01x07 - Legionnaires' Disease

[bunniefuu]

[March playing]

Narrator: as america
celebrated its 200th birthday

As an independent nation,
its birthplace--

Philadelphia--played host
to millions of tourists

And hundreds
of business gatherings.

Philadelphia made history
that summer,

But not for the bicentennial.

It was the mysterious death
of 34 people

That left a tragic legacy,
and launched

The most extensive medical
investigation in history.

Narrator: the summer of 1976
was a busy time for the city
of philadelphia,

Filled with bicentennial
celebrations,

Tourist activities,
and business conventions.

It should have been
a time of celebration

For city officials, as well,

But they faced a number
of unexpected difficulties.

Sanitation workers staged
a work slowdown

Over a wage dispute,

And the mountains
of uncollected garbage

Created serious
health concerns.

Then there was
a t*rror1st threat--

An anonymous tip warning
of possible v*olence

At the upcoming american
legionnaires' convention

In protest against recent
u.s. Foreign policy decisions.

That convention was
to be headquartered here

At the bellevue
stratford hotel,

One of philadelphia's finest,

And it was having
some of its own problems.

Hello. I received
a service call.

I'm here to check
the air conditioner.

Sure. Come on in.

Narrator: the hotel's
air conditioning system

Was malfunctioning,

And repairmen were doing
all they could

To get it up and running
before the convention.

Hotel security
was also working

To make sure that prostitutes
were kept away

From the hotel during
the busy summer season.

On july 21,



From around the state
of pennsylvania arrived

In philadelphia for
their annual get-together.

It was a time for business

And to renew old friendships.

Man: everybody was
looking forward to it--

A jolly, jovial time

Where we naturally had meetings
to attend, and so forth.

But normally, the business
would be over by noon,

And we could then...

Go out and visit the city.

Man: I had been through
I think, in pittsburgh--

One in harrisburg--

And I really didn't know
that much about philly.

I knew it's a big city,
and...i was anxious, too.

[March playing]

Narrator: after 3 days
of business and pleasure,

The 4,500 legionnaires
returned home.

The convention had ended,

But a mystery began
to unfold.

Man: lord, welcome
into your presence...

Narrator: 8 days later
in williamstown, pennsylvania,

Legionnaires james dolan

And john ralph died suddenly

Under mysterious circumstances.

Both had attended the convention
in philadelphia.

Man: I don't think we've had
two korean veterans die
in the same year,

Let alone two days apart
from each other.

Narrator: the official cause
of death--pneumonia.

The coroner described
their lungs as resembling
brillo pads.

Within days,

Other legionnaires fell ill.

I laid around the house
for about two days and, uh,

I just kept feeling
worse and worse.

My oldest boy is there
and he said, "dad,

I'm taking you to the doctor.
There must be something
wrong with you."

Narrator: the mysterious
illness struck swiftly.

First, headache,
then muscle and chest pain,

And a fever which could get
as high as 107 degrees.

Within 3 weeks,



Davis: then I thought,
"boy, here I am.
If I'm going to die..."

I mean, I had 5 kids.

That makes you think a lot.

And I thought, "oh, boy.

I hope that's not me."

Narrator: authorities in the
state capital of harrisburg
feared an epidemic,

And quickly called in
the centers for disease
control to investigate.

Dr. David fraser led
the investigation.

We had a situation which--
when we first heard

About the problem,
there had been 4 deaths.

Quickly thereafter,
we heard of 11 deaths,

And it increased
from that point.

So this was occurring
from unknown cause

In a major city
in the united states,

And had to have
everybody's attention.

Narrator:
fraser's first task--

To find out
why some legionnaires
were getting sick,

And others weren't.

Fraser: which,
at its most basic,

Involves...comparing

What people did
who became sick

With what people did
who stayed well.

Narrator: the investigation
would be complicated.

The legionnaires were spread
throughout the state,

And gathering information
would be difficult.

Dr. Fraser had some theories,

But little else.

The investigation into the death
of the american legionnaires

Would become the largest
and most complicated

Medical investigation
in history.

Narrator: by the time
dr. David fraser

And his team arrived
in philadelphia,

The death rate among
the infected legionnaires

Was 20% and rising.



