Health risks which may be encountered on beaches
We provide here an assessment by Brian Morgan, Marinet member, of the complex background and range of risks that may be encountered by visitors to England’s beaches. This is an authoritative summary of the subject, fully supported by scientific references.
Nearly all of the health hazards in UK waters arise from the quite recent activities of ourselves and our biological and chemically polluting discharges.
This has been made worse through our mismanagement of resources which have led to resistance to antibiotics and pesticides and other forms of resistance in our body’s protective mechanisms.
The greatest health threats on beaches are in this order:
1. The sediments and muds of estuaries: These harbour colossal amounts of bacteria and other 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., which collect together in bio-films and even proliferate there and doing so thousands times more than they do in the open waters. These are not detected by the Environment Agency’s monitoring.
2. The upper sands of beaches: These sands filter and hold many of the bacteria carried about in sediment bio-films and in the open waters. These levels of bacteria in the upper sands of beaches (around high tide mark) are in the range of a hundred or more times that in open water, and are also not detected by the EA’s monitoring.
3. Discharges from Sewage works and farms: These travel via streams directly onto or close to beaches. These are held in fresh water, so they initially float on the surface until mixed in the sea water. This can be a slow process of which the public are not warned.
4. Floating sewage discharge plumes from deep sea outfall pipelines: The outfall pipes are usually used in prime beach and hotel areas. These discharges, which can be unpredictable in timing, can spread to large areas of the sea and persist in terms of hours. The public are never warned.
5. Algal blooms: The algal blooms (population explosions of certain types of marine algae) float in near shore waters and are caused by an excess of nutrients, usually of farming origin. These can give off toxins which can cause skin ailments, and they are often attractively bioluminescent at night.
6. The droppings of seabirds: Particularly of seabirds which scavenge the food left-overs from beach-goers. These droppings are usually on the surface of the upper sands and their bacteria can be especially virulent.
The Environment Agency (EA) does not monitor these factors, and the EA only use a ‘catch all’ indicator of the presence of bacteria as stipulated under a European Directive for bacterial indicators in bathing areas. High levels of pathogens have very recently been identified on beaches declared “Excellent” by these EA methods — see ref. (A) at the foot of this blog.
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Now let us consider which pathogens are increasingly ending up on our beaches.
It is my belief that the extent of this and of other forms of pollution have now gone past the sustainable limit.
Harmful and harmless bacteria, protozoa and viruses can persist outside of the human body in beach sands and in sediments throughout the year.
There has been too much focus on faecal bacteria and algal blooms from excess nutrients. Little attention has been paid to the overall effect of human waste, as well as from pets and livestock, which is carried in sewage along with poorly treated effluent down rivers.
These vast discharges of sewage and poorly treated effluent, which approach 10 million tonnes per day, are made into rivers and the sea, thus affecting around approximately 12,000 kilometres of beaches. These discharges also carry protozoan cysts down into estuaries and into recreational waters where they are filtered into sands, and also into shellfish which are often taken for human consumption — see ref. (B) and (C)
Current methods used for testing for pathogens on beaches cannot be seen as satisfactory. It is fairly well agreed among researchers that there is a need to change from the decades-old practice of measuring faecal bacterial indicators (FBIs) which serve as guidelines only, to 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. bacterial indicators (PBIs) which are the actual causes of disease.
The accepted system, as used in the UK, seems to be giving highly over optimistic reports of the safety to health for recreational waters — see ref. (D) and (E)
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E coli, Staphylococcus aureus and Enterococci
These are among the commonest bacteria carried in sewage and effluent which are likely to lead to disease via beaches.
They persist in large quantities in sewage, both treated and untreated, and all of this ends up ultimately at our coastal beaches.
For healthy and physically fit people who use reasonable hygiene the risks, though present, are low. But the risks are increasing continuously.
Many amongst us, without even knowing it, are now victims to immuno-suppression through the windborne ultrafine particles — predominantly carried on the prevailing wind which in England is West and South West — which pervade the polluted air from industrial and domestic smoke and traffic exhausts in large tracts of our islands.
This makes us all the more susceptible now to respiratory, gastrointestinal and urinary infections in particular caused by these pathogens – the most likely illnesses from contamination at beaches — which previously we might have largely been able to resist. Enterococci have been shown to pose the greatest risk to children — see ref.(F)
The noteworthy diseases are:
Klebsiella: This is a bacterium which can lead to pneumonia.
