Our Latest Perspectives Posts

Honoring our Fallen Colleague through “Angels of America’s Fallen”

This summer, we are happy to report that the organization we advise, the American Chemistry Council, has contributed $5,000 in our name to the “Angels of America’s Fallen” program. “Angels” engages with the children of our country’s fallen military and first responders, offering coaching and instruction in sports, music, arts, and other healthy activities. These programs cannot replace fallen mothers and fathers, but they do provide opportunities for children to cultivate interests in areas to which they might not otherwise be exposed.

Jerod poses with fellow first-responders in 2011

Jerod poses with fellow first-responders in 2011

Our donation to “Angels” will be channeled by the National Swimming Pool Foundation to local Jewish Community Centers that will provide learn-to-swim scholarships to the children of fallen heroes. We are particularly pleased that the 2017 donation was made in honor of our dear, late colleague, Dr. Jerod Loeb.

Remembering Jerod

Our close-knit advisory group has not forgotten our friend, Jerod, who passed away on October 9, 2013, after battling cancer. Jerod was Executive Vice President of Healthcare Quality Evaluation at The Joint Commission in Oakbrook Terrace, Illinois. At The Joint Commission, he was a leader in accreditation and certification programs and involved in a variety of initiatives associated with performance measurement and patient safety, including those of the National Quality Forum, the Centers for Medicare and Medicaid Services, the International Society for Quality in Health Care, and the World Health Organization.

Jerod was also a community first responder who volunteered with the Buffalo Grove, Illinois Fire and Police Departments for about 15 years. He was a graduate of the Buffalo Grove Citizen’s Fire Academy and was a fully trained member of the Buffalo Grove Community Emergency Response Team.  In 2005, Jerod was appointed Commissioner of Fire and Police for the municipality of Buffalo Grove. Jerod’s volunteerism and professional efforts to promote a safer, healthier world continue to inspire us. Knowing Jerod as we did, we are certain that he would be pleased that some very special children will learn to swim this summer, and that they will be safer in and around water for the rest of their lives. This is just one small way in which Jerod’s work continues.

To contribute to Angels of America’s Fallen, please visit their website at https://aoafallen.org/.

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Zika Virus: What Can We Expect this Summer?

Mosquito repellent can help reduce exposure to mosquitoes that carry Zika virus; infants younger than two months can be protected with mosquito netting.

Mosquito repellent can help reduce exposure to mosquitoes that carry Zika virus; infants younger than two months can be protected with mosquito netting.

As summertime approaches and vulnerable areas of the US warm up, concerns over the potential spread of Zika virus are on the rise. The virus is spread mainly through the bite of an infected Aedes aegypti mosquito, but also can be transmitted sexually. Zika virus is associated with birth defects (microcephaly) in infants of infected mothers and Guillain-Barre Syndrome, an immune system disorder.

Last summer, several regions of the US were identified as possible sites of Zika virus outbreaks based on modeling studies1 and well-publicized outbreaks in Brazil and other areas of Latin America. Although there have been over 5,000 travel-related cases reported2 in the US since 2015, local transmission of the virus in the continental US occurred in just 224 cases in two geographic “pockets” last summer: Miami-Dade County, Florida (218 cases) and Brownsville, Texas (6). What does this summer hold for those of us on the lookout for Zika virus?

Zika: State of Play

Globally, the World Health Organization (WHO) reports Zika virus continues to spread to areas where mosquitoes are present that can transmit the virus. For example, the WHO recently reported three laboratory-confirmed cases of Zika virus in the Gujarat State of India. Because of the potential health effects on infants of infected mothers, the Centers for Disease Control and Prevention (CDC) tracks the number of pregnant women with any laboratory evidence of possible Zika virus infection in the US and US Territories (1,845 and 3,795, respectively, as of May 9, 2017). As of May 9, 2017, of 1,471 completed pregnancies reported to the US Zika Pregnancy Registry, there have been 64 liveborn infants with birth defects and 8 pregnancy losses with birth defects (approximately 5 percent birth defects).3

Currently, CDC data show nearly two-thirds of the 50 states have reported laboratory-confirmed cases of Zika virus in 2017. For the period January 1 – May 24, 2017, all 120 reported Zika virus cases were in travelers returning from affected areas. Many more cases, 498, were reported in US territories, with the majority in Puerto Rico. CDC presumes that all cases in US Territories were acquired through local mosquito-borne transmission. Meanwhile, Miami-Dade County and Brownsville are currently designated by CDC as “cautionary areas” to which pregnant women should consider postponing travel. In Florida, where I work at the Department of Health, none of the more than 90,000 mosquitoes tested to date have been found to be infected with the Zika virus, evidence that the virus has not “overwintered” here. We have a team of over 20 epidemiologists placed around the state to monitor Zika virus, and $20 million in state funds has gone to “skeeter control” districts for their spraying/larvaciding/eradication efforts. We are also aware that some cities and counties are planning to use genetically modified sterile mosquitoes to reduce mosquito populations.