And 39 more were seriously ill.

All of the legionnaires who died
had a form of pneumonia,

But investigators had no idea
what was causing it.

There are more deaths
in pennsylvania

From a disease
still not identified.

Narrator: the outbreak
was worldwide news,

And the press
had given it a name.

...ever since
the legionnaires' disease
became a major national story.

Narrator: the daily press
reports fueled the fear
many citizens felt,

And nowhere was
that fear more evident

Than in the town
of monessen, pennsylvania.

[Church bell tolling]

Andrew hornack was a bus driver

Who had driven
a drum and bugle corp

To the legionnaires'
convention in philadelphia.

After he arrived home,

He fell ill and died
from legionnaires' disease.

Although he was
extremely popular,

Few of his friends went to pay
their last respects.

Well, we've had a very sparse
visitation at the funeral home

Because...people seem to feel

That there might be some danger
involved to their own life.

Narrator: dr. Lewis polk
was philadelphia's
health commissioner,

And understood people's fears.

Polk: if you deal with
a catastrophe of a known cause--

Whether it's a flood or fire,
an earthquake, whatever--

Even though it may cause
a lot of damage and even
k*ll a lot of people,

Somehow, as human beings,

All of us can deal with
a known-cause catastrophe

Better than an unknown
cause, a true mystery.

Narrator: dr. Fraser and
the centers for disease control

Needed to gather information.

Investigators
crisscrossed the state

To interview sick legionnaires.

At the go-getters'
breakfast on friday,
did you have the coffee?

Yeah, just the coffee.
No rolls.

Narrator: they sent
detailed questionnaires

To everyone who attended
the convention.

"On friday the 23rd,

How often did you ride
the main elevators?"

Man, I don't know.

Narrator: they collected
hundreds of dust, air,

Water, and ice samples,

As well as rat
and pigeon droppings

From every hotel used

By the legionnaires.

Anything which might
be of interest

To the biologists
and toxicologists
of the c.d.c.

Was sent to atlanta
for analysis,

And tissue samples
from the autopsies

Were also collected
and analyzed.

C.d.c. Investigators had plenty
of competing theories.

Swine flu was at the top
of their list,

Since the symptoms were similar.

Parrot fever was also
a possibility--

A disease spread
by sick pigeons...

Perhaps a massive case
of food poisoning,

Caused by a problem at one
of the convention's
half-dozen hotels.

Polk: there were
some thoughts early on

That people in town
for a convention

Possibly might have overindulged
in one of several ways,

Whether it's...drinking
or sex or something.

Narrator: was it a new strain
of venereal disease

Called super gonorrhea?

The symptoms were similar
to super gonorrhea,

And there had
been two outbreaks in other
cities earlier that year.

Or did the outbreak stem

From the rats and the recent
sanitation strike,

Which left mountains
of uncollected garbage

In the very streets
the legionnaires walked through?

And what about
the anonymous tip

About a possible
t*rror1st attack?

Was it possible the legionnaires
had been poisoned?

But one of the most
puzzling questions

Was why some legionnaires
developed the disease,

While others did not.

After legionnaire bob mcgarry's
roommate developed pneumonia,

The c.d.c. Wanted him
to get to a hospital right away.

And when I told them
what I was there for,

They rolled out
the red carpet, and, uh,

They gave me a physical
like I never had before
in my life.

They wanted every type of...

Saliva...

Urine...

And anything else that I could
give them, to be sent

To the disease control center
in atlanta, georgia.

What we found, though,
in our survey of roommates,

Was that being
a roommate of somebody

With legionnaires' disease
didn't increase your chance

Of getting
legionnaires' disease.

And that was
a very important finding,

Because it suggested that,
first of all,

Exposure wasn't occurring
in the bedrooms there,

And it also suggested it wasn't
spread person-to-person.

Narrator: within 48 hours,

The first tissue specimens
analyzed by the c.d.c.

Eliminated typhoid,

The lassa and marburg viruses,

Pertussis, and the plague.

And after 5 days,

They eliminated many more,
including herpes,

Mumps and measles viruses,

As well as some
of their top suspects.

Blood tests also eliminated
the possibility

That it was super gonorrhea.

