I apologize in advance for the length of this post. I just couldn't stop myself.
Now, I should probably say at the outset that I did not much care for the writing in the book, which is largely in the style of a thriller, a genre I do not as a rule read or like. That aside, the information contained in the book is fascinating, and when I was done with it I became briefly convinced that epidemiology is my true calling...so in the end I do heartily recommend it.
The Blue Death is broken up into three parts, the first of which I found extremely confusing because it didn't fit with my conception of what the book was going to be about...I clearly didn't understand the "past danger in the water you drink" part of the subtitle. Anyway, the first section covered European cholera epidemics (mostly in London) in the 1800's, and the work a man named John Snow, who (fascinatingly) is considered both the father of modern epidemiology and of modern anesthesia. As cholera decimated London, Snow developed a theory, radical at the time, that the cause of the disease could be found in contaminated drinking water. Although this notion was roundly pooh-poohed at the time, it turns out that he was right. The discussion of Snow's work and the London cholera epidemic(s) contains some interesting tidbits about what it was like to live, drink water, and do science in London in the 1800's. But, as it is firmly placed in the past, it's not too terrifying for the modern day. It didn't make me think we're all going to die.
Cue the second section of the book, entitled "Thirsty cities and dirty water," which covers more modern material, beginning with the building of water treatment and delivery systems in Chicago, New Jersey, and maybe some other places I forgot about, in the 1900's. The description of how these systems were built is quite fascinating. For example, Morris describes how laborers dug blind tunnels from opposite ends of lake Michigan towards each other, and didn't miss(!), and how, harrowingly, an early scuba diver got trapped in a dam in New Jersey trying to dislodge something from a water intake pipe.
The last part of the second portion of the book is where the narrative begins to get scary. In particular, I am referring to the description of a massive outbreak of waterborne disease in Milwaukee, in 1993 (that's within my lifetime!). This outbreak almost didn't get identified as waterborne, but public health officials eventually (thankfully) figured out that the illness sweeping the city was due to something called a cryptosporidium oocyst, which was not removed from the water at the treatment facility--despite the fact that the water met federal cleanliness standards. Chew on that for a second. Or drink some water and then chew; you might be masticating oocysts.
The third and final portion of the book, "At war with the invisible" is the most terrifying. I marked up at least 30 pages that contain horrifying information about our "modern-day" water purification and delivery systems. I place "modern day" in quotation marks because, a Morris describes, the vast majority of the treatment facilities, pipes, and other related water infrastructure in the US are up to 100 years old, and are extremely outdated, rusting, and inefficient (at one point our water pipes are described as a "dark and corroded underworld [that] offers uncounted and unseen opportunities for the degradation of our drinking water"). On top of all this, the federal government, which is also discussed in this section of the book, has not done a whole lot to improve the safety of the nation's water supply. To quote Morris, "Washington rushes to correct environmental problems with all the speed and agility of a glacier on quaaludes."
I don't want to describe everything the book talks about, because then you won't read it. But let me share with you just some of the startling things I learned:
1. The number one method that the United States uses to clean water of killer bacteria is chlorination, followed by filtering. But mostly chlorination. Many municipal water suppliers--for example those supplying New York City--do not filter their water. Instead, they rely on dilution to minimize health risks. Yes, dilution. Let me let Robert Morris explain:
New York City depends on dilution and delay to reduce to the health risk from the treated sewage. Any pathogens in the water are assumed to disappear in the vast reservoirs or to die before they can reach the intake pipe. New York City's Department of Environmental Protection is so confident in its ability to protect this watershed that they do not filter the water....[and] New York is not alone. A handful of other major cities around the country including Boston, Seattle, San Francisco, and Portland, Oregon, do not filter their drinking water. Instead, they rely on watershed protection and chemical disinfectant to ensure the purity of their water.Does it work? Ehhh...sometimes:
Even those who manage the watershed must occasionally admit that the protection is imperfect. As recently as June 2005, after a heavy rain caused a sharp spike in turbidity, New York's health department warned city residents with compromised immune systems to boil their drinking water.Even if your water supplier does filter your water, don't be too content about its potability. As it turns out,
The filtration systems do not remove 100 percent of pathogens, and many of those pathogens are to some degree resistant to chlorine, the chemical used almost exclusively to disinfect drinking water in the United States. To make matters worse, the chlorine used to protect us from waterborne disease may threaten our health in other ways including cancer, still-births, and birth defects.Yep, turns out chlorine is not really that good for you. And hey, the news is just getting worse:
Accumulating evidence about the possible risks from the by-products of chlorination, together with the appearance of pathogens that resist chlorine, have prompted a new look at our reliance on chlorine. A recent study suggesting that the cancer risk may arise from inhalation rather than ingestion of volatile by-products makes this problem even more daunting.2. This brings me to my next point, which I (obviously) must make to tie into my whole antimicrobial-resistant disease coverage. Chlorine is not killing all the dangerous pathogens in our water. Furthermore, no one is really taking notice of these chlorine-resistant diseases, as they haven't become big enough problems yet. As Morris writes, "the history of drinking water is a story of disaster and response...the improvements...have almost always looked backwards." Perhaps the biggest takeaway from this book is this:
The risk we must fear is the one we have never seen.
