Spillover and Cascading Crises in Public Health and Water Systems: The Orlando Liquid Oxygen Shortage

In August 2021, COVID cases spiked in Florida with over 24,000 breakthrough cases per day making Florida the state with the highest increase at the time. Florida saw an increase in hospitalized COVID-19 patients during the last two weeks of August and became the 3rd state in the U.S. to exceed 3 million COVID cases. Not only did this impact public health, but it also created an unforeseen impact on the municipal water system. The surge in COVID cases created a surge in demand for treatment, one in which included liquid oxygen, used for respiratory therapy. Without liquid oxygen, ozone cannot be created and without ozone, the drinking water would be limited, leading to discoloration, a smell like rotten eggs, and questions about safety for consumption. Orlando officials issued an advisory requesting that residents reduced their frivolous water usage for at least two weeks. We use the Orlando case to explore the convergence, cascading and overlapping conditions of crises events. We argue that multiple events, interacting and overlapping will become increasingly common

Trends in Legionnaires\u27 Disease-Associated Hospitalizations, United States, 2006-2010

Background: Legionella pneumophila is a waterborne cause of both healthcare-associated and community-acquired pneumonia. Legionella pneumophila serogroup 1 is responsible for 80% of infections. There is currently limited published disease burden data on Legionnaires\u27 disease-associated hospitalization in the United States. Methods: In this study, we estimated the annual incidence of Legionnaires\u27 disease-associated hospitalizations in United States and identified demographic, temporal, and regional characteristics of individuals hospitalized for Legionnaires\u27 disease. A retrospective study was conducted using the National Hospital Discharge Survey (NHDS) data from 2006 to 2010. The NHDS is a nationally representative US survey, which includes estimates of inpatient stays in short-stay hospitals in the United States, excluding federal, military, and Veterans Administration hospitals. All discharges assigned with the Legionnaires\u27 disease International Classification of Diseases 9th Clinical Modification discharge diagnostic code (482.84) were included in this study. Results: We observed the annual incidence and number of Legionnaires\u27 disease-associated hospitalizations (per 100 000 population) in the United States by year, age, sex, race, and region. Over a 5-year period, 14 574 individuals experienced Legionnaires\u27 disease-associated hospitalizations in the United States The annual population-adjusted incidence (per 100 000 population) of Legionnaires\u27 disease-associated hospitalizations was 5.37 (95% confidence interval [CI], 5.12-5.64) in 2006, 7.06 (95% CI, 6.80-7.40) in 2007, 8.77 (95% CI, 8.44-9.11) in 2008, 17.07 (95% CI, 16.62-17.54) in 2009, and 9.66 (95% CI, 9.32-10.01) in 2010. A summer peak of Legionnaires\u27 disease-associated hospitalizations occurred from June through September in 2006, 2007, 2008, and 2010. Conclusions: Legionnaires\u27 disease-associated hospitalizations significantly increased over the 5-year study period. The increasing disease burden of Legionnaires\u27 disease suggests that large segments of the US population are at risk for exposure to this waterborne pathogen

Prevalence of Infection-Competent Serogroup 6 \u3cem\u3eLegionella pneumophila\u3c/em\u3e within Premise Plumbing in Southeast Michigan

Coinciding with major changes to its municipal water system, Flint, MI, endured Legionnaires’ disease outbreaks in 2014 and 2015. By sampling premise plumbing in Flint in the fall of 2016, we found that 12% of homes harbored legionellae, a frequency similar to that in residences in neighboring areas. To evaluate the genetic diversity of Legionella pneumophila in Southeast Michigan, we determined the sequence type (ST) and serogroup (SG) of the 18 residential isolates from Flint and Detroit, MI, and the 33 clinical isolates submitted by hospitals in three area counties in 2013 to 2016. Common to one environmental and four clinical samples were strains of L. pneumophila SG1 and ST1, the most prevalent ST worldwide. Among the Flint premise plumbing isolates, 14 of 16 strains were of ST367 and ST461, two closely related SG6 strain types isolated previously from patients and corresponding environmental samples. Each of the representative SG1 clinical strains and SG6 environmental isolates from Southeast Michigan infected and survived within macrophage cultures at least as well as a virulent laboratory strain, as judged by microscopy and by enumerating CFU. Likewise, 72 h after infection, the yield of viable-cell counts increased \u3e 100-fold for each of the representative SG1 clinical isolates, Flint premise plumbing SG6 ST367 and -461 isolates, and two Detroit residential isolates. We verified by immunostaining that SG1-specific antibody does not cross-react with the SG6 L. pneumophila environmental strains. Because the widely used urinary antigen diagnostic test does not readily detect non-SG1 L. pneumophila, Legionnaires’ disease caused by SG6 L. pneumophila is likely underreported worldwide