Clostridium: This is an easily transmissible bacterial pathogen, with troublesome antibiotic resistance, which causes diarrhoea and a form of colitis. It is found in farm livestock; and in soil, beach sands and muds as well as in the human community. It has been mapped in the Severn Estuary.
Aeromonas: This is a bacterium which causes gastroenteritis after ingestion of contaminated water. It also infects wounds and this infection can be severe in immune deficient persons. It can be contracted from bathing in bacterially infected waters.
Protozoa: (single-celled microscopic animals) listed below are significant in beach diseases:
Giardia: commonly found in recreational waters though it usually comes from discharges from animals into water. It gives diarrhoeal giardiasis which is debilitating but can usually be treated with selected antibiotics.
Toxoplasma: can be present in upper beach sands where dogs are allowed. But primarily it comes from cats, and can be passed to and from humans.
Cryptosporidium: causes a watery diarrhoea and can be transmitted by personal contact or in infected bathing waters.
Fungal skin infections: like Candida which is a yeast and is part of our normal flora which inhabits entrances to our bodies. Normally it gives no trouble but can affect vulnerable people or those with immune difficulties, and it can cause persistent and transmissible thrush in the mouth and other passages. This is endemic in Hull.
Aspergillus: is a fungus, widespread in our environment and can cause respiratory ailments.
Trichophyton: is a type of fungus, including the parasitic varieties that cause athlete’s foot, ringworm and similar skin infections of nail and skin.
Viruses and enteroviruses: in one study these were detected in 15% of samples of beach sands, but this is likely to vary according to location and river catchment. Commonly it includes Hepatitis A which is found in sewage and causes an acute infection of the liver.
Adenovirus: species can cause a range of illnesses such as respiratory, gastrointestinal and urinary infections.
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Antibiotic Resistant Bacteria on beaches.
This is part of a growing worldwide health problem, exemplified by WHO warnings as new mutations occur. These anti-biotic resistant mutations are spread by sewage, by communities, by foods and by travel.
Together with the concentration, accumulation and even proliferation of these mutations in beach sands and estuarine sediments, it is a major problem to us all, let alone beach-goers.
While a UK wide survey was done on the infection of surfers, it is the people in contact with beach sands and with estuarine sediments who are at a far higher risk. While only 6% of the surfers tested were found to be infected by the single E coli pathotype which was tested for, the risk of infection and even worse colonisation among sand-goers must be many times greater. The same research team at Exeter Medical School also conducted tests on another virulent pathotype of E Coli around UK beaches.
This has also been the subject of intense study of multiple pathotypes in the coastal waters of Northern China — see ref. (G)
Types of beaches:
There are different kinds of beaches with many being fed by different kinds of streams which in turn are influenced by the geology of the area, each of which can hold and transmit different diseases — see ref. (H)
Sandy beaches are favoured by beach goers, are fairly typical of flatter land but can be in enclosed coves.
The movement of the sand affects the types of disease pathogen which are mostly held in upper sands. It is the upper sands where the bacteria and other germs are filtered out at every tide, and the bacteria often live in biofilms.
But there is also some movement, to and fro, from sand to water. The levels of germs are far higher in the upper sands than in tidal water, and it is the upper sands where children mostly become infected during play. The quantity of pathogens carried also varies with the tide, with higher levels recorded on an outgoing tide and lower levels on an incoming tide.
There are different kinds of sands according to the roughness of the grains and their different movements with the tides. Windborne dunes with their rounded grains are more mobile than waterborne sands which are bonded a little more by organic material.
The connection between beach sands and disease has been well proven, and has recently become the subject of much research worldwide.
Gravelly beaches which usually overlie sand can also collect germs, but in deeper layers.
However as there is less direct contact, they usually prove safer. But in all these beaches potent and pathogen-laden droppings from seabirds, seeking the food left-overs from bathers, pose another risk.
Estuarine beaches are tidal and are at the outflows of larger river systems. These are quite different in that they usually accumulate large quantities of sediments and muds which in turn carry high levels of disease-causing organisms.
Germs of all kinds cluster onto the finer particles and create their own organic layers, called biofilms. These supply the organisms with nutrients, and protect them from the damaging effects of tidal movements and also from the ultraviolet rays (UV) in sunlight.
