Contra Costa County Health department (CCH) is currently investigating two recent Legionnaires’ cases leading to deaths associated with Legionnaires’ disease. Investigators are looking to the Zen Day Spa as a potential source of infection.

The Outbreak

Two deaths were reported to CCH last week, prompting an investigation into the Legionnaires’ disease outbreak. A 46-year-old Richmond man and a woman were hospitalized at Kaiser Oakland due to symptoms of Legionnaires’ disease, ultimately succumbing to their illnesses. Both patients reported visiting the same spa, Zen Day Spa, days before their symptoms began.

These were not the only cases linked to the Spa. CCH indicated that they are aware of a third case of Legionnaires’ disease linked to the Spa in June. This person fell ill, also with Legionnaires’ disease, after using the jacuzzi tub at the establishment. That patient recovered from the illness.

Business Lacked Permits

With solid links between all three patients, CCH began inspecting the facility. The Zen Day Spa, located at 12230 San Pablo Avenue in Richmond was found to be operating without a permit.

CCH’s Environmental Health Inspectors conducted an on-site assessment of the facility. Apparently, there were no existing records that the business has ever been issued the required permit for a spa or pool. Consequently, CCH closed the business on August 4, 2023, until further notice.

In a recent press conference, Contra Costa County Supervisor John Gioia explained that the spa did not have a business permit or an environmental health permit. “You have a business that failed to get a permit. So, that’s illegal,” he said. “Whether or not they have a city permit we don’t know for this business, but they didn’t have a permit for the spa and the reason you get a permit is to make sure that you meet state and county health standards,” says Gioia.

Samples Sent to the Lab

Water samples at the spa have been obtained and sent to the lab for analysis. Preliminary results to confirm the presence of Legionella bacteria are expected by early next week.

Common testing methods for Legionella bacteria include culturing the sample on specific culture medium or through genetic analysis with Polymerase Chain Reaction (PCR) testing to detect specific bits of DNA unique to that bacterium.

Health Department Investigation

According to KRON4, health officials are looking for people who may have been at the Zen Day Spa in Richmond over the past two weeks, which was visited by three people — including two who died last week — who recently contracted Legionnaire’s disease. Contra Costa County Board of Supervisors Chairperson John Gioia, who represents Richmond on the board, said Monday that it’s critical for anyone who visited the spa come forward immediately.

Gioia is also calling on Contra Costa Health to investigate and identify unpermitted spas throughout the county. He said Zen Day Spa didn’t have the required county environmental health permit from the health department and he’s waiting to find out if it had a required use permit from the City of Richmond.

“Right now, the emphasis is tracking down people who were there the past two weeks,” Gioia said. “It’s a bit like contact tracing.”

The spa was closed Friday after two people died on Thursday and Friday. Health officials said both people had visited the spa, at 12230 San Pablo Ave., just days before getting sick. A third person, who used the jacuzzi at the spa in June, has recovered from the disease.

Gioia said officials are also looking at the building’s ventilation system and whether the bacteria — which is usually transmitted by air — could have spread into two adjacent businesses. Health officials are still awaiting lab test results to confirm whether the spa was indeed the source of transmission.

How Do You Get Legionnaires’ Disease?

Legionnaires’ disease is caused by exposure to Legionella bacteria. This bacteria is often found in freshwater environments such as lakes and streams. It becomes a problem when it moves to human-made water sources and grows to harmful numbers.

People become infected when they breathe in water droplets containing the bacteria. The bacteria are microscopic in size, so the droplets do not have to be very big. Even the mist coming off a hot tub is sufficient to aerosolize the bacteria.

Common Sources

Several water fixtures or structures have the potential to house and disseminate Legionella bacteria. The most common source of Legionella outbreaks involves cooling towers. These are the large structures used in air cooling systems of some large buildings or industrial processes. But they are not the only potential source.

Large, complex plumbing systems are also a common source of Legionella exposure. Pipes that go unused for long periods of time or “dead legs” can hold water stagnant, allowing the bacteria to grow to harmful numbers and increase exposure risk once the water is moved.

Fixtures that rapidly move water, such as hot tubs or decorative fountains and water features aerosolize water. If the bacteria are present in the water, they can hitch a ride on those water particles and enter the body. Showerheads and sink faucets have also been known to do the same.

Any type of structure that holds water for a period of time, then allows it to move and potentially produce water droplets is a potential source of exposure. Even hot water tanks and hot water heaters can do this.

Who Is Most at Risk?

Not everyone who is exposed to Legionella bacteria will become sick with Legionnaires’ disease. Certain people are at higher risk of succumbing to the illness. This includes:

• People over 50 years of age
• Current or history of smoking
• People with preexisting chronic lung disease
• People with a weakened immune system

Symptoms of Legionnaires’ Disease

Many cases of Legionnaires’ disease go undiagnosed, as the symptoms are very similar to other pneumonia-type illnesses. It can even look similar to other types of pneumonia on an x-ray. Most people can recover without Legionella-specific treatment; however, recovery is much quicker with appropriate diagnosis and treatment. Either way, hospitalization is often necessary to treat more serious symptoms.

Symptoms often include cough, shortness of breath, fever, muscle aches, and headaches. Other symptoms may include diarrhea, nausea, and confusion.

People generally become sick around 2 to 14 days after exposure, but it isn’t exact. In some cases, it can take longer for symptoms to appear.

CCH Recommendation

CCH issued recommendations for both patrons of Zen Day Spa as well as healthcare providers in the county and surrounding area.

“CCH encourages anyone who may have recently visited Zen Day Spa to watch for symptoms of Legionnaires’ Disease. If they experience symptoms such as shortness of breath, fever, chills, and cough, they should seek immediate medical care.

CCH strongly advises healthcare providers to test for Legionella in patients with pneumonia who have visited Zen Day Spa within two weeks of their illness. Testing is also recommended for hospitalized patients with pneumonia of unknown cause.”

County Health Services is also reaching out to physicians, hospitals, and clinics to make them aware of the recent outbreak and to be aware of potential cases.

What Do I Do If I Suspect I Have Legionnaires’ Disease

There are a few things you should do if you suspect you have Legionnaires’ disease for the best possible outcome. Not everyone exposed will become sick, but those who do become sick often suffer serious illness.

See a Doctor Right Away

The health department recommends seeing a doctor “right away” if you develop pneumonia symptoms and suspect you may have been exposed to Legionella. Be sure to mention if you have been recently exposed, have used a hot tub, spent time away from home, or have been in the hospitalized in the last two weeks.

Make a List

For traceback purposes, making a list as soon as possible creates a more complete timeline. People may forget things over time, particularly when they are very sick. Make a list of the places you have visited in the last 2 weeks. This can narrow down the search for the source of infection.

Reach out to a Legionnaires’ Disease Lawyer

Your most important task is to get well or help a family member to get well. Consultation with a Legionnaires’ Disease Law Firm can help answer questions you may have and help you navigate this process. The Lange Law Firm, PLLC has a proven record of helping victims of preventable Legionnaires’ disease exposure. Reach out for a free consultation by calling (833) 330-3663 or click here to email.