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Officials Watch for Health Dangers, Hurricane wake

Officials Watch for Health Dangers in Hurricane Katrina's Wake

U.S., local health authorities watching for disease, injury, depression

By Charlene Porter
Washington File Staff Writer

Washington -- Hundreds of thousands of people remain displaced as a result of Hurricane Katrina’s damage to the Gulf Coast region of the United States. These survivors escaped the raging storm surge, churning debris and urban floods, but still face a variety of dangers to their health in the severely battered areas.

Immediate needs of homeless evacuees are being met through the large-scale mobilization of medical care units dispatched from federal and local agencies nationwide. At the same time, officials are looking to the future to identify what could become later waves of problems in the weeks and months to come.

The Department of Health and Human Services (HHS) already has deployed 4,000 medical personnel to staff a network of medical shelters across the more than 230,000-square-kilometer area stricken in the worst natural disaster in U.S. history.

The agency is recruiting health workers from all over the country, from all disciplines, to commit to a future tour of duty in the region, building a roster of volunteers, now some 17,000 strong, who will meet the area’s ongoing needs.

HHS Secretary Michael Leavitt, who took his second tour of the disaster area September 13-14, announced that his agency will streamline access to services by waiving the standard eligibility and enrollment requirements that beneficiaries of government benefits must meet.

This waiver applies to a variety of benefits and services, including medical help, mental health services and substance abuse treatment.

“No one who has been a victim of this disaster should be prevented from getting benefits they need because of government red tape,” Leavitt said in announcing the waiver.

DISEASE DANGERS

The alarming pictures of the flooded city of New Orleans -- a major metropolitan area awash in a vile stew of water, sewage, waste and spilled petroleum and chemicals -- created an ominous foreboding about what disease and danger could be left behind.

Some of the worst fears are not coming true as the waters recede day by day. Nervous speculation raised the possibility of outbreaks of disease seldom seen in the United States, such as typhoid or cholera, but the U.S. Centers for Disease Control and Prevention (CDC) has worked to quell such fears with education.

Infectious diseases that do not occur naturally in a given area will not appear suddenly in the aftermath of a natural disaster, the agency says.

Diseases that do merit watching, CDC reports, are those that can result from contact with polluted water, a very real concern for the many evacuees and rescue workers who have been in those waters up to their necks to reach safety.

Environmental Protection Agency (EPA) tests already have revealed a high level of E. coli and coliform bacteria lurking in New Orleans floodwaters. E. coli can lead to bloody diarrhea and abdominal cramps, and in a small percentage of cases can lead to kidney failure.

CDC has identified 19 cases of infection from the vibrio family of bacteria resulting in five deaths. This bacteria is normally present in Gulf Coast waters and causes wound infections or blood poisoning and is primarily a threat to people with weakened immune systems or liver dysfunction.

“This does not represent an outbreak,” said CDC Director Julie Gerberding in announcing the cases. “We see cases of this periodically from time to time along the coast, but we are investigating them to make sure that we’ve done everything we can to alert people and prevent further transmission through the water.”

The health agencies are calling for rigorous attention to protection, cleanliness and disinfection for workers who continue to come into contact with floodwaters as recovery and repair efforts are undertaken.

Diarrhea, upset stomach and respiratory illness are other diseases likely to appear in the short term, especially in evacuee shelters where people are living in close quarters.

Hygiene is critical to preventing these forms of infections, and Gerberding says CDC is taking steps to make sure proper facilities are in place in shelters.

The mosquito-borne West Nile Virus is another disease likely to flourish under current conditions. August and September are its prime months in the United States, and the Gulf Coast states reported cases even prior to Katrina.

The Federal Emergency Management Agency (FEMA) began an aerial mosquito-spraying program over New Orleans September 12 in attempt to minimize the danger.

THE SECOND WAVE

Health officials see a variety of potential health problems on the horizon as people return to evacuated areas to camp out in the wreckage of their homes, sort through the debris and rebuild. Agencies are taking care to inform the public about the risks.

Injury is one of the key worries, with people living and working in areas where natural gas or fuel lines may have broken or where methane and other explosive gases accumulate from decaying materials.

Under these circumstances, people also may take unnecessary risks, exposing themselves to the carbon monoxide emitted by a portable power generator or the fire risks of camp stoves and lanterns.

Mold and the accompanying respiratory illness or irritation it can bring on is another significant concern. In the subtropical summer weather of the Gulf Coast, microorganisms can grow rapidly, especially in a house that has been flooded.

The EPA is warning homeowners to dry out their homes thoroughly or microorganisms could remain for some time, with the potential to cause continued irritation to sensitive individuals or asthmatics.

In addition to warnings about practical matters, health officials also recognize that Katrina’s survivors have undergone a trauma of life-changing proportions. Some have lost not only family members, homes and possessions, but also jobs, pets and entire towns.

“You could call it the second wave of this hurricane that will come at some point later,” said Dr. Thomas Insel, director of the National Institute of Mental Health at the National Institutes of Health.

“Maybe not in days, maybe not in weeks,” he said, “[but] sometimes in months and years where you begin to get the second wave of distress that often shows up as a disorder like post traumatic stress disorder or oftentimes other kinds of syndromes such as substance abuse or just mental discord.”

Insel said mental health care will be an essential part of the medical response. Therapists and grief counselors were deployed to shelters in their earliest days of opening. This form of care is also part of the package of services HHS is providing to evacuees.

U.S. mental health service providers also are deploying counselors to survivors in far-flung areas where Gulf Coast residents have made temporary homes.

U.S. Surgeon General Richard Carmona wants to “make sure that everybody has the mental health support that they need to get them through these very difficult times.”

Still, Carmona predicts that the “psychological impact of this devastation is going to be what impacts us most over the long term.”

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