 Thank you. I'm in pools and spas. I don't float. I don't swim that much because I know what's in the water. I have no commercial ties to this business at all. I'm here to talk on science, so I have no reason to distort anything and speak strictly upon the science. But simultaneously, I'm going to do two things during this talk. One that I always do and one thing that I never do. And the one thing that I always do, like Ashkahn points out, I always talk about really gross, disgusting, nasty diseases. Some of them smell so bad they'll make a vulture puke. But, so I always do that. But if you will look at your watch, I'm doing it just before lunch. Blame Ashkahn because he thought it would be funny to get me to talk about diarrhea just before lunch. And the other thing that I never do, I'm in all black. I never were all black. Because today, under the right conditions, I am the voice of doom and gloom that you don't want to hear. I am the disease that you don't want in your float tank. And if we don't do something about it, I am the voice that will kill the entire industry, and that is not an exaggeration. But I'm really an optimistic kind of guy so that may not happen if we work together. But if we don't work together, it will happen, and that is a promise. But it probably won't because we are going to be able to work together. All right, now, I don't know much about floating, but what I hear here is one of the most upbeat dynamic groups I have ever been to. And the psychological material, because I've got a lot of experience on depression and I've been around a lot of people with it, and I've encountered it. Wow, we're talking about really positive things that are going on with the human mind. Wrong. I'm a microbiologist. I'm going to take you through the mind of a germ. So quit thinking like a human. Buckle up, because here we go, into the world of a demented microbiologist. First off, germs are everywhere. And if you're a germaphobe, there's the exit. Get the hell out, because that's what I'm talking about. And one theory says that there are more germs in you and on you than you have cells in your human body. Now, we don't know whether that's true exactly, but it's a damn good story to open up a talk like this with. And sterile environments really don't happen in the natural world. And then our own health depends upon the types and quantities of germs in our bodies. But that when we do really bizarre things like create artificial environments where the environment, the germs in the human body interact, we change that interaction. And that's what we're talking about is the change of the interaction between the germ and the human body and a 30% solution of magnesium sulfate is a pretty bizarre environment. So let's look at how the interaction between that occurs. Let's look at the world of the germ. Let's look at the human behavior model. Let's look at the environment. Let's look at human physiology. And it is where those areas interact that we are dealing with. It is the interaction between the environment, the germ, the human behavior and all of these are important. But germs don't have a lot of social anxiety. You call up a germ said, Hey, party. They're there. Human behavior is a little bit more erratic than we would like. Particularly, you know that if you got a teenager. We cannot prescreen our customers. We can't have them walk in and say, Hey, take this test strip, put it in your mouth and it turns blue. You can't come into my facility because you're at a high risk individual. We don't do that. Where we can manipulate is the environment. And we can do that by filtration. We can do that by disinfection. We can consider the pH, the alkalinity, all those little things that I work on every day in swimming pools and spas. But let's look at the world of germs. This is the world of all the germs. But we don't need to worry about all the germs. We only need to worry about those germs that cause disease, but not all germs. Just the germs that cause human disease. But we only need to worry about those human disease germs that are stable in water. But no, we only need to worry about those that are serious diseases because some of them really don't and they don't really create a threat. So it's a very small environment we need to do it. And if I could, I would have made that little red dot even smaller. But the other speakers that got better AV systems than I got. They got this cheap corporate system. It's damn it. They're making me look bad. Okay. What we're talking about is risk. Risk is the chance of something happening. It could be good. It could be bad. What we're talking about is if somebody gets sick in a float tank, that's bad. But there's a way we can analyze this stuff and we can go through a systematic approach. We call it risk analysis and we figure out what the risk is. And when we put a management structure in place and we call it risk management and we do it every day and you're all doing it and you're not aware of it. But let's look at three ways risk could occur. What are three risky things that you could do today? You could do something really crazy. Like getting a car. You could take a shower. You could do one of the most riskiest things in your entire life and eat alfalfa sprouts. So how do we manage these? Well, if we get in a car, you get in a car, you put a seatbelt on, you have a car with crumple zones that absorbs energy, you have airbags, you have engineering controls, and in the float system we have filtration. Wow, it's an engineering control. You've already got risk management designed and you didn't even know it. Now that you know that the riskiest food sold in North America is alfalfa sprouts, you could decide at lunch, I'm not going to eat those. You could send them back. You could not order them. But if you really want to eat them and you want to reduce your risk, fry them. The Ecoli will be dead. Risk management. But we're in business. And there's another way to do it. We could transfer that risk to somebody else because we could use insurance. We could pay somebody to say, take