Hope for a Vaccine

In a September 2016 interview, CDC director, Dr. Tom Frieden, noted that “Zika is likely to become endemic in this hemisphere. That means it will continue to spread at some level for years to come.” On the positive side, government scientists at the National Institute of Allergy and Infectious Diseases have developed an experimental vaccine that is being tested on human volunteers. According to the March 31, 2017 announcement, the trial is expected to conclude in 2019, but initial results could be available by the end of 2017. An effective vaccine will be critical in controlling the spread of Zika virus. Meanwhile, it’s important to implement the many known strategies that can help reduce our exposure to mosquitoes and Zika virus.

Tips from the Frontline of the Zika Virus Battle

The following tips include information from the Florida Department of Health’s “Drain and Cover” program, and can help control the risk of Zika virus and other mosquito borne illnesses:

  • Drain water from garbage cans, house gutters, pool covers, coolers, toys, flower pots, or any other containers where sprinkler or rain water has collected.
  • Discard old tires, drums, bottles, cans, pots and pans, broken appliances and other items that aren’t being used.
  • Empty and clean birdbaths and pets’ water bowls at least once or twice per week.
  • Protect boats and vehicles from rain with tarps that do not accumulate water.
  • Maintain appropriate pool chemistry (chlorine level and pH) of swimming pools. Empty plastic swimming pools when not in use and store in a way that avoids accumulating water.
  • Repair broken screens on windows, doors, porches and patios.
  • If you must be outside when Aedes mosquitoes are active (daytime), cover up. Wear shoes, socks, long pants and long sleeves.
  • Apply mosquito repellent to bare skin and clothing. Follow label directions. Repellents with DEET, picaridin, oil of lemon eucalyptus, para-menthane-diol, and IR3535 are effective and safe for pregnant and breast-feeding women, when used as directed. Use netting instead of repellents to protect children younger than two months.

Although it is difficult to predict how Zika virus will affect the US this summer, taking reasonable precautions to prevent exposure to mosquitoes is prudent, especially for those of us in vulnerable areas. Forewarned is forearmed!

Bob G. Vincent is an Environmental Administrator in the Florida Department of Health. He manages Department of Health programs for Healthy Marine Beaches, Safe Drinking Water, Water Well Surveillance and Public Pools and Bathing Places.

 

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1 These regions included the Gulf Coast and much of the Eastern Seaboard of the US.

2 Travel-related cases of Zika virus are those in which people are infected by mosquitoes while visiting countries in which the virus is endemic (regularly found). CDC reported 61 of these in 2015, 4,830 in 2016 and 119 as of May 19, in 2017.

3 CDC notes: “Although these outcomes occurred in pregnancies with laboratory evidence of possible Zika virus infection, we do not know whether they were caused by Zika virus infection or other factors.”

 

Avoiding Crypto at the Pool this Summer

Sign on a door to a hotel pool in Santa Barbara, California, April 2017

Sign on a door to a hotel pool in Santa Barbara, California, April 2017

This summer the Centers for Disease Control and Prevention (CDC) and health departments across the country will strive to keep an unwanted parasite out of America’s pools, hot tubs and water parks. The microscopic organism, “Crypto,” short for Cryptosporidium, causes diarrhea and spreads through recreational water via the fecal-to-oral route. Yes, that’s a revolting image, but an awareness of how Crypto spreads can go a long way toward preventing outbreaks that can put a serious dent in your summer fun.

Crypto is not present in every pool, but according to CDC data, the number of US Crypto outbreaks in aquatic venues doubled between 2014 and 2016.

A Challenge for Chlorine

kidpoolAlthough chlorine destroys most disease-causing germs in treated recreational waters within minutes, Crypto presents a unique challenge. The issue is that in its infectious life stage, the parasite is protected from chemical disinfectants by a hard outer shell, known as an “oocyst.” Thanks to that resistant shell, Crypto can survive for days in a properly chlorinated pool.1

Destroying Crypto oocysts with chlorine requires hyperchlorination (also known as superchlorination)—a process in which the chlorine level of water is raised for a sufficient period of time (hours) during which the aquatic facility is closed to patrons. Hyperchlorination procedures can be found in the CDC’s Fecal Incident Response Guide, “What do you do when you find poop in the water?”. Some pool owners choose to hyperchlorinate weekly as a preventive measure. Oocysts also may be controlled by optimizing pool water filtration or by adding secondary treatment in the form of ultraviolet radiation or ozonation.

