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    <p class=&quot;wp-caption-text&quot;>Damage at Rockport, Texas on August 26, 2017. Hurricane Harvey left a trail of devastation Saturday after the most powerful storm to hit the US mainland in over a decade slammed into Texas, destroying homes, severing power supplies and forcing tens of thousands of residents to flee. ( MARK RALSTON/AFP/Getty Images)</p> 
   </fbs-accordion> 
  </div> 
 </div> 
</div> 
<p>After the immediate damage and loss of life from Hurricane Harvey, many hazards remain, and infectious outbreaks will likely follow.</p> 
<p>Immediate problems will be from injuries, exposure and drownings. The longer-term fallout will include stress-related illnesses, ongoing anxiety and depression among those traumatized and displaced by the hurricane.</p> 
<p>Often overlooked are the biological effects. Infections&amp;nbsp;following hurricanes are usually gastrointestinal or wound related.</p> 
<p>All of these problems will be compounded by the neglect and dismantling of public health infrastructure.</p> 
<p><strong>Water-borne infections</strong></p> 
<p>Flood water will likely be heavily contaminated by sewage and by toxic chemicals, so&amp;nbsp;diarrhea will be common.</p> 
<p> 
 </p> 
<p>Major GI pathogens include parasitic infections such as <a href=&quot;http://www.cdc.gov/parasites/crypto/&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>Cryptosporidiosis</a>&amp;nbsp;and Giardia,&amp;nbsp;which cause prolonged diarrhea; viral infections from Hepatitis A, Norovirus or Rotavirus; and bacterial infections from E. coli, Shigella, Salmonella, Vibrio or leptospirosis. Except for the parasite cases, most of the infectious diarrhea will be self-limited. All of these infections are particularly problematic&amp;nbsp;for those at the extremes of age and those who become dehydrated.</p> 
<p>Cholera has not been a problem in the U.S. and is not expected to cause any outbreaks here. It is a major problem in the Middle East, India and Haiti, where it was introduced by UN aid workers following the devastating earthquake there.</p> 
<div class=&quot;vestpocket&quot; vest-pocket=&quot;&quot;></div> 
<p>Leptospirosis is an infrequently seen infection, caused by bacteria found in water and transmitted by the urine of rats, mice, raccoons and cattle, among others. It can infect dogs as well as people and can cause liver or kidney failure in both humans and pets. A fascinating <a href=&quot;https://www.cdc.gov/mmwr/preview/mmwrhtml/00048052.htm&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>outbreak occurred in Costa Rica among whitewater rafters,</a>&amp;nbsp;so those participating in&amp;nbsp;freshwater sports are at&amp;nbsp;risk. Outbreaks of leptospirosis occur sporadically around the world, often precipitated by flooding.</p> 
<p><strong>Wound infections</strong></p> 
<p>Further, wounds can be readily infected by the dirty water, and it is easy to cut yourself on sharp objects hidden by the water. There are some particularly virulent bacteria causing wound infections that would likely need stronger antibiotics than might typically be prescribed. These include Aeromonas and Vibrio.</p> 
<p>The warm waters of the Gulf Coast encourage Vibrio’s growth and will likely pose a particular risk after the hurricane. As mentioned in this recent post on Vibrio<sup>⁠</sup>, wound infections can be fulminant, characterized by sepsis and a rash with bloody blisters (hemorrhagic bullae). It’s important to recognize this, as different antibiotics are needed.</p> 
<p>Tetanus, a deadly disease that, fortunately, is readily vaccine preventable, is also a concern as numerous puncture wounds are likely and the water and soil&amp;nbsp;may be contaminated.</p> 
<p><u><a href=&quot;https://www.cdc.gov/disasters/trenchfoot.html&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>Trench foot</a></u>&amp;nbsp;is a complication of flooding made famous in World War I when such infections were common among soldiers. There can be skin and muscle damage and subsequent infection from the prolonged immersion, sometimes leading to gangrene and need for amputation.</p> 
<p><strong>Injuries </strong></p> 
<p>Immediate problems from flooding include drowning (the major cause of death), electrocution and <a href=&quot;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118941/&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>hypothermia</a>. <a href=&quot;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118941/&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>Orthopedic injuries</a> tend to grow after the initial storm subsides, as people begin to rebuild their lives, and peak several weeks later.</p> 
<p><strong>Mosquito-borne infections</strong></p> 
<p>After the hurricane subsides, there will be pools of stagnant water, a perfect breeding ground for mosquitoes. This was already a disproportionate risk in poorer areas of cities like Houston.</p> 
<div id=&quot;attachment_1513&quot; class=&quot;wp-caption alignnone&quot;> 
 <div class=&quot;article-body-image&quot;> 
  <a href=&quot;https://blogs-images.forbes.com/judystone/files/2016/04/Aedes-range-map-cdc1-e1460587485610.jpg&quot;><progressive-image class=&quot;progressive-placeholder&quot; src=&quot;https://thumbor.forbes.com/thumbor/960x0/smart/https%3A%2F%2Fblogs-images.forbes.com%2Fjudystone%2Ffiles%2F2016%2F04%2FAedes-range-map-cdc1-e1460587485610.jpg%3Fwidth%3D960&quot; low-res-src=&quot;https://thumbor.forbes.com/thumbor/100x0/smart/https%3A%2F%2Fblogs-images.forbes.com%2Fjudystone%2Ffiles%2F2016%2F04%2FAedes-range-map-cdc1-e1460587485610.jpg%3Fwidth%3D960&quot;></progressive-image></a> 
  <small class=&quot;article-photo-credit&quot;>CDC</small> 
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  <div class=&quot;caption-container&quot; ng-class=&quot;caption_state&quot;> 
   <fbs-accordion current=&quot;0&quot;> 
    <p class=&quot;wp-caption-text&quot;>Range of disease-bearing mosquitoes.</p> 
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  </div> 
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</div> 
<p>After Hurricane Katrina, <a href=&quot;https://wwwnc.cdc.gov/eid/article/14/5/07-1066_article&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>a doubling&amp;nbsp;of West Nile disease cases was seen in the hurricane-affected areas</a> of Louisiana and Mississippi.</p> 
<p><a href=&quot;https://www.bcm.edu/people/view/peter-hotez-m-d-ph-d/b1846a47-ffed-11e2-be68-080027880ca6&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>Dr. Peter Hotez</a>&amp;nbsp;of&amp;nbsp;Baylor&amp;nbsp;has explained repeatedly that the <a href=&quot;http://www.npr.org/sections/health-shots/2016/03/21/470683503/houston-prepares-now-for-zikas-potential-arrival-this-summer&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>poor are disproportionately affected by insect-borne diseases like Zika, dengue, West Nile and Chagas</a>. Standing water in tires and debris in the street form breeding grounds. Many poor people don’t even have window screens, let alone air conditioning, exposing them to a variety of infections.</p> 
<p><strong>Drinking water</strong></p> 
