Legionnaire's Disease

May 12, 2020

On July 21, 1976, the American Legion opened its annual three-day convention at the Bellevue-Stratford Hotel in Philadelphia, Pennsylvania. The American Legion is described as an organization of U.S war veterans headquartered in Indianapolis, Indiana. More than 4,000 Legionnaires attended, mostly men.

The event was to commemorate the bicentennial of the declaration of independence

It was supposed to be a huge celebration and an event full of joy, however, things did not fo as they had planned. 600 Legionnaires stayed at the Bellevue-Stratford Hotel, which at the time was considered the best lodging in Philadelphia. After the event, some of the attendees started to complain of pneumonia-like symptoms such as high fever, coughing and chest pain.

Ray Brennan, a 61-year old Legionnaire and retired US Air Force captain returned home from the event complaining of feeling tired. Three days after being home, on July 27th, Ray died of an apparent heart attack. On July 30th, Frank Aveni, another attendee of the event, also died of an apparent heart attack. Three other legionnaires and event attendees died this day. On August 1st, only 24 hours later, six more legionnaires died. All men were 39-82 years old and had all complained of tiredness, chest pains, lung congestion and fever topping 107 degrees!

Dr. Sidney Franklin who was a physician at the Philadelphia V.A Hospital began treating a few of his patients for shortness of breath and abnormal cases of pneumonia.

By August 2nd four of his patients were dead. Dr. Franklin began to notice a pattern and decided to contact the CDC to help investigate the cause. He was concerned that the men might have contracted swine flu, interestingly enough the country was already concerned about a nationwide swine flu epidemic. The Gerald Ford administration began making plans to vaccinate all Americans against a new strand of flu known as the Swine Flu.

By August 15th, many more attendees had fallen quite seriously ill, and 29 had been confirmed dead. Interestingly enough, a few other cases had popped up, a bus driver, some pedestrians that had walked past the hotel and a hotel air conditioner technician. The CDC began its investigation, one of the largest ever. All causes were being investigated, bioterrorism, foul play, microorganisms, and toxins. In a Morning Call article, Dr. David Spencer who was the director of the federal Center for Disease Control in Atlanta at the time said “What we know is really what we don’t know. It’s possible we'll never know.” So they were very concerned and very confused about what was going on. This was something that they had never seen before and considered it a “new” bacterium. He said that for a person to be considered to have Legion Fever, they must have been attendants at the convention, had a fever over 102 and evidence of pneumonia.

Although officials were encouraging the public to remain calm, they themselves were very concerned that this would become a, quote, “medical catastrophe”. Because they had not found a cause quickly, the public's imagination ran wild. People thought the cause might be domestic terrorism through chemical or microbiological means. Some thought it was a CIA experiment, others thought it might be a hoax to encourage people to get the swine flu vaccine.

In September the investigation shifted from an external cause such as poisoning to the hotel itself. They tested everything, carpets, wallpaper, air conditioning units, plastics, soap, and paper just to name a few. Microbiologist Joseph McDade had initially thought the cause was viral, but truly he didn’t know what it was.

During the Christmas season of 1976, Joseph decided to take a break and go to a holiday party. The party was not as relaxing as he had hoped though, one of his superiors criticized him for not yet finding the cause of the mysterious illness. Joseph was now more determined than ever and went back to the lab where he continued testing. Joseph was able to find the cause of the illness, in January of 1977. He injected guinea pigs with lung tissue from affected patients and that's when he noticed something. He found a red, rod-shaped organism, this was what was causing the illness. McDade had never seen anything like it before. Although the CDC had responded quickly to the outbreak, as did the Pennsylvania Health Department, it took six months for the cause to finally be discovered.

Investigators initially thought this “new” bacterium had been growing in the hotel refrigerators but it wasn’t until a second outbreak in 1977 that the true cause became known

Breeding in the cooling tower of the hotel's air conditioning system was a bacterium which they named Legionella. The bacteria aerosolized and spread through the air conditioning and infected people when they breathed it in. The cause behind the growth of Legionella Pneumophila was suspected to be the rapid heat change in the Philadelphia area. It had been super hot all of a sudden so when they turned the AC on the bacteria began to travel inside the hotel as well as outside the entrance.

All in all the outbreak reached 221 people and killed a total of 34, mostly men but there were a few women. It was known as one of the worst U.S medical tragedies of the 20th century.

After the identification of the epidemic and because of the national outrage, Congress held hearings and the Bellevue-Stratford Hotel was forced to permanently close. Now that they knew what the disease was and how it presented, they decided to work backward in time and see if they could find any more instances of the disease.

The first domestic epidemic they found was at the Hormel Foods Corporation meatpacking plant in Austin Minnesota in 1957. 78 people developed pneumonia. In 1979 survivors of the illness were tested and it was discovered that they had elevated levels of antibodies to L. pneumophila in their blood, leading investigators to believe that the cause had been the plants cooling tower.

In 1965 at St. Elizabeth’s Psychiatric Hospital in Washington DC, 81 patients developed pneumonia and 14 of them died. It was assumed that the cause was the lawn sprinkling system.

Believe it or not, the 1976 outbreak was not the first time this happened Bellevue-Stratford Hotel, although not as many people were affected. In September of 1974, the hosted the Independent Order of Odd Fellows out of 1,500 attendees, 20 developed pneumonia and two died.

In Spain, over a span of 7 years between 1973 and 1980, at least 150 tourists who stayed in the Rio Park Hotel contracted pneumonia. The source was proven to be the portable water system.

In more recent years, 1981-1997 at least 250, patients, visitors, and employees of the Los Angeles Wadsworth Veterans Administration Hospital died of Legionnaires Disease. The cause was also their portable water system.

According to the CDC Legionnaires has been on the rise since the 2000s, there were 10,000 reported cases in 2018. They say that the number is most likely low as the disease is most likely underdiagnosed.

This case was covered in the Forensic File episode called “Legionnaires Disease”

Bob Dylan wrote a song called “Legionnaires disease”, here’s the first verse

Some say it was radiation, some say there was acid on the microphone

Some say a combination that turned their hearts to stone

But whatever it was, it drove them to their knees

Oh, Legionnaire’s disease

Resources:

https://www.cdc.gov/legionella/about/history.html

https://en.wikipedia.org/wiki/1976_Philadelphia_Legionnaires%27_disease_outbreak

https://www.legionnairesdiseasenews.com/2017/07/look-back-1976-legionnaires-disease-got-name/

https://www.nytimes.com/2006/08/01/health/01docs.html

https://www.newspapers.com/image/276146481/?terms=Philadelphia%2Bfever