the risk away from me. Or we could have an consent form that says, it might be hazardous to get into my float tank, so sign this form and don't sue me if it happens. We've transferred the risk. But in other cases, we could say, well, the risk is small and I'm just going to do it anyway. And one of the things that you probably did this morning is take a shower. Now there's this little bacteria called Legionella nemophila and it grows in hot water systems, particularly in hotels. And then when you take a shower, it gets flushed out and now it's in the little droplets and you're in a shower, you probably have to breathe every once in a while. So now you've inhaled these little missed droplets and they go right into your lung and that's where Legionella likes to live. And now you've got Legionelosis. So here's your choice. You have a very low chance of getting Legionelosis in a shower and you'll feel clean and everything, so it'll be fine. Or you were out late last night and you're going to smell like a dead raccoon. Which do you want to do? Low chance, smell like a dead raccoon. That is called a management decision. All right, let's talk at risk assessment. Risk is a mathematical equation between something bad, a hazard, and exposure. And this is a mathematical equation and if you've done math with your kid in elementary school and middle school recently, you will know that if either one of these goes to zero, risk goes to zero. So we can control the type of hazard, and these are called germs, or we can control the type of exposure in here and we can do this and come up with our risk management system. So how would we do this? Well, that's the way chemists do it. And I'm not a chemist, I'm a microbiologist and that's way too simplified for me. So what we're going to say is the host must be susceptible to the germ. Now a week ago today I was on a business trip out in the Midwest and I went through my hometown where I grew up, little town in southeast Kansas and I drove down the street and all the big trees that were there when I was a kid all died. Everyone was dead, maybe 98% of them dead. They died from a disease called Dutch Elm disease. All the trees died, 98% of them. Didn't kill a single human. Guess what? Humans don't catch tree diseases. So the germ, the host must be susceptible to the germ. Barrier number one. The root of exposure must be appropriate. Okay, let's get back to that diarrhea topic because it's almost lunchtime. This, you think is a cup of coffee. Well, okay, just for the sake of purpose we're going to say this is a cup of E. Coli 0157H7, the nastiest, meanest, dirtiest one you're ever going to see on your life. We're going to say there's eight ounces in here. We're going to say there's an average count in here of about 10 million per milliliter and that'll give us about 24 billion E. Coli 0157H7s. Anybody in a CPO class? Here comes the math. Watch. On my arm approximately 30 to 40 million. The infective dose to cause disease is 10. CPO students, which is a bigger number? 30 million? 10. Test question. Will I get sick? No. Now I'll do the exact same thing with my nice cup of E. Coli 0157H7. What do you think now? Well, about three hours from now it's going to start with a little bit of pain down here and then it's going to go into chills and aches and fever followed by here it comes, Ashkan. Diarrhea. Soon to be followed by bloody diarrhea. Soon to be followed by kidney failure. Soon to be followed by death. What's the difference? It was the exact same number of bacteria. The exact same number. There's no difference. One's on the skin, one's in the gut. It all depends on where the germ ends. E. Coli is a gut pathogen, not a skin pathogen. The chemist didn't think about that when they did the risk equation. Yeah, you can see why chemists love me going to their meetings. The amount of the germ makes a difference. Oh, wait a minute. I have another cup of coffee back here. Well, it's the same one, but we're going to pretend it's different. Now I have three E. Coli three, three, not three million three. Now I drink the entire cup of coffee. Will I get sick? Three. What is the infective dose? Ten. CPO students, which number is bigger? Ten or three? Damn, it's getting easy on Monday already, isn't it? I won't get sick. I didn't reach the infective dose. All right. If any one factor is insufficient, you're not going to get sick. Okay. How do we make this applicable? You got to have the minimum amount of dose. You might have noticed that not everybody in this room is exactly the same. Some of us have the ability to collect more photons than others. Further, our immune systems vary. Our response to disease vary. And if I were in E. Coli last night and I would have stayed out late to midnight like Jocelyn wanted me to, I may not be feeling as good today because I drank all that adult beverage. No, some of us wanted to be able to talk today so we went to bed at nine o'clock. So I'm on today. How you feeling, Jocelyn? But all these factors come in. Is the host feeling good? Is the germ feeling good? And how does this in play to the health of our patrons? Well, I want to introduce you to a guy who I think could be the hero of the entire float system. I skipped a slide. Let's get to that one in a minute. But let's talk about how did these germs get into the body and then we'll introduce our hero just in a minute. They're going to get in three ways. Ask them to try to make it too complicated. It's not. You're going to inhale them. You're going to swallow them or you're going to get something really crazy like get wet. 99% of all the diseases in swimming pools and spas right there. That's it. That's it. That's how we're going to do. That's it. 99%. So let's talk about this. Now we've got a more complicated equation. We're talking about the quantity of germs. We know the exposure pattern. We know a lot more. We're beginning to get to the point where we can do a true risk assessment. We need data. We need to understand what germs we're dealing with. So how do we get data? Well, we go to the Centers for