Brian Morgan – Is the incidence of some fatal diseases linked to untreated sewage discharges? – Jul 2026

Written by Brian Morgan, with assistance from Stephen Eades.

Today in British society some bacterial diseases record high levels of fatality. This blog addresses two important questions. Are some of these diseases linked to sewage discharges, and why?

What are these diseases, and what is their rate of incidence?

Based on government data, we are able to identify these diseases and to record their rate of incidence in graph format. The ones being examined here are:

Enterococcus bacteremia.

Enterococcus bacteria live quite normally in the human gut, and so are naturally present in faeces. However, if they become present in the body’s urinary system they can cause a urinary infection. If that infection becomes more widespread, it may enter the bloodstream and cause blood poisoning (enterococcus bacteraemia) and become a very serious illness, sometimes leading to sepsis and meningitis. Disease causing enteroccoccus bacteria are now highly resistant to many standard types of antibiotic treatment.

Graph A: Enteroccocus bacteraemia deaths in England, in thousand per annum, 2012-2024. Source: Public Health England (PHE) and the UK Health Security Agency (UKHSA). Also, referenced to background environmental factors (sewage spill permits and Covid).

Escherichia coliform (E. coli) bacteraemia.

E. coli bacteria live quite normally in the human gut where they are harmless. They are, therefore, naturally present in faeces. However, if they enter other parts of the body, e.g. the urinary tract, they will cause an infection. Certain types of E. coli bacteria, like the species E. coli 0157 that are present in the gut and faeces of animals, are highly pathogenic to humans and if ingested can cause very severe gastric illness. If E. coli 0157 infection spreads to other parts of the body, or enters the bloodstream and causes blood poisoning (E. coli bacteraemia), the infection can be very serious. Some disease causing E. coli bacteria are now displaying a growing level of antibiotic resistance.

Graph B: E. coli bacteraemia deaths in England, in thousand per annum, 2012-2024. Source: Standard Precautions for Healthcare-Associated Infections all-cause-mortality 2023-4. Also, referenced to background environmental factors (sewage spill permits and Covid).

The first point of significance to note from these two graphs is that the incidence of two diseases, Enterococcus bacteraemia and E. coli bacteraemia, has been rising over the past ten years, and that the bacteria behind both diseases will be present in abundance in sewage and in raw sewage discharged into rivers and coastal waters.

Next, we introduce two graphs that record the incidence of Sepsis. When examining these graphs, there are two initial points to be borne in mind.

The first is that whilst Sepsis causes severe, life-threatening illness it is, technically, not a disease with its own distinctive bacterial, viral or fungal origin. Rather, it is an illness caused by the body’s extreme inflammatory reaction to some other bacterial, viral or fungal infections. Consequently, although Sepsis is sometimes confused with septicemia (infection of the bloodstream), Sepsis is treated by focusing on the original bacterial, viral or fungal infection in order to eliminate the body’s hyperactive response to that original infection.

Second, Sepsis can be triggered by any bacterial or viral disease. Sewage effluent will contain a vast range of diseases and, in particular, those associated with faeces and urine. As a result, Enterococcus bacteraemia and E. coli bacteraemia and their rate of incidence are notable on two counts. Firstly, the enterococci and and e.coli bacteria that can lead to bacteraemia will be abundant in sewage, and secondly, bacteraemia is a significant trigger, amongst others, of Sepsis.

Graph C: Gram negative bacterial Sepsis admissions to hospital in England, annual cases per hundred thousand people, 2000-2024. Source: Victoria B. Allen, 2025, Rising rates of sepsis in England: an ecological study. Also, referenced to background environmental factors (sewage spill permits and Covid).

Note: E.coli bacteria are gram negative bacteria, whereas Enterococcus bacteria are gram positive. Other gram negative bacteria that are abundant in sewage include:

◦ The Aeromonas species of bacteria, some of which can lead to gastroenteritis if ingested.

