LEVEL 1 CASE 7

Problem Title: Deadlier Than War

Investigator: Brent Ronald S. Almerol
Number of Sick: 200
Hospitalizations: 147
Deaths: 34
Location: US (1 State)

Overview:

A deadly illness has been causing a nationwide panic. Many people are sick, some have
died, and more people are dying everyday. No one can tell how they got sick or how the
illness is spreading.
Steps that were taken in investigating the outbreak:
1. There are currently 151 sick and 11 have died, many of the sick are older and most
are men. They all live in Pennsylvania, Everyone were in Philadelphia during July
21-24. According to reports, patients are having chest pains, fever (as high as 107
degrees), cough, and pneumonia.
2. The number of sick people peaked July 25-27. The Department of Health in
Pennsylvania sought for help in Epidemic Intelligence Service (EIS)
3. A lot of theories are circulating around the city, that causes the citizens to panic.
The investigator and the team of EIS, made an epidemic curve (epi curve) to keep
track of the data. The team spread across the city to interview 200 sick people and
their families.
4. According to the data:
 The number of sick people peaked July 25-27
 People stayed in different hotels, ate in different restaurants, and visited
different tourist sites.
 There is a high number of sick people who went to the military conference
and ages 50 and up. There is also a high number of sick people who stayed
at Deluxe hotel, and most of the sick person are men.

5. The investigators lead is the military conference which was held at the same hotel
the Deluxe Hotel where a lot of sick people stayed at and only one of the hotel’s
400 workers got sick.
6. The investigator interviewed the people who went to the conference.
7. The team tracked everyone who attended the conference since the conference did
not secure any attendance list. The investigators gathered the data and identified
the high attack rate among those who attended the specific event to identify the
source of the outbreak

8. All of the sick people were in Philadelphia sometime between July 21-24 but there
are people with the same illness who did not go to the conference but were in the
city.
 9. After thorough investigation, The investigator found out that everyone who are sick
had gone into or at least passed by the Deluxe Hotel on the days of the conference.
Some of the sick never even entered the hotel.
10. The investigator once again interviewed the patients and according to them:
 They went into the hotel to get a drink to cool off from the heat.
 Others stood near the entrance and feel the air conditioning.
 Some only walked on the opposite side of the street.
11. Based on the statements, one of the possible lead of the disease is the air around
the said hotel.
12. Months have passed and the outbreak was still unknown. One of the laboratory
scientist reruns some new test, and saw something that was missed before.
13. The team look through more samples from the sick patients and saw that the
unfamiliar bacterium is present in many of the samples.
14. According to research, the Legionella pneumophila causes an infection of the
lungs, a form of pneumonia. The bacteria grows in warm water, cooling towers that
air conditioned large buildings, and etc. which is probably the cause of disease
that spread around the Hotel.
15. The investigators conclude that the outbreak was caused by Legionella. Those
who have entered or passed by at the hotel and accumulated the disease breathe
in a mist or vapour (small droplets of water in the air ) that has been contaminated
with the bacteria of the Deluxe hotel’s air-condition.

Discussion:
Step 10 is the most important step since the investigator discovered that some of the sick
never even entered the hotel and just happened to passed by. The investigator then got
a possible lead which is just around the hotel.
Results:

 Legionella can grow in warm water of cooling towers, which are used in the air
conditioning systems of large buildings.
 Those who have inhaled the air from the Deluxed Hotel acquired the disease
 That explains why people who never even entered the building but stood near it
got sick.
 The cause of the outbreak is the hotel’s air-conditioning.
Reflection:

After that outbreak, every hotel should always clean their air-condition and some place
with warm waters. Hotels should have monthly cleaning and check-up of every facilities
and also they should always disinfect for the safeness of everyone.
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