Katrina: disease threat analysis from Laurie Garrett

Bruce Sterling says,
When prize-winning journalist and emergent-disease guru Laurie Garrett wrote her friends a gossipy note about the goings on at the Davos Forum, her bold remarks were swiftly forwarded to a host of strangers, including the readers of Viridian List. For about a year, Ms Garrett's noteworthy remarks were one of the most popular search-hits on Viridiandesign.org. Today Laurie Garrett is back, with remarks of even more intense interest to Viridian readers. Especially if you live anywhere within mosquito range of the NOLA eco-disaster zone.
Here's an admittedly lengthy snip from Ms. Garrett's e-mail.

The pull quote to remember, above all: "If government cannot inform, there is no government."

Looking forward, based again on my years of covering Third World disasters, here are my concerns:

1.) The Mississippi Delta region is the natural ecological home of a long list of infectious microbial diseases. It is America's tropical region, more akin ecologically to Haiti or parts of Africa than to Boston or Los Angeles. The most massive Yellow Fever epidemics in the Americas all swept, in the 19th Century, up the Mississippi from the delta region. Malaria was not eradicated from the area until after World War II. Isolated cases of dengue fever, another mosquito-borne disease, have been spotted in the region over the last ten years.

Not only are all the mosquitoes that traditionally carry these microbes still thriving in the area, but the Aedes albopictus mosquito == a large, aggressive monster, was introduced to the Americas from Asia about 15 years ago, and now thrives in the Gulf area. See: Link

Most of these troublesome mosquito species reproduce rapidly in precisely the conditions now present, post-hurricane. Some prefer massive stands of still, warm, polluted water: that would be New Orleans. Some, such as albopictus and Yellow Fever carrier Aedes aegypti See: Link

like small pools of unsalted water, such as fresh rainwater that accumulates in tree stumps and debris. One of their favorite breeding sites is the dark, warm, water-filled cavity of an abandoned tire, for example.

America's commitment to mosquito control has been declining steadily since we eradicated malaria, and even fear of West Nile Virus didn't spawn a massive re-commitment to funding mosquito abatement programs. Worse, to my knowledge nobody has ever had much success in clearing mosquitoes from the sort of massive water-soaked ecology that now is New Orleans, nor the scale of water-pooling debris found along the Gulf tri-state area.

It is perhaps ironic that the only real experience with this scale of insect control for the last two decades has been in developing countries: the CDC and State health folks should be reaching out to PAHO and the insect control expertises of Africa and the Caribbean right now. If we cannot manage to get ahead of the insects, there could very well be a disease crisis ahead. 2.) For years the CDC has warned about Vibrio cholerae. Vibrio vulnificus and other gastrointestinal organisms found in shellfish and some fish caught in the Gulf of Mexico. The old New Orleans mantra has been that Tabasco kills 'em, so chow down the raw oysters and forgettaboutit.

But we would not be the least surprised to see a surge in algal blooms and their vibrio passengers over the next two weeks both inside New Orleans and along the Gulf. Consider this: the hurricane must have disrupted all of the coral reefs in the region, and killed millions of fish. All that rot is now floating around in the Gulf. It is food for algal blooms. The vibrio live in the blooms.

3.) One word: sewage. The longer the region goes without proper systems for control of human waste, the greater the probability of transmission not only of cholera, but a long list of dysentery and gastrointestinal agents. Evacuating every human being from New Orleans will, of course, help, but there will remain potential disaster all along the tri-state coastline. Members of the Infectious Diseases Society of America, which has mobilized scientists and physicians nationwide in readiness to respond should an outbreak occur, have compiled this list of possible organisms to be concerned about at this time [see full text link for extensive list of diseases]

4.) Pharmaceutical supplies are a bewildering problem: why has nobody broken into pharmacies around New Orleans to get essential supplies for the refugees, and hospitals? We have dead diabetics, and probably epileptics seizing, CVD patients in need of nitro, and children who could benefit from proper antibiotics.

5.) One past hurricane in the region produced so much debris that the cleared garbage filled an abandoned coal mine. We have never in history tried to dispose of this much waste. It is hoped that before any officials rush off thinking of how to burn or dump a few hundred thousand boats, houses and buildings, some careful consideration is given to recycling that material for construction of future levees, dams, and foundations. Looking at aerial images of the coastline one sees an entire forest worth of lumber, and the world's largest cement quarry. No doubt tens of thousands of the now unemployed of the region could be hired for a reclamation effort that would be rational in scale and intent. It would be horrible if all that debris were simply dumped or burned without any thought to its utility.

6.) The mental health of hundreds of thousands of people must now be a priority. Uprooted, homeless, jobless, rootless and in many cases grieving for lost loved ones: These people will all suffer for a very long time. A key to their recovery is, again, a lesson from 9/11: information. Whether they are 'housed' in the Houston Astrodome, are in tents in Biloxi or end up a diaspora of Gulf refugees flung all across America, these people will for months be starving for information about their homes and communities. The poor will not be logging onto computers somewhere to read bulletins from FEMA. These people will rely primarily on broadcast information, and it is essential that the leaders of the three states and key mayors create reliable information sources for people to turn to. The Times Picayune online will, of course, be the primary go-to site for middle class Gulf refugees and expatriates, but to what outlet will a million poor folks turn? Knowing what is going on 'back home' is essential to mental health recovery. We have been in disasters in poor countries where wild rumors flowed among the poor for months, each one sparking a fresh round of anxiety and fear. If government cannot inform, there is no government.

7.) America, and this government, is going to witness an enormous political backlash from these events, stemming primarily from the African American community, if steps are not boldly taken to demonstrate less judgment, and greater assistance, for the black poor of the region. Cries of racism will be heard. In every disaster we have been engaged in we have witnessed a similar sense by the victims of disasters that they were being singled out, and ignored by their government, because of their ethnicity, religion or race. The onus is on government to prove them wrong.

8.) Much more thought needs to be given immediately to the needs of medical and psychiatric responders located just outside of the region. The patient flow they are now receiving is minuscule compared to the tidal wave coming their way, whether they are in Baton Rouge, Jacksonville or Houston. FEMA and HHS need to get a massive and steady flow of supplies their way, and coordinate tertiary care needs according to the skills base in each hospital. If it hasn't already, HRSA needs to issue clear waivers immediately for Medicaid coverage for the poor, so that no hospital in the region, private or public, has an excuse for turning people away.

Link to full text.