The Blue Death

by Dr. Robert D. Morris

  Finally, the foundation of any forward-looking program is research. Ample funding from the public and private sector to develop innovative treatment technology and to conduct research to quantify known risks, identify emerging risks, and anticipate future threats to our water supply are essential as growing populations, evolving pathogens, and changing industries place new and unanticipated stresses on our water supplies.

  TERRORISM

  Everything I have discussed so far in this book focuses on the problem of incidental and accidental contamination of our water supply. Between the nineteenth century and the morning of September 11, 2001, those who are responsible for drinking water safety had maintained the same focus. Then, as the twin towers of the World Trade Center crumbled to dust and horror, so did all our assumptions about safety and risk.

  In the wake of the 9/11 attacks, EPA Administrator Christie Todd Whitman told reporters at a White House briefing, “[W]e are actually feeling very comfortable as far as water supplies are concerned, that it would be very difficult to carry out the kind of attack that could result in true health implications to a general population.” The executive director of the American Water Works Association rushed to join her, stating, “Most systems have so much water and such effective treatment mechanisms, that anything less than many tankers full of dangerous agents would be diluted and easily neutralized. It is hard to imagine that anyone would have the ability to deliver such quantities effectively and without detection.”

  One can only hope that this was political posturing intended to divert terrorist aim. As Richard G. Luthy, a professor of civil and environmental engineering at Stanford University and chair of the Water Science and Technology Board of the National Research Council, warned in a presentation to the House Committee on Science:

  I caution you to question very carefully comments I hear from officials that refer to “truck load” quantities of chemicals being necessary to cause harm because of dilution from the large volumes of water being handled. Well, this simply isn’t true…and all the more so if the goal is fear, anxiety, and disruption.

  In February 2002 four Moroccan men lay sleeping in an apartment in the Tor Bella Monaca district in the south of Rome. Preparations were almost complete. Carefully sealed containers held four kilos of a cyanide compound. Their trove of false passports and driver’s licenses would allow them to move freely and disappear into the population as needed. A map of Rome lay on the kitchen table. Notes and markings on the map highlighted the location of key points in the city’s water-distribution system paying particular attention to the location of the U.S. embassy. As the Italian antiterrorist squad burst in that morning, it appeared the men were only waiting for the precise moment to attack.

  Although the diligent efforts of the Italian police thwarted this attack before it could happen, an effective attack of the kind these men appear to have had in mind is possible and could have killed hundreds, to devastating effect. Al Qaeda operatives have in fact conducted extensive research on U.S. water supplies and their control systems and indicated that these are potential targets of their attacks.

  Much has been made of the risk from the airborne release of weaponized anthrax spores, but there is no more efficient way to deliver biological and chemical agents to every home and workplace than through a water pipe. Whitman and her advisers at the EPA suggested that the nature of our water supplies ensures that any effort to contaminate them would have almost no chance of causing serious harm. This line of thought focuses on the large storage reservoirs that hold vast quantities of water for months or even years. The resulting dilution and degradation would minimize the threat from any introduced pathogen or chemical. Water treatment plants would further reduce the low concentrations of pathogens that did make it into the water supply.

  This logic falls apart in the face of the dark brilliance that sends civilian airliners into skyscrapers. The experts have correctly described the strengths in the design of our water supply systems that have eliminated scourges such as cholera and typhoid from the memory of most Americans. Just as the terrorists conceived a plan built on the sliver of metal that could bypass our anti-hijacking measures, they are well aware of the strengths of our water supply systems and perhaps more aware than we are of their weaknesses.

  One evening, while I was attending a meeting in Washington, D.C., I shared dinner with a pair of experts from two major water utilities. In the course of the discussion, one of them swore me to secrecy, leaned across the table, and explained how one could contaminate a major portion of an urban water supply with relative ease. On the off chance that diabolical minds have not figured out the details, I will refrain from offering specifics on how a successful attack might be undertaken, but it will not require truckloads of poison. If we are to stop men who take down skyscrapers with box cutters, we must learn to think like them. An attack with the potential to kill hundreds, sicken thousands, and to cause millions if not billions of dollars in economic damage might require nothing more sophisticated than a small group of men with bags of manure.

  Our water supplies are vulnerable. The distribution system is the weakest point in the system. The thousands of miles of pipe are difficult to defend and there is nothing more than low levels of chlorine to protect us against contamination. That chlorine will not inactivate toxic chemicals and is ineffective against many pathogens. A recent study even showed that the amount of chlorine in our water mains would have little effect on anthrax spores. Utilities are busily working to harden these systems, but the simple matter of replacing hundred-year-old pipes already overwhelms them. One can only wonder if they are up to protecting this sprawling piece of our essential infrastructure.

  With drinking water and other potential targets, we must recognize that all the rules have changed and that ironclad protection against yesterday’s threats offers no guarantees of security today. Preparedness demands that we understand what a few determined men can accomplish with the simplest of tools when extremist beliefs ignite within them a profound disregard for their own lives and a fanatical intent to do harm.

