The Hawaii Department of Health says one person is dead after contracting Legionnaires’ disease.

Officials say the patient died back in May after being hospitalized with pneumonia-like symptoms, and may have had an underlying medical condition.

We do not know the patient’s identity due to privacy laws.

“The patient had symptoms of pneumonia at the time of admission. They presumably got the infection before they arrived in the hospital,” said Dr. Erlaine Bello, medical director of the infection control department at Queen’s.

A total of four patients with the disease were recently hospitalized at Queen’s Medical Center. All were local Oahu residents.

Doctors believe the patient who died, along with another patient who has since been released, got Legionella from outside of the hospital.

But the state Department of Health got involved when it learned two other patients were already hospitalized when symptoms flared up, meaning it’s possible they contracted the disease from within the hospital.

Water samples were taken at the hospital Tuesday, and officials say it could take days, possibly even weeks, to get the results back.

Dr. Sarah Park, state epidemiologist, says the investigation is complex and requires a two-day sampling period.

“Some of the samples that are being collected are being sent to try to attempt culture, so that’s going to take some time,” Park explained. “It could be up to two weeks potentially. It could be even longer. It just depends on how fast this bacteria might grow. It depends on how much is found in each sample.”

Legionella has an incubation period of two to 10 days. It is spread through water that has been aerosolized, and is most likely to occur in people who have weakened immune systems.

It is not readily transmissible from person to person. Click here for more from the CDC.

To keep patients safe, Queen’s is not allowing high-risk patients with weak immune systems, including those being treated for cancer or severe lung disease, and transplant patients, to take showers or flush the toilet. They can only drink bottled water, and the hospital is replacing all of its faucets.

“They’ve limited exposure to water fountains, for example, and are instead handing out filtered water, so they don’t have to worry that their patients might be exposed to the spray from the water fountain,” Park said.

Park says they’ve even moved the two patients with Legionnaires’ out of their rooms.

“As far as I understand, they’ve enclosed those rooms as a precaution again to make sure that if the room that they’re in is a potential hazard, then they are not in use right now while we continue our investigation,” she said.

Queen’s says it is still safe for patients to come to the center for treatment.

“This is not cause for alarm or panic. We certainly are not thinking at all about evacuating people from the hospital,” said Bello.

Park says it would take at least 100 patients with Legionella to shut the hospital down.

“I want to remind people the first thing in any Legionellosis investigation that we do is make sure about the safety of the patients. We work with our healthcare facilities, and again, I want to say Queen’s is an example of how we hope that any healthcare facility in any future would respond,” Park said.

Maureen Meehan-Golonka, RN, president of the Hawaii Nurses’ Association, released the following statement:

“The Hawaii Nurses’ Association is working closely with QMC to address the legionella outbreak concerns especially as they relate to our nurses’ safety, and patients’ safety. QMC has provided HNA with information on the precautionary measures taken to protect fragile patients and steps taken by nurses to mitigate risks. 

We will continue to actively monitoring the situation with QMC and the CDC as this is an ongoing situation.”

The U.S. Centers for Disease Control and Prevention states hospitals are required to develop a water management program to reduce the growth and spread of Legionella in buildings.

There are internal and external conditions that could contribute to Legionella growth. Internal circumstances include sediment, water temperature fluctuations, changes in water pressure, pH level, water stagnation, and inadequate disinfection. External contributors include construction, water main breaks, or changes in water sources.

We wanted to know if ongoing construction at Queen’s could be a factor.

“We have sampled the cooling towers, but there’s been ongoing construction actually, or revision, for quite some time with our cooling towers,” said Bello. “We are investigating that and we have cultures pending from that, but that’s less likely.”

Queen’s gets its water from its own well. If Legionella bacteria is detected, it most likely would be from an internal source.  

This is not the first time the state Department of Health has investigated cases of Legionnaires’ disease.

In 2016, guests who stayed at WorldMark Kapaa Shore on Kauai got sick with at least two confirmed cases. Those sickened stayed at the hotel from late April to early May.

The hotel took measures to keep any other guests from getting sick.