Pool Rules – Diseases You Can Catch In The Pool

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Are there Communicable Diseases Swimming in your Public Pool?

By Robert Shmerling, M.D., Harvard Health Publications

The other day, the "pool monitor" of a public pool in our neighborhood wandered around reminding people to shower before getting into the water. For anyone asking why, she simply pointed to the conspicuous sign, posted, as required by public health regulations, that read: "All persons are required to take a cleansing shower bath before entering the pool."

The next rule caught my eye, as well: "No person with a communicable disease is allowed to use the pool."

When I first read these rules, they seemed reasonable enough. But as I thought about it, the logic was difficult to understand. What diseases or conditions are being prevented by these health codes? Many communicable diseases are not spread through water (for example, the common cold or most sexually transmitted diseases). How do these rules promote health?

Swimming by the rules

It's probably reassuring to most people to know that everyone is required to shower before getting in the pool and that a person who might pass a disease to you or your kids is not allowed in the water. Yet, it struck me that, as written, these rules were unlikely to be effective and would prohibit many from swimming who pose no threat to the health of others.

For example, a number of important communicable diseases; hepatitis B, hepatitis C and HIV come to mind; are not known to be spread by simply swimming in a pool with others. It would be unfair and would accomplish nothing to exclude people with these diseases from swimming pools. Never mind that these rules are probably impossible to enforce; my own observation is that they are often ignored.

I looked into what these rules were intended to accomplish, and here's what I found. First, the "communicable diseases" are only those known to be spread from person to person via contaminated water. More specifically, the regulations are aimed at preventing diseases caused by organisms that are shed in the feces of an infected person and can spread to another person who ingests contaminated water. The particular concerns are bacterial infections, (Shigella, Campylobacter, Salmonella, certain types of E. coli), hepatitis A and parasitic infections (Cryptosporidium and Giardia). A person who has been diagnosed with one of these infections should not swim in a pool in which others swim until the infection has resolved and recovery is complete. The time required to eliminate an infection and to no longer be considered infectious varies, depending on the organism, but waiting at least two weeks after complete recovery before swimming in a public pool is recommended. In the world of infectious diseases, there are relatively few that are relevant to your swimming decisions.

Now, about that pre-swim shower…

The reason a shower is required before entering the pool is that an infectious organism could be living on your skin and the shower is intended to reduce or eliminate the risk that you will expose others in the pool to that organism.

However, for those people who do take a shower before entering a pool, it is not likely that the quick rinse or even use of soap and water will do much to change what must be a very low risk in the first place. The acid level and chlorine in swimming pools already kills most infectious organisms (though cryptosporidia is a notable exception); and other than infections such as those listed above (that are spread by water contaminated with feces), most organisms living on your skin are of no risk to others anyway.

Why do health codes continue to require this?

It is possible that health codes and regulations were created in response to diseases that used to be more common than they are today. In addition, the understanding of disease may be better now than when these rules were established. For example, before different types of hepatitis were identified and their means of spread understood, it may have been more difficult to prevent their spread, so restricting pool access may have seemed reasonable at the time. There may have been fear of people who were ill, and sickness may be associated with poor hygiene, so requiring showers of everyone may have been appealing to those charged with overseeing public health. Finally, it may also be a matter of "inertia" once rules are set up, it's harder to change them over time than to simply leave them in place, especially if they don't seem to be causing much harm. It's hard to say that requiring showers of everyone entering a pool even if it's unnecessary is particularly harmful. On the other hand, if a person with HIV is kept out of the pool because of his or her "communicable disease," that's a discriminatory misunderstanding of the regulations' purpose.

Conclusions

It can be difficult to understand what your own doctor is saying but at least you have the opportunity to ask questions to clarify the message. But when the message is coming from your "public health doctor," it's not so easy to ask questions or to apply a one-size-fits-all rule to your own particular situation. Of course, that's the challenge of establishing public health codes and regulations to effectively protect health with rules that are not too constrictive and are applied fairly to all.

Perhaps the most important thing to know about preventing the spread of illness while swimming is to avoid the pool if you have a diarrheal infection or have been diagnosed with one of the waterborne communicable diseases mentioned above. If you don't have any of those illnesses and are otherwise healthy, you may still have no choice rules are rules but speaking from a strictly medical point of view, there's little reason to shower before swimming unless that's what you like to do.

Copyright © 2009 by the Presidents and Fellows of Harvard College. Used with permission of StayWell. All rights reserved. Harvard Medical School does not approve or endorse any products on the page. Harvard is the sole creator of its editorial content, and advertisers are not allowed to influence the language or images Harvard uses.

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What Is Depression??

While sadness touches all of our lives at different times, the illness of depression can have enormous depth and staying power. Even the ancient Greeks noted how disabling it could be, and that it was more than a passing bout of sadness or dejection, or feeling down in the dumps. If you have ever suffered from depression or been close to someone who has, you know that this illness cannot be lifted at will or wished or joked away. A man in the grip of depression can't solve his problems by showing a little more backbone. Nor can a woman who is depressed simply shake off the blues. 
 
Being depressed has nothing to do with personal weakness. Scientists' developing knowledge of brain chemistry and findings from brain imaging studies reveal that changes in nerve pathways and brain chemicals called neurotransmitters can affect your moods and thoughts. These neurological changes may bubble up as symptoms of depression — including derailed sleep, suppressed appetite, agitation, exhaustion, or apathy. In addition, genetic studies show that although no single gene prompts depression, a combination of genetic variations may heighten vulnerability to this disease. 
  
Nerve pathways, chemistry, and genetics aren't the whole story, though. Depression could be described as a lake fed by many streams. Its tributaries include traumatic or stressful life events, such as the death of a loved one, and psychological traits, such as a pessimistic outlook or a tendency toward isolation. An episode of depression may result from one particularly powerful experience or from a confluence of several factors. According to the National Institute of Mental Health, during a given year approximately 1 in 10 adults will suffer from some form of depression. Each episode usually affects a chain of people. It can fray bonds between you and your family and friends by spoiling intimacy, sapping emotional resources, and stealing the joy of shared pleasures. 
  
Thankfully, years of research and breakthroughs have made this serious illness easier to treat. Early recognition of the signs of depression is more common than in the past. Newer treatments, such as drugs targeted at specific changes in brain chemistry, can cut short otherwise crippling episodes. A variety of drugs and therapies can also be combined to boost the likelihood of a full remission. 
  
Just like a rash or heart disease, depression can take many forms. Definitions of depression and the therapies designed to ease this disease's grip continue to evolve. These shifts will continue to percolate through the field as more research flows in.

From the Harvard Health Publications Special Health Report, Understanding Depression. Copyright 2006 by the President and Fellows of Harvard College