Four Ways to Outsmart Crypto

  1. Don’t Enter the Water if You Are Sick with Diarrhea: To avoid contaminating aquatic facilities with Crypto, CDC recommends not swimming when you are experiencing diarrhea or for at least two weeks after diarrhea ends, especially if you have been diagnosed with Crypto. Based on our recent Water Quality and Health Council survey, which found that 25 percent of respondents would swim within one hour of having diarrhea, this recommendation needs to “go viral.”
  1. Shower First: Showering is needed to remove swimmer perspiration, oils and cosmetics that deplete chlorine and form irritating byproducts. With regard to Crypto and other illnesses spread via the fecal-to-oral route, however, a soap shower is needed to remove the trace fecal matter (about 0.14 g) on each person’s bottom. Children under the age of five, who have poor hygiene, really need this, but do parents realize it? Our survey found that about half of adult swimmers don’t even rinse themselves off in the shower before swimming.
  1. Avoid Swallowing the Water: This could be difficult, but minimizing the amount of water swallowed helps reduce the risk of ingesting Crypto, developing diarrhea, and further spreading the parasite. Let children know that as cool and sparkling as it may look, pool water, like bath water, is not for drinking. Approximately 60 percent of adults who responded to our survey admitted they swallow water while swimming.
  1. Check and Change Swim Diapers: Swim diapers may not provide the perfect seal around a child’s bottom, but a well-fitted diaper kept securely in place is a helpful hygiene measure. Parents and caregivers can check diapers every hour or so to be sure “full” diapers are not being immersed in the pool, effectively creating a “fecal tea bag.” Change diapers only in designated areas away from the pool. Thorough hand washing after using the bathroom or handling diapers is essential, no matter the venue.

Crypto is now the leading cause of reported recreational water outbreaks. It is our hope that by highlighting the stark facts about this nasty parasite, future outbreaks will be avoided. Summer is too short to miss out on the fun of enjoying recreational water facilities.

 

Chris Wiant, M.P.H, Ph.D., is president and CEO of the Caring for Colorado Foundation. He is also chair of the Water Quality & Health Council and a member of the National Drinking Water Advisory Council.

Ralph Morris, M.D., M.P.H., is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

 

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1 A properly chlorinated pool is one in which a minimum of 1 mg/L “free” chlorine is maintained.

 

Survey: 1 in 4 Adults Would Swim with Diarrhea

Diarrheal outbreaks linked to swimming are a persistent challenge for aquatic venues

WASHINGTON, D.C. — Americans will soon head to the pool as Memorial Day weekend marks the unofficial start of the swimming season, but a new survey reveals that there may be more in the pool than just water.

The survey, conducted on behalf of the Water Quality and Health Council, found that 1 in 4 adults (25 percent) would swim within one hour of having diarrhea, half of adults (52 percent) seldom or never shower before swimming in a pool, and that 3 in 5 adults (60 percent) admit to swallowing pool water while swimming.

These results are concerning to experts from the U.S. Centers for Disease Control and Prevention (CDC), the Water Quality and Health Council, and the National Swimming Pool Foundation® (NSPF®), given that waterborne outbreaks of diarrheal disease caused by the germ Cryptosporidium (or “Crypto”) remain a challenging health concern.

Crypto is a parasite that can spread when someone swallows water that has been contaminated with the fecal matter (poop) of an infected swimmer. Crypto is the most common cause of diarrheal illness and outbreaks linked to swimming pools or water playgrounds. In addition to diarrhea, some people experience lack of appetite, nausea, vomiting, weight loss, stomach cramps or pain, and fever.

The CDC advises those infected with Crypto to avoid swimming until two weeks after recovering from diarrhea. Parasites can remain in the small intestine for weeks and cause symptoms to reappear days after the infected person recovers.

“Normal chlorine disinfection of swimming pool water does a great job in destroying most germs, but Crypto presents a special challenge,” said Dr. Chris Wiant, chair of the Water Quality and Health Council. “An awareness of Crypto helps us remember that a healthy pool depends on swimmers being considerate of one another. Showering before swimming, refraining from peeing in the pool, and not swimming for two weeks after experiencing diarrhea can help keep swimming fun and healthy for everyone from ‘water babies’ to seniors.”

Other key findings of the national Healthy Pools survey include:

  • 72 percent of adults are unaware that Crypto is a parasite often spread in water.
  • 84 percent of adults are unaware that the use of chlorine at CDC-recommended levels will NOT kill Crypto instantly in swimming pools.

Crypto is not easily killed by chlorine and can live up to 10 days in well-treated pools,” said Michele Hlavsa, RN, MPH, epidemiologist and chief of the CDC’s Healthy Swimming program. “Just a small number of Crypto germs can make someone sick. That’s why it is important to keep Crypto out of the water in the first place.”

Swimmers and parents of young swimmers can take a few easy steps to prevent Crypto outbreaks:

  • Stay out of recreational water (e.g., pools, lakes, rivers, oceans) if sick with diarrhea and until diarrhea-free for two weeks. Patients typically continue to shed Crypto for up to two weeks after diarrhea stops.
  • Shower before you get in the water. Rinsing off in the shower for just one minute removes most of the dirt or anything else on your body.
  • Don’t swallow the water.
  • Report diarrhea incidents that occur in the water to aquatics staff immediately.

Drowning prevention is also key to maintaining a healthy and safe swimming experience. According to the survey, 60 percent of parents reported engaging in some type of distracted activity while their children swam in a pool, such as using a phone or tablet, reading a book, drinking alcohol, sleeping or leaving the pool altogether.

“Parents should designate a ‘Water Watcher,’ because supervision can save a life,” said Thomas Lachocki, Ph.D., CEO of NSPF®. “Water Watchers are important even if a lifeguard is present. Water Watchers should be at least 16 years old and able to recognize and execute a rescue, provide a floating or reaching object, alert someone nearby to help or call 9-1-1, and be able to administer CPR.”

