Something simple?

I get "Eureka" moments when I am in the lab.
What it usually entails is more work for me to figure if something is valid or not.
Fortunately, I have the samples coming in.
It has to do with something simple. It has to do a connection I need to prove.
The first step is to show that it will work for Stamford, CT. It does not have to work any place else.
The second is to verify many times that pH and salinity are related.
The third will be to show a correlation between pH and bacteria.
This is based on the fact (already proven many times in 30 years) that all of the elevate bacteria levels come from fresh water sources.
I already have one fact, all fresh water sources have a pH more acid than the Sound.
If I can show this correlation, someone will be able to go down to the beach and determine is the water is being affected by enough fresh water to initiate a closing.
There is no waiting period for the reading, it is instantaneous. If this works, it will be far better than anything anyone has thought of.
Will it work?
I have to test this theory to find out.

The truth about what goes into the Sound

You know I have been doing a significant study with Art Glowka on the discharges from treatment plants.
What I am beginning to understand is how the Sound does and does not mix with the fresh water coming from shore.
The pH reading surprised a bunch of PhD's at the Marine Fisheries Division of NOAA.
I decided to test a theory put to me by Art, that the lower pH was because the fresh water was not mixing with the Sound water because of its salinity. He was right on the money. chloride levels and pH do have a great deal of correlation.
Not a real surprise there, but it gave me a number of good ideas and one was that pH might be useful at predicting fresh water intrusion (and thus bacterial pollution) at beaches.
Another was even tho the 2 do not mix well, the nutrient load from fresh water is rapidly absorbed into the Sound and used up.
That is an important concept and one not widely accepted by anyone.

Beaches, Beach Closings and why Stamford does it

An article in the New Haven Advocate had me bemused. New Haven does not close the beaches when they have high bacteria levels.
They have not figured out that it is better to protect the public's health (and what then is a Health Deaprtment?), than sit on their hands and do nothing. They feel the data comes late and so is not valid.
I figured some of it out over 20 years ago. I did the testing and saw a pattern. Rain caused an elevation in bacteria at the bathing beaches.
We figured (We had a very proactive Health Director then and was very supportive) it was better to close a beach before we had proof positive that it would cause trouble (the bacteria tests) than to let people get sick.
In 1988, we had many reports of illness from people who ignored our warnings when we put up signs saying it might not be a good idea that they swim. The next year, we were more forceful about it and because many remembered the year before, they stayed out of the water.
We were also sure this was not sewage. We did know when there was a sewage problem and that was easy to close down areas affected, but this was not.
After a year of exhaustive testing, we found out it was the storm water.
We first thought it was all the raccoons that were living in the storm drains, but in 1990, rabies came and dropped the raccoon population 95%. The water was not as bad, but it would still close the beach for bathing.
The reality, we are an urban environment, water washing over the land and into the Sound did not get treated naturally, it was piped directly to the Sound. It was not "bad" water, but while it was coming out, we needed people to stay out of the water. It only took 24 hours till it was no longer in the water. We asked why and other people, part of the USGS, figured it would go into the sand and lie there waiting to be distrurbed, but unless there was an additional "load", it would not reach health concern levels.
We looked every year at the data, learned new things, saw new patterns, learned a lot. The marine police, the lifeguards, the recreation department all could observe things and help us out. It worked. People do not report being sick from swimming in the water at the beaches. They all lnow that you do not swim after a heavy rain. They even figured it would affect the fresh water lakes and ponds, People are smart, they need to be informed and they need to be protested. Since is my part.
Whats wrong with New Haven?

