’re standing in. They really don’t give a rat’s behind about this area. And if a few people from around here die, what do they care?

AA: So now you take a historically neglected neighborhood, and you throw in an outbreak of a disease with a weird name that is only killing people in the South Bronx. The stage is set for a very anxious town hall meeting.

TOWNHALL TAPE: Alright, so if everybody could grab a seat, we have plenty of folks outside.

AA: Day 16. There are 81 cases and seven people are dead. So many people show up for this meeting that 100 of them can’t even get in. In this room, the outbreak is very real. At the front, a row of city officials try to explain what’s going on.

JAY VARMA: This shows you a map of how we look at disease rates in the city…

AA: Dr. Jay Varma gets up in front of the crowd. He is at the New York City Department of Healt and he is in charge when there’s an outbreak in the city. He starts off by saying the people who are sick didn’t all live in the same building or swim in the same pool.

JV: The only thing they had in common was living in these neighborhoods, which to us is very consistent with the infection being caused by something that was in the air.

AA: And if it’s in the air, it’s most likely contaminated mist. Dr. Varma starts talking about cooling towers--these giant metal boxes that sit on the roof of some large buildings. A cooling tower is used to cool excess heat from the building and in that process it spews out mist. And the city had decided that this is the likely source of the problem. And please--don’t worry…

JV: It’s not connected to your drinking water. It’s not connected to your bath water, your sinks, your showers, or any other part of your plumbing.

AA: Dr. Varma tells the crowd that the health department has tested many cooling towers and only five are suspect. And again, don’t worry, those towers have been cleaned, and the disease-causing bacteria has been contained. But still, the whole thing is very confusing.

TOWN HALL ATTENDEE: Why is it only affecting the Bronx, what happened to the other outer boroughs?

TOWN HALL ATTENDEE: What about the standing water in the sewers, are y’all checking into that?

TOWN HALL ATTENDEE: I hear clusters, I hear treatment. Could those deaths have been prevented?

AA: The crowd is on edge and Dr. Varma gets flustered.

JV: No, no, no, I’m trying to emphasize to you that the air you breath is safe, the air you breath is safe…

AA: Remember Annie Minguez? Her cousin was in the coma? She was at this meeting too.

MINGUEZ: So my cousin Daniel Tejada couldn’t be here today, but he was 31 years old and he was home for four days with a 104 fever. We had a very, very long ICU stint. 28 days in the hospital. I a here because there is a cooling tower right outside his window in his bedroom. I came here because I need you to check that cooling tower.

AA: The Health Department says the problem is contained but the people aren’t buying it. They are still really scared. The next day -- day 17.

TAPE: I’m Roma Torre with the New York One Minute. Mayor DeBlasio is said to provide an update this morning on the outbreak of Legionnaires’ disease in the Bronx…

Mayor DeBlasio: Since July 10th, these are updated numbers now, since July 10th we have 86 cases reported and sadly seven deaths.

AA: The mayor explains that there are five contaminated towers. Now, this is really odd. how do five units on five different buildings on different blocks contain the same bacteria? Could it be breading?

TAPE: So Mayor, is it coincide that its’ in all five buildings, or does it jump from one building to another?

MAYOR deBLASIO: Well… I don’t know what I can say about jumping I’ll let the experts speak to that I think it is… (Fade out)

AA: Despite what the Health Department said, the outbreak does not seem contained. And more people are getting sick.

TAPE: That’s nerve racking, to know that at any instant you can contract a disease like that.

AA: Day 20. Ten people are dead. 101 are sick. Governor Andrew Cuomo decides that the problem had gotten too big for the city’s health department to handle on its own.

CUOMO: It’s almost like a bad science fiction movie.

AA: The governor calls in the Centers for Disease Control. They send a pack of disease detectives and microbiologists to work along with the health department. We’re going building by building to identify the cooling tower. There is no registry of cooling towers.

Hundreds of workers--police, firefighters, CDC, department of buildings, department of health--check out every cooling tower in the South Bronx.

TAPE: We are starting a massive testing effort in that immediate vicinity.

AA: More test positive. The city council passes a law requiring that every building in the entire city with a cooling tower clean it within two weeks.