The Water Quality and Health Council is once again making free pool test kits available this summer through its award-winning Healthy Pools awareness initiative. Swimmers can test their backyard pools or community pools to ensure a proper pH and chlorine level. Visit healthypools.org to order a free pool test kit.

The 2017 Healthy Pools survey was conducted online by Sachs Media Group, an independent research firm based in Tallahassee, Fla. Sachs Media Group interviewed 3,114 adults (18+ years old), April 28-30, 2017. The survey measured perceptions and misconceptions related to swimming pools and public health, with a margin of error of +/- 2.0 percent.

To learn more about the Water Quality and Health Council and its efforts to raise awareness of the importance of disinfection for public health, please visit waterandhealth.org.

Out of the Jungle: Yellow Fever on the Rise

Brown Howler Monkey According to a recent Science Daily report, thousands of brown howler monkeys in a forest in southeastern Brazil have died of yellow fever.

Brown Howler Monkey

According to a recent Science Daily report, thousands of brown howler monkeys in a forest in southeastern Brazil have died of yellow fever.

Yellow fever, a deadly scourge transmitted by mosquitoes that has impacted the course of human history time and time again, is on the rise in Latin America. The first yellow fever death in Brazil in 17 years occurred in January 2017, when a young person who worked in the jungle succumbed to the disease. A recent Pan American Health Organization (PAHO) “Situation summary in the Americas” reported that since the current outbreak began in Brazil in December 2016, there have been over 1,400 confirmed or suspected cases and at least 234 deaths in six states of that country. Suspected and confirmed yellow fever cases have also been reported in Colombia, Ecuador, Peru, Bolivia and Suriname.

Yellow fever is indigenous to some tropical regions of Central and South America and Africa, and is caused by the yellow fever virus, one of a family of Flaviviruses, which includes West Nile virus, dengue virus and Zika virus. “Flavus” is Latin for “yellow.” Because it is borne by an arthropod (mosquitoes are arthropods), it is also known as an “arbovirus.” Yellow fever is the most severe arbovirus ever to circulate in the Americas, according to a recent commentary in The New England Journal of Medicine (NEJM).

Out of the Jungle

The yellow fever virus is transmitted through both a sylvatic (jungle) cycle and an urban cycle. According to the PAHO “Control of Yellow Fever Field Guide,” in the sylvatic cycle, the virus circulates among primates, primarily monkeys, through the bites of several species of mosquitos, and may result in death (see photo above). In the Americas, in the urban cycle, the virus is circulated among humans through the bite of the Aedes aegypti mosquito, the same mosquito that transmits Zika virus, chikungunya and dengue fever.

The urban cycle is initiated when a person who was infected with the disease in the jungle enters an urban center in which there is a high density of A. aegypti mosquitoes. If that individual is bitten by the A. aegypti mosquito while the virus is circulating in his or her blood, the disease can be spread to others subsequently bitten by the same mosquito, setting off a chain of transmission. Large outbreaks can result in urban areas where there are high mosquito densities and a high percentage of unvaccinated or otherwise unimmunized people. So far there is no evidence of urban transmission in Brazil.

Yellow Fever Symptoms

Following infection, the virus incubates in the human body for three to six days. Although many people develop no symptoms at all, fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue may develop. Yellow fever is named for the jaundice exhibited by some patients. According to the World Health Organization, a small fraction of people infected with yellow fever develop severe symptoms and of those, approximately half die within seven to ten days.

A Vaccine and Vector Control

Fortunately, a very effective vaccine for yellow fever was developed in 1937 that is in wide use where the disease is endemic. According to the NEJM commentary, the current outbreak in Brazil is precariously centered in areas close to urban centers. Because urban Brazilians are not typically vaccinated against yellow fever, there is a concern that widespread urban transmission could begin, which could lead to “travel” cases in the US, such as we have seen with dengue, chikungunya and Zika viruses. Local US transmission can become a potential issue in regions such as the Gulf Coast states where A. aegypti mosquitoes thrive. In the age of world travel, we are a connected community, and with increasing tourism into jungle areas, the risk of importing yellow fever grows more likely.

As we know from recent experience with Zika virus, controlling the mosquito vector is a significant strategy for avoiding arboviruses. This includes removing outdoor standing water, properly chlorinating backyard swimming pools, maintaining window and door screens, and applying mosquito repellent appropriately (see tips). These are solid precautionary measures we can all take to help avoid any of the potential arboviruses circulating in our midst. Travelers to yellow fever endemic areas should ensure that they are immunized for yellow fever. Recently CDC announced a shortage of yellow fever vaccine, but noted there is a plan for providing safe vaccine at a limited number of clinics until the supply is replenished. For updates on the vaccine’s availability, please consult the CDC Travelers’ Health website. Travelers to areas in which yellow fever is endemic can also consider using bed netting, wearing protective clothing and applying mosquito repellent.

The more things change, the more they stay the same. Yellow fever is back (it never really went away), but unlike the devastating outbreaks documented throughout history, we now have proven effective measures to preclude them … if they are utilized.