<p>Water will be unsafe to drink after a hurricane. The CDC offers recommendations for those without bottled water, but frankly, the people affected likely won’t have electricity or many supplies. Sources of clean water in a home are the hot water tank and the water reservoir tank on toilets. Other <a href=&quot;https://www.cdc.gov/disasters/hurricanes/foodwater.html&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>water can be treated in one of three ways:</a></p> 
<ul> 
 <li>Bring water to a rolling boil for one&amp;nbsp;minute.</li> 
 <li>Use household bleach. Add 1/8 teaspoon of new, unscented liquid bleach to one&amp;nbsp;gallon of water. Stir well. Let the water sit for 30 minutes before you drink it.</li> 
 <li>Use water-purifying tablets.</li> 
</ul> 
<p>Water from private wells may become contaminated and should be tested.</p> 
<p><strong>Politics and public health</strong></p> 
<p>There are broader concerns only highlighted by the hurricane. Public health funding has been decimated. Since the early 2000s, there has been a&amp;nbsp;<a href=&quot;https://www.washingtonpost.com/national/health-science/states-worry-they-dont-have-money-to-fight-zika/2016/03/07/42aa6840-db20-11e5-891a-4ed04f4213e8_story.html?postshare=2111458763345448&amp;amp;tid=ss_tw-bottom&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;><u>drop of at least 41% in the number of people doing mosquito surveillance</u></a>. In other areas, too, “public health laboratory capacity for proactive surveillance is&amp;nbsp;<a href=&quot;http://www.cste2.org/docs/VBR.pdf&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;><u>poor to nonexistent in most states</u></a>,” according to the damning 2014 report by the Council of State and Territorial Epidemiologists.</p> 
<p>I was appalled at the barbaric announcement yesterday that the <a href=&quot;https://patch.com/texas/meyerland/hurricane-harvey-border-checkpoints-will-close-texas-state-highways-close&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>Border Patrol would not close checkpoints during the hurricane</a>, forcing people to risk their lives staying in dangerous areas threatened by the storm or face deportation if they attempt to evacuate. In contrast, in 2012 (Hurricane Isaac) and 2016 (Hurricane Matthew), <a href=&quot;https://patch.com/texas/meyerland/hurricane-harvey-border-checkpoints-will-close-texas-state-highways-close&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>ICE&amp;nbsp;took a more reasoned approach</a>, stating, “There will be no immigration enforcement initiatives associated with evacuations or sheltering related to Matthew, including the use of checkpoints for immigration enforcement purposes in impacted areas during an evacuation.&quot;</p> 
<p>There has previously been pressure on hospitals to report undocumented people to ICE. While that has stopped as a formal policy, <a href=&quot;https://www.statnews.com/2017/02/24/immigrants-doctors-medical-care/&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>immigrants are delaying seeking vital health care, understandably afraid that they would be targeted</a>. Not only is this cruel, but it is likely more costly, as waiting until an illness becomes catastrophic, and forces an emergency room visit, will be more expensive.</p> 
<p>Further driving people underground is poor policy. Studies have shown that the&amp;nbsp;<a href=&quot;http://thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30073-5/abstract&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>criminalization of drug use has a negative effect on HIV prevention&amp;nbsp;and treatment</a>, <a href=&quot;https://www.vox.com/2017/5/17/15641018/jeff-sessions-memo-tough-crime-public-health-hiv&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>increasing both the use of shared needles and the resulting HIV infections</a>. Lowering the threshold for prison for minor drug offenses helps only the prison-industrial complex.</p> 
<p>Similarly, <a href=&quot;https://www.vox.com/2017/5/17/15641018/jeff-sessions-memo-tough-crime-public-health-hiv&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>stigma increases rates of sexually transmitted diseases</a>&amp;nbsp;at a time when <a href=&quot;http://www.npr.org/sections/health-shots/2016/10/20/498719092/std-infections-rise-to-new-highs-after-states-close-health-clinics&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>health departments have suffered drastic cuts.</a></p> 
<p>In order to respond effectively to disasters, we need a competent and caring response — more than the “Heck of a job, Brownie” that we got during Katrina, and more than&amp;nbsp;<a href=&quot;http://www.businessinsider.com/trump-texas-hurricane-harvey-2017-8&quot; target=&quot;_blank&quot; rel=&quot;nofollow&quot;>President Trump’s lame “Good luck”</a>&amp;nbsp;as he left the White House. Trump’s FEMA director, Brock Long, has some qualifications for his role. But with climate-change deniers and those who are hellbent on undoing environmental protections at the helm of other agencies, as well as the increasingly strong-arm tactics of ICE, we’ll be hard pressed to respond effectively to this hurricane or other future disasters.</p>"><div id="attachment_839570930" class="wp-caption alignnone"> 
 <div class="article-body-image"> 
  <progressive-image class="progressive-placeholder" src="https://thumbor.forbes.com/thumbor/960x0/smart/https%3A%2F%2Fspecials-images.forbesimg.com%2Fimageserve%2F839570930%2F960x0.jpg%3Ffit%3Dscale" low-res-src="https://thumbor.forbes.com/thumbor/100x0/smart/https%3A%2F%2Fspecials-images.forbesimg.com%2Fimageserve%2F839570930%2F960x0.jpg%3Ffit%3Dscale"></progressive-image> 
 </div> 
 <div article-image-caption=""> 
  <div class="caption-container" ng-class="caption_state"> 
   <fbs-accordion current="0"> 
    <p class="wp-caption-text">Damage at Rockport, Texas on August 26, 2017. Hurricane Harvey left a trail of devastation Saturday after the most powerful storm to hit the US mainland in over a decade slammed into Texas, destroying homes, severing power supplies and forcing tens of thousands of residents to flee. ( MARK RALSTON/AFP/Getty Images)</p> 
   </fbs-accordion> 
  </div> 
 </div> 
</div> 
<p class="speakable-paragraph">After the immediate damage and loss of life from Hurricane Harvey, many hazards remain, and infectious outbreaks will likely follow.</p> 
<p>Immediate problems will be from injuries, exposure and drownings. The longer-term fallout will include stress-related illnesses, ongoing anxiety and depression among those traumatized and displaced by the hurricane.</p> 
<p>Often overlooked are the biological effects. Infections&nbsp;following hurricanes are usually gastrointestinal or wound related.</p> 
<p>All of these problems will be compounded by the neglect and dismantling of public health infrastructure.</p> 
<p><strong>Water-borne infections</strong></p> 
<p>Flood water will likely be heavily contaminated by sewage and by toxic chemicals, so&nbsp;diarrhea will be common.</p> 
<p> 
 </p> 