Ticks and Disease

It is time again that the main ticks that are active are the little larva, the ones who never fed on any thing yet and have never tested positive for any disease organism. Besides that, they are so tiny (the size of the dot in my "i") that I am always surprised when some one brings one in.
The good news is that for the next 3 months, there will be very little transmission of Lyme disease into the human population (the other ticks mostly are not feeding) until mid October!
We are still getting back reports from all the submission we have had ( it can take 6 weeks, but mostly 4 weeks) for us to get a report back from the CT Agricultural Station .
Why so long? Because they are testing all of Connecticut! That is a lot of ticks for a limited staff doing the work for free (these are really good people,trust me).
In the mean time, I put some thing on my plate that I probably should not have (see my post on overwhelmed). I was looking at tick data, data that no one else has because I will call every positive from the CT Ag Station to make sure people understand and go to their doctors. I also ask a few questions.
One thing we keep stressing is that if you find one tick, there is a chance there are more.
So when people report having symptoms and the tick is not positive or is unengorged, we make a very rational assumption that there was another tick.
While the Ag Station will put a disclaimer on all their tests, it is a very, very good test. It tests for the spirochetes in the tick by PCR. It has found the disease in ticks with no body, so it is very good!
So symptoms are the big thing. Why?
Besides the one issue I just raised, there are other issues, there are other diseases. While Lyme is spread by the white footed mouse, who remains infected for life (3 years) once it is infected. Deer do not get Lyme and can not transmit it, but they are know to carry babesia and Ehrlichia organisms. I have only had 5 posts on Lyme, so it gets to be more interesting to me than a lot of things.
Why all of this? Because one of the things I found in the survey was people having real symptoms when the tick they submitted was either not infected or unengorged.
Many doctor do treat quickly. There many cases of single dose Doxycycline being given, with no reports of symptoms afterward.
There were also cases where the doctor would not treat with out a positive blood test even though there were classic symptoms and a positive ticks.
The variance on the treatment was amazing, different drugs, different time periods, very little would even be considered standard.
That is the medical profession.
Should the Health Department take the lead on education? I think so, but it is not going to happen, the interest in being a front runner in anything is minimal.
There are many doctors who are very proactive in this area and this is a good thing.
This was just the begining of me taking apart my little survey. It does make life interesting.

Treatment plant outfall tests and why

I will not probably post the raw data anymore. I will tell you that the testing was performed verifying each tests using standard, USEPA and FDA methods, quality control and collection procedures. That is if you are interested, they are logged in at the Lab.
The results are some what surprising and you may question why I did certain tests.
An example is pH. Salt water oceans tend to be significantly more basic than the fresh water feeds. This tells me more about mixing of the two than anything I could think of. Why not salinity? Because treatment plant discharge will have significant salinity (not as much as the Sound, but still, I needed a better handle and pH seems to provide that).
Turbidity? The measure of particles in the water. comparable to secchi disk readings? maybe or maybe not. Rough water would increase the reading and might give a rise in the bacteria that I looked for.
Reactive phosphate - a nutrient, suggested ny one group as the limiting factor in the Sound for algae growth.
Nitrite - nitrogen - allwos be to look at possible bacterial activity and for the test performed alows me to determine Nitrate nitrogen.
Nitrate nitrogen is the bad boy according to the US EPA, but the levels have remained consistant inthe Sound for 50 years of testing.
Total coliforms - a good general bacteria that might live anywhere.
Fecal coliforms - more of fecal origin (all kinds), but are like total coliforms saphorites (meaning they will grow in warmer water). This is used as a standard by the FDA to determine if it is okay top harvest shellfish.
E. coli - the natural kind (not H 0157) again fecal in origin.
Enterococcus - a group D spterptococcus and used by the US EPA as an indicator of health at bathing beaches. It Likes salt water!
That is what I tested for and why.

Hysteria - again

The hysteria over swine flu appears to have ebbed.
The initial hysteria (mostly created by media misunderstanding) seems not to have effected to many people, yahoo recently reported that the US led the world in Swine Flu cases, there does not seem to be the initial hysteria at this point but why is this so?
It has to do with the shear volume of testing done in the US as part of routine surveillance.
What do the statistics really say?
I will use Stamford since I have access to all of that data.
in 2009 we have a total of 197 reported cases of influenza, this is more than all the other years and almost 2/5 of the total cases recorded since 2002 (7 years). This is all because of testing!
Influenza A (the normal one) accounts for 60% of the cases, H1N1 Novel (swine flu) accounts for 27%. There other types that are also being reported.
In May and June (when we began looking for the swine flu) 58% were normal influenza (even though it is NOT flu season). 37% were the H1N1 Novel (swine flu).
So cases are here, there is no need to panic or get hysterical.
The average age it affects is mostly of health young adults (~21 years) and it is not causing deaths (at least in Stamford).
The reality is that we are really looking hard and finding out more than ever before!