◦ The Acinetobacter species of bacteria. They are widely present in the environment, and propogate abundantly in sewage works. They are normally harmless. However, there are pathogenic strains, such as Acinetonbacter baumannii which can be difficult to treat as it has developed a resistance to some antibiotics. ◦ The Klebsiella species of bacteria. They normally have a harmless presence in the human gut and will be present in human faeces. However, when Klebsiella arises elsewhere in the body it can be very harmful. It is a major cause of urinary tract infection, of hospital acquired pneumonia, and if it infects the bloodstream can causes Sepsis. Many strains of Klebsiella display antibiotic resistance.

Both gram negative and gram positive bacteria can be pathogenic to humans. Sepsis can be triggered by both gram negative and gram positive bacteria.

Graph D: Deaths from Sepsis in England, annual cases, 2000-2024. Source: Office for National Statistics (ONS), UK Health Security Agency (UKHSA) and NHS. Also, referenced to background environmental factors (sewage spill permits and Covid).

It should be noted that all of the above graphs recording the levels of fatal illnesses are displaying a long-term upward trend.

Introducing the hypothesis that there is a link between the incidence of some fatal illnesses and the discharge of raw sewage.

So far, it has been established that the incidence of Enterococcus bacteraemia and E. coli bacteraemia have been rising since 2012 (comparable data is not available prior to that date), and that the causal bacteria (enterococci and e. coli) are abundant in sewage.

It has also been established that the rate of Sepsis has been rising gradually over the period 2000 to 2012, and has been accelerating significantly since. Amongst the main bacterial and viral causes of Sepsis is blood poisoning (bacteraemia).

Therefore, is there evidence that the increasing rates of incidence of these illnesses may be linked to disposal into the open environment (rivers, seas and fields) of raw and only partially treated human sewage?

Evidence regarding the disposal of raw and partially treated sewage directly into the environment.

Prior to 1980, sewage had been routinely discharged direct to rivers and coastal waters with no or little treatment. As a result, rivers were in a very poor condition. A case in point is the rivers of the Mersey Basin, covering greater Merseyside, greater Manchester and north-east Cheshire. In 1984 most of these rivers were ecologically dead. Elsewhere in England, many coastal towns discharged their sewage directly to sea, and in metropolitan cities like London, Bristol, Manchester and Tyneside sewage was given rudimentary treatment and then transported by boat out to sea and dumped.

This was still largely the situation in 1989 when government relinquished ownership of the water industry and placed it in the hands of shareholder-owned public limited companies. However by then, laws originating from Europe had begun to change the mind-set and legal duties of the industry, increasingly requiring sewage to be treated adequately, and outlawing its disposal without treatment. Notable among these laws were the Bathing Water Directive, 76/607/EEC, governing sewage discharged into bathing waters; the Urban Waste Water Treatment Directive(UWWT), 91/271/EEC (UK UWWT Regulations, 1994), which, from 1994, progressively required all sewage works to properly treat all sewage under all normal weather conditions; and in 1998 the UWWT Regulations banned the dumping at sea of sewage from the cities employing this practice. Since then, the UK government has also changed the law under the Environmental Permitting Regulations 2016 to require the industry to obtain permits from the Environment Agency that license and set rules for all discharges from the sewerage system. Also under these Regulations, government has issued statutory guidance in 2018 on the minimum treatment capacity for all sewage works.

Therefore, all of these changes would appear to refute the hypothesis that the increase in the incidence of certain fatal illnesses–Enterococcus and E. coli bacteraemias and Sepsis, as cited here – may be due to discharges of raw and inadequately treated sewage into the environment. Certainly, that will have been the intention of government.

So, what are the factors that might be countermanding this expectation? And, in turn, may sustain the hypothesis that the sewage we are presently releasing into the environment is leading to a worse rather than an improved outcome?

The changes that support the link between sewage discharges and the incidence of some fatal illnesses.

There are four areas that the hypothesis now considers:

• How do we dispose today of the sewage sludge that arises from English metropolitan cities that, formerly, was dumped at sea?

• When raw and partially treated sewage are disposed of into the open environment (rivers, seas and fields) do pathogenic bacteria travel from the disposal site to affect a wider area, and are they able to survive beyond the short-term, thereby increasing their capacity to infect?

• Have the Urban Waste Water Treatment Regulations ensured that all sewage is now properly treated at all sewage works during normal weather conditions? And, have the Environmental Permitting Regulations ensured that only authorised discharges of raw sewage occur, and that all sewage works have adequate treatment capacity so as to eliminate most discharges?

