What will you drink if you get thirsty enough? Cont'd

Pathogens, pathogens, pathogens . . .

Waterborne disease	Causative organism	Source of organism in water	Symptom
Gastroenteritis	Salmonella (bacteria)	Animal or human feces	Acute diarrhea and vomiting
Typhoid	Salmonella typhosa (bacteria)	Human feces	Inflamed intestine, enlarged spleen, high temperature; can be fatal
Dysentery	Vibrio cholerae (bacteria)	Human feces	Diarrhea: rarely fatal
Cholera	Vibrio cholerae (bacteria)	Human feces	Vomiting, severe diarrhea, rapid dehydration, mineral loss: often fatal
Infectious hepatitis	Virus	Human feces, shellfish grown in polluted waters	Yellowed skin, enlarged liver, abdominal pain: lasts up to 4 months, seldom fatal
Amebic dysentery	Entamoeba histolytica(protozoa)	Human feces	Mild diarrhea, chronic dysentery
Giardiasis	Giardia lamblia (protozoa)	Animal or human feces	Diarrhea, cramps, nausea and general weakness; lasts 1 week to 30 weeks, not fatal

Source: Reprinted by permission from Introduction to Water Treatment: Principles and Practices of Water Supply Operations, vol. 2, p. 284. Copyright 1984, American Water Works Association.

Giardiasis, the last condition on the chart, is caused by the most common pathogenic parasite in the United States (Levine and Craun 1990). Link http://www.waterandhealth.org/drinkingwater/12749.html

What else?

There are quite a few diseases that are of concern in a disaster situation, but we are concentrating on the water supply, post disaster threats. So, here are some other potential water borne risks . . .

1. Poliomyelitis (polio): With the use of an aggressive vaccine program and outbreak surveillance program, poliomyelitis has been radically controlled, but it could opportunistically make a come back if the water treatment system failed due to an earthquake. Poliomyelitis is caused by a waterborne viral infection. The virus lives in the throat and intestinal tract. It is most often spread through person-to-person contact with the stool of an infected person and may also be spread through oral/nasal secretions. Link http://www.waterandhealth.org/drinkingwater/12749.html

Polio can be imported from other countries by infected people. In the event of an earthquake, recent immigrants or visitors living in the poor sanitary conditions post disaster could be the mechanism of transmission and an outbreak of polio. From 1980 through 1999, there were 152 confirmed cases of paralytic polio cases reported in the US. While many of these cases were attributed to the use of live vaccines, eight of the 152 cases were acquired outside the United States and imported. Link http://www.cdc.gov/vaccines/vpd-vac/polio/dis-faqs.htm

History: Polio was one of the most dreaded childhood diseases of the 20th Century in the United States. There were usually about 13,000 to 20,000 cases of paralytic polio reported each year in the US before the introduction of the Salk inactivated polio vaccine (IPV) in 1955. Polio peaked in 1952 when there were more than 21,000 reported cases. The last cases of naturally occurring paralytic polio in the United States were in 1979, when an outbreak occurred among the Amish in several Midwestern states. Link http://www.waterandhealth.org/drinkingwater/12749.html

2. Cryptosporidium parvum: Cryptosporidium parvum is a parasitic protozoa transmitted through water. I mention this particular disease because it has caused problems in swimming pools through indirect person-to-person transmission. This is especially important as it has been suggested that the standard chlorination treatments used are insufficient against these durable and tiny oocytes. Link http://www.who.int/water_sanitation_health/dwq/en/admicrob5.pdf

3. Legionnaires hemophile: Although the "traditional" bacterial diseases of cholera and typhoid have largely been brought under control in this country, other microorganisms are constantly being identified and connected to waterborne illness. For example, the Legionnaires hemophile bacteria--the cause of legionnaires' disease-has recently been found in community water supplies (Stout et al. 1992), and tiny waterborne rotaviruses have been shown to be a major cause of acute gastroenteritis in infants and young children (Craun 1986). Link http://www.waterandhealth.org/drinkingwater/12749.html.

This list goes on, but I want to focus on the big names. So, changing gears let’s talk about water treatment.

Water treatment

Having said that, how much chlorine does it take to effectively disinfect drinking water? If you are prepared to treat drinking water in a disaster, 72Hours.org instructs you to – “Strain any large particles of dirt by pouring the water through layers of paper towels or clean cloth. Next, purify the water one of two ways:

• Boil – bring to a rolling boil and maintain for 3-5 minutes. After the water cools, pour it back and forth between two clean containers to add oxygen back; this will improve its taste.
• Disinfect – If the water is clear, add 8 drops (1/8 teaspoon) of bleach per gallon of water. If it is cloudy, add 16 drops (1/4 teaspoon) per gallon. Make sure you are using regular bleach— 5.25% percent sodium hypochlorite— rather than the “ultra” or “color safe” bleaches. Shake or stir, then let stand 30 minutes. A slight chlorine taste and smell is normal.” Link to 72Hours.org: http://72hours.org/water.html