Fred M. Reiff, P.E., is a retired official from both the U.S. Public Health Service and the Pan American Health Organization, and lives in the Reno, Nevada area.

 

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Color-coded Tips for Treating Algae in the Swimming Pool

Algae Swimming PoolAlgae in the swimming pool is an unwelcome sight, but one that usually can be dealt with effectively. The following “color-coded” tips can help you or your pool service professional identify and eliminate, or at least control, the most common types of algae. It is important to follow manufacturers’ directions for using and storing all pool chemicals.

Green Algae

Green algae usually appears when pool sanitizer levels are low or water circulation is poor; green algae turns pool water cloudy and murky. It is the easiest type of algae to remediate, but left unaddressed, green algae can worsen to the point of obscuring the floor and steps of the pool and potentially even a struggling bather, raising the drowning risk. Eradicate green algae by raising the chlorine level or adding an algaecide. Following treatment, it is important to run the filtration system continuously to clear the water by trapping the dead algae in the filter.

Avoid green algae by maintaining proper pool chemical levels. Additionally, avoid cross-contaminating your pool with green algae spores by thoroughly washing swimsuits and water toys before re-using them in the pool following a visit to a natural water body.

Black Algae

Black algae appears as black dots on pool plaster, especially where the plaster is pitted, etched, or where calcium deposits have developed. Poor water circulation in those areas helps protect black algae. In fact, the more deteriorated the plaster, the worse the potential problem.

Tackle black algae as soon as it appears by scrubbing the affected area with a stainless steel brush. The scrubbing action removes a protective coating that develops over black algae. Daily brushing is required until the algae spots disappear. In severe cases, it may only be possible to control black algae, and not to eliminate it completely. It is essential to keep scrubbing black algae spots as soon as they appear.

An additional recommended step is to treat affected surfaces with “trichlor” on horizontal pool surfaces and a copper-based broad spectrum algaecide on vertical pool surfaces. Broad spectrum chelated copper algaecide can also be used as a preventative measure. A word to the wise: Have your pool water analyzed for metal levels prior to adding any metallic algaecide, such as copper-based products. If metals are present in the pool water, adding a metallic algaecide could cause the pool water to become oversaturated with metals, which could lead to staining or water discoloration. It is also advisable to keep copper to a minimum from a human toxicity standpoint. Most drinking water municipalities keep copper levels below 1.3 ppm. The manufacturers of copper algaecides should be able to provide the “ppm added” from use of their product. Excess copper in swimming pools can cause blue-green coloration of the hair, nails and skin.1

Yellow/Mustard Algae

Yellow or mustard-colored algae is probably the most challenging type of algae to eradicate. First, the diagnosis may be difficult. Yellow algae in a blue pool may look green, but the pool is not likely to contain green algae unless the water is cloudy and murky. Yellow algae may also be mistaken for dirt or pollen. The diagnostic test is to see whether or not the yellow substance returns to the side walls of the pool after it is scrubbed. Dirt or pollen will drop to the floor of the pool, but yellow algae will reappear on the walls.

To further complicate matters, yellow algae can thrive in a well-balanced chemically treated pool. It can be introduced into your pool from lakes, ponds, on the wind or in the rain. It can also be transmitted through previously contaminated pool equipment, such as skimmers, leaf rakes or vacuum hoses and heads. Treat yellow algae with an algaecide or chlorine enhancer that specifically targets yellow algae.

Anti-algae Basics

To help avoid algae of all types, keep in mind the basics of chemical and physical pool maintenance.

CHEMICAL MAINTENANCE: Proper pool chemistry means free chlorine and pH are within target ranges. According to the US Centers for Disease Control and Prevention’s Model Aquatic Health Code, pool water free chlorine levels should be in the range of 1-4 ppm and the pH should be between 7.2 (minimum) and 7.8 (maximum). The ideal pH in a pool is 7.4 to 7.6.

PHYSICAL MAINTENANCE: Physical maintenance of the pool means keeping up with brushing and vacuuming the pool and cleaning skimmer and pump baskets. Algae love rough and deteriorating pool surfaces, so sanding and crack repair are helpful. Clean pool filters as the first step in battling algae. Operating pumps and filters for at least 8 to 10 hours per day throughout the summer keeps water moving, a deterrent to algal growth.

This article is based on “Tips and tricks for identifying and treating tough algae,” by Terry Arko in the March 2017 edition of The IPPSAN, a publication of the Independent Pool & Spa Service Association, Inc.

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1 Peterson, J. et al. (2006). Cupric keratosis: green seborrheic keratoses secondary to external copper exposure. Europe PMC 77(1): 39-41. Abstract online, available: http://europepmc.org/abstract/med/16475494.

Sweet Evidence for an Unsavory Practice: Peeing in the Pool

PeeInPoolPeople urinate in swimming pools. It’s been a widely discussed topic since we published the results of our 2009 survey concluding that one in five American adults admit to having “peed in the pool.” Now there is physical evidence for this unsavory act, and it appears in the form of an artificial sweetener, of all things. A Canadian research team has identified a chemical compound in pool water that indicates the presence of urine. The “chemical marker” is acesulfame-K, or “ACE,” a synthetic sweetener found in prepackaged foods. ACE passes through the body essentially unaltered, and is excreted exclusively in the urine. The researchers posit that ACE could be a useful indicator of pool water quality.