  We do not consume water. We contaminate it. Growing populations and increasing competition for finite resources of all kinds pose the greatest threat to the future of humanity. Water is the ultimate resource. The world has water in abundance, but accessible, safe water is scarce and will become increasingly so as demand rises and the volume of wastewater increases. In the arid lands of the world, unsustainable water use has become routine and projections of the future built on the simplest of mathematics paint a stark picture of crowded, thirsty cities amid drained aquifers and disappearing rivers.

  In 1849, John Snow put forth the radical theory that cholera can spread through microscopic agents in drinking water. He was greeted with derision and disbelief, but that idea redefined the way we look at our drinking water and played a key role in making the modern mega-city viable. Koch and the microbiologists who followed refined his idea and set the stage for the engineers who would in turn create the infrastructure that made safe water possible. Soon the problem of contaminated drinking water seemed to fade.

  Over time, the solution disappeared as well. Like much of the critical infrastructure that makes cities possible, our water supply has dropped from view. We simply expect it to work as we focus our energy and attention on other problems. We do so at our peril.

  In a changing world, our water supply faces new and unanticipated threats, but the infrastructure resists change. Just as in Snow’s day, those who disturb the status quo and point toward flaws in existing systems and the beliefs on which they are based must contend with opposition born of the obstinacy of entrenched ideas and the cost of change. That resistance ultimately arises not from the drinking water industry, but from us. We provide the tax dollars and the political will that makes change possible.

  Katrina reminded us that we should never dismiss a threat simply because nothing exactly like it has ever happened before. Levees that rest atop the pilings of den
ial will inevitably fail.

  Katrina also showed us what can happen if we view our infrastructure in isolation. Our efforts to manage the Mississippi River led directly to the steady erosion of the Mississippi Delta and the disappearance of the barrier that protected New Orleans from storm surges. Many experts have suggested that this process may lead to a scenario in which New Orleans becomes a fortress against nature, an island served by pumps and surrounded by immense levees, a last barrier against reality.

  We must protect the safety of our water, but doing so will require more than fancy treatment plants and new pipes. If we do not protect and preserve our waterways, the most advanced filter will not protect us. If we do not provide pure water and sanitation for the world’s poor, their misery and disease will make their way to our doorstep. If we do not take on the difficult, politically treacherous task of developing realistic plans for sustainable water supplies, we will find a world at war over water. If we do not take on the stewardship of our planet with evangelistic fervor, we will accumulate an ecological budget deficit that future generations can never repay.

  EPILOGUE

  STRATEGIES FOR SAFE WATER: A MODEST PROPOSAL

  Thousands have lived without love, not one without water.

  W. H. AUDEN

  Given the present and future threats to the safety of our drinking water, how do we protect ourselves? The following should be part of any strategy to provide full protection of water supplies in the developed world against present and future threats.

  1. Provide political, financial, and technical support for an aggressive campaign to make safe water universally available. Unsafe water is a global disaster with devastating consequences for the world’s poor, particularly their children. A multinational effort to provide safe water to the developing world will not only give these children a chance and improve the overall health of their families but will also improve the safety of our own drinking water by reducing the chance that new waterborne pathogens will emerge from these compromised supplies.

  2. Aggressively improve source water protection. This is the most important element of a safe water supply. Critical to this effort is tighter integration between agencies regulating surface water contamination and those regulating water treatment. The federal government can and should play a key role in helping break down political barriers to this effort, particularly when watersheds include multiple states.

  3. Move toward advanced technology for water treatment. We must continue to explore and develop alternatives to the hundred-year-old technology still employed by most treatment plants in the United States. At a minimum, plants producing water that poses health risks and aging plants approaching the end of their design life should be replaced with more technologically advanced systems with the capacity to remove both chemical and microbial contaminants, particularly when source water is compromised. These improvements should include a vigorous effort to develop and implement alternatives to chlorination such as ozonation.

  4. Mandate the use of multiple barriers. Multiple barriers are essential to the long-term success of water treatment. They are particularly important as a tool to control emerging pathogens. Their use must be part of water treatment, not only in the United States but also in the developing world.

  5. Repair and replace our aging drinking water infrastructure, particularly the distribution system. Repairing and replacing our aging infrastructure for drinking-water treatment and distribution will require hundreds of billions of dollars. Making this happen will require a concerted campaign of public education that should begin sooner rather than later. Repairs to the distribution system should seek to minimize its vulnerability to terrorist attack.

  6. Make point-of-use filters an integral part of our water supply system.

  Utilities should consider the universal installation of point-of-use water filters (i.e., filters located in homes and businesses at the point of use, also known as POU filters) as part of a complete multibarrier system. These systems could be selected, installed, and maintained by utilities or their subcontractors. Utilities should consider renting or leasing these systems to their customers in order to ensure that income is not a major barrier to their use. *

  7. Make improving water quality proactive rather than reactive. Water suppliers must move from a mode of operation driven by mere adherence to regulation and response to disaster to one in which improvement of water safety is a constant process. Active, ongoing oversight of drinking water by the public health community and well-funded research on water treatment and the risk of waterborne disease are essential to this process.