<p>Major GI pathogens include parasitic infections such as <a href="http://www.cdc.gov/parasites/crypto/" target="_blank" rel="nofollow">Cryptosporidiosis</a>&nbsp;and Giardia,&nbsp;which cause prolonged diarrhea; viral infections from Hepatitis A, Norovirus or Rotavirus; and bacterial infections from E. coli, Shigella, Salmonella, Vibrio or leptospirosis. Except for the parasite cases, most of the infectious diarrhea will be self-limited. All of these infections are particularly problematic&nbsp;for those at the extremes of age and those who become dehydrated.</p> 
<p>Cholera has not been a problem in the U.S. and is not expected to cause any outbreaks here. It is a major problem in the Middle East, India and Haiti, where it was introduced by UN aid workers following the devastating earthquake there.</p> 
<div class="vestpocket" vest-pocket=""></div> 
<p>Leptospirosis is an infrequently seen infection, caused by bacteria found in water and transmitted by the urine of rats, mice, raccoons and cattle, among others. It can infect dogs as well as people and can cause liver or kidney failure in both humans and pets. A fascinating <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00048052.htm" target="_blank" rel="nofollow">outbreak occurred in Costa Rica among whitewater rafters,</a>&nbsp;so those participating in&nbsp;freshwater sports are at&nbsp;risk. Outbreaks of leptospirosis occur sporadically around the world, often precipitated by flooding.</p> 
<p><strong>Wound infections</strong></p> 
<p>Further, wounds can be readily infected by the dirty water, and it is easy to cut yourself on sharp objects hidden by the water. There are some particularly virulent bacteria causing wound infections that would likely need stronger antibiotics than might typically be prescribed. These include Aeromonas and Vibrio.</p> 
<p>The warm waters of the Gulf Coast encourage Vibrio’s growth and will likely pose a particular risk after the hurricane. As mentioned in this recent post on Vibrio<sup>⁠</sup>, wound infections can be fulminant, characterized by sepsis and a rash with bloody blisters (hemorrhagic bullae). It’s important to recognize this, as different antibiotics are needed.</p> 
<p>Tetanus, a deadly disease that, fortunately, is readily vaccine preventable, is also a concern as numerous puncture wounds are likely and the water and soil&nbsp;may be contaminated.</p> 
<p><u><a href="https://www.cdc.gov/disasters/trenchfoot.html" target="_blank" rel="nofollow">Trench foot</a></u>&nbsp;is a complication of flooding made famous in World War I when such infections were common among soldiers. There can be skin and muscle damage and subsequent infection from the prolonged immersion, sometimes leading to gangrene and need for amputation.</p> 
<p><strong>Injuries </strong></p> 
<p>Immediate problems from flooding include drowning (the major cause of death), electrocution and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118941/" target="_blank" rel="nofollow">hypothermia</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118941/" target="_blank" rel="nofollow">Orthopedic injuries</a> tend to grow after the initial storm subsides, as people begin to rebuild their lives, and peak several weeks later.</p> 
<p><strong>Mosquito-borne infections</strong></p> 
<p>After the hurricane subsides, there will be pools of stagnant water, a perfect breeding ground for mosquitoes. This was already a disproportionate risk in poorer areas of cities like Houston.</p> 
<div id="attachment_1513" class="wp-caption alignnone"> 
 <div class="article-body-image"> 
  <a href="https://blogs-images.forbes.com/judystone/files/2016/04/Aedes-range-map-cdc1-e1460587485610.jpg"><progressive-image class="progressive-placeholder" src="https://thumbor.forbes.com/thumbor/960x0/smart/https%3A%2F%2Fblogs-images.forbes.com%2Fjudystone%2Ffiles%2F2016%2F04%2FAedes-range-map-cdc1-e1460587485610.jpg%3Fwidth%3D960" low-res-src="https://thumbor.forbes.com/thumbor/100x0/smart/https%3A%2F%2Fblogs-images.forbes.com%2Fjudystone%2Ffiles%2F2016%2F04%2FAedes-range-map-cdc1-e1460587485610.jpg%3Fwidth%3D960"></progressive-image></a> 
  <small class="article-photo-credit">CDC</small> 
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    <p class="wp-caption-text">Range of disease-bearing mosquitoes.</p> 
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<p>After Hurricane Katrina, <a href="https://wwwnc.cdc.gov/eid/article/14/5/07-1066_article" target="_blank" rel="nofollow">a doubling&nbsp;of West Nile disease cases was seen in the hurricane-affected areas</a> of Louisiana and Mississippi.</p> 
<p><a href="https://www.bcm.edu/people/view/peter-hotez-m-d-ph-d/b1846a47-ffed-11e2-be68-080027880ca6" target="_blank" rel="nofollow">Dr. Peter Hotez</a>&nbsp;of&nbsp;Baylor&nbsp;has explained repeatedly that the <a href="http://www.npr.org/sections/health-shots/2016/03/21/470683503/houston-prepares-now-for-zikas-potential-arrival-this-summer" target="_blank" rel="nofollow">poor are disproportionately affected by insect-borne diseases like Zika, dengue, West Nile and Chagas</a>. Standing water in tires and debris in the street form breeding grounds. Many poor people don’t even have window screens, let alone air conditioning, exposing them to a variety of infections.</p> 
<p><strong>Drinking water</strong></p> 
<p>Water will be unsafe to drink after a hurricane. The CDC offers recommendations for those without bottled water, but frankly, the people affected likely won’t have electricity or many supplies. Sources of clean water in a home are the hot water tank and the water reservoir tank on toilets. Other <a href="https://www.cdc.gov/disasters/hurricanes/foodwater.html" target="_blank" rel="nofollow">water can be treated in one of three ways:</a></p> 
<ul> 
 <li>Bring water to a rolling boil for one&nbsp;minute.</li> 
 <li>Use household bleach. Add 1/8 teaspoon of new, unscented liquid bleach to one&nbsp;gallon of water. Stir well. Let the water sit for 30 minutes before you drink it.</li> 
 <li>Use water-purifying tablets.</li> 
</ul> 
<p>Water from private wells may become contaminated and should be tested.</p> 
<p><strong>Politics and public health</strong></p> 
<p>There are broader concerns only highlighted by the hurricane. Public health funding has been decimated. Since the early 2000s, there has been a&nbsp;<a href="https://www.washingtonpost.com/national/health-science/states-worry-they-dont-have-money-to-fight-zika/2016/03/07/42aa6840-db20-11e5-891a-4ed04f4213e8_story.html?postshare=2111458763345448&amp;tid=ss_tw-bottom" target="_blank" rel="nofollow"><u>drop of at least 41% in the number of people doing mosquito surveillance</u></a>. In other areas, too, “public health laboratory capacity for proactive surveillance is&nbsp;<a href="http://www.cste2.org/docs/VBR.pdf" target="_blank" rel="nofollow"><u>poor to nonexistent in most states</u></a>,” according to the damning 2014 report by the Council of State and Territorial Epidemiologists.</p> 
<p>I was appalled at the barbaric announcement yesterday that the <a href="https://patch.com/texas/meyerland/hurricane-harvey-border-checkpoints-will-close-texas-state-highways-close" target="_blank" rel="nofollow">Border Patrol would not close checkpoints during the hurricane</a>, forcing people to risk their lives staying in dangerous areas threatened by the storm or face deportation if they attempt to evacuate. In contrast, in 2012 (Hurricane Isaac) and 2016 (Hurricane Matthew), <a href="https://patch.com/texas/meyerland/hurricane-harvey-border-checkpoints-will-close-texas-state-highways-close" target="_blank" rel="nofollow">ICE&nbsp;took a more reasoned approach</a>, stating, “There will be no immigration enforcement initiatives associated with evacuations or sheltering related to Matthew, including the use of checkpoints for immigration enforcement purposes in impacted areas during an evacuation."</p> 