TAPE: I thank you for the opportunity to testify today on the proposed legislation, which will require the registration of the city’s cooling towers.

AA: Businesses clean their towers. The deaths stop. And 32 days after the health department started its investigation, the city declares the outbreak over.

MH: Hold it, Amanda, that’s it? End of the story?

AA: Yeah. The source of the outbreak was a single cooling tower in the Bronx and they cleaned it.

MH: One tower. I thought there were five.

AA: Yes, I know, and I promise to explain all after the break. I’m going to roll back the story and tell you what happened behind the scenes.

MH: Alright Amanda. This is Only Human. I’m Mary Harris. We’ll be back in a minute.

****

MH: This is Only Human, I’m Mary Harris. And we’re back. And Amanda Aronczyk is here to tell us how New York City contained last summer’s Legionnaires’ outbreak.

AA: Right. And to do that, I’m going to ask you to rewind the whole story. Go back to the very start. Okay?

MH: Alright.

AA: And do you remember the first person we met?

MH: Oh, it was that guy in the hospital.

AA: That’s right. It is Annie Minguez’s cousin and he had a kind of pneumonia so he went to the ER.

TAPE: He’s very, very sick. His lungs are very infected.

MH: How did they know what he had?

AA: Well the hospital orders test, right, and the tests show that they are signs of legionella bacteria in his lungs and this starts a whole chain of events. Because when a lab finds signs of Legionnaires’ disease, by law the lab has to call a number and notify the government within 24 hours.

There are 90 diseases that require labs to take this step. You feel like you might develop boils just reading this list: measles, rabies, cholera, anthrax, monkey pox, syphilis, Ebola… Legionnaires is on this list. The report goes to the city’s health department. Then there’s another sick patient, another report. And another.

JV: The most basic function of public health is counting illness.

AA: This is Dr. Jay Varma and you’ve heard him before. He was the guy trying to keep everyone calm at that town hall meeting. He deals with “disease control” and if this story has a hero, he is it. So, Dr. Varma starts to get a few lab reports of possible Legionnaires’. At first, there’s no cause for alarm. This disease happens periodically, there’s usually a case or two around. But once 7 or 8 lab reports come in, and from the same neighborhood, that is when the Department of Health’s alert system is triggered.

JV: And it picked up that there was a cluster of 8 cases, which was… unusual.

AA: And recognizing this cluster is the start.

JV: We started our investigation when we detected this signal.

AA: Dr. Varma and his team have to find these 8 people and interview them, which is harder to do than it sounds. Think of Annie’s cousin, who’s in a coma. So they track down the sick people or their loved ones and ask questions like…

AM: Have you visited these neighborhoods? Did you ever get out of your car in these neighborhoods? Do you drive around with your car windows down?

JV: Are there other people in your household that are sick? Where do you work? Do you go to hot tubs?

AA: What do these 8 people all have in common?

JV: They didn’t all go to the same hospital, they didn’t go to the same doctor, they didn’t swim in the same pool, or hang out at the same fountains…

AA: And it can’t be from the drinking water or thousands of people would be sick. And it’s not just in one building, or all the infected people would live at the same address.

JV: The only thing they had in common is that they all live in seven different zip codes of the South Bronx.

AA: Back to the South Bronx.

REPORTER: Are you worried?

MAN: Uhhhhh. A little.

AA: The eight cases quickly grow to 30. The Health Department confirms: it’s an outbreak.

JV: We’re incredibly nervous and worried. We don’t know how this started, we don’t know how it’s going to proceed, and we don’t know how it’s going to end.

AA: Now, the heart of this kind of work is connecting the stories people tell you--where they were, what they did, when they started to feel sick--to a larger pattern. And in this case, it’s an environmental outbreak. They need to map it. So the Health Department plots the location of every sick person and then of every cooling tower on record in the South Bronx. And now they can see where most of the infections are located and which towers are likely to blame. This is when the media starts to follow the story.

CBS TAPE: In our morning rounds, disease detectives are racing to find all the sources of the widening Legionnaire outbreak right here in New York City…

AA: Dr. Varma and the disease detectives have to find the contaminated cooling tower quickly. So they have to test all of them for traces of legionella, which is the bacteria that causes the disease.

