Death raises protocol issues
‘Brain-eating amoeba’ floors Waco surf park
On Sept. 8, a young man from New Jersey who loved being outdoors got in the water at a surf park near Waco called Barefoot Ski Ranch to ride what some call the best artificial wave in the world.
Thirteen days later, the man, 29-year-old Fabrizio Stabile, was dead — killed by a so-called “brain-eating amoeba,” known by scientists as Naegleria fowleri.
The story horrified surfers and others around the country. While the organism is commonly found in warm, fresh water, it rarely infects humans. When people do catch it, they almost certainly die.
Stabile’s case raised questions about how water was cleaned at the surf park, a new attraction growing in popularity across the country, and one of two in Texas. State law strictly regulates a similar park in Austin, but it is unclear whether the Waco park fit the same definition. A spokesperson for the Waco-McLennan County Public Health District said they did not inspect the facility and did not further explain why.
It also highlighted a lack of protocol surrounding what to do when such an uncommon, bewildering infection occurs. The park told the local health district it would close the wave Sept. 28 — seven days after Stabile’s death. But patrons said they continued to surf there until Sept. 30.
One who visited on Sept. 27, surfing at a cost of $90 an hour, said he saw officials collect test samples but was not warned about what happened.
“I think they should have given us a choice,” said Edward Denton, 47. “They
should have told us: ‘There’s a potentially deadly amoeba that has a 97 percent death rate, and it’s your decision.’ … Now I could wake up tomorrow with a severe headache and have a 3 percent chance of living. ”
People exposed are considered safe if symptoms don’t emerge within 10 days. There were 34 reported infections between 2008 and 2017, according to the Centers for Disease Control and Prevention. Stabile is potentially the sixth associated with an artificial, recreational water source.
Test results on samples taken from the park with help from the CDC are pending. On its website, the park says it is “closed for winter.” On Friday, the high temperature in Waco was 91.
A popular trend
The artificial wave pool had been open for four months when Stabile visited the Barefoot Ski Ranch. Called the BSR Surf Resort, it was one in a growing list of attractions.
Stuart Parsons, a local roofer and champion barefoot waterskiier, first opened BSR in 2010 as a private lake, according to the Waco Tribune-Herald. In 2012, he launched the public BSR Cable Park, featuring a cable system that pulled wakeboarders across the water, attracting professionals from all over.
“It’s been my dream for years to have my own private ski lake, and that’s where this all started,” he told the paper in 2013.
Parsons steadily added to the cable park. He built a lazy river, then a series of four giant slides, called the Royal Flush. His goal was to open something new each year.
Artificial wave parks were gaining traction, with former World Champion professional surfer Kelly Slater among those pioneering the technology. Slater now operates a private facility in California expected to be a model for other locations he plans to open and a training ground for competitors.
Three years ago, Doug Coors, from the eponymous beer family, was another racing to build a land-locked surfing experience. He called his project NLand Surf Park and planned to debut it in Austin. Officials there met the concept with much debate.
No state operating standard fit what they were doing, said Bob Logan, vice president of development for NLand. Travis County wanted to regulate them under state guidelines for pools. The company argued that was neither feasible nor appropriate.
Each sued the other, until the two reached a deal: The county would allow the park to open. But the park had to provide daily reports on water quality.
“Our ownership, since the very beginning, believed in water quality and sanitation,” Logan said. “We wanted to create a healthy environment for everyone.”
Logan added in a second interview, “We did not enter this partnership as adversaries.”
NLand opened in October 2016, calling itself the first surf park in North America.
Legal changes
A solution to how to regulate giant pools emerged with a Houston-area master planned community called Balmoral. The developers wanted to build a lagoon, their “crowning attraction,” a place where residents could swim, paddle board or relax on a beach.
Balmoral planners approached state Rep. Senfronia Thompson about the regulatory issues. In the 2017 session, she authored H.B. 1468, which created a new classification in the health and safety code for an “artificial swimming lagoon.”
NLand meanwhile worked with state Sen. Kelly Hancock, who sponsored the bill. It passed. “They wanted to make sure that it was safe,” Thompson said.
Katie Moore, a compliance officer with the Texas Department of State Health Services, began drafting the enforcement standards, which vary depending on facility type. Lagoons were considered bigger than pools, with artificial liners. They did not include places where water recirculated from a spring.
Like in a pool, the water in a lagoon had to be disinfected and held at an appropriate pH. At NLAnd, which uses rainwater, the water is constantly sanitized and filtered.
“They have to maintain essentially the same standards,” Moore said. “The water has to be safe for human contact.”
With such rules, braineating amoeba should not be a risk. Properly administered chlorine kills the bacteria that the amoeba eats, explained Cynthia Chappell, professor of environmental and occupational health at UT Health. The amoeba has not been found in well-maintained pools, according to the CDC.
The more bacteria there is, however, the more likely the amoeba will grow. Warm water, such as that under the summer Texas sun, creates an even more conducive environment — and more risk for those who get water up their noses.
“The more concentrated it is,” Chappell said, “the more likely it is going to cause problems.”
This May, BSR opened its surf park. The owner, Parsons, told the Waco Tribune-Herald that he expected 375,000 visitors overall.
Familiar problem
The Waco-McLennan County Public Health District did not clarify why, exactly, it did not inspect the Barefoot Ski Resort.
“Amenities such as the BSR Surf Resort are a relatively new form of water entertainment,” the district wrote in a statement. “The Health District is working with the Texas Department of State Health Services to address the best way to regulate these types of water parks.”
The company, in its statement, said that it tested and chlorinated its water.
“BSR Surf Resort values the safety of our guests from Texas and all over the United States, and we strive to provide the safest environment for our patrons to enjoy all of our facilities,” the statement said. “We are in compliance with the CDC guidelines and recommendations concerning Naegleria fowleri.”
The CDC does not govern recreational water facilities, but it does offer input, said Jennifer Cope, the agency’s brain-amoeba expert. And what to do when a case is confirmed remains up for debate.
Lakes, of course, cannot be treated. They might be closed. How to handle potential cases at artificial parks is still being figured out.
“There’s kind of these places that fall in between,” Cope said. “It’s a little harder to say what should be done.”
Stabile was mowing his lawn a week after his visit to Waco when he began to have a severe headache that would not go away. As described on a GoFundMe webpage created to raise money for a foundation in his name, he “could not get out of bed and could not speak coherently.”
There is no good test for the amoeba, and the symptoms are easily misdiagnosed as meningitis. As is often the case, when they figured out what was wrong with Stabile, it was too late to do anything to save him.