<p>There has previously been pressure on hospitals to report undocumented people to ICE. While that has stopped as a formal policy, <a href="https://www.statnews.com/2017/02/24/immigrants-doctors-medical-care/" target="_blank" rel="nofollow">immigrants are delaying seeking vital health care, understandably afraid that they would be targeted</a>. Not only is this cruel, but it is likely more costly, as waiting until an illness becomes catastrophic, and forces an emergency room visit, will be more expensive.</p> 
<p>Further driving people underground is poor policy. Studies have shown that the&nbsp;<a href="http://thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30073-5/abstract" target="_blank" rel="nofollow">criminalization of drug use has a negative effect on HIV prevention&nbsp;and treatment</a>, <a href="https://www.vox.com/2017/5/17/15641018/jeff-sessions-memo-tough-crime-public-health-hiv" target="_blank" rel="nofollow">increasing both the use of shared needles and the resulting HIV infections</a>. Lowering the threshold for prison for minor drug offenses helps only the prison-industrial complex.</p> 
<p>Similarly, <a href="https://www.vox.com/2017/5/17/15641018/jeff-sessions-memo-tough-crime-public-health-hiv" target="_blank" rel="nofollow">stigma increases rates of sexually transmitted diseases</a>&nbsp;at a time when <a href="http://www.npr.org/sections/health-shots/2016/10/20/498719092/std-infections-rise-to-new-highs-after-states-close-health-clinics" target="_blank" rel="nofollow">health departments have suffered drastic cuts.</a></p> 
<p>In order to respond effectively to disasters, we need a competent and caring response — more than the “Heck of a job, Brownie” that we got during Katrina, and more than&nbsp;<a href="http://www.businessinsider.com/trump-texas-hurricane-harvey-2017-8" target="_blank" rel="nofollow">President Trump’s lame “Good luck”</a>&nbsp;as he left the White House. Trump’s FEMA director, Brock Long, has some qualifications for his role. But with climate-change deniers and those who are hellbent on undoing environmental protections at the helm of other agencies, as well as the increasingly strong-arm tactics of ICE, we’ll be hard pressed to respond effectively to this hurricane or other future disasters.</p></div>
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	</app-root><script id="ng-templates-state" type="application/json">{&q;environmentName&q;:&q;prod&q;,&q;is_mobile&q;:false,&q;/forbesapi/content/uri.json?shortcodes=true&a;slides=true&a;type=ng&a;tickers=true&a;bvallpages=true&a;autovpslider=true&a;stream=true&a;compressimages=true&a;mobile=false&a;prgsmobileads=false&a;relativeVideo=true&a;videoplayertype=brightcove_perform_with_keyvalues&a;swimlane=&a;uri=http://www.forbes.com/sites/judystone/2017/08/26/hidden-health-hazards-after-hurricanes-what-to-expect-after-harvey/&q;:{&q;content&q;:{&q;id&q;:&q;content_59a1f3f864aaf9435aebc28f&q;,&q;naturalId&q;:&q;blogAndPostId/blog/post/3536-2456&q;,&q;source&q;:&q;blogs&q;,&q;author&q;:&q;Judy Stone&q;,&q;title&q;:&q;Hidden Health Hazards After Hurricanes: What To Expect After Harvey&q;,&q;date&q;:1503790080000,&q;body&q;:&q;&l;p&g;[caption id=\&q;attachment_839570930\&q; photocredit=\&q;\&q;  align=\&q;\&q; width=\&q;960\&q;]&l;img class=\&q;dam-image getty size-large wp-image-839570930\&q; src=\&q;https://specials-images.forbesimg.com/imageserve/839570930/960x0.jpg?fit=scale\&q; data-height=\&q;642\&q; data-width=\&q;960\&q;&g; Damage at Rockport, Texas on August 26, 2017. Hurricane Harvey left a trail of devastation Saturday after the most powerful storm to hit the US mainland in over a decade slammed into Texas, destroying homes, severing power supplies and forcing tens of thousands of residents to flee. ( MARK RALSTON/AFP/Getty Images)[/caption]\r\n\r\nAfter the immediate damage and loss of life from Hurricane Harvey, many hazards remain, and infectious outbreaks will likely follow.\r\n\r\nImmediate problems will be from injuries, exposure and drownings. The longer-term fallout will include stress-related illnesses, ongoing anxiety and depression among those traumatized and displaced by the hurricane.\r\n\r\nOften overlooked are the biological effects. Infections&a;nbsp;following hurricanes are usually gastrointestinal or wound related.\r\n\r\nAll of these problems will be compounded by the neglect and dismantling of public health infrastructure.\r\n\r\n&l;strong&g;Water-borne infections&l;/strong&g;\r\n\r\nFlood water will likely be heavily contaminated by sewage and by toxic chemicals, so&a;nbsp;diarrhea will be common.\r\n\r\nMajor GI pathogens include parasitic infections such as &l;a href=\&q;http://www.cdc.gov/parasites/crypto/\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;Cryptosporidiosis&l;/a&g;&a;nbsp;and Giardia,&a;nbsp;which cause prolonged diarrhea; viral infections from Hepatitis A, Norovirus or Rotavirus; and bacterial infections from E. coli, Shigella, Salmonella, Vibrio or leptospirosis. Except for the parasite cases, most of the infectious diarrhea will be self-limited. All of these infections are particularly problematic&a;nbsp;for those at the extremes of age and those who become dehydrated.\r\n\r\nCholera has not been a problem in the U.S. and is not expected to cause any outbreaks here. It is a major problem in the Middle East, India and Haiti, where it was introduced by UN aid workers following the devastating earthquake there.\r\n\r\nLeptospirosis is an infrequently seen infection, caused by bacteria found in water and transmitted by the urine of rats, mice, raccoons and cattle, among others. It can infect dogs as well as people and can cause liver or kidney failure in both humans and pets. A fascinating &l;a href=\&q;https://www.cdc.gov/mmwr/preview/mmwrhtml/00048052.htm\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;outbreak occurred in Costa Rica among whitewater rafters,&l;/a&g;&a;nbsp;so those participating in&a;nbsp;freshwater sports are at&a;nbsp;risk. Outbreaks of leptospirosis occur sporadically around the world, often precipitated by flooding.\r\n&l;!--donotpaginate--&g;\r\n\r\n&l;strong&g;Wound infections&l;/strong&g;\r\n\r\nFurther, wounds can be readily infected by the dirty water, and it is easy to cut yourself on sharp objects hidden by the water. There are some particularly virulent bacteria causing wound infections that would likely need stronger antibiotics than might typically be prescribed. These include Aeromonas and Vibrio.\r\n\r\nThe warm waters of the Gulf Coast encourage Vibrio&a;rsquo;s growth and will likely pose a particular risk after the hurricane. As mentioned in this recent post on Vibrio&l;sup&g;&a;#8288;&l;/sup&g;, wound infections can be fulminant, characterized by sepsis and a rash with bloody blisters (hemorrhagic bullae). It&a;rsquo;s important to recognize this, as different antibiotics are needed.