CLEANUP: Disinfecting a rescue worker in New Orleans
Dead bodies. Let's get one thing straight: dead bodies from a natural disaster don't typically cause disease. Yes, it is horrible to see corpses submerged in the floodwaters of New Orleans, washed up in the woods of Mississippi and crushed under obliterated homes all along the Gulf Coast. But as disasters around the world have taught us over the years, the threat of disease comes not from the dead but from the living.
Infectious Disease. The major concerns at present are diarrhea and respiratory infections. Doctors, nurses and other medical personnel are working to keep those problems under control in shelters throughout the region. But medical teams will need to keep a close eye on the work crews that are clearing debris, pumping out flood water and searching through the mud and sludge.
One disease that's typically associated with severe flooding but is generally overlooked in the U.S. is leptospirosis, according to Dr. Clarence J. Peters, director for biodefense at the University of Texas Medical Branch at Galveston. Leptospirosis is caused by bacteria that normally infect rats and dogs. The bacteria doesn't cause major problems in these animals but is excreted in their urine. This becomes a problem, ironically, as floodwaters recede, leaving behind pools of water where the animals urinate. The bacteria infect humans through intact skin or cuts and wounds, causing fever and vomiting. It is sometimes mistaken for hepatitis but unlike hepatitis, can be cured with antibiotics.
Despite what you may have read or heard, there are no cases of cholera on the Gulf Coast. As many as five people have died from what appears to be an infection with Vibrio vulnificus. This bacteria occurs naturally in the waters of the Gulf Coast and is responsible for as many as 35 deaths a year in the U.S.—most often from eating raw seafood in the summer months. V. vulnificus comes from the same biological group as the cholera-causing pathogen but is nowhere near as deadly. Healthy people are generally able to withstand the infection, which is treated with antibiotics.
Chemicals and Heavy Metals. There's been a lot of concern about petrochemical plants leaking into the floodwater. But generally speaking, large petrochemical companies know where their plants are and have the personnel to assess and address any problems. The more difficult issue may well be with the hundreds, if not thousands, of smaller sources of contamination, like gasoline stations, pesticide stores and residential garages filled with cleaning solutions and who knows what else.
Gasoline from submerged cars and gas stations will probably evaporate in a few weeks, says John Ward, deputy director of the National Institute of Environmental Health Science Center at the University of Texas Medical Branch in Galveston. He's more concerned about local pockets of mercury, lead, chromium and arsenic that may have contaminated soil and water after being tipped over or displaced from storage containers.
Water. New Orleans gets its drinking water from the Mississippi River, which should have flushed itself of any floodwaters by now—leaving aside, for the moment, the preflood issues of agricultural and industrial contaminants. The treatment plants, pumping stations, underground pipes and mains are, of course, a different story. The first order of business will be repressurizing the system so that water leaks out, not in. Then tests of water quality will tell engineers where they have to concentrate their cleanup, flushing and rebuilding efforts.
Update: The Health Care Workers Come In
The portable toilets still hadn't arrived at Kindred Hospital in New Orleans as of Thursday evening, but a generator truck was providing electricity to half the building and teams of medical personnel, engineers, and National Guards were busy turning it into a kind of public health command center. A team of epidemiologists from the Centers for Disease Control and Prevention has set up shop at Kindred—which wasn't flooded—to monitor the public health situation and provide assistance to local and state health authorities as they figure out which health and medical needs they must address first.
"The logistics and communications are the biggest challenge," says Carol Rubin of the National Center for Environmental Health at the CDC. But she's seeing progress. Looking forward, Rubin says, some of the biggest health concerns facing remaining residents and rescue and engineering crews are injuries, carbon monoxide poisoning (from using campstoves or gas-powered generators indoors), and access to medical treatment for chronic conditions, such as diabetes or high blood pressure.
CDC personnel are setting up monitoring stations in the emergency rooms of three hospitals—East Jefferson, West Jefferson and the Oschner Clinic. They'll get a clearer picture of just what current health conditions are within the city by keeping tabs on cases of diarrheal illness, fevers and other problems.
Rubin and other members of the public health assessment team have learned they'll be sleeping on the Navy ship Iwo Jima on the Mississippi River near the French Quarter. "I'm told the quarters are tight but they have great showers," says David Daigle, a CDC spokesman with the team.