The c.d.c. Had eliminated
a number of possibilities,

But they still couldn't
identify the k*ller.

The questionnaires yielded
some important information.

Fraser: among the various
hotels we surveyed,

The highest rate
of illness that looked
like legionnaires' disease

Was among people who were
registered at the bellevue
stratford hotel,

And specifically in the week of
the american legion convention.

Narrator: however,
there were some victims
of legionnaires' disease

Who weren't
legionnaires at all,

Hadn't attended
their convention,

And never set foot inside
the bellevue stratford hotel.

Fraser: there were people
who walked along the sidewalk

In front of the bellevue
stratford who got sick,
who never went inside

Or on the street across the way.

Indeed, we found that people--

The more time people spent
on the sidewalk

In front of the bellevue
stratford, the more likely
they were to get sick.

Narrator: but for some
unknown reason,

None of the employees
of the bellevue stratford hotel

Contracted the disease.

What were the common factors
among those who did?

Most were over the age of 50.


Were smokers,

And some had other
underlying illnesses.

When fraser reviewed the
bellevue stratford's employees,

He discovered that, on average,

They were 10 years younger
and healthier than those
who got sick.

By now, 27 were dead.

The death toll was mounting,

And fraser still had no idea

What was k*lling these people

Or how it was being spread.

Narrator: dr. Fraser
and his team were convinced

The outbreak of legionnaires'
disease had something to do

With the bellevue
stratford hotel,

But they hadn't found
the connection.

It's just amazing.

They just can't
figure it out.

Why some would get sick
and others did not?

Right, right,
because, as I said,

I slept in the same room
with two fellas
that are dead.

Narrator: fraser believed
that the agent, or cause
of the disease,

Came from somewhere
near the bellevue
stratford hotel.

And since individuals
on the street

Had also developed the disease,

That told him something else.

We had some evidence

That it was not
waterborne or foodborne.

And so we were developing
the idea that this might
be an airborne infection,

But we had some additional
questions to answer about that.

Narrator: but if the agent
was inside the hotel,

Fraser's medical detectives
couldn't find it.

And since the outbreak
was slowing down,

He believed the cause
might now be gone.

His only hope was
that the scientists
in the lab could find it.

At the university
of connecticut,

Dr. William sunderman received
an anonymous letter saying

That the legionnaires were
intentionally poisoned

While in philadelphia.

Sunderman turned the letter
over to the f.b.i.,

But sunderman was an expert
on nickel carbonyl--

A clear, odorless liquid

Easily transformed
into a lethal gas.

He did a little
of his own research.

...nickel could spread
through the air,

That it certainly could
cause pneumonia,

That it caused a particular
pattern of pneumonia

That was not so different

From what we were seeing
in the legionnaires' cases

As to be obviously...
Excludable.

Narrator: tests
on liver samples revealed

That nickel was present
in those who died.

Dr. William sunderman,
the chief toxicologist

Doing the research work at
the university of connecticut,

Has pretty well established
that it was nickel carbonyl.

Narrator: but dr. Sunderman's
discovery was not
the breakthrough.

After days of testing,
researchers suspected

That nickel was peeling off
of the scalpels used
during the autopsies.

When plastic scalpels were used,

The nickel was
no longer present.

Investigators were no closer

To finding the cause
of legionnaires' disease.

There is a possibility that
we may never find the answer.

However, I will pledge

That this effort
and investigation will continue,

If it takes a year or two years,

To continue the investigation
to get to the bottom of it.

Narrator: over
the christmas holidays,
some of the c.d.c. Staff

Decided to take
some much-needed time off.

They had been working
around-the-clock
to find the cause

Of the legionnaires' outbreak,
without success.

There were no new cases
of legionnaires' disease,

But still no answers.

Dr. Joseph mcdade, a c.d.c.
Microbiologist, and his wife

Were looking forward to
the christmas holidays.

Joe, it's been
this first broke out.

Narrator: but what should
have been a diversion

Turned to frustration
as friends asked

Why he and his colleagues

Were unable to find
the cause of the outbreak.

Frustrated, angry,
and embarrassed,

Mcdade canceled
his christmas vacation

And returned to his lab.

