Interesting People mailing list archives
Hurricane Katrina Analysis - CFR Global Health Program
From: David Farber <dave () farber net>
Date: Sat, 3 Sep 2005 06:10:57 -0400
Begin forwarded message: From: AMBOLLC () aol com Date: September 2, 2005 7:58:52 PM EDT To: dave () farber netSubject: For IP, if you wish: Hurricane Katrina Analysis - CFR Global Health Program
From: SRosenstein () cfr org Date: September 2, 2005 6:53:40 PM EDT To: SRosenstein () cfr org Subject: Hurricane Katrina Analysis - CFR Global Health Program Dear Friends and Colleagues,As we head into Labor Day Weekend most of us are heartbroken by news from
Louisiana, Mississippi, and Alabama. The Council on Foreign Relations Global Health Program has been watching the situation closely, with aspecial eye on possible disease situations. We would like to bring some key
points to your attention. This transmission is going out on Friday,September 2: It is possible that the situation will have changed markedly by the time some of you read this, as you may not be checking your e- mail
until after the holiday.We would first like to draw your attention to the extraordinary work being
done by the staff of the New Orleans Times Picayune. You can see the newspaper, which is currently only able to publish online, here: http://www.nola.com/hurricane/katrina/ Friends on the Picayune staff tell us that the newspaper offices andprinting presses were overwhelmed in the flooding, forcing the entire staff to relocate to facilities at LSU in Baton Rouge. There, the exhausted staff
has been living 4-6 to a room in the dorms, or on cots in the makeshift newsroom, covering the demise of their fair city. If there is justice in the world, these folks will win the Pulitzer Prize for Community Service Journalism.Meanwhile, the Global Health Program sees parallels between such things as
the tsunami response, major epidemic outbreaks, refugee crises, and the U.S. government response to Hurricane Katrina and her aftermath. First, a lot of the early media coverage focused on repeating the samestock footage over and over of lootings. The looters were nearly all black,
and you could well imagine that many viewers were thinking, “How could those people behave that way?” The image of black looters, harking toriots in the past and “lawlessness”, may have sparked a temporary downturn in American concern. From that moment the call was not for rescue, but for
“law and order”. We are only now returning to a serious rescue mode, in light of public outcry regarding the estimated 20,000 people stranded without food, water, medicine, or hygiene in the New Orleans ConventionCenter. In our experience such shifts of external public opinion, however transient they may be, have enormous outcomes on the ground, where minutes
may have life-and-death consequences.Across the region we have some of the worst poverty in America, and most of that poverty has a black face. Mississippi, Alabama, and Louisiana: these
are states that consistently, since the Civil War, have ranked in thebottom five states in America for virtually every social achievement, from education and infant mortality to police corruption. Government, for many
of the region’s poor, has had one of two faces: corruption or overtneglect. New Orleans has had one of the highest murder rates in the nation
for decades and a notoriously corrupt police force. In our experience dealing with catastrophes and epidemics overseas, there is a DIRECT correlation between the historic relationship between government and its people, and the willingness of the populace to believe in and correctlyrespond to government instructions. Of course tens of thousands of people
failed to evacuate: why believe the government this time? And of coursethose folks who are slowly starving and baking in New Orleans assume that
government has abandoned them.I found myself recalling the way the Chinese people responded to the SARS
epidemic. Because they knew that their government had lied to them many times in the past and had covered up cases in the capital, people turned away from official government sources of information. Rumors spread likewildfire via cell phone text messaging, spawning a mass exodus from Beijing of tens of thousands of people. The medical system in China is notoriously corrupt and the peasants stay away from hospitals unless it is a matter of life and death. When government told the masses to go to the hospitals if
they had fevers, the Chinese refused. The SARS situation spiraled out ofcontrol in large part because the people had long-standing, sound reasons
for distrusting their government. Public health collapses if the bond oftrust between government and its people breaks, or never exists. I saw the
same thing with plague in India in ’94.Perhaps the single most crucial difference between New York’s response to
9/11 and New Orleans’ and the hurricane region’s response to the currentcrisis is communication and its corollary, leadership. Though cell phones
were disrupted and emergency responders in Lower Manhattan lost contact during the morning of 9/11, the people of New York knew immediately what was going on. We did not lose electricity citywide, TVs, radios. MayorGiuliani rose to the occasion brilliantly, making full use of every press
conference and broadcast opportunity to honestly assess the situation, telling New Yorkers what the government did, and did not, know. New Yorkers were frightened, of course, but they knew what was going on and they could see, minute by minute, what was being done in their behalf. In contrast, none of the people now trapped in New Orleans or wanderingaround in shock along the Mississippi/Alabama coastal communities have any
idea what is going on. They have no electricity, and therefore no television or radio. Information is entirely rumors. When reporters interview them, these desperate souls are grilling the journalists for news. This means that the comfort of observed leadership is completely absent. No matter what the Mayor of New Orleans says, his people cannothear him. They do not see the vast destruction. I doubt more than a handful
of the folks trapped inside New Orleans at this moment have any idea how massive the damage to the Gulf Coast is.Worse, there is real danger that the only overt sign of leadership will be
military, in the form of anti-looting enforcement and armed personnel.While bringing law and order to the situation is essential, the absence of obvious civilian leadership and information means many local refugees will
