TTC cooling tower pinpointed as outbreak source

Toronto Public Health (TPH) has identified a cooling tower at the Toronto Transit Commission's (TTC) Hillcrest Complex as the source of a recent Legionnaires' disease outbreak in the city's west end. In a news release, TPH said environmental samples from the tower matched a clinical sample from a confirmed case, according to a report by CBC News and repeated by other outlets.

The outbreak involved six confirmed cases among people who live, work in, or visited an area within about one kilometre of the intersection of Bathurst and Dupont streets. Symptoms developed between July 2 and July 26, and TPH reported no deaths among the cases.

"The affected cooling equipment was taken offline as soon as it was identified, and remediation measures are being undertaken in accordance with public health guidance," said Dr. Shima Shakory, TPH's associate medical officer of health, in the release as reported by CBC.

Dr. Michelle Murti, TPH's Medical Officer of Health, said there is no longer a risk of Legionella to the community. The TTC worked closely with health officials throughout the investigation, and the affected equipment was shut down, according to reports from CBC, CP24, and Global News.

How Legionnaires' disease spreads

Legionnaires' disease is caused by Legionella bacteria, which occur naturally in water sources and can also be found in hot tubs, sprinkler systems, humidifiers, and decorative fountains. People contract the disease by breathing in small droplets of water containing the bacteria, according to reports from CP24 and Global News.

The disease does not spread from person to person, officials said. As Dr. Murti explained to CBC, cooling towers are a common source of infection because they are large water sources with heated water that sprays mist over a wide area. That mist can travel up to two kilometres, which is how people become exposed.

Dr. Isaac Bogoch, an infectious diseases specialist speaking to CityNews, echoed that most cases come from inhaling bacteria from an environmental or human-made source, with HVAC systems and cooling towers among the most common. He stressed that not everyone exposed to the bacteria will become ill.

Possible link to long-term care home outbreak

TPH also identified a possible epidemiological link between the Bathurst-Dupont outbreak and a separate outbreak at Castleview Wychwood Towers, a long-term care home in the same area. That earlier outbreak involved five confirmed cases, as of mid-July. No new cases have been reported at the home, according to CBC.

Expert perspective: rarity and public risk

While TPH's Tuesday release confirmed the cooling tower as the source, earlier reporting by CityNews on Monday noted that the source had not yet been confirmed. Dr. Bogoch told CityNews that Legionnaires' outbreaks are uncommon, and it is even more rare for an entire intersection to be flagged as a hotspot for possible exposure. He added that while outdoor contamination is possible, it is less common than indoor sources.

Prevention and risk factors

People at higher risk for Legionnaires' disease include those over 50, smokers, people with chronic diseases or compromised immune systems, and it is more common in men. The disease can cause severe pneumonia, with symptoms like fever, cough, and shortness of breath, which can be difficult to distinguish from other types of pneumonia. Most doctors prescribe antibiotics that cover Legionella.

TPH has offered guidance to reduce risk, including setting hot water heaters to at least 50°C (122°F), running showerheads and taps on low for three minutes after periods of non-use, using distilled or sterile water in humidifiers and nebulizers, and properly maintaining hot tubs with appropriate disinfectant levels and pH. Wearing a mask when handling potting mix or compost can also help.

Officials have repeatedly stated that the risk to the public from this outbreak remains low.