• Is the virulence of pathogenic bacteria becoming stronger, and our ability to kill them weaker, thereby making them more troublesome and their environmental presence more significant?

We now examine each of these four areas.

Sewage sludge: from dumping at sea to disposal on land.

The overwhelming majority of the sewage that was dumped at sea following minimal treatment is now given anaerobic secondary treatment and, once treated, is disposed of on agricultural land as a fertiliser. Indeed, it is estimated that in England currently around 87% of all sewage sludge is disposed of in this way, and of the remainder 4% is incinerated, 6% is used in land reclamation, and 3% used as a fuel by industry.

Therefore, how effective is anaerobic treatment of sewage, and does it kill all the pathogenspathogens A virus, bacterium or parasite which causes disease is a pathogen. Disease causing pathogens live in the environment, and both humans and animals are hosts to them. Pathogenic viruses, bacteria and parasites are present in sewage, originating from humans and animals, and thus it is essential that sewage is given proper treatment in order to disable (kill) these pathogens before the end-products of sewage treatment (solids and water effluent) are returned to the environment.?

The answer depends greatly on the operating temperature of the anaerobic process. If the process is conducted at a temperature between 50-55°C (known as ‘thermophilic’) virtually all pathogens will be killed (99.999%). If conducted at between 35-38°C (known as ‘mesophilic’) the die-off rate is around 99%, i.e. some will survive. Note: a litre of raw sewage may originally contain around 1 billion or more pathogenic bacteria, so a figure of 1% surviving still represents around 10 million pathogenic bacteria per litre.

In England some anaerobic sewage treatment units operate at the higher thermophilic temperature, but it is estimated that the majority still operate at the lower mesophilic temperature which is allowed by government regulations issued in 2018. The Environment Agency is currently reviewing these matters.

There are consequences arising from this.

When the sewage from a number of England’s cities was being disposed of at sea, the exposure of the population to its pathogens was minimal. Nowadays, it is being anaerobically treated and most is being disposed of onto agricultural land. Mesophilic treatment is killing 99% of those pathogens, but 1% are surviving. The conventional view is that most of those pathogens will quickly die due to exposure to sunlight (ultra-violet radiation) and the drying of the sludge in the open air. However, bacteria can survive drying out (dessication) and remain pathogenic once they are able to reabsorb water, and if they become attached to particles of dust that become airborne they can travel tens, even hundreds of miles from their disposal site. Consequently, the potential for pathogenic bacteria in sewage sludge to infect people beyond the immediate disposal site is real.

Therefore, as there has been a considerable expansion in the amount of sewage sludge used by agriculture since 2000, it should be noted that there has been a parallel increase in Sepsis cases in the period from 2000 to 2010, and an even steeper increase since 2010 (Graph C), although other factors also come into play since 2010 which are considered below.

The long-term survivability of pathogenic bacteria released into the open environment.

The transport of windborne bacteria from their disposal site as an aerosol attached to particles (aerolisation) is a significant means of transmission to more distant places. Not only does this transmission occur from land disposal sites. It also happens when bacteria are released into water.

If raw sewage is repeatedly discharged into rivers, the bacteria in the sewage will form colonies that become attached to plants and objects such as stones on the river bed. These colonies are known as biofilms. These colonies are communities of different species of bacteria. Biofilms create a protective outer shield around their colony, organise themselves as a community and allow for the differentiation of roles within that community, and inside the bacteria exchange genetic material between one another other. Biofilms are very hardy and resilient. The conventional view is that pathogenic bacteria disposed of into watercourses will quickly die, but this is not true. Bacteria have developed strategies to ensure their long-term survival, and once secure and safe inside a biofilm bacteria will quickly multiply.

The bacteria inside biofilms can be released by being disturbed, or by attaching themselves to particles of sediment and bubbles of air that rise to the surface where they are aerolised and, carried on the wind, will travel to distant places.

Therefore, whether to land or river, prolonged or widespread release of raw sewage and pathogenic sewage sludge into the environment creates a huge reservoir of pathogens, thus exposing society to a seriously unhealthy reality.

