Notes from an emergency room doctor: It's summertime
and everyone's at the beach. I love the beach.
There's nothing like the feeling of warm sand
under curling toes. There's no sound more calming
than the ebb and flow of surf. But then again
There's nothing worse than choking on cloudy
salt water, as you're tossed about by unpredictable
currents. There's nothing more disgusting than
trying to get tar balls off your feet or sidestepping
flies hovering about seaweed or dead fish.
Beside the aesthetic vagaries of beachgoing,
there are medical dilemmas to attendance at lakes
and seashores. Every once in a while there's a
headline that scares the public away from beaches.
Sharks are a good phobia. More common though are
the sewage spills - the failures at our treatment
plants that result in untreated sewage spilling
into our swimming areas.
Swimming in polluted waters usually results
in diarrheal gastrointestinal illness brought
on by swallowing sewage-contaminated water or
respiratory illness caused by contaminated water
spilling into an airway. These illness usually
occur within 48 hours of exposure and are associated
with fecal coliform and steptococcal bacteria.
All that makes sense and encourages us not to
swim in sewers. But interestingly, studies show
that common infections are also more prevalent
in beaches with good microbiological water quality
- the so-called "clean and safe" beaches.
But "clean and safe," does not necessarily
mean free of all health risk. Eye, throat, and
skin infections, which generally do not result
from exposure to the kind of intestinal organisms
you find in sewage polluted waters, are common
at pristine beaches. It is the predominance of
these non-intestinal infections that suggests
some infections occur as a natural consequence
of swimming, and are not the result of contaminated
In a major study of "safe" beaches,
the most common illness reported at lakes was
"pink eye," with 69 out of 1000 swimmers
developing eye infections compared to only 12
out of 1000 nonswimmers. At ocean beaches, the
most common symptom was sore throats, reported
at rates of 44 out of 1000 swimmers and half that
for nonswimmers. Gastroenteritis, even in "safe
waters," was more common among swimmers than
These increased rates of mild infectious illness
are due to the alteration of normal skin and mucous
membrane barriers to infection in swimmers, and
the transmission of illness between swimmers.
Children also have higher rates of infection than
Needless to say, the rates of illness will increase
if swimming water contains any significant human
wastes. And anybody that swims in water with little
kids, has been a little kid, or is a little kid
at heart, knows what I'm talking about.
Another factor affecting the microbial content
of water unrelated to pollution is water temperature.
In one river analysis, bacterial counts were ten
times higher in summer than the winter months.
Several bacterial species require water temperatures
above 15^C to be metabolically active. So, despite
the risk of freezing your buns off, brave cold
water swimmers are at less risk for illness than
warm water bathers.
My daughter hates the beach. She abhors bathing
with other animals, i.e. fish. She likes to remind
me that lakes and oceans are places "where
fish go to the bathroom?" That doesn't bother
me as much as when they become places where people
go to the bathroom but there's no changing her
mind. She's a chlorinated pool kind of person.
Nevertheless, I'm going to be out there this summer.
If you see a whale of a man body surfing, that
may be me. I'll have to trust the people that
operate the sewage treatment plants and those
that guard the storm drains to keep our swimming
holes as unpolluted as possible. All life's pleasures
entertain some risks. So I'll live with an occasional
stomachache, earache, sore throat, or pink eye.
And I'll see you at the beach. Last one in is
a - statistician.