Brief Medical Follow-Up

by DemFromCT

Revere, at Effect Measure, has an excellent follow-up to this TNH post from yesterday.

Misinformation from those who should know better is also occurring in the aftermath of hurricane Katrina. DHHS Secretary Leavitt, for example, has warned of the risk of "typhoid and cholera" as a result of contaminated water, while others have talked generally of mosquito-borne disease and the hazards caused by dead people and animals. It is time to separate the real risks from the phantom risks.

...

The biggest health hazards may well be those we would classify under "injury." Heat-related illness might be at the top of the list here. As body core temperatures rise above 105 degrees F., mortality increases quickly. The high heat and humidity of the area, coupled with dehydration are a significant health hazard that requires intervention by providing fluids and cooler shelters. The many sources of physical injury, whether from feral animals (snakes, alligators, etc.), sharp metal debris, falls and injuries in an environment where the hazards are numerous and not easily visible can result in substantial accumulated morbidity and even mortality. The only remedy is removal of people to a safer environment, which should be the top priority. this is also true for the many chronically ill and vulnerable people who require medication, external support from power dependent devices and supervision.

The situation is complex but the bottom line here is simple: mobilize resources to remove people from the area as quickly as possible, while providing fresh food and water to those waiting evacuation. This is something a well-organized military force, like the National Guard, should have been equipped to do from the outset. If they can plan how to put hundreds of thousands of soldiers to invade an area in a twelve hour period, they can also plan how to remove civilians in a three day period.

Or can they?

Leavitt needs to stay the hell away from a camera and microphone. Risk communication is a huge need right now.  The CDC should have an available spokesperson to debunk fears about dead bodies causing or spreading disease. But the triage and evacuation of the ill from dehydration or existing medical conditions is the story here, followed by exposure, deydration and other 'baattlefiled' situations like injuries, and not infectious diseases.

This should be handled by National Guard and military working together, and would be well within their expertise. The world is watching, and the folks on the Gulf are hurting. The mobilization of any and all necessary elements for evacuation is the order of bidness now.

Comments

[emptywheel]

As a former Leavitt Governee in UT, can I add him to the list of folks who should be fired in disgrace when this whole thing blows over?

[Michael]

Weell, I'm afraid I'm going to have to disagree with Revere's assessment. Dead bodies in small quantities don't pose significant health risks, but they are certainly no fun to be around and if there are enough of them, there can be trouble. And dehydration isn't the only thing to worry about in the absence of functioning safe water supplies. Cholera, salmonella, and a host of other nasty illnesses are all capable of being transmitted through contaminated water. Given that there's also no electricity and no functioning natural gas supply, it's going to be damn hard to boil what water may be available in New Orleans long enough to get it to the point where it's safe to drink, and I seriously doubt that many of the people there have the necessary materials to purify water without boiling it. I'd rather have people more afraid of the water than less, because if they start drinking it out of desperation, they are almost certainly going to get sick. And in a city where the hospitals are out of food, water, drugs, and electric power, an outbreak of cholera, typhoid, salmonella, or even E. coli, is just too depressing to contemplate.

[ng]

As a former Leavitt Governee in UT, can I add him to the list of folks who should be fired in disgrace when this whole thing blows over?

I worked in public health as a government employee under Governor Tom Ridge of PA. Talk about dismantling proper infrastructure and replacing it with private sector greed satisfaction for the wealthy while denying any problems through media contreol, I mean that guy was the best. Duct tape will solve all New Orleans problems, just ask Ridge.

All the money, that should be spent on proper public infrastructure (not private sector sports stadiums, btw) and public health infrastructure, is being pocketed by carpetbaggers on the 9-11 gravy train while the unfortunates get the duct tape treatment when the going gets rough. Thanks Ridge, thanks Bush, and add to the list here_______!

[DemFromCT]

Michael, e Coli, Norwalk virus, and other diarrheal agents are real issues. However, cholera is not endemic and won't appear out of nowhere. Same is true of plague and typhoid.

Salmonella from spoiled food is an issue, as is giardia (intestinal parasites)from contaminated water. Other agents like rotavirus and cryptosporidium are real issues, too (daycare diarrhea).

[Michael]

Cholera might be a bit of a stretch, agreed. But as I said, I think I'd rather go a little overboard on the scare tactics if it will keep people from doing something really, really stupid.

Typhoid, on the other hand, I'm not inclined to dismiss so easily. We've long known that people can carry the agent for years without showing any signs of disease themselves, and given that a lot of the unfortunate people still caught in New Orleans are probably not able to afford regular medical care, it wouldn't surprise me if there were a carrier or two among them. Given that the sewers are all backing up and there's no real facility for purifying the water, any public health epidemiologist who wasn't worrying about typhoid should be fired.

