Alliance: 2020 COVID-19 health focus could be overshadowing Legionnaires’ Disease cases

A national advocacy organisation in the USA is warning anyone concerned about COVID-19 symptoms to get tested for another deadly disease: Legionnaires’ disease. National case reports this year indicate troubling declines in attention to Legionnaires during the pandemic – at a time that experts expect the rate of cases to increase.

The Alliance to Prevent Legionnaires’ Disease cautions the federal government is reporting a decline in reported Legionnaires’ cases this year of nearly 50 percent – a concerning sign when Legionnaires’ and COVID-19 share similar symptoms and legionella risk factors are on the rise from disruptions to normal water consumption patterns that can result in stagnant and aged water with diminished disinfectant levels allowing the bacteria to increase in water distribution systems, commercial and government buildings and even homes.

The group plans a free upcoming webinar for policy makers, healthcare professionals, families with immune-compromised individuals, public health officials and the general public to discuss the need to increase attention to properly assessing the potential for Legionnaires’ disease in the midst of the pandemic.  When diagnosed early, most people can be treated effectively for Legionnaires’ disease.

The Alliance advocates for better public understanding about and comprehensive handling of risk factors around waterborne legionella bacteria, which enters our homes and buildings in the water we use every day and can cause Legionnaires’ disease. Legionella bacteria can multiply in stagnant water (from cessation or reduction of water usage from any reason), and the risks of spread and infection are heightened as community and building water systems resume operation and normal water usage following COVID-19 shutdowns.

Despite the media attention focused on Legionnaires’ disease outbreaks involving multiple individuals at one time, the Alliance emphasises that the overwhelming majority of cases (or 96%) are individual and sporadic. And with so many of us working from home and spending far more time in the places where we are most intimate with water, it is critical to raise awareness about possible increased risks of exposure to legionella during this time.

In late August, the Alliance brought together national experts for a virtual conference to discuss the connections between COVID-19 shutdowns and increased risk of Legionnaires’ disease. Now the Alliance sees warning signs that the required focus on COVID-19 might be greatly overshadowing Legionnaires’ cases across the country, given the similarity of symptoms and diverted resources which may exacerbate underreporting of Legionnaires’ disease and increased risk of misdiagnoses.

Preliminary numbers from the U.S. Centers for Disease Control and Prevention show 2,547 Legionnaires’ cases reported through Week 36 in 2020 – a decline of nearly half of cases from the same point in 2019, or more than 46 percent. Prior to this, Legionnaires’ cases reported to the CDC have been growing steadily in the U.S. increasing more than five-fold (or 550%) from 2000 to 2017.

Dr. Hung Cheung, one of the nation’s foremost experts in respiratory environmental medicine and former State of Maryland medical director, says there are several concerns about the steep decline in reported Legionnaires’ cases. First, particularly when community COVID-19 prevalence is low, medical professionals should take extra steps to ensure those suspected of having COVID-19 do not have other diseases or co-infections such as Legionnaires’ disease given the very similar symptoms and presentation. Further, patients should not forego necessary medical check-ups because they are concerned about contracting COVID-19. Immediately contact your health provider should you experience any signs or symptoms of respiratory infection or distress, including high fever or difficulty breathing.

“Because of the many shared symptoms, ruling out other infections or co-infections are important as many are highly treatable,” said Dr. Cheung, President of Cogency, a provider of toxicological, environmental, and medical solutions. “The CDC states that about 1 out of every 10 people who gets sick with Legionnaires’ disease will die due to complications from their illness, making it imperative to diagnose promptly and accurately.”

APLD has planned an upcoming webinar with Dr. Cheung on Tuesday, Nov. 10, from noon to 1 p.m. EST to further address this concern and help individuals reduce their risks of exposure to legionella bacteria.

Brad Considine, Director of Strategic Initiatives, said the Alliance understands health care statistics can be skewed this year because of the pandemic’s burden on health departments and bandwidth issues. Legionnaires’ is a reportable disease, but due to lack of resources, either testing is not being performed, or the results are not being sent to or reported by the CDC, in addition to reduced medical visits.  But a nearly 50 percent decline in Legionnaires’ cases and the stark similarities in symptoms between the two diseases raise very large red flags for American health care.

“Given the historical trends and increased risks posed by COVID-19 shutdowns and recent re-openings, we are confident Legionnaires’ cases are on the rise this year, exposing more people to the bacteria,” Considine said. “These numbers signal an important warning: don’t assume you have COVID-19, even if you’re showing several known symptoms. Symptoms of Legionnaires’ disease include but are not limited to headaches, muscle pains, fever, cough, shortness of breath – all very similar to COVID-19. If you have a respiratory illness, ask your doctor for a simple urinary antigen test to rule out Legionnaires’ disease in addition to a COVID-19 test. It’s a decision that could save your life.”