Stalking A Killer

Sydney Morning Herald

Saturday May 6, 2000

Gary Tippet, Mark Forbes, Mary-Anne Toy, Victoria Button and Brett Foley

When the laboratory tests started coming in, the hunt was on for the source of a deadly disease. Gary Tippet, Mark Forbes, Mary-Anne Toy, Victoria Button and Brett Foley report.

ROBERT Campbell isn't sure what to call it. Premonition? Foreboding? Perhaps simply the ancient, unbreakable bond between a son and his mother. But on Good Friday, on holiday in Broome, he was struck by a strange but unshakable certainty that something was wrong with his mum, Nellie, 3,200 kilometres away in Templestowe.

Campbell had moved to Melbourne from Perth 10 months before, specifically to look after the ailing 83-year-old, determined not to entrust her to some anonymous old person's home. This was his first holiday but now, six days in, he needed to get to a phone.

His sister, Liz, answered and confirmed his fears. She told him that what had begun as a mild headache on the day he flew out had turned into symptoms of a cold and had deteriorated over the course of the week. Now Nellie was suffering severe headaches, pains and chronic lethargy. ``When Liz put Mum on, she could hardly speak and I told her to take her straight to the hospital," Campbell says. ``When the ambulance came she was so weak she didn't have the strength to get out of bed."

Campbell caught the first flight home and went straight to the Austin Hospital where his mother was now fighting for life. She only managed to whisper a few precious words to him before slipping into unconsciousness. At 3am, Tuesday, April 25, Nellie Campbell died.

That same Easter weekend, Margaret Brown was taking a few days off in Ballarat. On the Sunday she phoned her father, 78-year-old Ernie Brown, at his home at the Summer Hill Residential Park in Reservoir. He said he was very tired and was going back to bed. Margaret called again on Easter Monday and Ernie said he thought he might be coming down with the flu.

Worried now, Margaret returned home next morning to find her father with a fever and complaining of aches and pains all over. Next day he could barely breathe and she took him to his doctor. After x-rays he was taken to the Austin Hospital diagnosed with pneumonia.

The next morning, Don Storer, a 69-year-old Englishman visiting his son, Jonathan, and grandchildren, was admitted to Box Hill Hospital with almost exactly the same symptoms. On Easter Sunday Storer had complained of feeling desperately tired. Aches and pains began and by the time the family had a barbecue on Monday, he was groggy and could hardly keep his eyes open. Over the next two days, Jonathan says, his father could not eat or drink, suffered severe headaches, finally becoming delirious with a high fever. By the next afternoon he was in a critical condition in Box Hill.

At the same time Jonathan began hearing media reports about a possible outbreak of legionnaire's disease. The symptoms, he learned, were almost identical to those being suffered by his dad. He returned to the hospital and asked that staff test his father for the deadly disease. Two days later the test was confirmed.

Late that Thursday, Margaret Brown contacted the Austin and asked for the same tests for her father. On Friday morning, while awaiting the results, Ernie became critically ill and was transferred to intensive care where he began to be treated for legionnaire's.

Liz and Robert Campbell had heard the reports, too. They noticed that the outbreak was being linked to the new aquarium on the Yarra and for a moment suspected the worst. They had taken Nellie on a rare excursion on the Thursday before Easter - during what the health department was now calling the danger period.

``But we both decided that it couldn't have happened to Mum," says Robert, ``because we hadn't heard anything from the department." At 5.30pm on Thursday, April 27, a health department official phoned Liz. Nellie had a urine test while in hospital, he said, and it had returned positive for the legionella bacteria. It was their first contact with public health officials, the first they had heard of any tests or suspicion their mum had legionnaire's. Too late: Nellie's funeral had been at the Springvale Crematorium that morning.

On Wednesday, April 26, Dr Graham Tallis took a call from a scientist at the Victorian Infectious Diseases Reference Laboratory. Expect three cases of legionnaire's disease was the message. Tallis is leader of the Department of Human Services' 12-person response team which investigates every case of legionnaire's which must by law be notified to the Government. Professor William Hart, head of infectious diseases at the department, calls them the ``bug busters". Tallis prefers ``disease detective".

Dr Jane Greig, an epidemiology registrar on field placement from the National Centre of Epidemiology and Population Health in Canberra, joined the team on April 10. She had been sent to get experience in public health crises. In just over two weeks she was to find herself at the centre of Australia's largest ever outbreak of legionnaire's disease. It was the first working day after the extended Easter-Anzac Day break.

EARLY in the morning when Tallis was talking to the lab, ``they mentioned that they had an unusually high number of tests to do that day but we both assumed the reason was that it was post-Easter and there was a backlog and we were in the peak (post-summer) time for legionnaire's."