\r\n\r\nTetanus, a deadly disease that, fortunately, is readily vaccine preventable, is also a concern as numerous puncture wounds are likely and the water and soil&a;nbsp;may be contaminated.\r\n\r\n&l;u&g;&l;a href=\&q;https://www.cdc.gov/disasters/trenchfoot.html\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;Trench foot&l;/a&g;&l;/u&g;&a;nbsp;is a complication of flooding made famous in World War I when such infections were common among soldiers. There can be skin and muscle damage and subsequent infection from the prolonged immersion, sometimes leading to gangrene and need for amputation.\r\n\r\n&l;strong&g;Injuries &l;/strong&g;\r\n\r\nImmediate problems from flooding include drowning (the major cause of death), electrocution and &l;a href=\&q;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118941/\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;hypothermia&l;/a&g;. &l;a href=\&q;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118941/\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;Orthopedic injuries&l;/a&g; tend to grow after the initial storm subsides, as people begin to rebuild their lives, and peak several weeks later.\r\n\r\n&l;strong&g;Mosquito-borne infections&l;/strong&g;\r\n\r\nAfter the hurricane subsides, there will be pools of stagnant water, a perfect breeding ground for mosquitoes. This was already a disproportionate risk in poorer areas of cities like Houston.\r\n\r\n[caption id=\&q;attachment_1513\&q; photocredit=\&q;CDC\&q;  align=\&q;\&q; width=\&q;650\&q;]&l;a href=\&q;https://blogs-images.forbes.com/judystone/files/2016/04/Aedes-range-map-cdc1-e1460587485610.jpg\&q; target=\&q;_blank\&q;&g;&l;img class=\&q;size-full wp-image-1513\&q; src=\&q;http://blogs-images.forbes.com/judystone/files/2016/04/Aedes-range-map-cdc1-e1460587485610.jpg?width=960\&q; alt=\&q;\&q; data-height=\&q;327\&q; data-width=\&q;650\&q;&g;&l;/a&g; Range of disease-bearing mosquitoes.[/caption]\r\n\r\nAfter Hurricane Katrina, &l;a href=\&q;https://wwwnc.cdc.gov/eid/article/14/5/07-1066_article\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;a doubling&a;nbsp;of West Nile disease cases was seen in the hurricane-affected areas&l;/a&g; of Louisiana and Mississippi.\r\n\r\n&l;a href=\&q;https://www.bcm.edu/people/view/peter-hotez-m-d-ph-d/b1846a47-ffed-11e2-be68-080027880ca6\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;Dr. Peter Hotez&l;/a&g;&a;nbsp;of&a;nbsp;Baylor&a;nbsp;has explained repeatedly that the &l;a href=\&q;http://www.npr.org/sections/health-shots/2016/03/21/470683503/houston-prepares-now-for-zikas-potential-arrival-this-summer\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;poor are disproportionately affected by insect-borne diseases like Zika, dengue, West Nile and Chagas&l;/a&g;. Standing water in tires and debris in the street form breeding grounds. Many poor people don&a;rsquo;t even have window screens, let alone air conditioning, exposing them to a variety of infections.\r\n\r\n&l;strong&g;Drinking water&l;/strong&g;\r\n\r\nWater will be unsafe to drink after a hurricane. The CDC offers recommendations for those without bottled water, but frankly, the people affected likely won&a;rsquo;t have electricity or many supplies. Sources of clean water in a home are the hot water tank and the water reservoir tank on toilets. Other &l;a href=\&q;https://www.cdc.gov/disasters/hurricanes/foodwater.html\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;water can be treated in one of three ways:&l;/a&g;\r\n&l;/p&g;&l;ul&g;&l;li&g;Bring water to a rolling boil for one&a;nbsp;minute.&l;/li&g;\r\n \t&l;li&g;Use household bleach. Add 1/8 teaspoon of new, unscented liquid bleach to one&a;nbsp;gallon of water. Stir well. Let the water sit for 30 minutes before you drink it.&l;/li&g;\r\n \t&l;li&g;Use water-purifying tablets.&l;/li&g;\r\n&l;/ul&g;\r\nWater from private wells may become contaminated and should be tested.\r\n\r\n&l;strong&g;Politics and public health&l;/strong&g;\r\n\r\nThere are broader concerns only highlighted by the hurricane. Public health funding has been decimated. Since the early 2000s, there has been a&a;nbsp;&l;a href=\&q;https://www.washingtonpost.com/national/health-science/states-worry-they-dont-have-money-to-fight-zika/2016/03/07/42aa6840-db20-11e5-891a-4ed04f4213e8_story.html?postshare=2111458763345448&a;amp;tid=ss_tw-bottom\&q; target=\&q;_blank\&q;&g;&l;u&g;drop of at least 41% in the number of people doing mosquito surveillance&l;/u&g;&l;/a&g;. In other areas, too, &a;ldquo;public health laboratory capacity for proactive surveillance is&a;nbsp;&l;a href=\&q;http://www.cste2.org/docs/VBR.pdf\&q; target=\&q;_blank\&q;&g;&l;u&g;poor to nonexistent in most states&l;/u&g;&l;/a&g;,&a;rdquo; according to the damning 2014 report by the Council of State and Territorial Epidemiologists.\r\n\r\nI was appalled at the barbaric announcement yesterday that the &l;a href=\&q;https://patch.com/texas/meyerland/hurricane-harvey-border-checkpoints-will-close-texas-state-highways-close\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;Border Patrol would not close checkpoints during the hurricane&l;/a&g;, forcing people to risk their lives staying in dangerous areas threatened by the storm or face deportation if they attempt to evacuate. In contrast, in 2012 (Hurricane Isaac) and 2016 (Hurricane Matthew), &l;a href=\&q;https://patch.com/texas/meyerland/hurricane-harvey-border-checkpoints-will-close-texas-state-highways-close\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;ICE&a;nbsp;took a more reasoned approach&l;/a&g;, stating, &a;ldquo;There will be no immigration enforcement initiatives associated with evacuations or sheltering related to Matthew, including the use of checkpoints for immigration enforcement purposes in impacted areas during an evacuation.\&q;\r\n\r\nThere has previously been pressure on hospitals to report undocumented people to ICE. While that has stopped as a formal policy, &l;a href=\&q;https://www.statnews.com/2017/02/24/immigrants-doctors-medical-care/\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;immigrants are delaying seeking vital health care, understandably afraid that they would be targeted&l;/a&g;. Not only is this cruel, but it is likely more costly, as waiting until an illness becomes catastrophic, and forces an emergency room visit, will be more expensive.\r\n\r\nFurther driving people underground is poor policy. Studies have shown that the&a;nbsp;&l;a href=\&q;http://thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30073-5/abstract\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;criminalization of drug use has a negative effect on HIV prevention&a;nbsp;and treatment&l;/a&g;, &l;a href=\&q;https://www.vox.com/2017/5/17/15641018/jeff-sessions-memo-tough-crime-public-health-hiv\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;increasing both the use of shared needles and the resulting HIV infections&l;/a&g;. Lowering the threshold for prison for minor drug offenses helps only the prison-industrial complex.