These have been the subject of much constructive research, especially in the Severn Estuary. It is seldom advisable to swim or bathe at any of these beaches, no matter what quality rating may have been claimed for them.
Recently the dangers in estuaries have increased greatly with the increasing pollution of our rivers by micro-plastics, as well as from chemicals leaching from them. These micro-plastics are highly attractive to the bacteria and other pathogens and the micro-plastic particles actively help the bacteria to survive on biofilms, even assisting them to proliferate.
So the levels in these estuarine sediments, and the pathogens which they hold, are increasing to unprecedented levels.
We have three major estuarine catchments, two of them being the Thames and Severn, possessing beaches which even the Environment Agency class as “Poor”, and some have been de-designated. The Humber, carrying much of the effluent and pollution from the manufacturing north, is so polluted that it has no designated beaches. Many people here catch ‘thrush’ and skin infections from the muds alone.
The sands often, to rough figures, carry a hundred or more times the concentration of bacteria in the water; and in the case of estuarine muds, often a thousand or more fold. Added to that are new layers of micro-plastic biofilms which are carrying pathogens down our large river networks to collect in these estuaries. Again, much research has been done on these increasing hazards worldwide; but so far, there seems to be no regulation — see ref. (I)
Effectively, our coasts are surrounded by an invisible moat, filled with human pathogens, which is being topped up daily, faster than they can naturally decay — another scenario towards man-made disaster.
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How persistent are these pathogens in fresh and sea water?
E Coli (Escherichia coli-forms) are, as an example, remarkably stable in clear river waters and have been shown to survive for 200 days with little reduction.
The Intestinal Enterococci (IE) use a different tactic and hide in biofilms in sediments, so tend to persist better in estuarine waters.
On arriving into seawater, persistence for IE is appreciably less; but E coli can persist with a half-life of eight to ten days — and much more for the pathogenic STEC forms, especially when in biofilms on sediments.
Our precious clear chalk streams, with very little sediment, are the safest – until also polluted.
So whatever arrives at our beaches, even after average Sewage treatment, is appreciable; and will keep on moving to and fro offshore influenced by a range of variables (tides, salinity, temperature and freshwater input) until it is dissipated. But with the constant process of replacement, we are unlikely to find any appreciable lessening of health risks from day to day — see ref. (J)
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What is the pathogenicity : which diseases does this bring?
What is being measured by EA is not pathogenicity (the actual dangers to health) but the total numbers of similar shaped bacteria with a fairly low temperature resistance.
Just look for a moment at the actual quantities of E coli in a cattle’s gut, each of which produces 2 tonnes of faeces per year. The actual E coli content of this animal’s faeces is largely non-pathogenic. The most highly pathogenic forms to humans occur in roughly 1% and 2% of the cattle’s faeces. For Intestinal Enterococci (IE) there are relatively more to which we are especially susceptible with six predominantly harmful forms, but the quantities of IE are less than half of E Coli .
Faecal bacteria coming directly and in untreated form from cattle and other livestock contain specific highly pathogenic bacteria, with sub-species like Shiga toxin, and with the even more highly pathogenic forms coming from the enterococci (IE) which are highly resistant to sterilisation and to Sewage treatment.
The Scale of the Problem.
Quantity of UK sewage and farm effluent per day: The population of England is 56 million (UK as a whole is 66 million), and growing with immigration. Each person produces about 900 litres of fluid waste per day, most of which is subject to STW treatment. So about 6 millions tonnes per day.
Add to that the discharges to watercourses by livestock : 9.6 million cattle, 4.6 million pigs, 22 million sheep which tend to be reared more on hilly areas with high runoff. Also, sewage sludge is spread on fields resulting in leaching bacteria, giving a very rough low figure of 4 million tonnes per day.
This all ends up in and around roughly 7,600 miles (12,230 kilometres) of mainland coastline. This results in a staggering figure of nearly 0.83 tonnes of sewage per kilometre, or 0.83 kilogrammes per metre. Unbelievable!
The standard EU units of measurement of faecal indicators, E Coli and IE, are used around our designated beaches for five months of the summer (May to September), but there are also many popular but undesignated beaches which have no monitoring.
This is very much a postcode and commercial lottery, with deprived areas only getting second and third class treatment.
