Malady in Manhattan

Legionnaires' disease strikes

Immediately after investigating the recent outbreak of Legionnaires' disease at Indiana University, the indefatigable detectives of the U.S. Center for Disease Control in Atlanta had to respond to yet another alarm. The mysterious malady had erupted in Manhattan's crowded garment district. There, within a few city blocks, at least 75,000 men and women are jampacked by day, their indoor working conditions made bearable only by generous use of air conditioning.

When New York City hospitals began suspecting Legionnaires' disease as the cause of the unusual type of pneumonia from which six garment-district patients were suffering, they sent blood samples first to the CDC laboratory in Manhattan for analysis and then to Atlanta. The CDC confirmed the diagnosis. By then two victims had died, both deliverymen, who trundle racks loaded with dresses through traffic-choked streets. Investigators looking for clues to the source of the outbreak instantly checked to see if the two worked for the same shop; they did not, but were employed on the same block. A woman worker from a third shop near by had died, probably a victim of Legionnaires' too. With nothing to indicate a single, discrete source of infection, the only recourse was to sanitize the entire neighborhood.

The city's government acted swiftly. Mayor Edward Koch appointed his deputy director of operations, Paul Caswell, to head a task force coordinating the efforts of city agencies combatting the disease. Working in what resembled a war room, Caswell ordered air-conditioning systems in the area shut off; the CDC's investigators had traced the earlier Indiana outbreak to an air conditioner with a bacteria-contaminated water supply. City inspectors swarmed through the district, taking water samples from air-conditioning systems, and draining and sterilizing rooftop tanks where the water was stored. Below, sanitationmen hosed down the streets and added a dash of mild pine oil to sweeten the smell.

Caswell also set up two telephone hot lines for New Yorkers worried about having Legionnaires' disease to call in and discuss their symptoms. Almost 16,000 hot-line calls were logged in eight days. Health department technicians in a mobile van took more than 300 blood specimens from people who thought they might be infected. One surprising result: many of those working in the garment district were found to have antibodies against the bacterium now known to cause the disease, indicating that they had been infected--without suffering any apparent symptoms--some time ago. This, in turn, suggested that the Legionnaires' bug had been around the district for a while. Hundreds of air and water samples were also checked for presence of the elusive bacteria. All tests proved negative, and the program has now been discontinued.

As some cases of Legionnaires' disease were added to the list while other suspected cases were struck off, the number of possible victims bobbled up and down around the 100 mark, with only eight positively confirmed. Last week Koch's commandos and the CDC detectives agreed that the outbreak had apparently passed its peak. The workers, glad to have the area scrubbed down and cleansed as never before, were jubilant as air conditioning was turned on again--an event that generated a block-long sigh of relief in Macy's huge department store, which borders the district. At week's end rack carts carrying fall fashions jockeyed through traffic and pedestrians as usual. As mid-September buyers swarmed in, the garment district's business was back to normal. qed

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