He pulled the slide
of a guinea pig

Which had been injected
with liver tissue

From a legionnaires' victim.

It was a slide he had seen

Hundreds of times before.

But this time,

In his deserted lab,

He noticed something
he didn't recognize--

A new bacterium,

One dr. Mcdade
had never seen before.

Narrator: dr. Joseph mcdade,
a c.d.c. Microbiologist,

Saw something
he never noticed before

As he examined tissues
of guinea pigs exposed

To the mysterious disease.

But at first,
he thought he was looking
at a contaminated specimen.

So they were probably
some other kind of bacteria.

And he,
as I understand it,

Decided to retest
those specimens--

No longer assuming
that these were contaminants,

But on the off chance
that this was the agent.

Narrator: he tested
his newfound organism
with a blood sample

From a legionnaires'
disease survivor.

That blood sample
would contain antibodies

Which successfully fought
the disease.

If the antibodies were present,

The sample would turn green.

Mcdade looked
through the microscope

And saw a bright green glow.

So he demonstrated
that the bug was present

In the liver
of the guinea pig,

And he demonstrated
that legionnaires
developed antibodies

Specific to that agent.

Well, that was the breakthrough.

Narrator: 147 days
after the outbreak,

The bacterium which k*lled 34

And hospitalized 221 others

Was officially given
its name--

Legionella pneumophila,

In honor of the legionnaires
in philadelphia.

And researchers
identified an antibiotic

Which would k*ll it--
erythromycin.

But the question remained:

Where did the bacteria
come from,

And how was it spread?

By the time researchers knew
what they were looking for,

They couldn't find it in any
of the samples from the hotel.

The bacteria had
long since died.

But researchers quickly
discovered its properties.

It multiplied in warm,
watery conditions,

And could travel
through the air

In contaminated
water droplets or mist.

Since some of the victims
never set foot

Inside the bellevue
stratford hotel,

But were on the sidewalk
in front of the hotel,

Dr. Fraser believes
that the bacteria

Most likely came from
the roof of the hotel--

From the air conditioning
water-cooling towers.

Inside the cooling towers,

Warm water is cooled

As it cascades
over wooden louvers.

The excess water falls

Into a collection pan
at the bottom,

Where it stagnates if it fails
to drain properly.

Investigators believe
it was here,

Inside these
water-cooling units,

Where the deadly
legionella bacteria

Grew and multiplied.

It was drawn up into the air

By the unit's powerful fans.

Now airborne,

The deadly mist of bacteria
and warm water

Flew up into the atmosphere

And floated down the side
of the building,

Making its way
to the street below.

It landed on pedestrians
walking by the hotel,

And was also drawn
into the hotel lobby

By intake fans on the south side
of the building.

Hotel employees probably
developed an immunity
to the bacteria,

Or weren't susceptible
because they were
younger and healthier

Than those who contracted
the disease.

The cooling-tower theory
was never proven,

Probably because the bacteria

In the bellevue stratford's
cooling towers had already died.

But investigators discovered
the same bacteria

In similar cooling towers
in other parts of the country.

Scientists believe legionella

Has been k*lling
for thousands of years.

And when blood samples
from earlier

Unexplained outbreaks
were examined,

They discovered
the legionella bacteria.

Austin, minnesota, 1957--

The earliest
documented outbreak;

Washington, d.c., 1965,

Where legionella k*lled


Bob mcgarry and charlie davis

Were two of the more
fortunate legionnaires

From the 1976 convention.

Charlie davis developed
legionnaires' disease,

Spent 3 weeks in the hospital,
but recovered.

Bob mcgarry escaped
the disease altogether,

Even though he and charlie
roomed together.

Bob was younger, didn't smoke,

Or have any previous
respiratory ailments.

But the outbreak had
a lasting effect

On these two lifelong friends.

They lost many of
their brothers that summer,

And neither one
ever attended

Another legionnaires'
convention.

I was at the wrong place
at the right time,

As far as that was concerned.

Had it not been for
the unfortunate incident
that occurred

With the rest of
the delegates and brothers,

I could say today
it was a great time.

But I was not going
to press my luck.

I seen it once.
I don't want to do it again.

I seen it once.
I don't want to do it again.