  BIBLIOGRAPHY AND NOTES

  A selection of some of the most useful references used in preparing this manuscript is included below. Additional references, images, links, and other information relevant to the book are available at: http://thebluedeath.com.

  CHAPTER 1: THE BLUE DEATH

  As mentioned in the book, John Snow never married and died relatively young. This may explain why there is no surviving record of his personal life. As a result I had to rely on his published work and the publications of his contemporaries to draw a picture of Snow by inference. A few general references on Snow and on cholera proved particularly helpful.

  General Snow References

  The best starting point for looking further into John Snow is the wonderful Web site assembled by Dr. Ralph Frerichs, at the UCLA School of Public Health: http://www.ph.ucla.edu/epi/snow.html.

  Not just the best Web site on Snow, this is one of the best Web sites I have encountered on any subject. Among its many resources is a digital library of all Snow’s publications (unfortunately, a feature not added until after this book was completed).

  By far the most complete biography of Snow published to date is that assembled by a group at Michigan State University. It has a trove of information about Snow:

  Vinten-Johansen, P., H. Brody, N. Paneth, S. Rachman, and M. Rip Cholera, Chloroform, and the Science of Medicine: A Life of John Snow. Oxford: Oxford University Press, 2003.

  The book has a recently added Web site with many relevant publications and images at http://www.matrix.msu.edu/~johnsnow/index.php.

  Some of the most useful articles on Snow are:

  Froggatt, P. “John Snow, Thomas Wakley, and The Lancet.” Anaesthesia 57, no. 7 (July 2002): 667–75.

  McLeod, K. S. “Our sense of Snow: the myth of John Snow in medical geography.” Social Science and Medicine50, nos. 7–8 (July 2000): 923–35.

  Richardson, B. W. “John Snow, M.D., a representative of medical science and art of the Victorian era.” British Journal of Anaesthesia 24, no. 4 (1952): 267–91 (reprinted from The Asclepiad, 1866).

  Snow, S. J. “John Snow MD (1813–1858). Part I: A Yorkshire childhood and family life.” Journal of Medical Biography 8, no. 1 (February 2000): 27–31.

  ———. “John Snow MD (1813–1858). Part II: Becoming a doctor—his medical training and early years of practice.” Journal of Medical Biography 8, no. 2 (May 2000): 71–77.

  ———. “Commentary: Sutherland, Snow and water: the transmission of cholera in the nineteenth century.” International Journal of Epidemiology 31, no. 5 (October 2002): 908–11.

  I am indebted to Dr. David Zuck for sharing his unpublished biography of Charles Empson with me.

  General References on Cholera

  For a history of cholera in Europe with a focus on England: Longmate, N. King Cholera: The Biography of a Disease. London: Hamish Hamilton, 1966.

  For a history of the medical perspective on cholera: Pelling, Margaret. Cholera, Fever and English Medicine, 1825–1865. New York: Oxford University Press, 1978.

  The book that inspired John Snow to become a vegetarian and to drink distilled water is a bizarre read and an interesting window into what it meant to be a vegetarian in Victorian England: Newton, John Frank. The Return to Nature; or, A Defence of the Vegetable Regimen: with Some Account of an Experiment Made during the Last Three or Four Years in the Author’s F
amily. Pt. the 1st. London: Cadell and Davies, 1811.

  The cholera outbreak in Sunderland is described in: Ainsworth, William. Observations on the Pestilential Cholera (Asphyxia Pestilenta) as It Appeared at Sunderland in the Months of November and December, 1831 and on the Measures Taken for Its Prevention and Cure. London: Messrs. Ebers and Co., 1832; and Haslewood, William. History and Medical Treatment of Cholera, as It Appeared in Sunderland in 1831, Illustrated by Numerous cases and Dissections. By W. Haslewood and W. Mordey. London: Longman, Rees, Orme, Brown, Green, & Longman, 1832.

  The subsequent outbreak in Newcastle and Gateshead including detailed descriptions of the treatments offered is described in: Greenhow, Thomas Michael. Cholera, as It Recently Appeared in the Towns of Newcastle and Gateshead; Including Cases Illustrative of Its Physiology and Pathology, with a View to the Establishment of Sound Principles of Practice. Philadelphia: Carey & Lea, 1832.

  CHAPTER 2: SNOW ON CHOLERA

  For the debate in the medical community on cholera when Snow first developed his theory on drinking water see:

  The London Medical Gazette, vols. 1–48 (nos. 1–1256); December 8, 1827–December 26, 1851.

  Royal College of Physicians of London. Cholera Committee. Report on the Nature and Import of Certain Microscopic Bodies Found in the Intestinal Discharges of Cholera, on the 17th Oct., 1849. London, 1849.