Disease Control and we look at their data. But they have to get their data somewhere. So how did they get data? Well, it starts off by somebody getting sick and then they have to recognize they're sick and then they have to figure out how they got sick and then they have to figure out where they're exposed and they have to pick up a phone call and report it and then the local agency has to have enough data to decide to do something about it and then they have to investigate it and then they have to issue a report and then it has to go to the state and then the state sends it to the CDC and sooner or later they issue a surveillance summary in one of my favorite publications ever. It's called Morbidity Mortality Weekly Report. And if you want to have a germaphobe that you work with, what you do is you print out a copy of it and you lay it on your desk. It'll gross the hell out of people. Morbidity, mortality, weekly report. And I've had two bosses that are germaphobe and they leave me the hell alone. All right, so now we've got all this data. That's three or four years to get all that data, but we've got 20 years of it we can look back on and we can use that. And so now we can take that data and we can assay that and we can say there's two kinds of water that we can talk about. We can talk about swimming pools and spas. We can talk about fresh water and there's reports from the CDC on these two topics and we compare these and we come down to the bottom of it and when we look at it low and behold float tanks are more similar to swimming pools and spas and they are natural water and Ashconn and Graham go off to all these conferences and they run into this crazy idiot who's wearing black up here and trying to make a total ass of himself that happens to be an expert on recreational water illness and that's why I'm here and for the beer. So now we take that data and we apply it. Here's the same guy. Here's the germs. That's it. That's the entire list. Legionella, E. coli, Shigella, Norovirus, Giardia, Cryptosporidium and Pseudomonas. 99% of all the germs and now we're done. Oh hell you saw that coming. No we're not. We can get better than that because we can define it by exposure and that's what the CDC is just beginning to do because I've been yelling at him for 10 years to do it. So now we look at swimming pools and spas and low and behold swimming pools don't have Legionella but it grows in swimming pools. It's in there but why don't they have because you don't have droplets and the droplets don't get inhaled in the bacteria don't get in the lungs and you don't get disease. So don't take a shower get in the swimming pool right? Except that in the swimming pool there's all these gastrointestinal germs in there and people get sick from swallowing water but they don't swallow water in a spa. Matter of fact in 20 years I can't find a single outbreak of gastrointestinal illnesses in spas. What's the difference? Human behavior. Oh I got back to that early slide after all didn't I? You wondered how that was coming in. Okay so the human behavior is different but Pseudomonas people are wet. Bacteria is there. You're wet. Bacteria is there. Bacteria is having a party because it's living inside of your skin. Let's do the comparison. We go through the comparison of the water quality and the parameters and everything and something jumps out. I'm a physiologist. Holy cow have you people got some salt in the water. This is where that hero comes in. You might have heard of this guy. I think this is the guy that he is the savior of the entire industry and if you think this story is fishy you would be right because this guy lived in a little place called Mount Vernon on the Chesapeake and Potomac rivers just south 11 miles south of present day Alexandria, Virginia. That's where he lived and in the spring there was these huge runs of shad that ran up the river. Huge runs. Now people in England and we were English at the time George was English. He was a good businessman. He figured hey wait a minute let's catch all these fish and let's ship them to England. So George took his grew up they were slaves caught all the fish. Now just north of Alexandria is a place called Arlington and that's where Ronald Reagan National Airport is so George went out caught all the fish drove him by truck up to Ronald Reagan National Airport put him on a 747 and flew him to London made a fortune from the British then led a revolution against the British and was still rich afterwards and the British continued to buy fish but wait a minute he did it before there were 747s before there was Ronald Reagan National Airport before there were motor vehicles and before there were refrigeration he shipped hundreds of barrels of fish and this was before Benjamin Franklin figured out where the Gulf Stream was so it took 60 days in some cases to get barrels of fish from Alexandria to London. George made a fortune. If the fish smelled like you can imagine they would have smelled George wouldn't have made a fortune but he did something brilliant he used a magic chemical salt. Now I'm a physiologist float tanks instantly salt. We all need salt we all need a specific kind of salt we need the concentration of salt and if we have more salt we have less water and our cells need a balance between salt and water and as we have more salt we have less water and we have a way of measuring that and we call available water or water activity and it's a sub w sometimes it's capital a sometimes it's small a I don't care. All right but we can measure it. Hey Ashcon remember took you forever to find it guess how long it took me to make this slide for this presentation Ashcon 90 seconds it's publicly available information it's as high technology called Google. All right so here's a w and we can measure it distilled water zero one point zero zero pseudomonas cannot grow if the aw is less than zero point nine seven E. Coli 0157987.95 Candida you can go right down let's get down to the 20 sodium chloride that's less salt than you're using in sodium chloride the aw is point eight three