Has the Urban Waste Water Treatment Regulations (UWWT), 1994, ensured that all sewage is now properly treated at all sewage works during normal weather conditions. And, have the Environmental Permitting Regulations , 2016/18, ensured that only authorised discharges of raw sewage occur, and that all sewage works have adequate treatment capacity?

The Urban Waste Water Treatment Regulations (UWWT), 1994.

Sewage going into our rivers and seas is of two kinds, treated and untreated (raw). Prior to 1990 the level and proportion of raw sewage entering rivers and the sea was overwhelming, but in the ten year period following the introduction of the UWWT Regulations in 1994 proper treatment (secondary treatment) has been installed at all sewage works. Efficiently run secondary treatment can remove up to 99% of all pathogens, but to eliminate the whole load (the extra 1%) requires a further stage of treatment – tertiary – and the UWWT Regulations only required this in special circumstances.

The introduction of universal secondary treatment has, of course, been tremendously beneficial. Some rivers have been made a great deal cleaner compared to their condition before. However, as well as not requiring universal tertiary treatment, the UWWT Regulations also have another major flaw.

The Regulations continue to allow the discharge of raw sewage in times of “exceptional rainfall” (storms). Further, they fail to precisely define either the term “ exceptional rainfall” or how large the spare treatment capacity at a works should be to ensure that raw sewage is stored when it rains and then treated once the rain has stopped.

As a result, although the water companies upgraded the treatment level at sewage works, they did not upgrade the storage capacity of their works to cope with times when it rains.

Instead, they have increasingly opted to dump the extra flow of raw sewage into rivers and the sea. And, just as important, government has done nothing to alter that.

Equally important, the population in England has grown by 3.4 million between 2000-2010 and by 4 million between 2010-2020 (7.4 million between 2000-2020), thus adding further to the extra load, while government has taken almost no action to make the companies increase storage capacity.

Consequently, whenever it rains large amounts of raw sewage are once again being dumped in the rivers and sea.

It is this reality that leads this blog to argue that there is a link between raw sewage disposals and the increase in the levels of fatal diseases associated with sewage. This reality (hypothesis) is recorded in the Graphs on Enterococcus and E. Coli bacteraemias and Sepsis (Graphs A to D) which clearly show that these diseases are increasing. The outstanding question, therefore, is whether government and the water companies have been restraining raw sewage discharges? Or, have they been allowing them to continue at a high level or, even worse, increase?

The Environmental Permitting Regulations (EPR), 2016, and EPR Guidance to water companies on storm overflows, 2018.

In 2016 government introduced permits (Environmental Permitting Regulations) that put all sewage discharges into rivers and the sea onto a legal basis, requiring all outlets and their discharges to comply with the terms of a license (permit). In practice, the water companies now have to pay for a permit to make their discharges; but, although they are required to conform to the terms of that permit, they now effectively hold a license to pollute. These permits have also had other consequences. The Environment Agency, which issues and regulates the permits, is required to largely fund its enforcement activity from the revenue from these permits instead of receiving grant-funding from government for this purpose. As a result, the polluter is providing the regulator with its income. Also, the polluter under this system of permits, self-regulates, i.e. reports to the regulator when it has breached the rules of the permit and, until that report is made by the polluter, the regulator assumes that everything is functioning correctly. This system has been likened to the criminal reporting to the police when he or she has committed a crime.

The terms of the permits are issued so that they are compliant with the UWWT Regulations, which means there is no legal restriction on the number of storm overflows that can be made. Government has modified this in its 2018 EPR Guidance by requiring water companies to evaluate the performance of their storm overflows to assess whether they are ‘satisfactory’ or ‘unsatisfactory’ and, more importantly, requires all sewage works to have adequate storm sewage storage capacity equal to three times the inflow to the works during dry weather (3 times dry weather flow, or 3DWF). However, there has been no enforcement of these requirements. When Marinet surveyed the industry in 2002 by means of a Freedom of Information request, it found that nearly all sewage works have a storage and treatment capacity equal to only between 1DWF and 1.5DWF. In other words, most sewage works will experience pressure to overflow whenever it rains. As can be seen from the following graph, the trend in the number of storm overflows, averaging out wet and dry years, has been relentlessly upwards since the introduction of discharge permits in 2016.