\r\n\r\nSimilarly, &l;a href=\&q;https://www.vox.com/2017/5/17/15641018/jeff-sessions-memo-tough-crime-public-health-hiv\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;stigma increases rates of sexually transmitted diseases&l;/a&g;&a;nbsp;at a time when &l;a href=\&q;http://www.npr.org/sections/health-shots/2016/10/20/498719092/std-infections-rise-to-new-highs-after-states-close-health-clinics\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;health departments have suffered drastic cuts.&l;/a&g;\r\n\r\nIn order to respond effectively to disasters, we need a competent and caring response &a;mdash; more than the &a;ldquo;Heck of a job, Brownie&a;rdquo; that we got during Katrina, and more than&a;nbsp;&l;a href=\&q;http://www.businessinsider.com/trump-texas-hurricane-harvey-2017-8\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q; target=\&q;_blank\&q;&g;President Trump&a;rsquo;s lame &a;ldquo;Good luck&a;rdquo;&l;/a&g;&a;nbsp;as he left the White House. Trump&a;rsquo;s FEMA director, Brock Long, has some qualifications for his role. But with climate-change deniers and those who are hellbent on undoing environmental protections at the helm of other agencies, as well as the increasingly strong-arm tactics of ICE, we&a;rsquo;ll be hard pressed to respond effectively to this hurricane or other future disasters.&q;,&q;description&q;:&q;Physical destruction from hurricane winds and rain is just the beginning of the challenges that Texas will face.&q;,&q;image&q;:&q;https://specials-images.forbesimg.com/imageserve/839570930/960x0.jpg?fit=scale&q;,&q;type&q;:&q;blog&q;,&q;storyType&q;:&q;post&q;,&q;uri&q;:&q;http://www.forbes.com/sites/judystone/2017/08/26/hidden-health-hazards-after-hurricanes-what-to-expect-after-harvey/&q;,&q;comments&q;:[],&q;visible&q;:true,&q;authors&q;:[{&q;naturalId&q;:&q;blogAuthorId/blog/author/1503953&q;,&q;name&q;:&q;Judy Stone&q;,&q;avatars&q;:[{&q;size&q;:400,&q;image&q;:&q;https://secure.gravatar.com/avatar/e1cb44b9e708b2e80b90a591cd7c532b?s=400&a;d=mm&a;r=g&q;},{&q;size&q;:136,&q;image&q;:&q;https://secure.gravatar.com/avatar/e1cb44b9e708b2e80b90a591cd7c532b?s=136&a;d=mm&a;r=g&q;},{&q;size&q;:62,&q;image&q;:&q;https://secure.gravatar.com/avatar/e1cb44b9e708b2e80b90a591cd7c532b?s=62&a;d=mm&a;r=g&q;},{&q;size&q;:40,&q;image&q;:&q;https://secure.gravatar.com/avatar/e1cb44b9e708b2e80b90a591cd7c532b?s=40&a;d=mm&a;r=g&q;}],&q;url&q;:&q;http://www.forbes.com/sites/judystone/&q;,&q;type&q;:&q;Contributor&q;,&q;profileUrl&q;:&q;/sites/judystone/&q;,&q;twitterName&q;:&q;drjudystone&q;,&q;authorType&q;:&q;individual&q;,&q;email&q;:&q;drjudystone@gmail.com&q;,&q;blog&q;:false,&q;timestamp&q;:1517257459449,&q;topics&q;:[&q;powering-productivity&q;,&q;pharma-and-health&q;,&q;business&q;,&q;entrepreneurs&q;,&q;workforce-management&q;,&q;healthcare-innovation&q;,&q;tech&q;,&q;food-agriculture&q;,&q;social-entrepreneurship&q;],&q;description&q;:&q;I am an Infectious Disease specialist, experienced in conducting clinical research and the author of Conducting Clinical Research, the essential guide to the topic. I survived 25 years in solo practice in rural Cumberland, Maryland, and now work part time as an Infectious Diseases locum tenens physician. I especially love writing about ethical issues, and tilting at windmills as I advocate for social justice. As part of my overall desire to save the world when I grow up, I have become particularly interested in neglected tropical diseases. In my next life, I would love to teach overseas. When not slaving over hot patients, I can be found playing with photography, friends’ dogs, or in my garden. Follow on Twitter @drjudystone&q;,&q;recentActivityCount&q;:0,&q;latestActivityDate&q;:1447095600000,&q;dailyActivityCount&q;:0,&q;primaryBlogNaturalId&q;:&q;blogAuthorId/blog/author/blog-3536&q;,&q;shortUri&q;:&q;http://onforb.es/1zcaQ6W&q;,&q;displayChannel&q;:&q;business&q;,&q;displaySection&q;:&q;pharma&q;,&q;contributorSince&q;:1418348685000,&q;slug&q;:&q;judystone&q;,&q;showNoVestPocket&q;:false,&q;embargo&q;:false,&q;primaryChannelId&q;:&q;channel_1&q;,&q;primarySectionId&q;:&q;section_4&q;,&q;enableContribContact&q;:true,&q;sigfile&q;:&q;&l;em&g;My book, \&q;Conducting Clinical Research: A Practical Guide,\&q; can be found &l;a href=\&q;http://conductingclinicalresearch.com/buy_the_book.php\&q;&g;here&l;/a&g;. For more medical/pharma news and perspective, follow me on Twitter @drjudystone or here at &l;a title=\&q;Judy Stone\&q; href=\&q;http://forbes.com/sites/judystone\&q; target=\&q;_blank\&q; rel=\&q;noopener noreferrer\&q;&g;Forbes&l;/a&g;&l;/em&g;&q;,&q;enableTwitterFeed&q;:false,&q;disableCanonical&q;:false,&q;disableDigest&q;:false,&q;forbesTwitterProfile&q;:{&q;screenName&q;:&q;DrJudyStone&q;,&q;name&q;:&q;Judy Stone&q;,&q;profileImageUrl&q;:&q;http://pbs.twimg.com/profile_images/921476400703524866/rjxRkzEF.jpg&q;,&q;description&q;:&q;Infectious Disease doc, @Forbes contributor: pharma, health, #infections, #MedEthics, #socialjustice Author Conducting Clinical Research https://t.co/RyzOIHIUEc&q;,&q;createdDate&q;:1234489327000,&q;location&q;:&q;Maryland and Maine&q;,&q;url&q;:&q;https://t.co/GCyIm7W5Qu&q;,&q;expandedUrl&q;:&q;http://www.forbes.com/sites/judystone/&q;,&q;displayUrl&q;:&q;forbes.com/sites/judyston…&q;,&q;verified&q;:false},&q;inactive&q;:true,&q;primaryChannel&q;:{&q;id&q;:&q;channel_1&q;,&q;channelId&q;:&q;channel_1&q;,&q;channelName&q;:&q;Business&q;,&q;sectionId&q;:&q;section_4&q;,&q;sectionName&q;:&q;Pharma &a; Healthcare&q;,&q;url&q;:&q;/healthcare&q;,&q;shortName&q;:&q;Pharma &a; Healthcare&q;},&q;division&q;:&q;FC&q;,&q;allowEmail&q;:false,&q;avatar_map&q;:{}},{&q;naturalId&q;:&q;blogAuthorId/blog/author/blog-3536&q;,&q;avatars&q;:[{&q;size&q;:0,&q;image&q;:&q;&q;},{&q;size&q;:0,&q;image&q;:&q;&q;},{&q;size&q;:0,&q;image&q;:&q;&q;},{&q;size&q;:0,&q;image&q;:&q;&q;}],&q;url&q;:&q;http://www.forbes.com/sites/judystone/&q;,&q;profileUrl&q;:&q;https://blogs.forbes.com/judystone/profile/&q;,&q;twitterName&q;:&q;drjudystone&q;,&q;authorType&q;:&q;individual&q;,&q;blog&q;:true,&q;timestamp&q;:1518215172522,&q;topics&q;:[&q;powering-productivity&q;,&q;pharma-and-health&q;,&q;business&q;,&q;entrepreneurs&q;,&q;healthcare-innovation&q;,&q;social-impact&q;,&q;social-entrepreneurship&q;,&q;workforce-management&q;,&q;tech&q;,&q;science&q;,&q;sportsmoney&q;,&q;food-agriculture&q;],&q;recentActivityCount&q;:0,&q;latestActivityDate&q;:1447095600000,&q;dailyActivityCount&q;:0,&q;primaryBlogNaturalId&q;:&q;blogAuthorId/blog/author/blog-3536&q;,&q;primaryContributor&q;:&q;blogAuthorId/blog/author/1503953&q;,&q;primaryContributorData&q;:{&q;naturalId&q;:&q;blogAuthorId/blog/author/1503953&q;,&q;name&q;:&q;Judy Stone&q;,&q;avatars&q;:[{&q;size&q;:136,&q;image&q;:&q;https://secure.gravatar.com/avatar/e1cb44b9e708b2e80b90a591cd7c532b?s=136&a;#038;d=mm&a;#038;r=g&q;},{&q;size&q;:400,&q;image&q;:&q;https://secure.gravatar.com/avatar/e1cb44b9e708b2e80b90a591cd7c532b?s=400&a;#038;d=mm&a;#038;r=g&q;},{&q;size&q;:40,&q;image&q;:&q;https://secure.gravatar.com/avatar/e1cb44b9e708b2e80b90a591cd7c532b?s=40&a;#038;d=mm&a;#038;r=g&q;},{&q;size&q;:62,&q;image&q;:&q;https://secure.gravatar.com/avatar/e1cb44b9e708b2e80b90a591cd7c532b?s=62&a;#038;d=mm&a;#038;r=g&q;}],&q;blog&q;:false,&q;shortBio&q;:&q;I cover infectious diseases, medicine, drug development, and ethics.