So, what do water districts do? “The effectiveness of the chlorination process depends upon a variety of factors: chlorine concentration, contact time, water temperature, pH value, and level of turbidity (AWWA 1984). Disinfectant concentrations and contact times used by different water utilities vary widely, usually depending on the characteristics of the water being treated. Several states and advisory groups suggest minimum requirements or recommendations for these parameters, but there are no federal standards for them (Hoff and Akin 1986).” Link http://www.waterandhealth.org/drinkingwater/12749.html “Most municipal drinking water supplies maintain chlorine levels such that the concentrations of chloroform in the systems range from 0.02 to 0.05 milligrams per liter (Wilson 1980), well below the standard of 0.10 milligrams per liter that the EPA has set as a safe level for ingestion of Trihalomethane, (THM).” Link http://www.waterandhealth.org/drinkingwater/12749.html. Let’s say that you have a physical therapy swimming pool at your clinic as your only source of drinking water. What then? The same steps apply for this water source. No more than the EPA of 0.10 milligrams per liter or treat it by the gallon per the 72hours.org website. Here are some basic guidelines for pool treatment.

Basic Guidelines for Pool Treatment

Carefully read and follow the manufacture’s instructions printed on the chlorine treatment package. Test the water regularly – it’s a simple process to use a test kit. You want to maintain water balance by measuring:

• Free available chlorine (FAC), which should never fall below 1.0 ppm (parts per million)

• Monitor the total chlorine, to assure that combined available chlorine (CAC) levels are less than 0.2 ppm

• Monitor the pH level pH is to be kept between 7.2 and 7.8, indicating that the chlorine is working effectively

• Monitor the total alkalinity to make sure that pH levels stay steady

• Monitor the calcium hardness of the water to protect pool surfaces from corrosion.

How Much of What?

The guidelines set by the National Spa and Pool Institute are widely used, but to be certain, you should also check the health codes of the jurisdiction where you live. The chemicals a pool needs to maintain the required standards differ from pool to pool – and day to day. Keeping records to "get to know" a pool can help you interpret its characteristics and perform the correct task.

NATIONAL SPA AND POOL INSTITUTE Suggested Chemical Standards for Swimming Pools
Free chlorine, ppm	1.0 - 4.0
Combined chlorine, ppm	None
pH	7.2 - 7.8 (ideal range of 7.4 - 7.6)
Total alkalinity, ppm (for liquid chlorine, cal hypo, lithium hypo)	80 - 100
(for gas chlorine, dichlor, trichlor and bromine compounds)	100 - 120
Total dissolved solids, ppm	Not to exceed 1500 greater than at pool start-up
Calcium hardness, ppm	200 - 400
Cyanuric acid, ppm	30 - 50

Link http://www.waterandhealth.org/pool_spa/POOLTREATMENT101.php3

Let’s say you did have to drink that clinic’s physical therapy pool water . . .

Some people might be inclined to add more chlorine just to be safe. What happens though if you take pool water that was presumably treated already, but you decide to treat it again just to be cautious during a disaster? Here is something else to think about. . . Studies show that chlorine causes cancer and, predictably, too much more so. Consider this . . .

Side Effects of Chlorine

There are many known carcinogenic disinfectant byproducts formed by adding chlorine to drinking water called organochlorines. Regulating chlorinated drinking water is a problematic at best because of the many public health benefits of killing waterborne pathogens. “While the EPA denies that there is "conclusive" causation linking chlorinated drinking water and health effects, the point is not reassuring. A growing number of studies have linked chlorinated drinking water to cancer and reproductive harm in humans. The most respected cancer study is a compilation of 10 separate epidemiological studies on chlorinated drinking water and cancer known as the Morris study. It found disinfection by-products in chlorinated water to be responsible for 9% of all bladder cancers and 15% of rectal cancers in the U.S. This translates into 10,000 additional deaths per year for just these two organs, a figure the Morris researchers believe to be an under-estimate. Also, a 1998 California Department of Health Study found that pregnant women with high exposure to chlorinated drinking water nearly doubled their risk of miscarriage, from a rate of 9.5% to 16%. The at-risk group drank water with greater than 75 parts per billion trihalomethanes. Link to “Cancer On Tap: The Risk of Chlorinated Water” http://www.greensense.com/Features/Action/cancer_on_tap.htm

The Big Conclusion

As so many diseases are effectively controlled through the chlorination of water, it would be disastrous not to chlorinate the drinking water supply. If you are concerned about the carcinogenic effects of over chlorinating pool water, for example, consider boiling it instead, but understand that chlorination is the accepted industry standard for safe drinking water. Another consideration, in an emergency or a disaster, is that you may not have the ability to boil water so be sure to stockpile water purification tablets or regular bleach to ensure safe drinking water.

Enjoy your next effortless glass of water although you may now decide that ignorance is bliss!!!!!