Graph E: Millions of hours of raw sewage spills (“storm overflows”), 2016 to 2024, measured by event duration monitoring (EDM) on combined sewer overflows (CSOCSO The sewerage system generally carries surface water from rain falling on paved areas (roads, pavements, roofs, etc.) via a separate sewer from the sewer which carries foul water (sewage). Surface water sewers are generally low in contamination and are allowed to discharge direct to rivers and sea with no treatment, whereas foul sewers go to a sewage treatment works. When there is heavy or prolonged rainfall sewage treatment works may receive some of this rainwater and thus become overloaded. In these circumstances they need to overflow, discharging the overflow with little or no treatment. This overflow either goes direct to a river or the sea or, more commonly, into a surface water sewer which already connects with a river or the sea. This event, when a surface water sewer is compelled to accept poorly or untreated foul water, turns the surface water sewer into a combined sewer (surface and foul water) on account of the foul water sewer overflowing into it. When this happens the discharge from the surface water sewer is known as a ‘combined sewer overflow’.). Source: House of Commons Library, March 2026: Sewage Discharges.

So, is there a connection – a valid hypothesis – for believing that the upward trend in the amount of raw sewage that government has allowed the water companies to discharge into rivers, and particularly since 2016 when permits to pollute were introduced, been leading to an increase in the incidence of fatal cases connected with sewage-associated diseases? To view the evidence we reproduce below all the earlier graphs:

Graph A: Enterococcus bacteraemia deaths, England, 2012-2024.

Graph B: E. coli bacteraemia deaths, England, 2012-2024.

Graph C: Gram negative bacterial Sepsis admissions to hospital in England, 2000-2024.

Graph D: Deaths from Sepsis in England, 2000-2024, referenced to background environmental factors (sewage spill permits and Covid).

Graph E: Millions of hours of raw sewage spills

The portrait presented by these graphs, A to E, is clear. During the period 2016-2024 when discharges of raw sewage into rivers has been on the rise, there has also been a corresponding rise in the incidence of sewage related fatal diseases.

Therefore, we return to the hypothesis, is there a connection between the amount of raw sewage we are dumping in rivers and the level of fatal sewage-related diseases that we are experiencing? Obviously, it is a difficult question to answer. However, before we attempt to do so there is one other important body of evidence that must still be considered.

Is the virulence of pathogenic bacteria becoming stronger, and our ability to kill them weaker, thereby making them more troublesome and their environmental presence more significant?

If the pathogenic bacteria that we are concerned with are becoming more virulent and, therefore, more harmful, it might be argued that this could explain the connection we are seeing between the increase in the amount of raw sewage in our rivers and the increase in sewage-associated diseases.

In other Marinet blogs we have shown how bacteria are able to become more virulent. In a sense, it is entirely normal. Evolutionary pressure means that all life forms develop new strategies to survive when this is necessary, and bacteria are no exception. In fact, the ability of bacteria to develop new survival strategies is most remarkable, and in the case of bacteria causing fatal illness that evolutionary pressure is nowadays also increasingly due to our use of antibiotics. Thus, increased “virulence” is expressing itself in the form of the development of pathogenic strains that are able to resist the antibiotic medicines that would have previously killed them.

If we consider the gram negative bacteria that are contributing to the increase in Sepsis admissions to hospital, see Graph C, the following are significant bacteria in this category that are readily present in sewage and are displaying an “acquired” resistance to certain antibiotic treatments:

Gram Negative bacteria in sewage that cause fatal illness.	Antibiotic treatments now displaying a degree of “acquired” antibiotic resistance.
E. coli bacteraemia	Co-amoxiclav, Ciprofloxacin, Gentamicin, Piperacillin-tazobactam, and third generation Cephalosporins.
Aeromonas specis of bacteria	The following classes of antibiotics: Beta-Lactam/Inhibitor combinations, Carbapenems, Cephalosporins (3rd/4th generations), Fluroquinolenes, Tetracyclines, Sulfonamides, and Colistin .
Acinetobacter species of bacteria, and particularly Acinetobacter baumannii	Carbapenems, Extended-Spectrum Cephalsporins, Fluoroquinolones, Aminoglycosides, Peniclillin and β-Lactam/Inhibitor Combinations, Tigercycline, and Colistin (Polymyxin E).
Klebsiella species of bacteria	Penicillins, Cephalosporins, Carbapenems, Fluoroquinolones, Amonoglycosides, Sulfonamides.