JV: We start running out late in the afternoon…

AA: Armed with little specimen bottles…

JV: Climb on top of buildings…

AA: Put their hands into the towers…

JV: Scoop up water, sometimes take little cotton brushes and collect swabs.

AA: Next…

JV: Drive these specimens up to Albany, where there’s a special lab method that can be used called PCR, same thing you see on CSI, to tell us immediately, within the next 12 hours, is there the possibility that there’s legionella in this water.

AA: Turns out it’s not just in one or two samples, but in several of them.

JV: And that’s when we start to realize that in fact a lot of these cooling towers are dirty.

AA: They figure out that five cooling towers contain traces of the bacteria that could make you sick. But this test is just a screening. It can’t tell you if the bacteria is dead or alive. So to be safe, the Health Department goes ahead and cleans the five suspect cooling towers. And now they’re ready to tell the public.

TOWN HALL TAPE: Alright, so if everybody could grab a seat, we have plenty of folks outside...

AA: Remember that town hall meeting where everyone got so upset? We are back at that meeting. Dr. Varma puts up his presentation…

JV: This shows you a map…

AA: And when Dr. Varma makes this presentation he believes that they have treated the problem towers, meaning they have contained the outbreak.

JV: No, no, no, I’m trying to emphasize to you that the air you breath is safe, the air you breath is safe…

AA: But people are still really scared.

AM: I came here because I need you to check that cooling tower.

AA: Here’s the thing about this meeting. Yes, Dr. Varma is quite confident the outbreak is over, but he still needs to prove it.

JV: It takes weeks for the bacteria to grow and to be tested and to do all that. So we will eventually get an answer to this…

AA: They have to match bacteria from the towers to the infected people. This means they need some time. Because to really understand what they’re dealing with, they need to take all the samples they’ve collected, and grow more legionella bacteria in their labs. And legionella does not like to be rushed.

Mayor deBlasio: Since July 10th we have 86 cases reported and sadly seven deaths.

AA: Meanwhile, more people are getting sick and more people are dying. And this, of course, is a problem for the Health Department. So let me explain. There’s an incubation period for this disease. There is a lag time from when you are exposed and when you show symptoms and when you get diagnosed. To the public, it doesn’t look like they’ve got this disease under control.

TAPE: Governor Cuomo is joining us now by phone…

AA: And it’s at this moment that Governor Andrew Cuomo jumps in.

CUOMO: It’s almost like a bad science fiction movie.

AA: He bigfoots the situation. He calls in the CDC. Remember?

TAPE: We are starting a massive testing effort in that immediate vicinity.

AA: They send their disease detectives and microbiologists to New York. And hundreds of workers find way more cooling towers than the Department of Health originally identified. So they do the whole thing again.

JV: Climb on top of buildings…

AA: Put their hands into the towers…

JV: Scoop up water...

AA: And…

JV: Collect swabs...

AA: Then, drive up to Albany. And repeat. Until all of the towers have been tested. The next thing that happens is building owners in the entire city of New York are given two weeks to clean their cooling towers. And for a fleeting moment, water treatment workers are local celebrities. Completely in demand.

FRED MOGUL: Can I go inside, can I go inside?

PETE STEMPKOWSKI: Oh yeah absolutely…

AA: WNYC reporter Fred Mogul goes out with Pete Stempkowski, he’s the guy who does this kind of cleaning work.

FM: So what’s the grossest thing you’ve ever encountered?

PS: Pigeons. Pigeons and raccoons are pretty nasty. You know they get in there, they want to drink the water. Maybe the fan hits them. There’s eagles over there. The eagles will pick up a squirrel and start eating it by the tower… you get a lot of stuff like…

FM: Just like a decaying…

PS: A decaying carcass in the water. It’s pretty nasty. And it happens. That happens. That’s why you’ve got to look at your systems.

AA: Not that a decaying squirrel carcass is the cause of Legionnaires’. But you need to clean these systems regularly or bacteria will grow.

FM: Got any clients that say, yeah that’s great, but you know, once a year is enough for us?

PS: Yes, yes, because it’s cost. It’s, you know, it’s all money, it all costs money.