The Problem with Peeing in the Pool

Besides being a rather discourteous thing to do, peeing in the pool contributes to poor pool water quality. Urine contains nitrogen-containing compounds that combine chemically with chlorine disinfectant to produce eye, skin and respiratory irritants. That strong chemical smell around some pools is not “the smell of chlorine,” but chemical products of chlorine’s reaction with urine, perspiration, cosmetics and body oils from swimmers. Chlorine, added to destroy waterborne pathogens that could make swimmers sick, is depleted by its reaction with these impurities. That’s why the Centers for Disease Control and Prevention encourages swimmers to shower before swimming and refrain from sneakily relieving themselves underwater.

Strategies to Avoid Using the Pool as a Toilet

We believe the key to ending peeing in the pool is multi-pronged and includes effective swimmer education and scheduled pool breaks, especially for young swimmers. We recommend swimmer hygiene messaging be a part of all swimming lessons and that clear signage around the pool encourage sanitary practices. Certain pool regimens also can be helpful. As the National Swimming Pool Foundation (NSPF) notes in a recent press release, being submerged in water stimulates the body to create more urine. NSPF offers the following commonsense recommendations to help prevent peeing in the pool:

  • Swim coaches should require bathroom breaks 30-60 minutes into practice.
  • Parents of young children should enforce a snack, sunscreen or bathroom “out of pool” time every 30 minutes.
  • Facility managers should schedule short breaks, such as 10 minute “adult swims” or out of pool activities every hour.

Swimming is fun and the health benefits of aquatic recreation are enormous. As evidence mounts that swimmers are fouling the very waters they enter to enjoy, the time is right to confront the problem.

Chris Wiant, M.P.H, Ph.D., is president and CEO of the Caring for Colorado Foundation. He is also chair of the Water Quality & Health Council and a member of the National Drinking Water Advisory Council.

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Smells Like Chlorine?

Smells Like Chlorine

The nose is an extremely sensitive “detector” that sends information to the brain where it is interpreted.

They say “the nose knows,” but I say the nose can be confused. Chlorine odors are a good example. Several different chlorine odors can arise from various chlorine-based substances and in different circumstances. They are not all simply due to “chlorine.” A prime example is the irritating smell commonly attributed to chlorine around some poorly managed swimming pools. That smell is from a couple of chemical compounds in the chloramine family. Some chloramines form when chlorine disinfectants react chemically with nitrogen-based substances from the bodies of swimmers, including urine. The poolside pronouncement of “too much chlorine in the pool” may be more aptly described as “too much peeing in the pool.” Ironically, the odor could signal that more chlorine is needed in the pool.

Not One Chloramine

Chloramines start out as ammonia— NH3— which looks like a three-legged stool with the nitrogen atom as the “seat” and a hydrogen atom at the end of each “leg.” Ammonia is common in the environment, and Ammoniaalthough household ammonia has a very sharp odor, ammonia has no odor at the very dilute levels typically found in water. When chlorine is added to water in sufficient amounts, it breaks ammonia down into nitrogen (N2) gas and hydrogen (as water or H2O). But if the amount of nitrogen increases (from peeing in the pool, for example), the balance between chorine and nitrogen is disturbed and the ammonia is only partially deconstructed.

TrichloramineWhen three chlorine atoms replace the hydrogen atoms on the ammonia molecule, the resulting compound is trichloramine, a pungent, irritating compound that is often mistaken for “too much chlorine” in the pool, even at very low concentrations. Trichloramine and its sister chemical dichloramine (with two chlorine atoms and one hydrogen forming the “legs”) are responsible for the odor you might smell when you enter an enclosed pool area in which there is poor airflow through the building. Besides just smelling bad, these same two chemicals can also turn swimmers’ eyes red.

DichloramineThe problem with trichloramine and dichloramine goes beyond that irritating smell. When trichloramine is present in the pool, the level of “free chlorine” available to disinfect the water and protect swimmers from microbial disease is greatly diminished. That’s why it’s important to check pool water regularly for the pH and the presence of free chlorine1. Pool managers are obliged to do just that, and pool patrons can do the same with easy-to-use pool test strips.

MonochloramineTrichloramine and dichloramine have a third sister – monochloramine. As the name suggests, in this compound, only one of the hydrogen atoms on the ammonia has been replaced with chlorine. This chemical, however, carries no odor and is an effective disinfectant that has been used successfully by many water treatment plants for many decades. What a difference a minor change in a chemical formula can make!

Monochloramine is typically formed in source water by first adding chlorine to break down any ammonia (into nitrogen and water) and then adding back trace amounts of ammonia in carefully monitored amounts to produce only monochloramine.