Soon after the call, the fax machine began receiving official notification, including the patient's name, test result and the referring doctor, laboratory or hospital. The first task was to find each patient's treating doctor for permission to interview their patient, or the family if the patient is unable to be interviewed. By the end of the day that had been done. All three patients were too ill to be interviewed but there seemed no apparent link between any of them. Next morning four more notifications had arrived and Tallis, who would normally follow up all legionnaire's cases himself, called on three of the department's public health nurses, Marion Moloney, Pauline Lynch and Anne Murphy, to help.

All four work side by side. While Lynch and Murphy were interviewing on the phone, Tallis heard Moloney put down the phone. ``I asked her where her case had gone and she told the story and mentioned the aquarium and I said `Oh, that's interesting, the man yesterday also went to the aquarium'.

``Then Pauline, who was still on the phone interviewing a family member but who was listening in, said `My case went to the aquarium too'. That was when the penny dropped." Within 20 minutes epidemiology registrar Dr Jane Greig and two environmental health officers had been dispatched to the aquarium. By 10.45am they were at the main entrance carrying a small Esky with dozens of empty plastic sample containers.``We had to be careful not to jump to conclusions but this felt unusual because it was three cases simultaneously virtually, and all were in intensive care," says Tallis.

The officials were taken to the museum's curator, marine biologist Craig Thorburn. They told him they suspected the aquarium was spreading legionella and they wanted water samples from all the fish tanks and the air-conditioning cooling towers. They took their samples. Then they went to break the bad news to Peter O'Brien.

O'Brien came to the aquarium business late. He bought his first, Underwater World on the Sunshine Coast, after it went into receivership in 1993 and turned it into a success. Then the Melbourne businessman, scion of the O'Brien catering family, began thinking of building one in his home town. It was to take five years and every bit of O'Brien's perserverance, ingenuity and financial support. Plans to build in St Kilda were scuttled by a planning dispute, Asian investors withdrew and the then premier, Jeff Kennett, tried to persuade him to build it on the docklands.

Finally, with the help of Melbourne City Council, the Yarra bank site was selected. ``Peter's put his head on the chopping block a number of times to get this project up," a close friend says. Now he was devastated at the news that his $33 million baby might have been the source of a legionnaire's outbreak and that people might die.

Robert and Liz Campbell had been trying to get their mum, Nellie, out of her house since late last year. With little success. Her poor health - she had recently suffered renal problems - and need for a wheelchair limited their options. Finally, on Thursday, April 13, everything seemed to come together. Nellie, was in good spirits and a day at the new aquarium seemed perfect. It was a choice that has since racked them with feelings of guilt. ``We had really battled to take get her out and give her some pleasure, and now we can't help thinking if we had not talked her into going she would probably still be alive today," says Robert, fighting back tears.

When they arrived all five disabled parking bays were taken and Robert had to wait with his mother in the foyer for 45 minutes while Liz looked for a parking spot. After lunch they decided to join the queue snaking its way along the side of the complex. Now, with the benefit of cruel hindsight he suspects that half-hour wait meant standing within range of the constant fine mist from the aquarium's air-conditioning cooling towers probably where his mother became fatally infected. Greensborough security worker Dick Smithson, 53, remembers the same gossamer mist when he visited three days later. Weekend crowds meant the line was stretching around the front of the building and along the river and he and his family waited in it for almost an hour.``As I was standing there I could feel all this stuff coming down on top of us," he says from a hospital bed at the Austin. ``I kept looking because I thought it might have been raining but it wasn't: it seemed to be coming out of the building, up high near the restaurant." As the health officials met with O'Brien that Thursday, April 27, one of their mobiles rang. It was Tallis: a fourth case had just been confirmed. The victim had also been to the aquarium. Craig Thorburn phoned the cooling tower maintenance firm, Tamar Australia Pty Ltd and an employee arrived in 21 minutes to ``slug dose" the system with chlorine.

Aquarium general manager Bob Adams recalls that one of the first questions they asked the health officials was whether legionella could grow in saltwater, which makes up most of the aquarium's 30-odd tanks. They didn't know, but it turns out there was no evidence of legionella in any. In the light of plummeting attendances following the revelations, Adams allows himself a rare joke: ``The fish are all right, they're just lonely." But a priority was to limit the damage.

As soon as the Human Services staff left O'Brien's office he rang PR troubleshooter John Fetter. Fetter, the former chief of staff of Kennett government minister Phil Gude, established the firm GFB&S with Gude and several other Kennett refugees after last year's election loss. O'Brien spelt out a PR nightmare: four people were hospitalised and the department's infectious diseases section was about to make an announcement linking the aquarium with a legionnaire's outbreak. He had another meeting with the department in half an hour. Could Fetter come? Fetter dropped everything. Be honest, upfront and proactive, he told O'Brien.