view themselves as an occupied or policed population. Given overtones of racism, this could be explosive.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’stropical 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 theMississippi 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 thattraditionally 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: http://www.cdc.gov/ncidod/dvbid/arbor/albopic_new.htm .) Most ofthese 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:http://www.cdc.gov/ncidod/dvbid/dengue/ae-aegypti- feeding.htm ) like
small pools of unsalted water, such as fresh rainwater thataccumulates 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 beendeclining 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-poolingdebris 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(http://www.cdc.gov/ncidod/dbmd/diseaseinfo/cholera_g.htm ), Vibrio vulnificus and other gastrointestinal organisms found in shellfish
and some fish caught in the Gulf of Mexico. The old New Orleansmantra 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 potentialdisaster 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 outbreakoccur, have compiled this list of possible organisms to be concerned
about at this time: Enteric: Typhoid (depends on likelihood of carriers- fairly plausible) Cholera Enterohemorrhagic E coli Enterotoxogenic E coli Enteroinvasive E coli Campylobacter ShigellaVibrio parahemolyticus and vulnificus (including contamination of
gulf shellfish) Clostridium perfringens Bacillus cereus Salmonella Staphylococcal intoxication Rotavirus Norovirus Giardia Cryptosporidium Cyclosporidium Other enteric-spread: Hepatitis A Hepatitis E Polio (very high herd immunity) Coxsackie and other Enteroviruses Rabies Leptospirosis Botulism Vector borne: West Nile Virus (likely to be highly problematic) Eastern Equine Encephalitis St. Louis Encephalitis LaCross Encephalitis Dengue fever (real risk) Malaria Typhus fever (remote likelihood, last outbreak 1921) Murine Typhus (not often major) Trench (Quintana) fever Relapsing fever (Borrelia recurrentis) Plague (unlikely, non-endemic area) Respiratory and close contact: Meningiococcus Tuberculosis Measles, mumps (herd immunity likely very high) Pertussis (herd immunity modestly high among high-risk age groups)4.) Pharmaceutical supplies are a bewildering problem: why has
nobody broke into pharmacies around New Orleans to get essentialsupplies 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 theregion 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 manycases 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 Gulfrefugees 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 inpoor 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 todemonstrate 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 theregion. 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 andsteady 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.Finally, we would like to share with you (see below) a letter that went out to physicians and scientists nationwide today, from the Infectious Diseases Society of America (IDSA). If you cut through the acronyms and jargon you
can see the point: they are mobilizing. Laurie Garrett Senior Fellow for Global Health Council on Foreign Relations 58 E. 68th St. NY, NY 10021 (212) 434-9794 or (212) 434-9749 lgarrett () cfr org www.lauriegarrett.com Research Associate, Scott Rosenstein, SRosenstein () cfr org Dear Colleague, All of us have been shocked and dismayed by the devastating effects of Hurricane Katrina. We sympathize with those affected and would like to provide assistance and relief both as individuals and as a Society. Over the last 48 hours, IDSA and HIVMA leaders and staff have been in contact with infectious diseases physicians in the affected areas, with staff from the Centers for Disease Control and Prevention (CDC) and theNational Institutes of Allergy and Infectious Diseases (NIAID), with local health officials, and with others in order to determine how our Society and
members can be of greatest help in this rapidly evolving situation. Sections of the IDSA and HIVMA websites (www.idsociety.org andwww.hivma.org) have been set aside to provide current information regarding
opportunities as we learn of them and to provide information on relevant infectious diseases in this situation.1. Physicians to provide primary care are needed in all of the affected
areas. The websites provide links to the medical societies of the three affected states who are seeking volunteer physicians, as well as to the Federal Emergency Management Agency (FEMA), which is also seeking volunteers. Volunteers should not report directly to the affected areasunless directed by a voluntary agency. Self-dispatched volunteers can put
themselves and others in harms' way and hamper rescue efforts.2. As the situation evolves, we expect that there will be an increasing need to provide infectious disease patient consultations. IDSA has offered the expertise of its members to help in this regard. To do so, Health and
Human Services Secretary Mike Leavitt has asked NIAID and IDSA tocoordinate provision of a telephone/e-mail ID consult service. NIAID will be the clearinghouse for calls from consulting physicians, who will then be
linked to ID consultants. If you are interested in participating in this activity, please provide your contact information on the IDSA website. 3. We are evaluating the potential use of the Emerging InfectionsNetwork in the affected areas to identify outbreaks of infection early in
their course. 4. HIVMA is working to ensure that persons with HIV/AIDS from the hurricane-affected areas have access to HIV medications and medical carefinanced through public programs like Medicaid and the Ryan White CARE Act, without burdensome eligibility or residency requirements. HIVMA will also
be posting information about state and local policies that have been implemented to further these goals.We will provide additional information regarding relief activities on the website as it becomes available. Your comments and suggestions are welcome, as is first-hand information regarding infectious disease and public health
experiences in the affected areas. Best regards, Walter E. Stamm, MD IDSA President _____________________________ Scott A. Rosenstein, MA, MPH Research Associate, Global Health Council on Foreign Relations 58 East 68th St. New York, NY 10021 http://www.cfr.org phone: (212) 434-9749 fax: (212) 434-9827 email: srosenstein () cfr org ------------------------------------- You are subscribed as lists-ip () insecure org To manage your subscription, go to http://v2.listbox.com/member/?listname=ip Archives at: http://www.interesting-people.org/archives/interesting-people/
Current thread:
- Hurricane Katrina Analysis - CFR Global Health Program David Farber (Sep 03)