“It couldn’t happen where I live.” Many in the United States probably thought that when watching the horror occurring in Flint, Michigan, from 2014 to 2016. At that time, Flint residents — and the public at large — were “officially” made aware that there was something wrong with the water coming out of Flint faucets and showerheads — “officially” only because the same Flint residents already knew there was something wrong and had been saying so for quite some time. Discolored water that tasted bad was coming out of their taps. Showers that, instead of cleaning, were causing rashes to develop. The cause was increased lead (Pb) levels in the water. Everyday hero, Dr. Mona Hanna-Attisha, chronicled well her horror in realizing the changed water source was leaching lead from the piping distribution systems in the city. Lead is especially harmful to children both within and without the womb — it can impair their cognitive development permanently, leading them to be disabled their entire lives. It also is likely that lead contact can weaken the immune system.
Then, sometime after the lead exposure, some people started getting even sicker. Really sick. The cause: Legionella pneumophila, a naturally forming bacterium that lives in the water. If you were to drink it, you’d be fine. Nothing would happen if it were to come in contact with your skin. No issues would develop if you got water with Legionella pneumophila in your eyes or ears. The issue comes if the bacteria become aerosolized, via a faucet or shower, and a person with a compromised immune system (like those who were exposed to lead) was to breathe in these water droplets. At this point, the bacteria, which thrive at temperatures from 80° F to 120° F, could grow rapidly in the lung aioli, causing severe fever and pneumonia. This is known as Legionnaire's disease. Somewhere between 10% to 25% of people who contract these bacteria die. Those who survive often have conditions that plague them for months, years or even lead to further complications that ultimately kill them. The number of Legionnaire’s disease cases continues to increase year after year, for a number of reasons — misdiagnosis, plumbing design and construction, water conservation and water overuse, etc. In 2015, there were 6,079 cases. By 2018, the number had risen to 9,933 cases. And now this terrible disease began to strike the people in Flint.
As the leached lead likely began to weaken many Flint residents’ immune systems, Legionella bacteria took advantage to deliver serious, deadly consequences. The official death toll due to Legionnaire’s disease was 14 people. However, as a PBS “Frontline” documentary found out, the actual death toll was most likely much higher, due to the exclusion of complications and misdiagnosis; “Frontline” estimated that more than 120 people died as a result of Legionnaire’s disease in Flint. Many more still deal with the debilitating after-effects today.
We think of Flint as a distant place. We also think there is no way our plumbing systems are unsafe. We believe that a Flint-like situation can’t happen where we live. We assume the water coming into our homes is safe. We take for granted that our sewer lines will take our waste away. We walk into the dentist’s office to have wisdom teeth pulled expecting to walk out. We expect that when we walk down the street, the natural gas systems won’t cause harm to us. Every day, as we interact with any number of plumbing systems, we expect them to work and improve our lives. But the success of plumbing systems in improving our day-to-day lives has also been its undoing. Complacency has set in. And the rarity of witnessed failures has led us to believe that plumbing must be simple. This belief leads us to ignore the legion of small pinpricks that continue to negatively impact us every day. In fact, as a society, we have created a host of ways to ignore it.
As human beings, we are intensely irrational creatures. We fall for any number of logical fallacies for any number of reasons. One logical fallacy that we have fallen for in this case is Occam’s Razor — “The simplest solution is the best.” However, in this case, the simplest solution is not always the best. In the world of plumbing systems, we have used a number of “rules of thumb” or “quick fixes” to “make things easy,” “speed up the construction process,” or “save water.” However, in an effort to streamline plumbing engineering and construction, or to save costs or resources, we have created a host of unintended consequences for which we are now paying dearly; unintended consequences in the form of building water systems that make us sick, disable us for life and even kill us.
Second-order thinking is not a natural skill for most of us; it is a part of a strategic planning mindset and that is a learned skill. As a Farnam Street article once said, “Often when we solve one problem, we end up unintentionally creating another one that’s even worse.” It can be difficult to anticipate which problems our solutions create, especially if decision-makers lack the necessary training and education to realize this. We would do well to remember Newton’s Third Law of Motion states that “Every action has an equal and opposite reaction.” This law plays out in the world of engineering every day. Unfortunately, the people who have made decisions about our drinking water systems often have not seemed to understand this lesson and have repeatedly made decisions that have jeopardized our well-being in small ways. When combined, enough of these small negative consequences create large, slow-moving disasters. Often these large, slow-moving disasters are precisely the type that are so easy for human beings to ignore.
Large disasters easily capture our attention. When the Hyatt Regency Bridge collapsed in Kansas City in 1981, the result was difficult to ignore and garnered national news coverage: 114 killed and more than 200 people injured. The technical reason for the failure was a decision made during construction to deviate from the original design to hang one walkway from the other in lieu of using a common rod. This doubled the load on each washer and nut, which ultimately led to the catastrophic failure of the multiple walkways. The nontechnical reason for the failure included the engineer of record failing to properly review the revised design and consider the unintended consequences of the small revisions.