Combating Hysteria

All who have met me in my 30 something years of working with the city, know that I am a fairly no nonsense kind of guy when it comes to m work (I won't go to out of work or non-work areas with that attitude though).
When the data has been against the city, I stand against the city, when the data does not support what the public thinks, I am sorry, I will not make things up for anyone's convenience.
StamfordNotes has a quick review of the new "documentary" about Lyme and I also heard some discussion on NPR concerning the info on the movie.
I have a rather strange stand when it comes to Lyme disease, there is a lot of unnecessary hysteria over the disease and a lot of mind boggling complacency also.
The complacency comes in the form of doctors not being proactive when it comes to treating when symptoms are present, preferring to rely on blood tests.
I take my cue in this from the state health department lab, which a number of years ago (10?), stopped offering a blood test for Lyme, even tho it is on the significant illness list of reportable diseases. Their Reasoning? The test was inaccurate! That was more than enough for me. After years of working on it, the tests still relies on an antibody response from humans to be effective. We do not all get the rash, we do not all or can identify that lousy feeling that comes form the infection. Those are immune responses, without them, the test will not work.
Now for the hysterical part. Lyme is every where, it is spreading, it will get us all.
Partly true, mostly because of man. An environmental organization in Westchester presented that the rapid spread of Lyme has been mostly because of our own push into the suburbs and the decline of predators of the white footed mouse.
Well we know that the deer population explosion is due to us and our desire to protect "Bambi", but what woth the mouse?
The mouse is the primary vector of Lyme disease, not deer. They get infected and stay so for their entire 3 year life. The deer do not get and can not pass on Lyme.
We have given them great hiding spots in loose stone walls and have pushed creatures like owls out of the area. Even the raccoon population has decreased by over 95% since 1`990 (this is due to rabies, not specifically man) and they did feast on the mice as well.
But Lyme disease has remained at a constant infection level since 1989 (when we did the first testing), It has not increased in prevalence and the reality is that we were very late is discovering something that has been in this country for long before we were.
So whay is not every one crippled with Lyme?
Thjat is the next point of hysteria - when doctors prescribed antibiotic for just about everything, a person with sudden aches would go on a quick course and weather theree were other things involved or not any possibility of Lyme disease was stopped in its tracks.
The organism is very susepible to antibiotics. Its effects may linger for years, but that is not the disease anymore, it is not dissimilar to syphilus in that way, if you do not treat it early, you will always have a "marker" showing you have been exposed.
Quick treatment works!
The studies on the single dose have been performed and by several orginizations, the New England Journal of Medicine and the Chicago Journal of Medicine are a couple.
It works, convincing doctors of that is a different sstory, the CDC refers to those orginizations in regards to the single dose of doxycycline within 72 hours of a tick bite, other wise it is 4 weeks.
Convincing people who have not discovered a problem until months after and having doctors who now are reluctant to treat gives great rise to hysteria.
It is actually understandable, but it is not the end of the world and we are not all going to be horribly crippled by untreatable Lyme.
And yes I have had Lyme, twice and do understand it well.

What happens in Greenwich

The following are taken in similar intervals as from Stamford's treatment Plant. There are major differences! The tides are incoming on both samples (Greenwich and Stamford).

Outside Captain's island (Basically in the Sound)
total coliform CFUs/100 mL 20
fecal coliform CFUs/100 mL 2
Escherichia coli CFUs/100 mL 2
enterococcus CFUs/100mL 16
phosphorus as reactive phosphate less than 0.221 mg/L
nitrite nitrogen less than 0.003 mg/L
nitrate nitrogen 0.588 mg/L
pH 8.33
turbidity 1.52 NTU

mid Greenwich harbor
total coliform CFUs/100 mL 44
fecal coliform CFUs/100 mL 4
enterococcus CFUs/100 mL 32
Escherichia coli CFUs/100 mL 4
phosphorus as reactive phosphate less than 0.221 mg/L
nitrite nitrogen less than 0.003 mg/L
nitrate nitrogen 0.647 mg/L
pH 8.22
turbidity 1.36 NTU

Indian Harbor Yacht club
total coliform CFUs/100 mL 500
fecal coliform CFUs/100 mL 90
enterococcus CFUs/100 mL 160
Escherichia coli CFUs/100 mL 70
phosphorus as reactive phosphate 0.224 mg/L
nitrite nitrogen less than 0.003 mg/L
nitrate nitrogen 0.772 mg/L
pH 7.90
turbidity 2.15 NTU

Grass island Boat Ramp (near the treatment plant discharge)
total coliform CFUs/100 mL 670
fecal coliform CFUs/100 mL 120
enterococcus CFUs/100 mL 190
Escherichia coli CFUs/100 mL 80
phosphorus as reactive phosphate 0.471 mg/L
nitrite nitrogen 0.004 mg/L
nitrate nitrogen 0.935 mg/L
pH 7.72
turbidity 2.30 NTU

Note the gradual increase in Nitrogen . Phosphate and turbidity and decrease in pH as the samples approach the treatment plant discharge.

Statistics and epidemiology

I am posting this so that you will take the next post(s) with a proper understanding of what you can and con not say using statistics.
The following is a very good example of the convoluted way to say something that is absolutely WRONG by using statistic (and epidemiology).