Assessing Boil Water Notices as Health-Risk Communication: Risk Perceptions, Efficacy, and Compliance during Winter Storm Uri

Winter Storm Uri was an extreme disaster that impacted much of the United States during February of 2021. Texas and Oklahoma were generally not prepared for such an event and experienced massive power grid failures. This led to cascading risks including water system disruptions and many boil water notices (BWNs). The breakdown of some communication channels and the inability to enact protective actions due to power outages, as well as travel limitations on public roads, complicated both dissemination and implementation. Under these conditions, a non-representative, cross-sectional, survey was collected to assess individuals experience BWNs and how perceived efficacy impacts compliance. The survey was performed in accordance methods approved by Institutional Review Boards at the University of Texas at Tyler (IRB-FY2021-129) and Wayne State University (IRB-21-02-3278 using Qualtrics XM (Qualtrics, Provo, UT). Participants were restricted to adults living in Texas or Oklahoma during February 14 to February 26, 2021 that were at least 18 years of age. Responses from adults (18+ years old) living in Texas and Oklahoma during the Winter Storm Uri were collected March 2 through April 21, 2021. Overall, there were a total of 893 respondents; 775 from Texas, 101 from Oklahoma (including Native American reservations), and 17 respondents that did not identify their location. 886 record dataset, results of survey Data dictionary: WHIRLid: Number identify a unique survey respondent (excluding previews); State: State or Territory; Q5IMPACTEDBYSTORM: Were you in an area impacted by the winter storm during approximately February 14th through the 26th?; Q7BWADURINGSTORM: Was your home under a boil water advisory or notice, or a do not drink order following the winter storm during this time period?; Q11RUNNINGWATER: Since the winter storm, did you experience a loss of running water?; Q12_1ELECTRICITY: During the time of the water advisory did you have: - Electricity to boil water; Q16_1LOWPRESSURE: Identify all of the conditions with drinking water in your home since the winter storm started on February 14th, 2021? - Low pressure/low flow; Q16_3DISCOLOR: Identify all of the conditions with drinking water in your home since the winter storm started on February 14th, 2021? - Discolored (e.g., red water); Q16_4BADSMELLING: Identify all of the conditions with drinking water in your home since the winter storm started on February 14th, 2021? - Water that smelled; Q16_6FROZEN: Identify all of the conditions with drinking water in your home since the winter storm started on February 14th, 2021? - Frozen pipes; Q35BWAPERCEPTIONS1: How would you rate the quality of the water at your faucet?; Q36BWAPERCEPTIONS2: Would you say you are generally satisfied or dissatisfied with the water at your faucet?; Q37rBWAPERCEPTIONS3: In your view, how safe or unsafe is the water at your faucet?; WQPerception: Water Quality Perception Scale based on AWWA Survey (Mean scores of Q35, Q36, and Q37r); RiskPerception: Risk Perception Scale based on Rimal and Real (2003) (Mean of Q38 and Q39); Q38SUSCEPTIBILITY: Susceptibility (Mean of scores from Q38_1SUSCEPTIBILITY1 and Q38_2SUSCEPTIBILITY2 ); Q38_1SUSCEPTIBILITY1: Compared to most people my age, I understand that my risk of getting a water borne disease is:; Q38_2SUSCEPTIBILITY2: The likelihood of my getting a water borne disease is:; Q39SEVERITY: Severity (Mean of scores from Q39_1SEVERITY1 and Q39_2SEVERITY2); Q39_1SEVERITY1: Water borne diseases are serious diseases that can cause harm.; Q39_2SEVERITY2: Water borne diseases are more serious than most people realize; Q40EFFICACYSCALE: Efficacy Scale (Mean of Q40RESPONSEEFFICACY and Q40SELFEFFICACY); RESPONSEEFFICACY: Response Efficacy (Sum of Q40_1-3); Q40_1RESPONSEEFFICACY1: Water advisories work in preventing water borne diseases.; Q40_2RESPONSEEFFICACY2: Following a water advisory is effective in preventing water borne diseases.; Q40_3RESPONSEEFFICACY3: If I follow a water advisory, I am less likely to get a water borne disease.; SELFEFFICACY: Self Efficacy (Sum of Q40_4-5); Q40_4SELFEFFICACY1: I am able to follow a water advisory to prevent getting a water borne disease.; Q40_5SELFEFFICACY2: Following a water advisory is easy to prevent getting a water borne disease.; Q40_6SELFEFFICACY3: Following a water advisory to prevent water borne diseases is convenient.; Q43AGE: Age Group; Q44RACE: Race; MinorInHouse: Does child under 18 live in your household?; GenderGroup: Gender; Q47FAMILYINCOME: Family Income; EducationGroup: What is the highest level of education you have received?; Q49EMPLOYMENT: Employment statu