As Morris notes:
When you look at the world from the perspective of a pathogen, human success in beating back most infectious diseases from the industrialized world has created a vast, underexploited ecological niche. A pathogen that can find its way past the detergents, filters, disinfectants, and antibiotics that we throw up in front of it has hit the mother lode. In terms of evolution, this means that a pathogen with the characteristics necessary to get around these barriers will have the greatest chance of reproducing and infecting others. In other words, when we place a barrier in front of a pathogen, we simply redefine the criteria for success.You guys, we might all start getting cholera again! And yet it is proving politically unpopular to create systems and regulations that might prevent such an event. Not only does the issue of water purification "lack political sex appeal," but "the rusting cast iron pipes beneath our streets have all the allure of a fungal infection." Sigh. (Side note: Robert Morris sure can turn a nice phrase now and then.)
The emergence of chlorine-resistant pathogens such as cryptosporidium or toxoplasma as agents of waterborne disease provide clear evidence that treatment-resistant organisms can and will emerge. The appearance of a strain of cholera that exhibits a degree of chlorine resistance suggests that even an old and fearsome waterborne nemesis may have the capacity to reinvent itself.
3. Think the American water supply, in our nice industrialized modern country, won't make you sick except when something goes horribly wrong? THINK AGAIN.
So how much waterborne disease is there in the United States? The truth is that we don't know, but several lines of evidence suggest that millions of cases of waterborne disease, perhaps more than ten million, may be occurring every year in the United States.And that's not all! Not only is our water treatment infrastructure outdated and inadequate, letting pathogens and sometimes raw sewage through, but our water is also, perfectly legally, full of industrial chemicals. Writes Morris:
Conventional water filtration as relied on by most American cities was never intended to remove chemical contaminants from drinking water, and for most utilities chemical removal remains a low priority...modern industry produces and releases tens of thousands of different chemicals. Most, if not all, of them find their way at some level into our water supplies. The EPA regulates fewer than one hundred out of tens of thousands of chemicals that can appear in our water supplies, selecting candidates based on their toxicity and prevalence.What about those they do regulate?
Regulators focus on single chemicals as they evaluate risk and set standards. Logistics and costs tend to limit risk assessments to a small set of health outcomes, primarily cancer. It is impossible to look at the full range of human diseases when evaluating health risks. As a consequence, we make the implicit assumption that unexamined risks do not exist.That assumption sure seems to be working out well for us, huh.
4. If we don't act now, things will not stay at the status quo. Because remember climate change? Well, to the extent to which climate change affects the weather systems, it will also likely affect water safety:
Some have suggested that global climate change lies behind the record hurricane season that spawned Katrina. Whether or not this is true, increasing global temperatures will certainly raise sea levels and make coastal cities more vulnerable. The increase in severe storms predicted by most climate scientists will also increase the frequency of flooding, the flow of contaminated runoff into our water supplies, and the frequency with which raw sewage flows into our rivers, lakes, and streams...Heavy rains can send contaminated runoff and raw sewage rushing toward the intake of water supplies downstream. Dry conditions, on the other hand, reduce the amount of water available to dilute treated contaminants flowing into the lake or river.5. Think the dangers in our drinking water are due only to ignorance, laziness, and/or natural forces? Think again! We haven't even talked about terrorists yet! I'm not going to belabor this point, but i think it's significant that Morris devotes a section of his book to the issue. As he writes:
Much has been made of the risk from the air borne release of weaponsized 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...Al Qaeda operatives have...conducted extensive research on US water supplies and their control systems and indicated that these are potential targets of their attacks.Swell.
6. A final point. I suspect that, like me, you are thinking about switching to bottled water. This is addressed as well, and Morris comes out on the side of 'not really a good idea.'
Even if we set aside concerns about the environmental impact of the bottles, the water inside may not offer the benefits we imagine. Despite the fact that it costs almost a thousand times more than tap water, there is no guarantee that bottled water is safer. Bottled water is less closely regulated than tap water and is not required to meet stricter standards for purity.Honestly, probably the best thing you can do is filter your tap water, and filter it good. Don't let your Brita go several months past its expiration. Change it regularly, and you will, most likely, be fine. For now, at least.
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I shall leave you with a final thought. Want to ignore this post, or the whole issue? Think your water is safe because you've never gotten sick? That's cute. But it's not going to make things better:
The staunch belief in the adequacy of the status quo and the dismissal if not outright derision of those who challenge the prevailing belief has...set the table at which disaster dined.I've said it before, and I'll say it again...it's become my new mantra: Complacency kills.
Go out and get yourself a copy of The Blue Death!
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