Table 2.
Guidance developed since COVID‐19 for building water management
| Listed in order of Most recent date issued | Specific health risks explicitly identified | Action during building closures | Actions suggested prior to building use | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Inspection | Flushing (amount, speed) | Other cleaning | Shock disinfection | Other step | Worker safety mentioned | Testing | |||
|
Expert report (this study) & Key messages in the supplementary information |
Legionella, Mycobacteria, Pseudomonas aeruginosa, free‐living amoeba, High lead and copper concentrations, Disinfection byproducts |
Flush at least weekly, Consult public health authority, Maintain temperatures, Advise against draining |
Several potential actions described. Consult public health authority |
YES—aerosols with pathogens, shock disinfection water, and scalding | Consult public health authority | ||||
| Nations and organizations with multiple nations represented | |||||||||
| ESGLI (2020): Guidance for Managing Legionella in Building Water Systems during the COVID‐19 Pandemic (ESGL, 2020); PHE (2020): COVID‐19 and Food Water and Environmental Microbiology Services (PHE, 2020) | Legionella |
Inspection, flush weekly, Maintain temperatures, Monitor disinfectant residual, Shock disinfection before shutdown |
NO | YES—Limited instruction | NOT SPECIFIC | YES—FULL | YES—Refill water heaters | YES— SCALDING |
Temperature Biocide Legionella |
| CDC (2020): Guidance for Building Water Systems (CDC, 2020) |
Legionella, Biofilm‐associated bacteria |
Water management plan | YES—Slime only | YES | SOME SPECIFIC ACTIONS | YES— PARTIAL | YES—Water management plan | NO | Disinfectant residual |
| Ireland HSA (2020) Control of Legionella Bacteria During and After the COVID‐19 Pandemic (Ireland HSA, 2020) | Legionella |
Training employees, Legionella control plan, Flushing (weekly), Risk assessment, DO NOT drain |
Guidance references these processes but does not give instructions. | ||||||
| Canada PSPC (2020): Building Water System Minimum Requirements (PSPC, 2020) |
Legionella, Lead |
Flush every 3 days to 1 week, (with detail instructions) Maintain a log Post signage |
NO | YES—Detailed instructions depending on use condition | MANY SPECIFIC ACTIONS | NO | YES—Provide alternative water until proven safe | YES—Mentions personal protective equipment (PPE) and opening outlets slowly | Microbiology |
| New Zealand Ministry of Business and Environment (2020): Ensuring the Safety of Building Water System Post COVID 19 Lockdown (New Zealand Ministry of Business and Environment, 2020) |
Legionella Microorganisms/pathogens Heavy metals |
NO | YES—Floor drains | YES—Detail instructions | NO | NO | NO | NO | NO |
| New Zealand Ministry of Health (2020): COVID‐19 Drinking Water Advice: Returning to Normal Service (New Zealand Ministry of Health, 2020) | NO | NO | YES—Detailed for private water supply; or communicate with municipal supplier | YES—“Until appears normal” with some other instructions | NO | NO | NO | NO | NO |
| U.S. State, Canadian Province, and local agencies | |||||||||
| Connecticut Department of Public Health (2020): Building Water System Return to Service Guidance (Connecticut Department of Public Health, 2020) | Biofilm/Legionella growth, corrosion resulting in discolored water, odor, lead and/or copper release, and disinfection byproduct formation | NO | YES—Long list of items | YES—Detailed instructions including water volume calculation |
MANY SPECIFIC ACTIONS |
YES—With certain conditions | YES—Ongoing flushing 1/day for 12 weeks | YES—Mentions PPE and opening outlets slowly |
Total coliform (all buildings) Legionella (some buildings) |
| Washington Department of Health (2020) COVID‐19 Guidance for Legionella and Building Water System Closures [version 2, April 30, 2020] [36] a | Legionella, Mycobacterium avium, lead | PREVENTATIVE AND REMEDIAL FLUSHING | NO | YES | SOME SPECIFIC ACTIONS | YES | YES | YES | Legionella |
| Indiana Department of Environmental Management (2020): IDEM Guidance for Flushing Water Systems (Indiana Department of Environmental Management, 2020) | Legionella, corrosion issues | NO | NO | YES—Detail instructions including time‐based | SOME SPECIFIC ACTIONS | NO | NO | YES—Mentions PPE | NO |
| Indiana State Department of Health (2020): Building Water System Startup Guidance (Indiana State Department of Health, 2020) | Lead, copper, Legionella | NO | YES—Long list of items | YES—Detail instructions including time‐based | NO | NO | YES—More actions depending on test results; Centers for Disease Control and Prevention guidance if municipal water source | NO |
“Bacteriology” Metals (lead, copper) |