At the meeting O'Brien immediately offered to close the aquarium. The surprised departmental staff said it wasn't necessary as the tower had already been treated. A prior relationship with the department's head of communications, Bram Alexander, was useful to Fetter. ``I obviously requested Human Services to put something in the press release to reassure the public and say it was safe," Fetter said. ``Dr Graham Rouch was good enough to put that in his name." Rouch, Victoria's chief health officer, was due to retire the next day after 29 years of service. He threw the aquarium a PR liferaft. The aquarium was now ``the safest place to visit in Melbourne", he said in the press release, a quote the aquarium would soon be repeating ad nauseam.

But there was one other quote from Rouch much less widely disseminated. Victoria has often boasted having world-leader guidelines in controlling legionnaire's. But the Government had conceded the guidelines were inadequate in at least one important respect well before the tourist facility had even opened. Last August, Rouch said the department had ``made a mistake" by not encouraging specific tests for legionella in the guidelines and instead recommending general bacteria tests as an indicator of the likelihood of legionella. The department was ``now encouraging legionella testing and would later legislate for it". But the aquarium never tested specifically for legionella. Rather it relied on general bacteria counts as recommended in the outdated guidelines. A sample taken by health officials the day the outbreak was traced to the aquarium revealed levels of 6,900 legionella organisms per millilitre, almost seven times the 1,000-organism level which indicates a high risk. It was legionella pneumophila serogroup 1, the same kind that hit the outbreak victims. However, the general bacteria levels, meant to be a guide for the effectiveness of biocide in the tower, returned a low reading the same day.That contradiction calls into question the advisability of the current system of relying on general bacteria to indicate likely legionella status. And according to the managing director of water treatment company Hydro-Chem, Mr Neil Duncan, other documented evidence shows there is no positive correlation at all, that lower general bacteria counts actually indicate legionella is more likely to be present. If the disease outbreak had not occurred or had not been traced by health officials to the aquarium, the tourist attraction would never have known about the legionella in its system.

In fact legionella is everywhere. Clive Broadbent, an air-conditioning expert hired by the aquarium, was almost poetic in a media conference as he described how it is found in moisture on the leaves of trees in tropical forests and at the bottom of holes drilled more than a kilometre into the earth. Other experts, more prosaically, reminded us we can find it in the water from our taps and in the dirt in our back yards. However, it is rarely dangerous unless inhaled. Air-conditioning towers are a perfect breeding ground for the bug.

So we shouldn't be surprised if it found its way into the aquarium cooling towers. As the experts put it, you can expect towers to be ``challenged" by legionella. As Dr John Carnie of the Department of Human Services puts it, the real issue is not why legionella got into the towers but why the chemical treatment regime designed to kill bugs failed. The most likely theory, says aquarium consultant Dr Vyt Garnys, is that the biocide chemicals in the towers were overcome by an abnormally large bacterial load from building works nearby. ``Cooling towers are designed to work under a range of expected conditions. They're not designed to work optimally under unusual circumstances. ``Preliminary results have revealed dust containing iron - which promotes legionella growth - in the towers matching dust from the building site, he says. According to the aquarium, staff saw plumes of dust from the work, particularly when girders on the site, a raised railway line, were replaced. WorkCover and the Department of Human Services are also investigating possible causes, but, unlike the aquarium's experts are not willing to comment in detail on what they have found so far. However, Dr Carnie mentions dust in the system, environmental dust, temperature changes and environmental changes as factors which can allow legionella to survive in towers."

There are many questions raised by the outbreak. Who was responsible for the testing and maintenance of the towers: the aquarium, the construction firm, the air-conditioning firm or the maintenance sub-contractor? How did the bacteria get into a new system? Why didn't the towers' chemicals kill the bug once it got in? Why does Victoria, which boasts of having the best prevention regime in the world, not insist on a specific test for legionella? Whatever the answers, they come too late for Nellie Campbell and Ilse Junge and their grieving families. And almost too late, as well, for other victims like Ernie Brown and Dick Smithson, now neighbours in Ward 7C at the Austin Hospital. Ernie had gone to the complex with 61 other members of his Darebin senior citizens' club, The Golden Oldies. One other member is now also in the Austin and five more are awaiting test results for legionnaire's disease.

Margaret Brown says her father had been looking forward to the trip for weeks. ``This was a very big day because he spent some time in hospital last September with a heart condition and he had not been able to get out and about very much. Luckily my father is a real fighter and I think that is the only thing that got him through this because for him to be laid up in bed we knew it had to be something more than just flu."On Easter Sunday, one week after his visit, Dick Smithson was struck down with chronic pain and fever. He put off seeing his doctor but the following Thursday night, he was rushed to the hospital. It was the first time in his life he had spent a night in hospital and, he says now, the closest he has come to death.``Honestly I thought I was going to die, I really thought this is it."