Disasters of all sizes and velocities tend to be the result of a series of small decisions that had accidental results. These small decisions still follow Newton’s Third Law in a metaphysical sense — action and positive and/or negative reactions occur. In the world of plumbing — the industry I know and love — we have seen one unintended consequence after another occur. From low-flow plumbing fixtures increasing the potential for waterborne pathogen amplification to new disinfectants causing corrosion to HVAC engineers not understanding how to properly install medical gas systems and creating risk to patients, in so much of plumbing system engineering and construction our society has created so many small hazards. After 80-plus years of these practices, these small, unintended consequences have added up. All we needed was a final catalyst to push the entire system over the edge.
In many ways, that final catalyst appears to have been the COVID-19 inspired lockdowns of 2020. So much of our plumbing systems — people and materials — were already under strain before the pandemic. Economic and health concerns caused many systems to break. With COVID closing many parts of the economy, revenue for the industry fell dramatically and has caused the loss of industry knowledge that we may never get back. However, most noteworthy, the circumstances of mass building vacancy likely exasperated the waterborne pathogen amplification that was taking place in preceding decades. Stagnant water sitting in vacant buildings has an increased potential for harmful metals to leach into the water and for bacteria like Legionella to grow and multiply. This makes the water system more hazardous over time. It presents a particle concern for the building occupants who are first to return to the building; if building owners were not diligent about their flushing and testing, there is an increased likelihood that the people who first “reoccupied” the buildings were exposed to contaminants of some kind. Unfortunately, even this concern was diminished. While almost the entire plumbing and water industry was shouting this concern from the mountaintops, the construction industry at large ignored the concern due to a focus on COVID. While the numbers of COVID-related deaths and economic decline due to lockdowns have been often discussed, the actual impact in terms of number of sicknesses and dollars spent on water-related disease is hard to quantify, as the science on this is still emerging. However, we will undoubtedly discover some of the problems that were caused over the upcoming years. The challenge will be allocating resources to fully understand the problem and then determining the correct course of actions for solutions.
Fortunately, there are solutions; unfortunately, they require effort on all our parts. I’ve spent much of my adult life understanding the context of what has led the plumbing industry to where we are. I now hope to try and summarize my experience and work for you all. If we, as a society, don’t gain at least an understanding — if not an appreciation — for plumbing at this critical juncture, we risk our health and safety long term. The problems we see now will continue to increase in size and scope until we end up having total systemic failure.
Even then, due to the decentralized nature of plumbing systems, we will not see these failures occurring simultaneously. These failures likely will mimic Flint but will occur with increasing frequency in various parts of the United States. News stories in which entire communities or cities lose access to clean water and sanitary conditions will likely increase in frequency. I expect to see national news stories that synthesize dental gas deaths and injuries across the country within the next five to 10 years. In light of our newfound focus on COVID, I also predict that as a country, we will begin to pay more attention to bacteria and viruses that live in our water systems than ever before. The current crisis offers a great opportunity for us to reset our purpose on one of our most important resources — water.
The good news is many already recognize that plumbing is essential. During COVID, many, if not most, of the country’s governments deemed the plumbing industry “essential services” — no small matter! Considering that human beings can only survive three days without water, I think most of us would agree with this declaration. Sadly, however, when it comes to the engineering and construction of buildings, this thought process is not followed. Often the discussion of plumbing is not even part of the discussion for projects. This devaluation is likely a result of our daily decisions as a society — we really don’t talk much about plumbing. Worse yet, when we do talk about plumbing, we often do so using words to demean it. At the very least, this language needs to change. Words have meaning, and if we don’t value plumbing with our words, we shouldn’t be surprised if our plumbing systems begin to fail with more frequency. At the World Plumbing Council’s virtual event in 2020, the question was raised: “If we think plumbing is essential, then why don’t we act like it?”
Our words, and the way we talk about plumbing, make an impact. A famous proverb by Frank Outlaw comes to mind at this instance:
“Watch your thoughts, they become words;
watch your words, they become actions;
watch your actions, they become habits;
watch your habits, they become character;
watch your character, for it becomes your destiny.”
If our words about plumbing systems diminish the industry, we shouldn’t be surprised when the financial incentives drive to the lowest common denominator, quality suffers as a result and then our systems fail. We literally get what we asked for. Our language and knowledge about plumbing need to improve if we want to avoid more failure. Winston Churchill’s words ring true: “We shape our buildings, and afterward our buildings shape us.”
In this sense, our society is failing plumbing, and thus our plumbing systems fail us.
I hope and pray that all the people of this world have access to clean water and sanitary sewer systems. In the United States, we have such an advantage in this regard, but this advantage is eroding more quickly over time due to our words and actions. Flint is one of many “canaries in the coal mine,” as it were, for us. If we want to avoid further danger, we each have our part to play and need to take action now. Thank you in advance for your time and consideration in reading this column, and then taking the knowledge here and helping make a difference in our country and the world. I hope this information allows you to open a dialogue in your own life and lets you appreciate the intricate systems behind the walls that form part of the basis of our society. The question for us is simple: can we afford not to?