everything above it will not grow will not survive whoa as we had I can't find magsulfate probably because we don't use it a food preservative but we're way down in here way down in here I think we're doing pretty good this is a pretty any microbial environment it's impressive to a physiologist it's not impressive to departments of health because they haven't had all the classes that I did in food science and some of those classes out in food science at Arkansas you got the taste panel they gave you free food grad student free food okay here is a risk assessment legionella can't multiply pseudomonas cannot multiply E. Coli chagella die off over several hours they will decline viruses maybe Giardian cryptosporidium are very environmentally hardy so we've already eliminated about half of the major bugs just by talking about salt they're not an issue but could you still get sick well let's take a theoretical case where somebody had a case of cryptosporidium or Giardia about 10 days ago they're feeling better they don't have diarrhea right now but you know the commercial it's one of the toilet paper commercials where the bears are walking around and there's no bear family they walk into the cabin who I can't stay here they got the wrong kind of toilet paper in here what are they talking about they're talking about that all of us carry a few grams of feces on our back sides and we know from statistical studies done down in Arizona by Charles Gerbusting they were grad students of course naturally they had to do this kind of work we know that the average person carries 0.14 grams of feces on their backside so let's take this person that was sick about 10 days ago and they still have some of these germs in the gi tract because we're in the healing process and we're going to put them in a float tank they didn't take a shower first they didn't follow instructions they washed these off and we're going to make a theoretical assumption that we don't run the filter because this is the kind of thing the health department is going to ask and they're going to say what happens if the next person gets into the float tank and swallows water what is the statistical likelihood of them getting one of these diseases and we can do this we can take three scenarios they had a little bit they had a moderate amount or we can do a worst case so let's take a small amount they washed off a hundred thousand oocysts we can calculate how many are in each mill of water and we can calculate how many ounces of water that individual has to swallow to become ill so in this top scenario this person must swallow 22 and a half ounces of float water thank you okay so they get a little more washed off of them on person a the next person has to swallow and this is an average amount perhaps just theoretical calculation they have to swallow two and a quarter ounces that's about a quarter of my cup of E. coli up in here what's the chance that somebody's actually going to swallow two and a quarter ounces of mag sulfate water is it zero will a health department ask you is it zero it's not zero but it's very slight but instead of being sick 10 days ago what about our person a was sick yesterday with diarrhea and so they've got a lot more so now they've washed off 10 million oocysts and they're salt tolerant and so the next person gets in there and they only have to swallow a quarter of an ounce they could get sick but don't we have something called a filter what happens if we have a one micron bag filter and we run various cycles between users do we have the same thing well we can do that too and this top group we only ran about two cycles on a one micron bag filter only two cycles and look in the worst case scenario you've watched 10 million crypto in there that person has to swallow two and a quarter ounces to get sick wow that's about two three cycles that's it but if you run it like five cycles now that person has to swallow a pint and a half whoa but you know I really like the fact that up there is top one up here 225 ounces 225 ounces they've got to swallow a gallon and a half of water we can do the mathematical calculation so we can do the risk assessment we can figure out what's going on and at the world aquatic health conference three gentlemen will be presenting this type of much more detailed analysis to a small little group referred to as the u.s. Centers for Disease Control and Prevention because Michael will be sitting in the front aisle I'll make sure of it correct so we haven't presented it yet but it's available so you're seeing the preview of it based on all the above what's going to happen in a float tank okay theoretically the demented mind of a microbiologist is going to tell you legionella it's not going to happen it's not going to grow it's not going to multiply it can't become significant it will never grow fast enough you don't have aerosolizing devices legionella is not an issue by the way legionella is the only one that is universally fatal about 40 percent of the cases of legionella in spas are fatal so the number one high fatality organism is not a threat period end of debate not arguable by any health department pseudomonas it can't multiply it will not reach levels significant this is the one they're always going to ask about no then they're going to say well what about staff la caucasaurus well i'm going to say well you find me one case of staff la caucasaurus one just one that has ever been documented to be transmitted in water in pools and spas just one it doesn't happen it might survive but it's not transmitted in water it's transmitted on the furniture in your front offices in your changing rooms oh crap we haven't got there yet dermal diseases are not an issue in float tanks end of debate ecoli shigella pretty close to zero crypto and geridia close but not quite zero but if that user gets into that float and has diarrhea all bets are off you will drain the tank you will disinfect it and you will start some scratch and if they tell you you don't have to somebody doesn't know their science the science is clear there is no