AA: While all of these cooling towers were busy being cleaned, the city health department was still waiting for the legionella bacteria to grow in the lab. And the CDC? They are helping out. A scientist named Matthew Moore oversaw the CDC’s team and he said that the local health department had done something very helpful early on.

MATTHEW MOORE: What they did was very, very simple but very, very effective.

AA: During the outbreak, health officials told hospitals to collect “respiratory specimens.” This is the gunk you hack up if you’re sick with pneumonia.

MM: If you can get these strains from patients, then you can get much more information about that particular strain of Legionella and most importantly you can compare it to what you find in the environment.

AA: What they’re saying is this is how they identified the source of the outbreak. They look at what’s in the gunk and they match it to what’s in the cooling towers.

MM: So for New York City to communicate with thier hospitals and to get over 20 specimens from patients was extremely important, extremely valuable to the investigation.

AA: And how close was the match from what was being found in the water to the people?

MOORE: It was pretty much perfect.

AA: The health department and the CDC matched all 26 specimens from patients to one single cooling tower. The culprit? It’s perched on top of a former theater where Houdini and the Marx Brothers once performed. Ironically, when it first opened in 1913 it had a state of the art ventilation system and ensured “hygienic conditions” and a “healthful” interior.

Today it is called the Opera House Hotel. And its cooling tower? That was the source of the outbreak. Dr. Varma says that for all of the effort that was made to solve this case, there was one other thing at work…

JV: Every outbreak had a component of something where you just get lucky. You’re not just smart but something right happens.

AA: This piece of good luck? It came only eight days into the investigation. Back when Dr. Varma and his team had just started sampling the cooling towers.

JV: You know, that same day, we got a call actually from CDC in Atlanta saying that we have a report of somebody who stayed at a hotel in the South Bronx, and now is diagnosed back in their home state with Legionnaires’ disease, we’re just letting you know about this.

AA: At the time, Dr. Varma thought to himself, huh. That’s an interesting report. Probably should look into that.

JV: So we get on the computer, and get on Google Earth. And we have some very smart staff that scan in and say, you know what, that looks like a cooling tower. And then we ask our environmental staff, “you know, you have these two imperfect lists, have you heard of this building before?” They’re like, no, this isn’t on any of our lists. And then we look at a map, in addition to Google Earth, and say you know this hotel is smack dab in the middle of where we’re getting a lot of people reporting themselves getting ill.

AA: And there it was. After all the fear, the confusion, the city-wide protocols, the source of the outbreak had been contained weeks before. In fact, it was one of the very first towers the city cleaned. And Mary, that is the full story.

MH: So, what do we take from all this?

AA: Well, think about the history of public health, right? It’s essentially a list of very boring things that you need to do to stay healthy. You should poop far from where you eat, you should wash your hands.

MH: Go get your vaccines…

AA: Yeah, exactly. And in a city today we regulate the kitchens, and restaurants, and the elevators, and the sewage systems.

MH: And now, in New York, we regulate those cooling towers.

AA: That’s right. I think it’s still a little bit unclear how much that’s going to help. One of the water treatment guys that I spoke to said that bacteria can be a bit like a houseplant. So you put it in one window and it wilts, and then you move it somewhere else and it does really well. There’s a lot of environmental factors that go into growing bacteria.

MH: So, you’re saying we’re going to have more outbreaks.

AA: Yeah, maybe, I mean I think the hope is that if it happens again in the future it’ll be much smaller than the one that happened in the Bronx.

MH: Hmm.

AA: And Mary, one more thing, before we go. Do you remember Annie Minguez’s cousin?

MH: Yeah the cab driver who got sick.

AA: That’s right. He was really sick and the doctors had to put him into a coma. And on the ninth day, in the coma, it was looking really bad. And on the twelfth day, he opened his eyes again.

AM: When he finally woke up and he was in a regular room, you could tell that he was himself again, joking, and you could tell that he was paying attention to what we were saying and remembering conversation. I looked at him and I said, “did you know that I loved you this much?” And he said, “yes, I did.” And I said, “No, I don’t think you do. I said I don’t think you knew.”

MH: In New York City last summer, 133 people were infected with Legionnaires’ disease. There were 16 deaths, which makes it the largest Legionnaires outbreak in the country since 1976.