The highest levels of sewage treatment are reserved for shell fisheries, ecologically sensitive areas and a few prime beach hotel towns.
Which routes do they take?
Farm effluents will come, untreated, via streams and rivers.
Ex- STW treated human effluents can arrive by river or stream, or by deep sea pipelines in commercially sensitive areas. Bacterial runoff from sewage sludge spread on fields will be considerable too — it will likely to be of higher bacterial content, but lower pathogenicity.
What do they individually do to us?
The bulk of E coli are not harmful to us, but the few highly pathogenic ones cause a range of diseases and can be life-threatening.
The worse forms were imported mutations in the 1980s and 90’s. But their pathogenicity is still evolving and increasing, the more we try to limit their attacks.
It is the same story as relates to anti-biotic resistance, anti-pesticide resistance, anti-fungicide resistance, anti-herbicide resistance, anti-coagulant resistance; and now disinfectant resistance, anti-UV resistance and chlorination resistance. All of man’s ill considered attempts to limit the problem only makes it worse.
This is explained by the Darwinian concept of Natural Selection, or self preservation. As we introduce these methods they do kill off large swathes of the species, but not all. Those with some resistance then interbreed, and the problem of resistance increases.
Our lack of coordinated treatments has left us “Naked to our Enemies”.
Beach Gradings.
These are set according to the test results using criteria from Europe. The EA measure FIBs (Faecal Indicator Bacteria) by their colony forming ability.
But look more deeply and you will see that they are measuring these bacteria as a class overall, with no measure at all of what affects us most — the selective pathogenicity among them. My personal view is that current monitoring is largely pointless.
Faecal bacteria are likely to be, first and foremost, from mankind directly; or indirectly via farming and industry. Most are present due to the consequence of social activities, as well as neglect by man.
Imported and mutating pathogens.
Unfortunately, we are now suffering from a range of mutated varieties of E coli pathogen that seem to have developed abroad, and imported here. Specifically the STEC or E coli 0157, and it’s sub-varieties.
Persistence of these pathogens in natural waters.
E Coli have been shown to be very persistent in clear river water, for at least 200 days has been demonstrated.
In lake water or water containing biotic material much less where they survive in the region of up to 12 days, unless protected in biofilms where they seem to be able to last indefinitely.
Faecal bacteria naturally decay in sunlight in sea water, with a declared half-life of about eight days. But they can also find protection in estuarine sediments and especially micro-plastic biofilms, so it is difficult to interpret these readings in terms of pathogenicity. The most pathogenic sub-species have been shown specifically to persist even longer in seawater.
There are better methods now for measuring specific pathogens both by classical fluorescence and now by genetic methods.
Our shorelines vary greatly. I have checked inputs of farming origin which are more significant as they have never been subject to Sewage Treatment Work (STW) processes.
We have ideas of the rates of decay and of daily replenishment. But we do not really know how much is there because it persists or decays at different rates, in different places and in different seasons. So really, we have very little knowledge of the true degrees of pathogenicity and hence of the potential to cause disease.
We have the science to be able to follow these pathogens, but little seeming priority from the authorities to do so.
The health risks when bathing or playing at sea beaches were traditionally often irritating but relatively minor, and are quite different from those in rivers and inland water bodies.
In the sea they can lead to skin, eye, ear, gastric, urinary and respiratory infections from biological pollutants in the water. More rarely, illnesses such as meningitis and hepatitis occur and can be severe to life-threatening.
But now we also have many new chemical hazards from the tens of thousands of newly synthesised chemicals which are allowed to drain into our waters – whether slowly accumulating or with cell altering capabilities e.g. carcinogenic etc, we simply do not know — see ref. (K)
Faecal bacteria originating from treated, or even untreated sewage, are likely to be less pathogenic than the faecal bacteria coming from cattle.
This disparity is also influenced by the diet of the cattle and the use of high-shedding cattle (intensive farming husbandry). This contrasting disparity does not mean there is no risk. Just that it is likely that the risk, unpredictably, will be less.
Discharges are more or less continuous around our coasts. They arise diurnally from local sewage works and more randomly from further afield; this diurnal pattern is also lost when discharges come via rivers or streams down to the sea.
