"We are gravely concerned about the potential for cholera, typhoid, and dehydrating diseases that could come as a result of the stagnant water and the conditions," Health and Human Services Secretary Mike Leavitt said at a press conference here today to formally declare the Gulf Coast region as a public health emergency.
The mayor of New Orleans, Ray Nagin, said the death toll is uncertain, but he estimated that it could be hundreds or even thousands. "We know there is a significant number of bodies in the water." Casualty counts from Biloxi and other Gulf Coast communities have not yet been made available.
New Orleans, which sits below sea level and is surrounded by the Gulf of Mexico, the Mississippi River and Lake Pontchartrain, is on high alert for disease, including waterborne infections.
In addition to cholera and typhoid, officials are concerned about other bacterial and parasitic infections, such as salmonella, E. coli, cryptosporidiosis, or strongyloidiasis, to name a few, said Roger Lewis, Ph.D., an associate professor and director of the Environmental Health Laboratory at Saint Louis University School of Public Health in Missouri.
"A lot of these microorganisms that would be flushed into the ocean or rivers are now sitting in a stagnant pool," Dr. Lewis said in an interview. The lack of sanitation in New Orleans and other flooded communities poses a major health risk. "All this fecal matter can really produce an incredible amount of pathogenic microorganisms."
Even fecal matter from the dead can pose a health risk. Typically, a decomposing body does not pose a health risk. However, Dr. Lewis said, there could be a potential threat if the dead cannot be located and collected quickly and if the decomposing body had a virulent infection at the time of death. Rescue workers who come into contact with the dead, Dr. Lewis said, and are unaware of any infection, could be susceptible.
Even if the death toll "remains in the low hundreds, the waterborne illnesses are significant," Dr. Lewis said.
The CDC and FDA advise flood victims who do not have access to bottled water to boil and bleach tap water, but Dr. Lewis said these older recommendations are not practical for the current situation.
"How are you going to boil it because there's no power and where are people going to get chlorine right now?" he said.
Mosquito-borne illnesses, including West Nile, malaria, dengue, and even yellow fever, are concerns now given the extensive amount of still water throughout the hot and humid Gulf Coast where temperatures are in the 90s, Dr. Lewis said. How quickly officials can get some of this water drained, he added, could help minimize the risk of potential mosquito-borne illness outbreaks.
David Satcher, M.D., the former director of the CDC, also warned about the potential for tetanus. Speaking on CNN today, Dr. Satcher said all of the broken metal, glass and other debris puts residents at high risk for injury. Injured individuals requiring medical attention may find it difficult to get tetanus shots given the lack of functional medical facilities in the region, he said.
There have also been reports of carbon monoxide deaths and poisoning, said Dr. Satcher, as residents without electricity attempt to operate gas stoves in poorly ventilated areas. There have been reports of two deaths and nine persons poisoned by carbon monoxide.
As the threat of injury and infection looms, the military is rushing aid by land, air, and sea to help provide medical services to a region whose hospital systems were severely crippled by the storm. Federal health officials are also working to get emergency and first aid supplies to the region.
However, Gulf Coast residents who have chronic conditions such as diabetes or heart disease and are unable to get their medications may still be at risk, and it's uncertain whether there will be sufficient supplies or the means to get these supplies through flooded communities to help these residents.
"That's one of the biggest concerns right now," Dr. Lewis said.
People who have chronic conditions are also more likely to be at risk of infection given the surrounding conditions, he said. The children, the elderly, and people with weakened immune systems are the most vulnerable.
"There's no water to drink, the air quality is poor, there's no air conditioning, it's very hot, you're wet, and so people who are sick or frail or immunocompromised could develop an illness that's difficult to treat," Dr. Lewis said.
Food-borne illness is not a huge risk, but hunger is. "Food may be available, but it may not be safe," Dr. Satcher said. People who are stranded might not have access to good food and there's concern among health officials that people who are hungry might attempt to eat spoiled food that could contain bacteria or other pathogens, he said.
Any gastrointestinal illness as a result of eating spoiled food would be difficult to treat, added Dr. Lewis, because right now "there's very little in the way of medical care" until more aid arrives.
One major health risk that is not as obvious as infection or injury is psychological trauma, said Dr. Satcher.
"The mental health implications are very serious," Dr. Satcher told CNN. "I'm very concerned about the children who are experiencing this." He said that people need to have the resources made available to them to openly discuss "their depression and grief."
Dr. Satcher said government officials are currently working to get counselors and psychologists to the region to help residents cope.
- Reviewed by Robert Jasmer, MD Assistant Professor of Medicine, University of California, San Francisco