[Michael]

I take it back. Here's what the CDC has to say about cholera:

"A person may get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water.

The cholera bacterium may also live in the environment in brackish rivers and coastal waters. Shellfish eaten raw have been a source of cholera, and a few persons in the United States have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill."

Brackish rivers and coastal waters? Check.
Shellfish eaten raw? Check.
Shellfish from the Gulf of Mexico? Check.
Inadequate treatment of sewage and drinking water? Check.

[janinsanfran]

The world is watching. At some point it will sink in that this is true. This from Reuters:

LONDON (Reuters) - The world has watched amazed as the planet's only superpower struggles with the aftermath of Hurricane Katrina, with some saying the chaos has exposed flaws and deep divisions in American society.

World leaders and ordinary citizens have expressed sympathy with the people of the southern United States whose lives were devastated by the hurricane and the flooding that followed.

But many have also been shocked by the images of disorder beamed around the world -- looters roaming the debris-strewn streets and thousands of people gathered in New Orleans waiting for the authorities to provide food, water and other aid.

"Anarchy in the USA" declared Britain's best-selling newspaper The Sun.

"Apocalypse Now" headlined Germany's Handelsblatt daily.

The pictures of the catastrophe -- which has killed hundreds and possibly thousands -- have evoked memories of crises in the world's poorest nations such as last year's tsunami in Asia, which left more than 230,000 people dead or missing. . ..

"A modern metropolis sinking in water and into anarchy -- it is a really cruel spectacle for a champion of security like Bush," France's left-leaning Liberation newspaper said.

"(Al Qaeda leader Osama) bin Laden, nice and dry in his hideaway, must be killing himself laughing."

A female employee at a multinational firm in South Korea said it may have been no accident the U.S. was hit.

"Maybe it was punishment for what it did to Iraq, which has a man-made disaster, not a natural disaster," said the woman, who did not want to be named as she has an American manager.

"A lot of the people I work with think this way. We spoke about it just the other day," she said.

Commentators noted the victims of the hurricane were overwhelmingly African Americans, too poor to flee the region as the hurricane loomed unlike some of their white neighbors.. . .

"In one of the poorest states in the country, where black people earn half as much as white people, this has taken on a racial dimension," said a report in Britain's Guardian daily.

Luxembourg Foreign Minister Jean Asselborn, in a veiled criticism of U.S. political thought, said the disaster showed the need for a strong state that could help poor people.

"You see in this example that even in the 21st century you need the state, a good functioning state, and I hope that for all these people, these poor people, that the Americans will do their best," he told reporters at a European Union meeting in Newport, Wales.

I've shortened it some. There's more but you get the gist. Wonder if this will function at all as embarassment over pictures of civil rights protesters getting hosed did in the late 50s?

[DemFromCT]

Forget about typhoid and cholera. From CDC:

There is no indication for the following vaccines given the anticipated conditions in the region:
1. Hepatitis A
2. Typhoid vaccine
3. Cholera vaccine
4. Meningococcal vaccine
5. Rabies vaccine
link

[viget]

Dem--

I really don't know what to think about Cholera. I mean, it might really be a problem. As Michael pointed out, it is actually endemic in the Gulf of Mexico (maybe not necessarily where NOLA is), and this was a fact I was surprised to hear during my ID block in med school. I wouldn't be so quick to discount it. However, I would put it fairly down low on my differential.

All I know, if people at the Astrodome start having profuse watery diarrhea soon, we'll find out if that's right.

[viget]

And I'd also point out that the link you provided is only for vaccines for hurrican responders, not for treatment options for victims. At this point, if they've got the illness, they've got the illness and you're not going to stop it with a vaccine. Plus there is no cholera vaccine available as the link explains. I agree, there is no need to vaccinate responders against cholera or typhoid, but that doesn't mean that the victims won't come down with it.

[DemFromCT]

Nothing's impossible, viget, but it's low down on the list from folks who regularly work in the region. The higher up on the list problems are exposure, dehydration, injury with skin infections and the more typical diarrheal illnesses (some of which are viral) as well as spoiled food problems.

Also low down on the list are dengue, West Nile and other mosquito-borne illnesses.

[DemFromCT]

Put another way by chez Nadezhda:

Just to be clear -- it's not that there are no increased risks to diseases like cholera nor that there's absolutely no risk from dead bodies floating about. It's a matter of putting risks in perspective and public health priorities for where immediate attention should be directed. Even if the government can't get in to affected areas to provide assistance, at least they should be providing accurate information so that people can better help themselves. It would also be nice if the media, instead of spreading titillating specters of future horror, could take its responsibilities seriously and start correcting these sorts of potentially fatal but widely shared misapprehensions.