Katrina: Full health consequences not known

NEW ORLEANS - The full health consequences of Hurricane Katrina will probably never be known.

The frantic effort to rescue and treat thousands of stranded survivors left little in the way of records describing their illnesses and injuries. The long-term health effects of the storm and flooding on the scattered evacuees will be chronicled in a hundred places and will be hard to document and analyze.

In Northern Nevada, that story waits to be told. Staff from the state health department, Washoe County Health Department, REMSA and doctors and nurses at hospital emergency rooms were prepared Monday for the arrival of 300 evacuees.

Instead, they were told the evacuees were not likely to come. But after a week of high-intensity preparation, medical officials were ready for anything - from hurricane-related illness to pre-existing conditions.

Reported illnesses related to Katrina include norovirus, a non-fatal intestinal illness that can cause nausea and diarrhea, and a bacterial infection called Vibrio vulnificus that resides in warm tidal waters, affects those with weakened immune systems, and has been the cause of several fatalities.

"We were anticipating that some of our evacuees might indeed have those types of medical illnesses and/or problems," said Michelle Kling, acting district health officer for Washoe County Health Department. "However, we've been told that is why the process is slowing down - they're doing an improved screening on the front end."

At Reno-Tahoe International Airport, doctors, nurses and REMSA officials were ready to treat any evacuees suffering from serious illness and needing transportation to hospitals.

Those passing this initial screening would be taken to Dini-Townsend Hospital in Sparks for further evaluation, including questions geared toward pre-existing conditions like diabetes, heart problems and blood pressure. The American Red Cross was set up there.

They were then to be given housing assignments. For those going into shelters, a formal plan was in place to watch for contagious diseases.

"If there had been an infectious disease occurring in the shelters, we'd be immediately aware of that and be able to treat disease transmission," Kling said.

Approximately 100 evacuees have come to Northern Nevada on their own, she said, and Monday morning the health department had sent out nurses to assess medical conditions in a few of the known families.

Across the nation, teams from the Centers for Disease Control and Prevention fanned out across New Orleans, trying to find out what information was available and laying the groundwork to capture as much as possible.

Despite the gaps in the record, what seems almost certain is that the epochal disaster will not be followed by plague and pestilence.

"We do not generally see massive outbreaks after these events," said Ali Khan, the physician and epidemiologist who is CDC's team leader in Orleans Parish.

This is true even of natural disasters in the developing world. Khan helped head up the World Health Organization's response to last winter's tsunami in Indonesia. The populations of dozens of villages and towns were instantly reduced to primitive living conditions, living in hand-built shelters, defecating on the ground and drawing water from streams.

"That was hundreds of thousands of deaths and damage over multiple countries," he said. "We had a handful of cases here and there of measles, a handful of cases of dysentery that were quickly taken care of. So there was not these large outbreaks that people fear."

There are many reasons for this, the most important being the robustness of the human body and its immune system. Although the floodwater covering much of New Orleans is highly polluted, few if any people are drinking it, and mere contact is not enough to cause disease, except in rare cases.

One of the ailments floodwater might cause is Vibrio vulnificus. It can infect wounds or cause illness in people who eat raw seafood. People with weak immune systems or alcoholics are the most vulnerable. Wound infections with Vibro vulnificus are fatal 20 percent of the time; food-borne cases more often.

So far, CDC has heard of fewer than a dozen cases in the hurricane zone, with several fatalities. Late last week, Thomas A. Clark, 35, a medical epidemiologist from the federal public health agency, was looking for more.

"Have you had any cases of Vibrio vulnificus?" he asked Wanda Eppling, a supervisor in the microbiology lab at Ochsner Foundation Hospital on the northern border of New Orleans.

"No, we haven't seen any, but I hear East Jefferson had one," she said, referring to a nearby hospital.

"I talked to them and they said it was actually Vibrio alginolyticus. That's something different, although it's probably salt water-related, too," Clark said.

CDC epidemiologists will collect data from hospitals, analyze it once a week and provide reports to the state and city health departments and the hospitals themselves. They will also go back and extract information from ER records to learn the pattern of illness and injury the event wrought, at least in those who made it to hospitals that were still functioning.

Norovirus, which causes a nonfatal intestinal illness, has been diagnosed in numerous evacuees in the Houston Astrodome, officials said.

What is almost certainly lost to scientific analysis is information about the spectrum of illnesses treated by emergency medical teams in the giant staging areas here and in Baton Rouge as large numbers of the city's poorest, sickest and least mobile citizens were removed en masse.

Sitting at a small table over a stained carpet on a concourse at Louis Armstrong International Airport, Erik Larsen, an emergency medical physician from White Plains, N.Y., tried to describe the days immediately after the storm and flood.

"The sadness of some of the stuff we have seen here is overwhelming," he said. "You see these people with little children, barefoot and holding all the things they own folded over in a sheet, people who have no idea where they're going or what their future is ... "

Any evacuee in Northern Nevada who needs medical assistance, can call the Red Cross at 856-1000.


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