The diurnal nature of discharges from STWs is clearly evident. But in some areas the discharges are also frequent, being usually untreated discharges from septic tanks and other sources, especially as on the East Coast of Yorkshire.
I have collated all EA beach bacteria data over the last four years, and patterns are emerging. I have recorded great inconsistencies in discharges and treatment. For example, I am now confident that I can identify the locations of even intensive poultry farms and of multiple septic tank effluents etc, using EA published data.
So, personally speaking, I believe that the EA test results around our coasts in the summer months are largely meaningless, if not misleading, as are the high gradings of beaches which the EA assumes from these EA test results.
There are a total of 420 government designated beaches: 300 are graded ‘Excellent’ by the EA, 92 ‘Good’, 21 ‘Sufficient’, and 7 ‘Poor’ (i.e. failing the EA ‘Sufficient’ standard).
Septic tanks.
These are usually emptied untreated directly into locally waterways or transported by tanker to be dumped, often illegally.
This is especially the case along the coast of East Yorkshire with an archaic sewage disposal structure, and with its series of undesignated beaches which lack therefore even token protection, although they are also amongst the most popular.
Intensive poultry farm discharges.
The discharges from poultry farms are very high in Intestinal Enterococci (IE), and include new and virulent imported forms.
It would be rare for these discharges to receive any form of treatment, and they are usually discharged directly into streams and water bodies. These seem to pose substantial health risks at recreational waters, with no warnings to the public.
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The floating plumes of sewage from off shore discharge pipes.
Sewage discharges are of freshwater, and these float on the surface of sea water in large plumes — freshwater is lighter in density than sea water. These plumes are often sized in terms of square kilometres, taking up to two hours to mix with the seawater underneath. This is a real risk to swimmers and there are never warnings about it.
When a Sewage Treatment Work’s (STW) discharges are made from deep sea pipes, they form large surface plumes in the sea. Evidence has been assembled in USA using satellite data. Swimmers are never warned of this hazard, and they can be swimming in a surface layer made entirely of treated or untreated sewage effluent – yet not be aware of it.
Accumulation of pathogens in berm sands.
This is highly significant and again the public are not warned of the dangers, especially to children and the elderly. The high tides wash up onto these sands, and filter down through them, trapping many bacteria and viruses and, in turn, locking them in biofilms. This means that readings of FBI (Faecal Bacterial Indicators) taken at high tide are going to be low; and when the FBI readings are taken at low tide, they will be high. This has been confirmed in House of Commons Environmental Reports — see ref.(L)
Sea wrack on sands.
This has been examined, and shown to pose some but low risk.
The growth of faecal bacteria in intertidal sediments.
This has been the subject of much study and brings with it further cause for concern of transmitted disease.
There are free-living bacteria which flow with the water. Also, they can move from suspension to sink to the bottom.
The size of particle is critical to what is being carried and most are found on the finest sediments, controlled more by their specific area than their size. Most are between 6 and 10 microns, though up to 50 microns can carry E coli; but most are borne at less than 4 micron, so these carry the greatest virulence.
The increasing occurrence of AMR (anti-microbial resistance) among these reservoirs of bacteria.
This has been the focus of long study at Exeter University, and is the cause of much concern. E Coli strains with greatest AMR have been found in wet sand; and, up to 72% of bacteria in sand have been found to have greater AMR than those in the water — see ref. (M)
Algal blooms, often toxic and bioluminescent.
Usually caused by excess phosphorus and nitrogen nutrients in the water, so more related to farming fertilisers than sewage. Best avoided — see ref. (N)
Discharges from intensive livestock farms.
These can be highly virulent. Poultry farms have high levels of pathogenic entrococci in newly identified pathotypes. Pig farms bear more E Coli, although in fewer but still virulent pathotypes.
They can bear toxic mutant pathotypes of several kinds which can cross over to other species.
Much of their waste is discharged untreated into local streams. These flow down to the sea where the bacteria are absorbed into berm sands, allowing movement into and out of the water with the tides. Longshore drift can be an influence here — see ref.(O)
FIBs (Faecal Indicator Bacteria) are only monitored by EA on designated beaches for 20 weeks of the year.
But the pathogenic types are not measured routinely, at all.