&q;,&q;description&q;:&q;I am an Infectious Disease specialist, experienced in conducting clinical research and the author of Conducting Clinical Research, the essential guide to the topic. I survived 25 years in solo practice in rural Cumberland, Maryland, and now work part time as an Infectious Diseases locum tenens physician. I especially love writing about ethical issues, and tilting at windmills as I advocate for social justice. As part of my overall desire to save the world when I grow up, I have become particularly interested in neglected tropical diseases. In my next life, I would love to teach overseas. When not slaving over hot patients, I can be found playing with photography, friends’ dogs, or in my garden. Follow on Twitter @drjudystone&q;,&q;allowEmail&q;:false},&q;shortUri&q;:&q;http://onforb.es/1zcaQ6W&q;,&q;displayChannel&q;:&q;business&q;,&q;displaySection&q;:&q;pharma&q;,&q;contributorSince&q;:1418330880000,&q;slug&q;:&q;judystone&q;,&q;showNoVestPocket&q;:false,&q;embargo&q;:false,&q;primaryChannelId&q;:&q;channel_1&q;,&q;primarySectionId&q;:&q;section_4&q;,&q;enableContribContact&q;:false,&q;enableTwitterFeed&q;:true,&q;disableCanonical&q;:false,&q;disableDigest&q;:false,&q;forbesTwitterProfile&q;:{&q;screenName&q;:&q;DrJudyStone&q;,&q;name&q;:&q;Judy Stone&q;,&q;profileImageUrl&q;:&q;http://pbs.twimg.com/profile_images/921476400703524866/rjxRkzEF.jpg&q;,&q;description&q;:&q;Infectious Disease doc, @Forbes contributor: pharma, health, #infections, #MedEthics, #socialjustice Author Conducting Clinical Research https://t.co/RyzOIHIUEc&q;,&q;createdDate&q;:1234489327000,&q;location&q;:&q;Maryland and 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id=\&q;attachment_839570930\&q; class=\&q;wp-caption alignnone\&q;&g; \n &l;div class=\&q;article-body-image\&q;&g; \n  &l;img class=\&q;dam-image getty size-large wp-image-839570930\&q; src=\&q;https://specials-images.forbesimg.com/imageserve/839570930/960x0.jpg?fit=scale\&q; data-height=\&q;642\&q; data-width=\&q;960\&q; /&g; \n &l;/div&g; \n &l;div article-image-caption=\&q;\&q;&g; \n  &l;div class=\&q;caption-container\&q; ng-class=\&q;caption_state\&q;&g; \n   &l;fbs-accordion current=\&q;0\&q;&g; \n    &l;p class=\&q;wp-caption-text\&q;&g;Damage at Rockport, Texas on August 26, 2017. Hurricane Harvey left a trail of devastation Saturday after the most powerful storm to hit the US mainland in over a decade slammed into Texas, destroying homes, severing power supplies and forcing tens of thousands of residents to flee. ( MARK RALSTON/AFP/Getty Images)&l;/p&g; \n   &l;/fbs-accordion&g; \n  &l;/div&g; \n &l;/div&g; \n&l;/div&g; \n&l;p&g;After the immediate damage and loss of life from Hurricane Harvey, many hazards remain, and infectious outbreaks will likely follow.&l;/p&g; \n&l;p&g;Immediate problems will be from injuries, exposure and drownings. The longer-term fallout will include stress-related illnesses, ongoing anxiety and depression among those traumatized and displaced by the hurricane.&l;/p&g; \n&l;p&g;Often overlooked are the biological effects. Infections&a;nbsp;following hurricanes are usually gastrointestinal or wound related.&l;/p&g; \n&l;p&g;All of these problems will be compounded by the neglect and dismantling of public health infrastructure.&l;/p&g; \n&l;p&g;&l;strong&g;Water-borne infections&l;/strong&g;&l;/p&g; \n&l;p&g;Flood water will likely be heavily contaminated by sewage and by toxic chemicals, so&a;nbsp;diarrhea will be common.&l;/p&g; \n&l;p&g; \n &l;fbs-ad position=\&q;inread\&q; progressive=\&q;\&q;&g;&l;/fbs-ad&g;&l;/p&g; \n&l;p&g;Major GI pathogens include parasitic infections such as &l;a href=\&q;http://www.cdc.gov/parasites/crypto/\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;Cryptosporidiosis&l;/a&g;&a;nbsp;and Giardia,&a;nbsp;which cause prolonged diarrhea; viral infections from Hepatitis A, Norovirus or Rotavirus; and bacterial infections from E. coli, Shigella, Salmonella, Vibrio or leptospirosis. Except for the parasite cases, most of the infectious diarrhea will be self-limited. All of these infections are particularly problematic&a;nbsp;for those at the extremes of age and those who become dehydrated.&l;/p&g; \n&l;p&g;Cholera has not been a problem in the U.S. and is not expected to cause any outbreaks here. It is a major problem in the Middle East, India and Haiti, where it was introduced by UN aid workers following the devastating earthquake there.&l;/p&g; \n&l;div class=\&q;vestpocket\&q; vest-pocket=\&q;\&q;&g;&l;/div&g; \n&l;p&g;Leptospirosis is an infrequently seen infection, caused by bacteria found in water and transmitted by the urine of rats, mice, raccoons and cattle, among others. It can infect dogs as well as people and can cause liver or kidney failure in both humans and pets. A fascinating &l;a href=\&q;https://www.cdc.gov/mmwr/preview/mmwrhtml/00048052.htm\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;outbreak occurred in Costa Rica among whitewater rafters,&l;/a&g;&a;nbsp;so those participating in&a;nbsp;freshwater sports are at&a;nbsp;risk. Outbreaks of leptospirosis occur sporadically around the world, often precipitated by flooding.&l;/p&g; \n&l;p&g;&l;strong&g;Wound infections&l;/strong&g;&l;/p&g; \n&l;p&g;Further, wounds can be readily infected by the dirty water, and it is easy to cut yourself on sharp objects hidden by the water. There are some particularly virulent bacteria causing wound infections that would likely need stronger antibiotics than might typically be prescribed. These include Aeromonas and Vibrio.&l;/p&g; \n&l;p&g;The warm waters of the Gulf Coast encourage Vibrio’s growth and will likely pose a particular risk after the hurricane. As mentioned in this recent post on Vibrio&l;sup&g;⁠&l;/sup&g;, wound infections can be fulminant, characterized by sepsis and a rash with bloody blisters (hemorrhagic bullae). It’s important to recognize this, as different antibiotics are needed.&l;/p&g; \n&l;p&g;Tetanus, a deadly disease that, fortunately, is readily vaccine preventable, is also a concern as numerous puncture wounds are likely and the water and soil&a;nbsp;may be contaminated.&l;/p&g; \n&l;p&g;&l;u&g;&l;a href=\&q;https://www.cdc.gov/disasters/trenchfoot.html\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;Trench foot&l;/a&g;&l;/u&g;&a;nbsp;is a complication of flooding made famous in World War I when such infections were common among soldiers. There can be skin and muscle damage and subsequent infection from the prolonged immersion, sometimes leading to gangrene and need for amputation.&l;/p&g; \n&l;p&g;&l;strong&g;Injuries &l;/strong&g;&l;/p&g; \n&l;p&g;Immediate problems from flooding include drowning (the major cause of death), electrocution and &l;a href=\&q;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118941/\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;hypothermia&l;/a&g;. &l;a href=\&q;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118941/\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;Orthopedic injuries&l;/a&g; tend to grow after the initial storm subsides, as people begin to rebuild their lives, and peak several weeks later.&l;/p&g; \n&l;p&g;&l;strong&g;Mosquito-borne infections&l;/strong&g;&l;/p&g; \n&l;p&g;After the hurricane subsides, there will be pools of stagnant water, a perfect breeding ground for mosquitoes. This was already a disproportionate risk in poorer areas of cities like Houston.