For those of you who watch what you eat, here's the final word on nutrition and health. It's a relief to know the truth after all those conflicting medical studies.

1. Japanese eat very little fat and suffer fewer heart attacks than the British or Americans.

2. Mexicans eat a lot of fat and suffer fewer heart attacks than the British or Americans.

3. Africans drink very little red wine and suffer fewer heart attacks than the British or Americans.

4. Italians drink large amounts of red wine and suffer fewer heart attacks than the British or Americans.

5. Germans drink a lot of beer and eat lots of sausages and fats and suffer fewer heart attacks than the British or Americans.

CONCLUSION: Eat and drink what you like. Speaking English is apparently what kills you.

You will be referenced to this page after the next post(s) when appropriate.

H1N1 Influenza A - update

Sent: Wednesday, July 08, 2009 2:49 PM
Subject: Centers for Disease Control and Prevention (CDC) Update

You are subscribed to Updates from Centers for Disease Control and Prevention (CDC). This information has recently been updated, and is now available.

July 7, 2009

CURRENT SITUATION

· Three novel H1N1 influenza viruses that are resistant to the antiviral drug oseltamivir have been detected from 3 countries.

· These rare instances of oseltamivir resistant novel H1N1 influenza viruses remain isolated findings at this time.

· The oseltamivir resistant viruses identified have been sensitive (susceptible) to zanamivir.

· There is no evidence of genetic reassortment with seasonal H1 viruses among the three cases of oseltamivir resistant novel H1N1 influenza viruses.

· At this time, WHO and CDC do not recommend any changes in antiviral guidance.

· The few people who have been infected with oseltamivir-resistant viruses have had illness similar to that caused by oseltamivir-sensitive viruses. Illness has not been more severe, and oseltamivir-resistant viruses have not been identified among close contacts.

· Surveillance for the detection of antiviral resistance in novel H1N1 influenza is ongoing among domestic and international isolates submitted to CDC.

· There are two influenza antiviral medications recommended for use against novel H1N1 influenza. These are oseltamivir (trade name Tamiflu ®) and zanamivir (trade name Relenza ®). Either medication can be used.

· Highest priority should be placed on treating patients hospitalized with influenza or those who are ill with influenza who have an age or medical factor placing them at higher risk for more severe illness or influenza-related complications.

· See Interim Guidance on Antiviral Recommendations for Patients with Novel Influenza A (H1N1) Virus Infection and Their Close Contacts for more information.

GENERAL INFORMATION ABOUT ANTIVIRAL RESISTANCE

· Influenza viruses can develop resistance to antiviral medications.

· Antiviral resistance means that a virus has changed in such a way that the antiviral drug is less effective in treating or preventing illnesses caused by the virus.

· Influenza viruses constantly change as the virus makes copies of itself. Some changes can result in the viruses being resistant to one or more of the antiviral drugs that are used to treat or prevent influenza.

· Antiviral resistance is detected through laboratory testing.

· Additional cases of antiviral resistance are likely to be detected.

· CDC and its WHO partners continue to conduct surveillance for antiviral resistance. The data indicate that the prevalence of oseltamivir resistant viruses is low. Among 202 novel influenza A (H1N1) viruses from the United States tested by CDC this year, none have been resistant to oseltamivir.

· Information on resistance of influenza viruses to the four antiviral medications is updated weekly on the CDC FluView surveillance report which is found at: http://www.cdc.gov/flu/weekly/fluactivity.htm

INFLUENZA ANTIVIRAL MEDICATIONS

· Influenza antiviral medications are prescription medicines (pills, liquid or an inhaled powder) with activity against influenza viruses, including novel H1N1 influenza viruses.

· Antiviral drugs work by decreasing the spread of flu viruses in the respiratory tract.

· Influenza antiviral medications work best when started soon after illness onset (within 2 days) , but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications.

· There are four influenza antiviral medications approved for use in the United States . The four antiviral drugs are oseltamivir (brand name Tamiflu ®) ; zanamivir (brand name Relenza ®) ; amantadine (Symmetrel®, generic) ; and rimantadine (Flumadine®, generic) .

o This novel (H1N1) influenza virus is sensitive (susceptible) to the neuraminidase inhibitor antiviral medications, zanamivir and oseltamivir (other than the three viruses recently identified). It is resistant to the adamantane antiviral medications, amantadine and rimantadine.