Bleach Smell

Unlike the chloramine family of compounds, chlorine bleach is a solution of water and sodium hypochlorite with the chemical formula NaOCl [bleach contains sodium (Na), oxygen (O) and chlorine (Cl)]. The odor of bleach (bleach that is not infused with a fragrance) is not nearly as pungent as that of di- and trichloramines. When the chlorine in bleach combines with nitrogen-based substances, however, smelly di- and trichloramines can form by chemical reaction. This could happen in the swimming pool environment, for example.

Chlorine Gas

Chlorine is a common, naturally occurring element, but due to its reactivity, it usually occurs in nature combined with other elements, such as sodium in common table salt, NaCl. It is also produced industrially as part of the “chlor-alkali” process in which both chlorine and sodium hydroxide (NaOH) are generated by applying electricity to salty water. In that process, chlorine is produced as a gas consisting of twin atoms chemically bound together, and is represented by chemists as “Cl2.” Both chlorine and sodium hydroxide are used to help produce hundreds of everyday products, including water treatment chemicals, PVC pipes, pharmaceuticals, paper, aluminum, silicon chips for computers and even the titanium metal used in joint replacements.

Chlorine gas is a respiratory irritant that the human nose can detect at very low levels (0.2-0.4 parts per million in air; just for reference, one part per million is equivalent to four drops of ink in a 55-gallon barrel of water). At these low concentrations, chlorine gas smells very much like household bleach. When levels rise to the range of 1-3 ppm, however, mild mucous membrane irritation is noted and higher level exposure becomes increasingly dangerous.2 That is why the chlor-alkali industry takes extensive measures to ensure the safe production, handling and transportation of chlorine gas and even the less reactive sodium hypochlorite and calcium hypochlorite.

Not Just One Chlorine Compound

Chlorine is a reactive element that is found in many different compounds exhibiting different but sometimes similar properties, including odor. It is credited to have dramatically improved public health over the past 100 years through its ability to disinfect water.  I hope this discussion helps to clarify “the smell of chlorine.” Now your nose knows! 

Stephan A. Hubbs retired from water treatment operations at the Louisville Water Company in 2004. He was involved in the development of the first chlorine by-products regulation in 1975-1979 and remains an active volunteer in the drinking water community today.

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1 Hypochlorous acid, or HOCl, for you chemists!

2 The Chlorine Institute, Inc., Pamphlet 63: First Aid, Medical Management/Surveillance and Occupational Hygiene Monitoring Practices for Chlorine, Edition 8, June, 2011.

Go Swimming This Winter!

Looking for a fun way to stay fit this winter? Consider swimming in an indoor pool. Swimming provides a great workout for the whole body—core (including abdomen), arms, legs, glutes and back, according to WebMD. It helps increase flexibility and strength without taxing the joints, a welcome advantage for people with arthritis. And feeling buoyant in the water can be both relaxing and soothing, reducing mental stress.

Indoor Pool Air Quality

One potential deterrent to indoor pool swimming is the strong chemical odor around some indoor pools. We have addressed the phenomenon popularly known as “too much chlorine in the pool” numerous times, but it bears repeating here: The irritating chemical odor around some pools is not due to chlorine, but to certain substances formed when chlorine disinfectant combines with nitrogen-containing contaminants brought into the pool by swimmers.

To compound matters, inadequate air exchange over the pool contributes to the build-up of irritants in the indoor pool space. If your indoor pool air is irritating, speak to the pool manager about air flow in the room, but consider your own personal “swimmer hygiene” as well.

Why is chlorine added to pool water anyway? Chlorine-based disinfectants are needed to control waterborne germs, helping to keep pool water safe for swimmers. Chlorine’s presence is non-negotiable (it’s even present in “salt” pools), so to minimize irritants forming, swimmer hygiene must be addressed. Many swimmers do not realize how much influence their hygiene has on pool water quality. Swimmers should shower before entering the pool and refrain from “peeing in the pool.” Showering thoroughly with soap removes body oils, perspiration, makeup, lotions and traces of urine and fecal matter from the skin. When chlorine combines with these substances, there is less of it available to destroy the germs in the water that can make swimmers sick. Inadequate pool chlorine levels can lead to swimmer’s diarrhea and swimmer’s ear, for example. And peeing in the pool, no matter how stealthily it can be done, is not cool!

A Family Affair

Swimming can be a family affair. Parents, swimming is an “electronic gadget-free” activity! The pool is a unique environment in which to connect family members across the generations. The buoyancy of pool water is a great equalizer as older swimmers are able to avoid high impact to their aching joints. Older family members can help teach younger ones to swim and then race them across the pool.

Ensuring that each family member can swim is an investment that can pay dividends over a lifetime. In addition to being a life-saving skill, swimming can enhance the quality of life. A variety of outdoor recreational activities in and around the water, including boating, fishing, water-skiing and more, become available and enjoyable for confident swimmers.

So, as counter-intuitive as it may seem to locate your swim suit and goggles and head for the pool when the weather forecast includes ice and snow, consider the benefits and the fun of winter indoor swimming.

