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Last One In Is A Statistician

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 water.

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 non-swimmers.

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 adults.

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.