· Most persons with novel H1N1 influenza have had mild illness lasting several days and have recovered without need for antiviral treatment. Treatment is generally reserved for patients hospitalized with influenza or those who are ill with influenza who have an age or medical factor placing them at higher risk for more severe illness or influenza-related complications.

· Use of antiviral drugs to prevent illness (chemoprophylaxis) is usually reserved for certain specific situations. Widespread use of antiviral medications for chemoprophylaxis is not encouraged as injudicious use of antiviral drugs might be a factor in causing more viruses to become resistant.

Centers for Disease Control and Prevention (CDC) · 1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)

Stamford's Sewage treatment Plant

It is a very well run operation. This last year they received a million dollars in Tax credits for their managing the effluent so well. The Nitrogen discharge is under 1 mg/L with its methods and usually about 0.1 or 0.2. This is some contrast to the normal Nitrogen (as Nitrate) levels that are found naturally in The Sound (0.58 mg/L).
So part of the study Art Glowka and I are undertaking is to see how the treatment plants effluent is absorbed.
The test case was Stamford's Plant and the numbers were very typical of something clean.
The first 2 samples, going up the discharge point were typical of Long Island Sound Water. No Phosphate, no Nitrite Nitrogen and a Nitrate Nitrogen around 0.52 to 0.55 mg/L
Because this was much closer to shore, there were bacteria. In the furthermost sample, no Total or fecal coliform and 2 colonies/100 mL of enterococcus.
The second sample, which was near the break wall, had 20 Total coliform colony forming units in 100 mL of sample, 5 of which were fecal coliform, all 5 proving to be E. Coli. There were 47 enterococcus colonies per 100 mL, probably due to water fowl at the sampling point.
The next sample was interesting, the Nitrate level dropped to 0.436 mg/L, but no measurable nitrite or phosphate. This was near Dyke Park. Total coliform levels were still at 20 CFU's per 100 mL with 14 being fecal coliforms, all confirming as E. Coli. Enterococcus bacteria levels were at 14 CFU's per 100 mL.
The last sample was only a short distance from the outfall (50 meters) and was a surprise.
phosphate was measurable at 0.389 mg/L
nitrite nitrogen was measurable at 0.004 mg/L
and Nitrate was 0.823 mg/L
total coliform CFUs/100 mL by membrane filtration (m-Endo) 90
fecal coliform CFUs/100 mL by membrane filtration (m-TEC) 25
enterococcus CFUs/100 mL by membrane filtration (m-EI) 35
Escherichia coli CFUs/100 mL by membrane filtration (m-TEC) 20
These are the results down stream of the best sewage treatment plant in the area.

Beaches

How long have I studied Stamford water quality at the beaches? 30 years? May be, but I really got down and dirty with it 20 years ago. This is the run off from all the rain cleaning urban streets and storm systems and hopefully providing food for creatures to eat because out there in the Sound a mile out there is nothing!
The unsettled weather, the 3 inch rain and the other thunder storms all around us has cause the water to have a lot of unusual bacteria organisms, none over limit to allow me to close them, but I would tell you to be careful going into the water. Wash off after.
We have not seen that mystical white Styrofoam type stuff, "Sewage grease" that I believed would be there from the 3 inch rain, but the weather has been very unsettled and may have broken it all apart in the near waters.
The next four or five days promise to be nice weather and that maybe enough to settle every thing down.
From the info I get from beach net, the indicator bacteria (and a pathogen in its own right) will come out of wet sand during this unsettled weather. it has not been numbers I worry greatly about and certainly not in numbers that would allow me to shut down bathing on a Fourth of July weekend, but caution is urged.

Observations on the Sound

Art Glowka and I started the first of many surveys yesterday. This was taken a mile south of Westcott cove in 80 feet of water. It was a slightly subsurface sample and the water temperature was 63 F out there. The sky was slightly overcast, so there was no direct sun.
He wanted me to look for the nutrients I can do, I got curious.
Samples were taken at 5, 7, 9 and 11 AM at the same location.
There was no reactive phosphate or nitrite-nitrogen.
The nitrate nitrogen varied between 0.525 mg/L to 0.629 mg/L.
The Secchi dish reading was between 4 and 5.
That is not a lot of nutrient and the nitrogen level is consistent with what everyone else has found.

Now for me.
the pH varied between 8.17 to 8.25
There were no indicator bacteria in any sample.
No total or fecal coliform and no enterococcus species.
There were a few non-coliform bacteria growing on the total coliform plate, they are not significant except that they a aerobic bacteria.
Turbidity varied between 1.32 to 1.64 NTUs.
The sample would be considered very clean.