Legionnaires’ death puts city on alert as 15 critical

HEALTH chiefs were today bracing themselves for a fresh wave of legionnaires’ cases after it emerged one man had died from the disease while 15 others were critically ill in hospital.

NHS consultant Dr Duncan McCormick refused to rule out the prospect of more deaths as experts battle to identify the source of what is now Scotland’s worst ever outbreak of the disease.

Investigations have centred on four industrial cooling towers in west Edinburgh, including those at Burton’s Foods off Calder Road, pharmaceutical firm MacFarlan Smith in Gorgie and the North British Distillery.

Health Secretary Nicola Sturgeon was chairing an urgent summit with senior emergency personnel today in a bid to take control of the outbreak.

People showing symptoms of the disease are being asked if they attended Hearts’ Scottish Cup victory parade, any Jubilee street parties or other large gatherings in a bid to discover any links between those with the bug.

But NHS Lothian said the only common factor established so far was that all those affected lived or worked in the Dalry, Gorgie or Saughton area.

City resident Leanne McLaren has told friends on Facebook how her father was struck down with the illness several days ago and had been recovering in the bed next to the man who died.

She wrote: “It couldn’t get any worse, they have found the legionella bug in his body [legionnaires’] so that’s what the pneumonia is. He’s on a ventilator now and the public health board will be investigating to find out where he got it.”

In a later post she said her father was being moved to St John’s Hospital in Livingston as the ERI created room to cope with the influx of new legionnaires’ patients.

But after the illness claimed its first life she said medical staff had reversed that decision.

Patients are being treated at three hospitals – ERI, St John’s and the Western General. Last night the ERI enacted its its emergency plan which involves clearing some wards and using them as intensive care units.

As well as 17 confirmed cases, a further 15 people are suspected to have contracted the illness.

Thirteen men and two women aged between 33 and 74 are in a critical condition and are being treated in intensive care in hospitals in Lothian. One man has recovered and has been discharged.

The patient who died was a man in his 50s with an underlying health condition.

An incident management group, including officials from the Health and Safety Executive and the city council’s environmental health department, met again yesterday afternoon to discuss progress on efforts to establish the source of the outbreak.

Samples have been taken from cooling towers at four industrial sites thought to be the most likely source, but the results will take up to ten days. Even then, it may not be possible to confirm where the disease came from.

In the meantime, the towers have been flushed with a high-chlorine solution to kill the legionella pneumophila bacteria, which cause the disease.

With an incubation period of up to 14 days, it is thought that more people could already be infected and not yet be showing symptoms.

Dr McCormick, consultant in public health medicine for NHS Lothian, said he hoped the single fatality so far would be an “isolated case” but could not “guarantee it”. And he added that investigations “frequently do not find the source”.

“The disease frequently affects people who have underlying health issues, particularly men who smoke, drink or have chronic illnesses such as liver disease or bronchitis,” he said.

“The average amount of cases in Edinburgh each year is around five. They usually present themselves one at a time. Given that we now have 17 confirmed cases, that’s a very uncommon event – it’s the largest cluster that I have ever come across. The incubation period is between two and 14 days, the average is five and a half days.

“If we are correct about the source of the outbreak being the cooling towers, we would expected to see people with symptoms present themselves over the next five or six days, followed by a decline in the number of cases. But we would expect an increase in the number of cases before then.”

A Scottish Government spokesman said: “The Scottish Government is working closely with NHS Lothian and other relevant agencies during these ongoing investigations.

“The Health Secretary, who has been kept closely informed of all developments, will chair a meeting of the Scottish Government’s resilience committee today, at which she will be further updated on the situation and on the progress of efforts to identify the source.”

Timeline

Thursday, May 28: The first case of legionnaires’ is identified.

Monday, June 4: The Evening News reports that three men are being treated in intensive care, and another in a high dependency unit, with four other suspected cases. All cases are from the south-west of the city. NHS Lothian’s health and safety executive meet with the council’s environmental health department and Scottish Water to discuss the city’s response.

Tuesday, June 5: Health chiefs warn the outbreak is likely to get worse before it gets better after confirmed cases rises to six. Efforts to track the source focus on industrial cooling towers in Dalry, Gorgie and Saughton.

Later that evening, it is revealed a man in his 50s with underlying health conditions has died at the ERI. Confirmed cases rise to 17 with a further 15 suspected, the majority linked to Dalry, Gorgie and Saughton – 13 men and two women aged between 33 and 74 are in a critical condition. The source continues to be investigated.

Heed the warning signs

The symptoms of legionnaires’ disease are similar to those of flu.

The illness usually begins with mild headaches and muscle pain, followed by the onset of more severe symptoms, including a high fever of 40C or above, more severe muscle pain and chills.

Once the bacteria begins to infect the lungs, patients may also experience a persistent cough, usually dry at first but which may develop into coughing up mucus or blood, shortness of breath and chest pains.

About 30 per cent of people will also experience gastrointestinal symptoms including nausea, vomiting, diarrhoea and loss of appetite, and about half will experience changes to their mental state, such as confusion.

Older people, particularly men, heavy smokers and those with other health conditions are at greater risk of contracting the disease.

The disease is contracted by breathing in small droplets of contaminated water.

When doctors are aware that the illness is present in the community, they have a much better chance of diagnosing it earlier.

Misdiagnosis ‘beggars belief’ says patient’s wife

THE wife of a patient fighting for his life with legionnaires’ disease has told how doctors initially sent him home with tablets for an upset tummy.

Chartered surveyor Rick Gibb, 54, from Chesser, was struggling to breathe when he went to Edinburgh’s Western General Hospital. But after a brief consultation he was given imodium and told to go home and rest. The next day he had to be rushed into intensive care at Edinburgh Royal Infirmary.

His wife Margaret, 61, said: “I thought he was a goner. He was absolutely ashen. I have seen a lot of dead people in my time and he was that same colour.

“I thought I was coming home from the hospital a widow.”

And she is furious his symptoms were not taken more seriously.

She said: “If you can’t breathe there is something wrong with you and it beggars belief that he was sent home with something for diarrhoea. But you take it for granted that doctor knows best. The doctors now say he has legionnaires’ disease, pneumonia and an infection in both lungs.”

NHS Lothian said they could not discuss the case.