When you finally return to work after the lockdown, coronavirus might not be the only illness you need to worry about contracting at the office.
Office buildings once filled with employees emptied out in many cities and states as shelter-in-place orders were issued. These structures, normally in constant use, have been closed off and shut down, and health risks might be accumulating in unseen ways.
“The buildings aren’t designed to be left alone for months,” said Andrew Whelton, an associate professor of civil, environmental and ecological engineering at Purdue University.
Dr. Whelton, other researchers and public health authorities have issued warnings about the plumbing in these buildings, where water may have gone stagnant in the pipes or even in individual taps and toilets. As lockdowns are lifted, bacteria that build up internally may cause health problems for returning workers if the problem is not properly addressed by facilities managers. Employees and guests at hotels, gyms and other kinds of buildings may also be at risk.
The biggest worry is Legionella pneumophila. The bacteria can cause Legionnaires’ disease, a respiratory condition. It leads to death in about one in 10 cases, according to the Centers for Disease Control and Prevention. The National Academies of Science, Engineering, and Medicine estimates that over 52,000 Americans suffer from the disease each year.
A single small outbreak can sicken many people. During the water crisis that started in Flint, Mich., in 2014 after the city changed its water source and officials failed to inform the public of water quality problems, many people became sick. The crisis was linked to the deaths of 12 people from Legionnaires’ disease.
After an outbreak at the North Carolina Mountain State Fair last September, 135 people contracted the disease and four died, according to the state’s department of health and human services. Investigators blamed a hot tub exhibit that sent Legionella through the air and was inhaled by passers-by.
Most worrying, Legionnaires’ disease tends to affect people with compromised immune systems.
“Covid patients and survivors could be more vulnerable to this, so when they go back to work we might be concerned about another infection,” said Caitlin Proctor, a postdoctoral fellow at Purdue who, along with Dr. Whelton conducted a study that has been accepted for publication in the journal AWWA Water Science examining risks from water stagnation during the coronavirus lockdown.
Once forming in a building’s plumbing, Legionella can be dispersed through the air when toilets are flushed. Even turning on taps, as employees wash their hands to limit the spread of the coronavirus, can send water droplets into the air that carry Legionella.
Typically, facilities managers reduce the risk of Legionella and other bacteria by pouring small amounts of disinfectant into a building’s water systems. But when the water is left stagnant for too long, the disinfectant disappears.
“Even just after a weekend, disinfectant can be gone in some buildings and the water is vulnerable to contamination,” Dr. Whelton said.
Facilities staff can also flush out old water and bring in a new and fresh supply. Or they can send a high dose of disinfectant through the building and raise temperatures to kill the microbes.
Shutdowns in the U.S. began in mid-March, meaning some buildings have now been closed for two months. And the researchers say that the consequences of long-term water stagnation are relatively unknown.
“We haven’t really done studies on monthslong stagnation,” said Dr. Proctor. “The ecological system may change. So while we’re looking at these organisms, maybe other organisms pop up.”
William Rudin, C.E.O. and co-chairman of Rudin Management Company which manages 16 commercial office buildings in New York, said his staff is being careful and cautious in their approach to reopening.
“Our engineers go through the building testing systems all the time,” he said. “That’s standard procedure.”
One problem for some property managers may be inconsistent and incomplete guidance from regulators and health authorities. Dr. Proctor and Dr. Whelton’s study assessed 21 sets of guidelines developed around the world since the pandemic began, including the C.D.C.’s and 11 from states and counties.
Frequently Asked Questions and Advice
Updated May 20, 2020
How many people have lost their jobs due to coronavirus in the U.S.?
Over 36 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Is ‘Covid toe’ a symptom of the disease?
There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.
Can I go to the park?
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
How do I take my temperature?
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Should I pull my money from the markets?
That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.
How can I help?
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
“Not all of the guidelines are created equal,” said Dr. Proctor. “The original C.D.C. guidelines only covered certain systems.”
Because the effects of long-term water stagnation are so little understood, most of the guidelines are based on preventive measures and may not directly address reopening after long-term shutdowns.
“They all go different ways,” said Michèle Prévost, a co-author of the study and the industrial chair of drinking water on the Natural Sciences and Engineering Research Council of Canada. “It’s not ill-intended, there’s not that much evidence to guide our choices.”
Unfortunately many of the public health officials who would normally be tackling these issues and getting information out are currently focused on responding to the spread of the coronavirus.
“Health officials are overstretched and have conflicting information,” said David Dyjack, executive director of the National Environmental Health Association. “Health officials simply cannot keep up. Public health is being asked to do things it’s never had to do before.”
Even if only a small portion of buildings have problems, with so many reopening at once, the researchers fear there will be more outbreaks than usual.
“Not every building will have issues but based on what we know, enough of them probably will,” Dr. Proctor said.