| Oklahoma Department of Environmental Quality (2020) Water Quality Recommendations for Opening Closed or Less Frequently Used Buildings (Oklahoma Department of Environmental Quality, 2020) | Lead, copper, disinfection byproducts, legionella, biofilm‐associated bacteria | Create water management plan, maintain water heater, flushing, | YES—Maintain system | YES—Some detail including flushing in stages | SOME SPECIFIC ACTIONS | NO | YES—Contact utility | NO |
Temperature pH Disinfectant |
| Oregon Health Agency Public Health Division (2020) Guidance for Reopening Building Water Systems after Prolonged Shutdown (Oregon Health Agency Public Health Division, 2020) | Legionella, harmful bacteria, lead, copper | Flush weekly (some considerations given) | NO | NO— But mentioned as preventative | NO | NO | NO | No | Coliform |
| Arkansas Department of Health Engineering (2020) Flushing Guidance for Buildings with Low Occupancy or No Occupancy During Covid‐19 [33] | Microbial, chemical (lead, copper) | Occasionally flushed | YES—Sediments | YES—Limited instructions | SOME SPEICIFC ACTIONS | NO | NO | NO |
Disinfectant Bacteriological |
| Public Health Madison & Dane County (2020) Water Quality and Your Business: Tips for Re‐opening After Closure Make Sure Your Building's Water System and Devices Are Safe to Use (Public Health Madison & Dane County, 2020) | Legionella | Routine flushing | NO | YES—Considerations given including time‐based | NO | NO | YES—Reuse wastewater | NO | NO |
| City of Durham (NC) (2020) Flushing Water Systems for Reopening (City of Durham, n.d.) | Disease causing microorganisms, corrosion control can be impacted | Preventative flushing | NO | YES—Limited instructions | NO | NO | YES—Capture and reuse water for outdoor use | NO | NO |
| Minnesota Department of Health (2020) COVID‐19 Reopening Guidance for Noncommunity Public Water Systems (v2) (Minnesota Department of Health, 2020) | Legionella, sediment, loss of residual, lead and copper, bacteria in equipment | Flushing as part of reopening plan | YES | YES | YES—Well and storage tanks | NO | NO | NO | Coliforms |
| Vancouver Coastal Health (2020) Water Stagnation Risks Due to Prolonged Reduced Building Occupancy (Vancouver Coastal Health, 2020) | Legionella pneumophila | Flush periodically, maintain hot water, reduce access | YES—Several elements added | NO—But periodic flushing during closure is briefly mentioned | YES—Clean pools | NO | YES—Consult water management plan | NO | NO |
|
Ohio Environmental Protection Agency and Ohio Department of Health (2020) Water Quality Recommendations for Opening Closed or Less Frequently Used Buildings (Ohio Environmental Protection Agency and Ohio Department of Health, 2020)b |
Metals (lead and copper), opportunistic pathogens (Legionella, Pseudomonas, nontuberculosis mycobacteria), organics (disinfection byproducts, trihalomethanes and haloacetic acids) | Water management plans, flushing as a preventative measure | NO—But be aware of other hazards | YES—Some considerations given | NO | YES—Use a professional | YES—Continuous disinfection is an option | YES—PPE mentioned | Inorganic, Bacteriological, Unsafe metals, Microbial pathogens, Pressure, Disinfectant residual, Temperature |
| Nongovernmental organizations | |||||||||
| ESPRI (2020) v1: Coronavirus Building Flushing Guidance [no differences found in version 2] (ESPRI, AH Environmental Consultants, et al., 2020) **Additional (released May 12, 2020) “ “Reducing Risk to Staff Flushing Buildings” (ESPRI, 2020)a |
Disease causing microorganism, Legionella pneumophila, Toxic metals such as lead. Harmful substances such as disinfection byproducts. |
Keep water heaters on, Routine flushing, Create water management plan, Shock disinfection can be considered |
YES | YES—Detail instructions including time‐based | SEVERAL SPECIFIC ACTIONS | YES—With certain conditions | YES—Ongoing flushing 1/week for 12 weeks |
YES—With shock disinfection. **additional document mentions PPE, aerosol reduction techniques |
Disinfectant residual |
| IAPMO (2020) Rehabilitating Stagnant Building Water Systems (Demarco, 2020) | Legionella and other pathogens, corrosion issues, off color and taste | Routine flushing (3–4 days) | NO | YES—Some instructions including time‐based | SEVERAL SPECIFIC ACTIONS | YES—Some systems | YES—Other building systems, floor drains, filter maintenance | YES—High levels of pathogens—Open valves slowly | Legionella (some buildings) |
| American Water (2020) Has your facility been closed for weeks? Flush the Pipes (American Water, 2020) | Lead, Legionella | Routine flushing (biweekly) | NO | YES—Some instructions including time‐based | NO | NO | NO | NO | NO |
Paper coauthor William Rhoads advised on document; perhaps affecting results.
COVID‐19 closures were not specifically mentioned, but COVID‐19 is mentioned in an appendix document, and the authors indicated this document was written in response to COVID‐19 closures.