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Why Cryptosporidium is Responsible for over 80% of Swimming Pool Illness Outbreaks, and What Can be Done about It

Causes of recreational water illness outbreaks

Causes of recreational water illness outbreaks, 2005-2006 (CDC MMWR Report, Sept. 12 2008)

Cryptosporidium is a microscopic parasite that is responsible for the majority of swimming pool illness outbreaks in the US with symptoms ranging from diarrhea to death. An outbreak this summer in Ohio sickened hundreds of swimmers. With that level of notoriety, it should come as no surprise that “Crypto” was the subject of much discussion at the recent National Swimming Pool Foundation’s annual World Aquatic Health Conference in Nashville (October 19-21). The figure at right illustrates the dominant role of “Crypto” in 35 reported recreational water illness outbreaks between 2005 and 2006.

Crypto lives in the intestines of mammals and is what is known as an enteric pathogen, spread through the feces of infected people and animals. According to the Centers for Disease Control and Prevention (CDC), Crypto can cause diarrheal disease in people two to ten days after they become infected. Swimming pool Crypto outbreaks start when fecal matter from an infected swimmer or animal contaminates pool water. Given that a single fecal event can release over one billion organisms into the water and ingesting as few as 10 or fewer organisms can cause infection in a healthy person,1 the disease potential of Crypto is both extremely high and easily observed once an outbreak begins. Symptoms usually last from one to two weeks, but may last longer in people with weakened immune systems. Infectious oocysts can be excreted for up to 60 days after gastrointestinal symptoms have ended. Death can result when the immunocompromised (e.g., young children, the elderly and the chronically ill) are infected.

Chlorine Resistance

Unlike the other waterborne pathogens represented in the pie chart above, Crypto is chlorine-resistant. This unique characteristic explains why it is the most common cause of illness in pool swimmers. Most waterborne pathogens are destroyed by chlorine, and many pools are adequately chlorinated to achieve that level of protection. In its infectious form, however, Crypto sports a thick, protective, outer shell known as an “oocyst.”

Filtering Crypto

In this year’s World Aquatic Health Conference’s “Advanced Filtration Science” symposium, University of North Carolina at Charlotte researcher and professor Dr. James Amburgey provided helpful perspective around the Crypto issue by noting that analytical testing for Crypto is expensive, and that often the pool management is unaware of its Crypto problem until there is an outbreak. His experiments show Crypto oocysts escape swim diapers within five minutes of a diapered child being in the pool. Additionally, research shows 8.3% of noninstitutionalized adults are fecally incontinent.2 Just one fecal “event” in a pool can release over one billion oocysts into the water!

Optimizing Filtration

Because chlorine disinfection is ineffective against Crypto at normal swimming pool levels, oocysts must be removed through filtration (or exposed to advanced disinfection units employing ozone or UV light). Dr. Amburgey stated that a typical swimming pool sand filter removes only about 25 percent of oocysts each time the water is filtered (typically every 4-6 hours). Fortunately, there are several chemical and design factors that can be tweaked to achieve much greater removal rates. For this, the researcher recommended all three of the following techniques already employed by the drinking water industry:

  • Slowing the rate of filtration (≤ 10 gallons per minute per square foot of filter area)
  • Increasing the filter depth (≥ 24 inches of 0.5 mm effective size sand)
  • Using coagulants (0.1 mg aluminum per liter of water with alum or polyaluminum chloride)

The first two factors make intuitive sense: Slowing the rate of pool water filtration and increasing the filter depth increase the odds of oocysts being caught in the matrix of a pool filter. Most importantly, however, Dr. Amburgey emphasized that coagulants dramatically enhance filtration. As filter media and oocysts are both negatively charged, there are no electrical attractions between them to enhance filtration. Positively charged coagulants added to swimming pool water, however, can effectively promote oocysts sticking to filter media. It is important to note that optimizing coagulation for Crypto removal can be complicated and is best left to researchers.

Other options suggested to enhance filtration include replacing sand with at least 18” of Ceraflow-70 (an ultrafine granular ceramic media), ceramic membrane filters, and the use of “precoat filters” where a woven material is precoated with at least 0.15 pound of diatomaceous earth (a fine powder) per square foot of filter area (forming a layer that is roughly 1/8” thick) that has pores small enough to trap Crypto particles. With pore sizes in the range of 1 micron (0.001 millimeter), diatomaceous earth can remove 99.99% of oocysts of diameter 4 microns in pool water.

Time will tell if swimming pool filtration is more widely optimized to help prevent future US Crypto outbreaks. As the recent World Aquatic Health Conference demonstrates, one thing is for sure: The right discussions are taking place.

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1 Yoder, J.S, Wallace, R.M., Collier, S.A., Beach, M.J. and Hlavsa, M.C., “Cryptosporidiosis Surveillance-United States, 2009-2010,” Morbidity and Mortality Weekly Report, September 7, 2012. On line, available: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6105a1.htm

2 Whitehead, W.E., Borrud, L., Goode, P.S., Meikle, S., Mueller, E.R., Tuteja, A., Weidner, A., Weinstein, M., Ye, W., (2009). “Fecal incontinence in US adults: epidemiology and risk factors,” Gastroenterology, 137(2): 512-7.