other way to eliminate the risk in the kind of systems that we've got drain the water and start from scratch or there are other things that we should consider maybe now we'll get to those in a minute but that's all theoretical and i think it was grand rapids at national environmental health association weren't sitting there at lunch with graham and ashconn and then these guys looked across the table at me and we gone hey yeah we've been doing microbiology you've been doing what you know it's like they've been collecting microbiology crap i didn't it's not published okay so ashcon sent me the data it's not perfect it's not the way i would have done it because i'm a micro geek and they were doing it at the contract lab and the contract lab was doing standard things and unless you tell a contract lab exactly what you to do they're going to pull a standard method out and they're going to say hey we can do it this way and we can charge her $35 a plate and we can make a fortune at it and it's not necessarily the data that you want but they can make a fortune on it but we can still get some data out of it here it is graham's this ever been seen in public before okay you're seeing it all right cpo students take this data down because there's a test on it tomorrow damn there's not but let's put a summary on it hetero trophic plate count general bacteria zero pseudomonas zero coliform zero e coli zero staphylococcus or zero wow wait a minute a theoretical model coincides with an actual world data fellow scientists top that one I hadn't seen the data before i write the slides i got one right okay put the two together theoretical real world respiratory will not happen dermal with pseudomonas aeruginosa will not happen gastrointestinal illness user behavior very similar to spas and in 20 years of looking at this data i have never not once ever found a documented case of a gastrointestinal illness from a spot we have the same user pattern and we have something called better filtration when we're using a bag filter we've changed the game all together and we've got back into the engineering controls we've got back into the human behavior we've got back into the physiology we've tied all that together there we go feeling a little bit better am i still dr. doom and gloom you damn right i am we're in the tunnel and there's light it's one of two things yet the other daylight or a train okay i have been doing this as of today 27 years and seven days take it from me that is not daylight the name of this train is called regulations all right now graham and ashcon proposed something yesterday and i didn't know they were going to do it and it ties perfectly into what we need to talk about for the next couple of minutes because there's two kinds of trains and what this group does collectively over the next 24 to 48 months determines what kind of train it is train number one it is 110 fully loaded cars of coal coming out of wyoming going through my hometown in cancels it is going 80 miles an hour and it will run over the hell the top of you and leave you dead like a possum laying on the sun option a your choice option b it is amtrak it is slowing down and coming up to the station and it is going to let you on and it's going to invite you into the club car and it's going to give you a croissant and a shy team do you want to fight the train or work with the train i'm in pools and spas this is a decision that we make collectively you make i might be able to help a little bit but you have to make the decision and put the energy in as to which way it's going to go because that train is coming it's already approaching and the conference for the model aquatic health group is already published up and the cdc is already put it in and some states are already putting in there and that is called regulations okay i'm going to finish early because i got fast on a couple slides but here's what i want to think today the first thing i'm going to tell you is you damn well better have an operations manual it better be detailed it better have training in there and when they walk in there you better know what you're doing in case of an accident and if you don't have that work on it tonight instead of going to the bar to if somebody said yeah i had diarrhea last week get them the hell out of your facility and tell them to come back in 14 days period this is not something subject to discussion this must be your policy to protect your livelihood and the health and safety of your next patrons periodically disinfect all the other surfaces because i'm not worried about the water i'm actually worried about the other surfaces i'm worried about the fungi that are growing on the walls i'm worrying about the staff out in the changing areas are you disinfecting that with a material that says us epa registration number blah blah blah on the side of it because if you're not using a disinfectant on those surfaces you're fooling yourself get a hospital grade disinfectant and put it in there and use it or the health department is going to eat your lunch because they know about it and if you don't you're at risk consider using that bag filter with uv you can use other things but that combination is already in some of the regulations you can put peroxide in there you can put other things in there but this is the minimum combination you should be using in a float tank and if there's a fecal incident you're draining it okay where should we be going in the future do not do not do not do not do not ever say your float tank is germ free because i'll prove you're wrong health department can be your friend or your enemy make them your friend publish the current data yes gram ashcon and i are working on it collect more data and where we are weak is we don't know about fungi we don't know about staff on surfaces we don't know about viruses we don't know about giardia we don't know about crypto but we can get that information before it's imposed on us that requires collective work darn it i'm 17 seconds over and i'll be glad to talk about any diseases over any meal you want to share