Stormwater Dissolved Organic Matter: Influence of Land Cover and Environmental Factors

Dissolved organic matter (DOM) plays a major role in defining biological systems and it influences the fate and transport of many pollutants. Despite the importance of DOM, understanding of how environmental and anthropogenic factors influence its composition and characteristics is limited. This study focuses on DOM exported as stormwater from suburban and urban sources. Runoff was collected before entering surface waters and DOM was characterized using specific ultraviolet absorbance at 280 nm (a proxy for aromaticity), molecular weight, polydispersity and the fraction of DOM removed from solution via hydrophobic and H-bonding mechanisms. General linear models (GLMs) incorporating land cover, precipitation, solar radiation and selected aqueous chemical measurements explained variations in DOM properties. Results show (1) molecular characteristics of DOM differ as a function of land cover, (2) DOM produced by forested land is significantly different from other landscapes, particularly urban and suburban areas, and (3) DOM from land cover that contains paved surfaces and sewers is more hydrophobic than from other types of land cover. GLMs incorporating environmental factors and land cover accounted for up to 86% of the variability observed in DOM characteristics. Significant variables (<i>p</i> < 0.05) included solar radiation, water temperature and water conductivity

Linking source and effect : resuspended soil lead, air lead, and children's blood lead levels in Detroit, Michigan

This study evaluates atmospheric concentrations of soil and Pb aerosols, and blood lead levels (BLLs) in 367 839 children (ages 0-10) in Detroit, Michigan from 2001 to 2009 to test a hypothesized soil → air dust → child pathway of contemporary Pb risk. Atmospheric soil and Pb show near-identical seasonal properties that match seasonal variation in children's BLLs. Resuspended soil appears to be a significant underlying source of atmospheric Pb. A 1% increase in the amount of resuspended soil results in a 0.39% increase in the concentration of Pb in the atmosphere (95% CI, 0.28 to 0.50%). In turn, atmospheric Pb significantly explains age-dependent variation in child BLLs. Other things held equal, a change of 0.0069 μg/m3 in atmospheric Pb increases BLL of a child 1 year of age by 10%, while approximately 3 times the concentration of Pb in air (0.023 μg/m³) is required to induce the same increase in BLL of a child 7 years of age. Similarly, a 0.0069 μg/m³ change in air Pb increases the odds of a child < 1 year of age having a BLL ≥ 5 μg/dL by a multiplicative factor of 1.32 (95% CI, 1.26 to 1.37). Overall, the resuspension of Pb contaminated soil explains observed seasonal variation in child BLLs.7 page(s

Determining the relative importance of soil sample locations to predict risk of child lead exposure

Soil lead in urban neighborhoods is a known predictor of child blood lead levels. In this paper, we address the question where one ought to concentrate soil sample collection efforts to efficiently predict children at-risk for soil Pb exposure. Two extensive data sets are combined, including 5467 surface soil samples collected from 286 census tracts, and geo-referenced blood Pb data for 55,551 children in metropolitan New Orleans, USA. Random intercept least squares, random intercept logistic, and quantile regression results indicate that soils collected within 1. m adjacent to residential streets most reliably predict child blood Pb outcomes in child blood Pb levels. Regression decomposition results show that residential street soils account for 39.7% of between-neighborhood explained variation, followed by busy street soils (21.97%), open space soils (20.25%), and home foundation soils (18.71%). Just as the age of housing stock is used as a statistical shortcut for child risk of exposure to lead-based paint, our results indicate that one can shortcut the characterization of child risk of exposure to neighborhood soil Pb by concentrating sampling efforts within 1. m and adjacent to residential and busy streets, while significantly reducing the total costs of collection and analysis. This efficiency gain can help advance proactive upstream, preventive methods of environmental Pb discovery.8 page(s

Fast-Scan Deposition-Stripping Voltammetry at Carbon-Fiber Microelectrodes: Real-Time, Subsecond, Mercury Free Measurements of Copper

Elevated concentrations of hazardous metals in aquatic systems are known to threaten human health. Mobility, bioavailability, and toxicity of metals are controlled by chemical speciation, a dynamic process. Understanding metal behavior is limited by the lack of analytical methods that can provide rapid, sensitive, in situ measurements. While electrochemistry shows promise, it is limited by its temporal resolution and the necessity for Hg modified electrodes. In this letter, we apply fast-scan deposition-stripping voltammetry at carbon-fiber microelectrodes for in situ measurements of Cu­(II). We present a novel, Hg-free technique that can measure Cu­(II) with ppb sensitivity at 100 ms temporal resolution