A friend of mine - and I can assure you what he says is the way it is!
___________________________________________________________
Friday, September 09, 2005
DR. BROBSON LUTZ: Beware of myths, but health risks are real
Beware of misguided public health information
After every major hurricane, alarms of infectious diseases abound. Survivors are bombarded with warnings about impending epidemics of cholera, typhoid fever, tetanus, and dysentery. Elected officials routinely warn citizens to watch out for poisonous snakes.
Hurricanes spawn medical misinformation in direct relationship to the ferocity of the winds and water. Each new storm generates its own unique rumors. With Katrina it has been sharks in the flood waters, mosquitoes spreading contagious diseases after feeding off floating corpses and skin blistering toxins in the flood waters.
In 1969 Hurricane Camille devastated the Mississippi Gulf Coast. My classmates at Tulane Medical School wanted to help. Under the tutelage of a professor of epidemiology we traveled to the Mississippi coast and immunized dozens of survivors against typhoid fever. We wanted to help. Actually, we left rescue workers with sore arms that probably impeded their subsequent relief efforts.
As we move forward, the endemic health problems will not be strange and rare diseases. We will have endemic cuts, lacerations and puncture wounds. Skin and soft tissue infections will be the major infectious disease problem. These will be not be caused by the exotic pathogens but by the common ones -- Staphylococcal and streptococcal infections.
Staphylococcal resistance is already well established in Louisiana, and we will see more methicillin-resistant Staphylococcus aureus (MRSA) infections that are resistant to previously useful antibiotics such as Keflex. The most serious wound infections we will encounter will be from Vibrio vulnificus, a organism well-established in our salt water marshes. This infectious bully usually just targets persons with diabetes, liver diseases and other immune impairments.
The other major infectious disease threat is mosquito-borne viruses. Fortunately, the storm blew away most of our established mosquito population. But survivors will soon repopulate the area and old eggs now submerged in water will hatch and pupate quickly. The increase in the insect population will bring back many bird species probably including those carrying West Nile and St. Louis encephalitis.
Aerial spraying for insects needs to start ASAP with the right chemicals, not the ones that are the cheapest for private contractors to spray. Some chemical supply companies provide “kickbacks” to contractors who use their less effective products just like some of the big drug companies give rebates to hospitals for using their particular brand of drug. Hopefully, the Army will take over all aerial spraying missions.
Flies are also a problem after any disaster in warm areas of the world. After Hurricane Betsy, rescue workers easily spotted the attics containing dead bodies by looking for swarms of black flies on roofs. House to house searches are not necessary to find dead bodies. Follow the fly swarms.
After Katrina, one of our elected officials announced that mosquitoes will transmit disease by biting corpses in our streets. Mosquitoes do not feed off dead bodies. Infectious diseases are not spread this way. Dead bodies on the streets and in the water are an etiologic agent for severe psychological trauma, not contagious diseases.
Earlier this week, I heard that a state health official warned television viewers about cholera and other enteric diseases. Cholera is a pathogen that is rare in our environment. It requires human consumption of food or water contaminated with a causative pathogen which is not even established in our wetlands. Cholera and typhoid are not infections that survivors will face in the upcoming weeks and months.
Former city health director Dr. Rodney Jung told me years ago that snake rumors flourish after each hurricane. Snake sightings do increase with flooding, but no physician I know has ever treated a person for a snake bite related to a hurricane. Fortunately, the alligators displaced by storms are mostly too small to cause injury and the larger ones are not likely to harm humans unless cornered. The small sharks that washed over from Lake Pontchtrain were totally benign.
Tetanus was a problem after the recent Asian tsunami where many persons never had the benefit of childhood immunizations in the first place. Tetanus will not be a problem here. Even though a tetanus booster is recommended every 10 years, the primary series of immunizations for children provides essentially lifetime protection. Adults who got their childhood immunizations are well protected.
Most diarrhea immediately after a storm is stress related and not due to infectious causes. Present supplies of bottled water and uncontaminated food will prevent typhoid fever, salmonella and most other enteric diseases.
The newest mythical threat on the block is mold. I heard a former director of the Centers for Disease Control say on national television that the mold that will be growing in all our flooded houses is “very dangerous”. He has been behind a desk and out of the trenches for too long. Mold growth indicates excessive moisture, but environmental molds are more legal fodder than disease producers.
As we recover, each day will be a challenge. Stress related problems will soar. The first-aid for preventing storm stress is secure water, food and good shelter. Overall trauma such as chainsaw injuries will be the major cause of morbidity post-storm. Gasoline powered generators and gas grills inside are dangerous and carbon monoxide has already claimed several people who survived the storm.
It is time to put medical myths to bed. Our usual cast of bacterial villains will cause trauma-related wound infections. For most healthy adults these infections will range from trivial to mild. For persons with diabetes and other underlying chronic diseases, Vibrio wound infections can be fatal.
Forget about cholera, tetanus, typhoid fever and catching contagious diseases from the dead. Our real medical villains will be storm stress and trauma.
Brobson Lutz, MD
Health spokesman Orleans Parish Medical Society
www.nola.com