While we are only considering here the health risks to people bathing in recreational waters we should not overlook the risk, and with a far greater cost within our society, from high fatality sepsis-like diseases, many of which are ultimately due to the constantly mutating pathogens throughout our society which are mostly of bovine and avian origin. These mutating pathogens are carried in sewage spills, as also by foods and meats, and also in hospital themselves due to hygiene deficiencies. These numbers have developed today and over the past decade into massive proportions.
References:
(A) National University of Ireland, Galway, reported in The Independent 1st June 2021 “Deadly bacteria found in popular swimming spots, ranked “Excellent” in water quality tests”. See: www.independent.ie/news/environment/deadly-bacteria-found-in-popular-swimming-spotsranked-excellent-in-water-quality-tests-40490670.html
(B) Al Saif 1996 The distribution of Clostridium difficile in the environment of South Wales, Microbiology Society (Map). See: https://pubmed.ncbi.nlm.nih.gov/8683549
(C) Hafiz, 1976, Clostridium difficile; isolation and characteristics, J Med Microbiol 9; 129-136. See: https://pubmed.ncbi.nlm.nih.gov/933146
(D) Meals, Monitoring for Microbial Pathogens and Indicators, EPA, 2013, Tech notes. See: www.epa.gov/nps/nonpoint-source-monitoring-technotes
(E) Zhang 2006 Evaluation of pathogenic indicator bacteria in structural best management practices. J Environ Scienc, Pub Med. See: https://pubmed.ncbi.nlm.nih.gov/17000540
(F) Schraufnagel, 2020, The health effects of ultrafine particles. Experimental and Molecular Medicine. See: www.nature.com/articles/s12276-020-0403-3
(G) Zhao 2020, Estuarine sediments are key hotspots on intracellular and extracellular antibiotic resistance genesgene A string of the DNA (deoxyribonucleic acid) molecule that is the fundamental unit of inheritance, so it is variations in the make up of this molecule in the gene that controls variations in an organism's appearance and behaviour. Genes are found in the nucleus of the organism's cells.. Science Direct. See: www.sciencedirect.com/science/article/pii/S0160412019314722
(H) Solo-Gabrielle, 2015,.Beach sand and the potential for infectious disease transmission, Oceans and Harm to health. JMBA. See: https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.711.1231&rep=rep1&type=pdf
(I) Hassard, 2016, abundance and distribution of enteric bacteria and viruses in coastal and estuarine sediments, Frontiers in Science. See: www.frontiersin.org/articles/10.3389/fmicb.2016.01692/full
(J) Yang and Liu, 2017, Simulation of the fate of faecal bacteria in estuarine and coastal waters, based on a fractionated sediment transport model, Severn Estuary. China Ocean Engineering. See: www.chinaoceanengin.cn/fileZGHYGCEN/journal/article/zghygc/2017/4/PDF/zghygc-E2016085.pdf
(K) Beversdorf, The potential for beach sand to serve as a reservoir for E Coli, and the physical influence of cell die-off. See: https://pubmed.ncbi.nlm.nih.gov/17448172/ and Sfam Journals, 2006, Journal of Microbiology.July 2021, E Colli contamination of the River Thames, in different seasons and weather conditions. Research Gate. Very thorough. See: www.researchgate.net/publication/263568623_Escherichia_coli_contamination_of_the_river_Thames_in_different_seasons_and_weather_conditions
(L) Suzuki 2021, Plant debris are hotbeds for pathogenic bacteria on recreational sandy beaches, Scientific reports. Pdf, good refs. See: www.nature.com/articles/s41598-021-91066-w
(M) Leonard, Gaze, Environment International, Human recreational exposure to antibiotic resistance bacteria in coastal bathing waters. 2014. See: https://pubmed.ncbi.nlm.nih.gov/25832996
(N) The Guardian, 4th January 2020,Lethal algal blooms, an ecosystem out of balance. See: www.theguardian.com/environment/2020/jan/04/lethal-algae-blooms-an-ecosystem-out-of-balance
(O) Ye and Chang, 2007, Hazard of Pathogenic Organisms in Discharge from Livestock and Poultry Breeding farms, J Ecol and Rural Environment, cn . See: http://en.cnki.com.cn/Article_en/CJFDTotal-NCST200702013.htm
Optional References
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Rippy: Physical dynamics controlling variability in nearshore faecal pollution; faecal indicator bacteria as passive particles. Scripps Ocean Institute. Marine Pollution Bulletin
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