Viridian Note 00452: The Return of Laurie Garrett
- Key concepts:
- Laurie Garrett, plagues, Katrina
- Attention Conservation Notice:
- Likely to make you feel even worse about Katrina than you do already.
(((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.)))
Source: once again, somebody forwarded her email
From: Council on Foreign Relations Global Health Program
Date: September 2, 2005 6:53:40 PM EDT
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 a special 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 and printing 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. (((Note: Laurie Garrett is a Pulitzer Prize winner.)))
"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 same stock 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 to riots 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 Convention Center.
"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 the bottom 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 overt neglect. 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 correctly respond to government instructions. Of course tens of thousands of people failed to evacuate: why believe the government this time? And of course those 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 like wildfire 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 of control in large part because the people had long-standing, sound reasons for distrusting their government. Public health collapses if the bond of trust 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 current crisis 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. Mayor Giuliani 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 wandering around 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 cannot hear 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'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: http://www.cdc.gov/ncidod/dvbid/arbor/albopic_new.htm
"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: http://www.cdc.gov/ncidod/dvbid/dengue/ae-aegypti-feeding.htm
"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 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 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:
"Enteric:
Typhoid (depends on likelihood of carriers – fairly plausible)
Cholera
Enterohemorrhagic E coli
Enterotoxogenic E coli
Enteroinvasive E coli
Campylobacter
Shigella
Vibrio 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 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. (((My, that one is particularly apt.))) We have never in history tried to dispose of this much waste. (((Really?))) 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.
"Finally, we would like to share with you 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
www.lauriegarrett.com
Research Associate, Scott Rosenstein, SRosenstein@cfr.org