Therefore, from the standpoint of this hypothesis (sewage discharged into the environment is driving increased levels of certain fatal illnesses), the thesis goes beyond the statement that antibiotic-resistant sewage related diseases are experiencing elevated levels of fatality because of the increased levels of acquired resistance (virulence) to the antibiotics that are treating them.

The thesis is stating: because these antibiotic-resistant strains of the bacteria will be present in faeces and thus in sewage, the discharge of raw and partially pathogenpathogens A virus, bacterium or parasite which causes disease is a pathogen. Disease causing pathogens live in the environment, and both humans and animals are hosts to them. Pathogenic viruses, bacteria and parasites are present in sewage, originating from humans and animals, and thus it is essential that sewage is given proper treatment in order to disable (kill) these pathogens before the end-products of sewage treatment (solids and water effluent) are returned to the environment.-free sewage into the open environment, notably rivers, will result in those bacteria becoming mobile and infecting the population at large. And, if the level of discharges increases, then the incidence in those fatal diseases will also rise.

The evidence presented here has shown that the levels of certain fatal diseases (Enterococcus and E. coli bacteraemias and Sepsis) have been rising, and noticeably since 2016 when the permitting regime governing raw sewage discharges (“storm overflows”) was introduced by government. And, since that date, the amount of untreated sewage discharged into rivers has been similarly rising, even when variations in annual rainfall levels are taken into account.

[Note; the discharge data on the amount of sewage discharged into rivers does not measure the volume of sewage, only the total number of hours during which discharges are made. Therefore, the assumption is that if the number of discharge hours has been rising, so also will the volume that has been discharged.]

Consequently, it is argued that the hypothesis stands. Namely, the evidence points to the reality that the levels of the sewage related diseases studied and recorded here are rising because the levels of raw and partially treated sewage are rising. In short, the relationship is causal.

Conclusion.

Can this hypothesis be proved? Of course, the answer is no, it cannot. There are too many variables in the line of causality to make that possible. Nevertheless, the logic of the facts and the logic in our knowledge as to how sewage-associated fatal diseases arise, clearly suggest that the thesis has a strong measure of probability, and thus validity.

Given this degree of probability, and given the serious public health risks that we are subjecting the population to when empirical reality is recording a substantial rise in sewage-associated fatal diseases, and those same diseases are recording ever greater difficulties in treatment due to antibiotic resistant strains, and those particular strains are abundant in raw sewage, the question that we must ask ourselves, and particularly of government, is: why are we discharging large, and increasing, levels of raw sewage into our rivers?

Some people may challenge this hypothesis, and the argument and evidence on which it is based. However, if those people want to prove that it is incorrect, then that proof is very readily available. It is: simply stop raw sewage being discharged into our rivers. If the hypothesis is not valid, the incidence of the diseases studied here will either remain at the same level or continue to rise because the cause is elsewhere. And, if the hypothesis is valid, the cessation of discharges of sewage should result in the incidence of these diseases decreasing, perhaps markedly.

The reality confronting us is simple: it is very likely that curing sewage-associated fatal diseases will be hard, and probably grown even harder, due to antibiotic resistance. Therefore, can we afford to go on playing roulette with the nation’s health by dumping massive amounts of raw sewage into our rivers?

To any logical and reasonable person, the answer must be, no.

We know that full (tertiary) treatment will kill all pathogens, and that adequate storage capacity at sewage will make this possible under nearly all weather conditions. If you are in any doubt, see these short videos and their full explanation of the treatment process – highly recommended.

So, why are we continuing to do this?

The important question we need to ask, especially of the water companies and government is, when are we going to totally stop dumping raw sewage in our rivers and seas?

If nothing happens soon, the next health crisis to befall us could be far sooner than we think.