A Public Health Nightmare
New Orleans—Members of California Task Force 3 Urban Search and Rescue’s Decontamination Unit “decon” U.S. Coast Guard personnel working rescue missions by boat. The floodwaters are highly contaminated with E. coli and other health hazards. (Bob McMillan/FEMA photo)
“Water, water everywhere,
Nor any drop to drink.”
These lines from Samuel Taylor Coleridge’s famous poem, “The Rime of the Ancient Mariner,” immediately come to mind when you view footage of a flooded New Orleans. Experts have criticized Mayor Ray Nagin for encouraging residents to return to the city, where safe drinking water is in short supply. The Environmental Protection Agency has found high levels of lead, arsenic, fecal matter and bacteria—including E. coli—in floodwaters and sediment.
“The spread of disease from contaminated water will be the top health threat for the more than 2 million people impacted by the hurricane,” says Dennis G. Maki, MD, a professor of medicine and specialist in infectious diseases at the University of Wisconsin–Madison. “Restoring fresh drinking water and repairing sewer systems is the most urgent health issue. Any delays would be catastrophic.”
But the real risks of contaminated water have been misrepresented by TV’s “talking heads,” according to Alan P. Zelicoff, MD, author of “Microbe: Are We Ready for the Next Plague?” and a senior scientist at ARES Corp., a risk-management consultancy whose clients include NASA and the U.S. Departments of Energy and Defense. Experts “wringing their hands” over cholera, typhoid and tetanus have been providing the public with erroneous information, he asserts.
“There is no cholera in New Orleans—and there hasn’t been any for over 100 years—so the chances of it occurring were virtually zero,” says Dr. Zelicoff, inventor of the Syndrome Reporting Information System (SYRIS), a state-of-the-art surveillance system that alerts physicians, veterinarians and public health officials to the first signs of an outbreak of deadly diseases. “Typhoid, if it did occur, would be extremely difficult to spread—except among those foolish enough to drink the sewer water. Anyone with the slightest understanding of environmental [naturally occurring] infectious disease would understand this. And tetanus is caused by a soil organism that can get into cuts and bruises. It is certainly awful for the individual who gets it, but there were no cases. Tetanus has never been reported to transmit from person to person—other than among IV drug users who share infected needles—so it was way down the list of diseases of importance.”
The genuine major disease threats, according to Dr. Zelicoff, include:
- Meningococcal meningitis
- Hepatitis A (and perhaps hepatitis B, while less likely)
- Enterovirus (a virus that infects the gastrointestinal tract, with the ability to spread to other parts of the body)
Each of these diseases, he explains, may occur when individuals are confined to crowded quarters.
“With 20,000 people sleeping on the floor of the Astrodome, which is about 2 acres, this translates into a density of several million people per square mile—a perfect setup for meningococcus,” Dr. Zelicoff says. “There are only two ways to deal with this potential threat: Disperse people as quickly as possible, which is what has happened at most—but not all—refugee centers. The second is vaccination. The vaccine is very safe, but it has two problems: It is expensive, at around $100 per injection, and it only covers about two-thirds of the known types of meningococcus. One type, known as type B, has defied all of our efforts for developing a vaccine.”
Hepatitis A and influenza present the same public health challenges. Influenza is a highly mutable virus that can rapidly become more lethal in crowded conditions, Dr. Zelicoff notes.
“To not vaccinate everyone coming into shelters against influenza is, in my view, the single largest mistake made so far,” he says. “It is too soon to know if we’ll have a lethal influenza outbreak, but so far we’ve gotten by on pure luck alone.”
Dr. Zelicoff fears experts at federal and state levels will ignore the observations and wisdom of local public health officials.
“In the end, public health—like politics—is local, and no one knows the situation on the ground better than local public health officials,” he says.
The end result?
“Resources get wasted, and the outbreaks that need attention are either missed or untreatable because all of the resources are gone when they occur,” Dr. Zelicoff warns.
“Despite the painful lessons that actual outbreaks have taught us, we remain vulnerable to the inadvertent introduction of a serious disease, such as newly evolved strains of avian influenza in humans,” he adds. “Worse, we remain especially vulnerable to an intentionally introduced disease, which is possible as a terrorist act. But it needn’t be so. We need to replace our haphazard patchwork of a public health system, where isolated professionals do their daily work largely in a vacuum, without the slightest idea of what they might have to face in the next days or even hours. We need to improve communication among the nation’s 5,000 or more independent public health offices and with the ‘consumers’ of their information: physicians, veterinarians and government officials who must decide if, for example, a case of meningitis warrants a massive, immediate, region-wide vaccination campaign, at great expense to the public treasury, or if the situation can be observed for a period of time.”
Dr. Zelicoff says he has little faith that national and state public health officials will learn any lessons or change the way they approach a disaster like Hurricane Katrina until there is a massive outbreak of disease.
“We have already seen enterovirus, though it isn’t very transmissible if you wash your hands before eating,” he says. “I hope an outbreak doesn’t happen, but it is the only catalyst for change that I can realistically imagine.”