New York City is facing a Legionnaires' disease outbreak in Harlem: more than 60 people affected and at least three deaths linked to contaminated cooling towers. The situation has raised alarms, but it shouldn't surprise us.
Because the danger isn't in the facades. It's in what you can't see: in the pipes, the tanks, the systems that were designed to operate, but that no one thought about how to maintain.
And if this is happening in a city like New York, with its strict protocols, how vulnerable are we in the Caribbean? In countries like the Dominican Republic, where the heat necessitates the constant use of central air conditioning and hot water systems, the risk is even higher. Without a preventative approach, a new project can unknowingly become a breeding ground for disease.
The warning isn't just about Legionella. There's another silent phenomenon: sick building syndrome. This refers to a set of physical symptoms—headaches, fatigue, shortness of breath, eye irritation, or general malaise—experienced by occupants of a building, which improve upon leaving it. The World Health Organization has extensively documented it, and its cause is almost always related to indoor air quality, faulty HVAC systems, humidity, invisible pollutants, or lack of maintenance.
It's not stress. It's poor ventilation, incorrectly specified materials, humidity, bacteria, and design choices that weren't considered for continuous use. And most seriously: it's design without operational responsibility.
In the real estate world we celebrate spectacular renderings, premium locations and financial returns, while neglecting an essential aspect: how does that building work when it is delivered?
I've worked on dozens of projects where the budget included imported marble, but not a preventative maintenance plan. Where the design sold style, but not health. And where no one—neither the client nor the technical team—stopped to ask if that system would remain stable in five years.
Today, more than ever, integrating health, sustainability, and real-world operations into every technical decision is no longer a luxury or a trend. It's a responsibility.
From our work in architecture and development we have seen that it is possible to do it without sacrificing aesthetics or profitability, but it requires a decision from the first line of the plan.
What happened in Harlem could happen in any city. And if we don't design with actual use in mind, the cost won't just be structural. It will be human.
