“Enemy of the People”

Cyanobacteria in a Petri dish, from EPA.gov

In the Henrik Ibsen play “Enemy of the People.” the citizens of a small Norwegian town believe that bathing in the local mineral springs is good for one’s health. The town’s doctor discovers that the springs make people ill. The doctor, simply by advocating for public health, becomes an “Enemy of the People.”

In real life, a small number of activists believes that “urban swimming” in the Lower Charles River Basin (near the Museum of Science) is safe. They are currently promoting a swimming dock that will float in the Charles. I live in the neighborhood, and row on the Charles, so was naturally curious. It’s a Preventive Medicine question, so suitable for this newsletter. It appears that, like in Ibsen’s play, regular swimming in the Charles would result in more harm than good. Not all the hazards are obvious, but like, in the movie Jaws, “Just when you thought it was safe to get back in the water,” it isn’t.

Environmental interventions have health consequences. Consider something as simple removing forest underbrush. Undisturbed forests are fire hazards because of increased underbrush. Manicured forests, however, contribute to the Lyme disease epidemic, by decreasing the habitats for predators of deer and mice, who are the reservoir for Lyme ticks.

Charles River Water quality has improved since 1995, as monitored by E. coli in surface water. The pro-swimming group is locked into this “fact.” However, EPA data show that “swimmable” days in the Charles River Basin peaked at 65% in 2011, and were down to 45% in 2016. (CWRA 2016 Annual report p9)

The runoff...creates excellent growing conditions for bacteria. Click To Tweet

NOAA climate data for New England shows a pattern of more intense rain storms in the spring, followed by hotter, drier summers. Summer temperatures in the Basin (BU bridge to the Boston Harbor Dam) have risen 10 degrees Fahrenheit over the last 20 years. (CRWA Annual Report) Storm water runoff overwhelms sewage systems, and the untreated waste goes into the ever-warmer Basin. The runoff of human and agricultural waste, combined with higher temperature water, creates excellent growing conditions for bacteria. Think of the Lower Charles Basin as a wide, shallow petri dish – 18 feet deep, 2000 feet wide, and maximum summer temperatures of 80-84 degrees.

The Conservation Law Foundation is suing the EPA because the Charles is still below what government standards promised in 1995. The EPA, in turn, is promulgating regulations for towns and real estate owners abutting the Charles, that will cost 1 billion dollars, to reduce runoff. It seems unlikely we are awash in lawsuits and regulation because the water is getting cleaner!

Just when you thought it was safe to get back in the water.

Picture from UC Davis Veterinary School – No copyright application.

Let me introduce the new version of Bruce the Shark – cyanobacteria – better known as blue-green algae. The green oily slick in front of the row boat in the picture below is a small algal bloom. There is a bloom in the Gulf of Mexico the size of Connecticut. There is a bloom in the Arabian Sea the size of Mexico.

Cyanobacteria are like creatures in Jurassic Park. They can’t be killed by the heat of Middle Eastern Deserts, or the cold of Antarctica ice. They will lie idle for years in cystic form, and then proliferate when moisture appears. Toxins from a cyanobacteria bloom in Lake Erie in 2014 shut down the water treatment plant for Toledo, Ohio.  The toxin, microcystin, can cause nausea, vomiting, and liver damage.  It is not destroyed by boiling or cooking; water had to be trucked in for 500,000 residents.

Lake Erie Bloom Picture.

Cyanobacteria toxins are dangerous. According to the CDC, getting toxic water on the skin can produce rashes, hives, or blisters (especially on the lips and under swimsuits). Inhaling water droplets can cause runny eyes and nose, a sore throat, asthma-like symptoms, or severe allergic reactions. Swallowing toxic water can cause gastroenteritis, acute or delayed liver toxicity, with abdominal pain, diarrhea, and vomiting. The neurotoxins can produce weakness, difficulty breathing, convulsions, and occasionally death. Keep in mind that swimmers consume small amounts of water; swimming children consume 8 times more water than adults based on body weight.

MDPH identified 150 algae advisories across the state since 2009, 11 for the Charles River alone. Current rules call for closing the affected portion of the basin for a minimum of two weeks after sighting a surface bloom. Closings have last a minimum of two weeks, some a month or more.

Just when you thought it was safe to get back in the water.

“Anytime we see a bloom, essentially, you’re in bloom conditions for two weeks. More commonly they last for about two months. Sometimes they look like pea soup, sometimes they look like a paint spill.  However, sometimes they have no visual indicators; the water looks like it always looks.” (Julie Wood, Charles River Watershed Association, Boston Herald 5/17)

In addition to producing toxins, cyanobacteria can extract oxygen from the water. Larger fish are more vulnerable to asphyxiation. Below is a map of a 2015 fish kill in the Charles. Visible algae were seen between the Harvard and Longfellow Bridges that year, but fish died as far upstream as Newton. Should people be swimming in a river where fish are dying?

Fish Kill Map – 2015.

What we know about cyanobacteria is disturbing. What we don’t know is more disquieting.  The EPA only recently created a citizen/scientist campaign (Cyanos.org) to gather information about the range and distribution cyanobacteria in America. They will send you an app for your phone to report blooms, or a test kit for a look at what is in the water.

“At what point is the information sufficient for these agencies that are supposed to protect public health to act more aggressively? They should be operating on the precautionary principle. We don’t want to wait 20 and 30 years and find out the entire time we’ve been exposing an entire generation to a toxin,” Christopher Killian, on cyanobacteria, Conservation Law Foundation (The Concord Monitor, 4/17/2016).

We don’t want to wait & find out we’ve been exposing an entire generation to a toxin. Click To Tweet

I share the opinion of Mr. Killian, and if it places me with Ibsen’s fictional Dr. Stockman as an “Enemy of the People,” I’ll consider it good company

James Katz MD

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