&l;/p&g; \n&l;div id=\&q;attachment_1513\&q; class=\&q;wp-caption alignnone\&q;&g; \n &l;div class=\&q;article-body-image\&q;&g; \n  &l;a href=\&q;https://blogs-images.forbes.com/judystone/files/2016/04/Aedes-range-map-cdc1-e1460587485610.jpg\&q;&g;&l;img class=\&q;size-full wp-image-1513\&q; src=\&q;//blogs-images.forbes.com/judystone/files/2016/04/Aedes-range-map-cdc1-e1460587485610.jpg?width=960\&q; alt=\&q;\&q; data-height=\&q;327\&q; data-width=\&q;650\&q; /&g;&l;/a&g; \n  &l;small class=\&q;article-photo-credit\&q;&g;CDC&l;/small&g; \n &l;/div&g; \n &l;div article-image-caption=\&q;\&q;&g; \n  &l;div class=\&q;caption-container\&q; ng-class=\&q;caption_state\&q;&g; \n   &l;fbs-accordion current=\&q;0\&q;&g; \n    &l;p class=\&q;wp-caption-text\&q;&g;Range of disease-bearing mosquitoes.&l;/p&g; \n   &l;/fbs-accordion&g; \n  &l;/div&g; \n &l;/div&g; \n&l;/div&g; \n&l;p&g;After Hurricane Katrina, &l;a href=\&q;https://wwwnc.cdc.gov/eid/article/14/5/07-1066_article\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;a doubling&a;nbsp;of West Nile disease cases was seen in the hurricane-affected areas&l;/a&g; of Louisiana and Mississippi.&l;/p&g; \n&l;p&g;&l;a href=\&q;https://www.bcm.edu/people/view/peter-hotez-m-d-ph-d/b1846a47-ffed-11e2-be68-080027880ca6\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;Dr. Peter Hotez&l;/a&g;&a;nbsp;of&a;nbsp;Baylor&a;nbsp;has explained repeatedly that the &l;a href=\&q;http://www.npr.org/sections/health-shots/2016/03/21/470683503/houston-prepares-now-for-zikas-potential-arrival-this-summer\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;poor are disproportionately affected by insect-borne diseases like Zika, dengue, West Nile and Chagas&l;/a&g;. Standing water in tires and debris in the street form breeding grounds. Many poor people don’t even have window screens, let alone air conditioning, exposing them to a variety of infections.&l;/p&g; \n&l;p&g;&l;strong&g;Drinking water&l;/strong&g;&l;/p&g; \n&l;p&g;Water will be unsafe to drink after a hurricane. The CDC offers recommendations for those without bottled water, but frankly, the people affected likely won’t have electricity or many supplies. Sources of clean water in a home are the hot water tank and the water reservoir tank on toilets. Other &l;a href=\&q;https://www.cdc.gov/disasters/hurricanes/foodwater.html\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;water can be treated in one of three ways:&l;/a&g;&l;/p&g; \n&l;ul&g; \n &l;li&g;Bring water to a rolling boil for one&a;nbsp;minute.&l;/li&g; \n &l;li&g;Use household bleach. Add 1/8 teaspoon of new, unscented liquid bleach to one&a;nbsp;gallon of water. Stir well. Let the water sit for 30 minutes before you drink it.&l;/li&g; \n &l;li&g;Use water-purifying tablets.&l;/li&g; \n&l;/ul&g; \n&l;p&g;Water from private wells may become contaminated and should be tested.&l;/p&g; \n&l;p&g;&l;strong&g;Politics and public health&l;/strong&g;&l;/p&g; \n&l;p&g;There are broader concerns only highlighted by the hurricane. Public health funding has been decimated. Since the early 2000s, there has been a&a;nbsp;&l;a href=\&q;https://www.washingtonpost.com/national/health-science/states-worry-they-dont-have-money-to-fight-zika/2016/03/07/42aa6840-db20-11e5-891a-4ed04f4213e8_story.html?postshare=2111458763345448&a;amp;tid=ss_tw-bottom\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;&l;u&g;drop of at least 41% in the number of people doing mosquito surveillance&l;/u&g;&l;/a&g;. In other areas, too, “public health laboratory capacity for proactive surveillance is&a;nbsp;&l;a href=\&q;http://www.cste2.org/docs/VBR.pdf\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;&l;u&g;poor to nonexistent in most states&l;/u&g;&l;/a&g;,” according to the damning 2014 report by the Council of State and Territorial Epidemiologists.&l;/p&g; \n&l;p&g;I was appalled at the barbaric announcement yesterday that the &l;a href=\&q;https://patch.com/texas/meyerland/hurricane-harvey-border-checkpoints-will-close-texas-state-highways-close\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;Border Patrol would not close checkpoints during the hurricane&l;/a&g;, forcing people to risk their lives staying in dangerous areas threatened by the storm or face deportation if they attempt to evacuate. In contrast, in 2012 (Hurricane Isaac) and 2016 (Hurricane Matthew), &l;a href=\&q;https://patch.com/texas/meyerland/hurricane-harvey-border-checkpoints-will-close-texas-state-highways-close\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;ICE&a;nbsp;took a more reasoned approach&l;/a&g;, stating, “There will be no immigration enforcement initiatives associated with evacuations or sheltering related to Matthew, including the use of checkpoints for immigration enforcement purposes in impacted areas during an evacuation.&a;quot;&l;/p&g; \n&l;p&g;There has previously been pressure on hospitals to report undocumented people to ICE. While that has stopped as a formal policy, &l;a href=\&q;https://www.statnews.com/2017/02/24/immigrants-doctors-medical-care/\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;immigrants are delaying seeking vital health care, understandably afraid that they would be targeted&l;/a&g;. Not only is this cruel, but it is likely more costly, as waiting until an illness becomes catastrophic, and forces an emergency room visit, will be more expensive.&l;/p&g; \n&l;p&g;Further driving people underground is poor policy. Studies have shown that the&a;nbsp;&l;a href=\&q;http://thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30073-5/abstract\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;criminalization of drug use has a negative effect on HIV prevention&a;nbsp;and treatment&l;/a&g;, &l;a href=\&q;https://www.vox.com/2017/5/17/15641018/jeff-sessions-memo-tough-crime-public-health-hiv\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;increasing both the use of shared needles and the resulting HIV infections&l;/a&g;. Lowering the threshold for prison for minor drug offenses helps only the prison-industrial complex.&l;/p&g; \n&l;p&g;Similarly, &l;a href=\&q;https://www.vox.com/2017/5/17/15641018/jeff-sessions-memo-tough-crime-public-health-hiv\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;stigma increases rates of sexually transmitted diseases&l;/a&g;&a;nbsp;at a time when &l;a href=\&q;http://www.npr.org/sections/health-shots/2016/10/20/498719092/std-infections-rise-to-new-highs-after-states-close-health-clinics\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;health departments have suffered drastic cuts.&l;/a&g;&l;/p&g; \n&l;p&g;In order to respond effectively to disasters, we need a competent and caring response — more than the “Heck of a job, Brownie” that we got during Katrina, and more than&a;nbsp;&l;a href=\&q;http://www.businessinsider.com/trump-texas-hurricane-harvey-2017-8\&q; target=\&q;_blank\&q; rel=\&q;nofollow\&q;&g;President Trump’s lame “Good luck”&l;/a&g;&a;nbsp;as he left the White House. Trump’s FEMA director, Brock Long, has some qualifications for his role. 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