The Effect of Hurricanes on Epidemics of Airborne and Waterborne Illnesses

In the wake of a natural disaster, death is not uncommon. Although communicable diseases do occur after hurricanes, death is more so caused by blunt trauma, crush-related injuries, or drowning.[1] For example, during Hurricane Katrina, three hundred eighty-seven victims drowned, two hundred forty-six people sustained trauma or injuries severe enough to cause their deaths, and two hundred twenty-six victims had no specific cause of immediate death. For those who had injury-related causes of death though, six died from heat exposure, four unintentionally from firearms, two from homicide, four from suicide, three from gas poisoning, and one from electrocution. In total, Hurricane Katrina caused nine hundred eighty-six unfortunate deaths.[2]

Though the number of immediate deaths caused by Hurricane Katrina is astonishing, even more people perished after she had run her full course. Thus, it is clear that the hurricane itself is not fully responsible for the loss of life so there must be another factor at play. Not only are the effects of severe hurricanes and other natural disasters long-lasting, but also deadly. Diseases often spread among survivors leading to even more loss of life. Although most people correctly believe that, following natural disasters, there is an increased risk of infectious disease outbreaks, they often believe that that risk is higher than it truly is. In large part, this misconception is due to exaggeration by the media. Without specific evidence, the media reports about the imminent threat of disease which causes unnecessary panic, confusion, and sometimes health-related actions within the population.[3]

Another false belief is that dead bodies cause disease.[1] People worry that the bodies of those who have passed may infect those who have survived with disease. However, the main cause of disease is actually population displacement. Population displacement leads to other issues such as contaminated water and overcrowding which results in increased contact with infected individuals. Contaminated water is especially hazardous after natural disasters because various illnesses can develop from exposure to it.[1]

According to the Centers for Disease Control and Prevention (CDC), the diseases which can spread after disasters like hurricanes are “cholera, diarrhea, Hepatitis A, Hepatitis E, leptospirosis, parasitic diseases (eg, amebiasis [Entamoeba histolytica], cryptosporidiosis, cyclosporiasis, and giardiasis), rotavirus, shigellosis, and typhoid fever.”[4] The factors which could influence the risk of being infected by any one of these diseases include availability of clean water, damage to sanitation and sewage systems, degree of crowding, pre-existing health conditions of the population, immunity to illness, and access to healthcare.[1]

People tend to overcrowd certain areas causing population displacement

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Population displacement is problematic because it increases the risk of infectious disease outbreaks. Population displacement causes people to move physically and crowd places which have taken the least amount of damage during a hurricane. Gastroenteritis, also known as the stomach flu, resulted after Hurricane Katrina in over a thousand evacuees. In overcrowded settings, noroviruses like gastroenteritis are easily spread.[5] Acute respiratory infections (ARI) are another major cause of illness and death among displaced populations because of close proximity to other individuals. After Hurricane Mitch occurred in 1998, the number of observed cases of ARI increased by four times in Nicaragua.[1] The condition of illnesses like tuberculosis can also be worsened because of population displacement and reduced access to healthcare. Following Hurricane Katrina though, an emphasis was placed on finding new cases of tuberculosis and continuing treatment of the known ones.[3] It helps put minds at rest to know that even in a state of emergency, officials do everything they can to try to save as many lives as possible. Not only does population displacement allow communicable diseases to spread more easily, but it also causes sudden population influxes in certain areas which leads to unsanitary living conditions.

Water may become contaminated if a hurricane destroys the sanitation and sewage systems because then there is no way to clean the water. In crowded areas, the need for sanitation and sewage systems only increases. Bodily fluids and feces are likely to infiltrate the water and taint it. If people consume unsanitary water, they could contract any number of diseases, including meningitis, cholera, Salmonella, E. coli, and other diarrheal infections. Those directly affected by Hurricane Katrina suffered from diarrhea, tuberculosis, norovirus, Salmonella, cholera.[1] The CDC received reports of the occurrence of diarrheal disease from groups of individuals in evacuation centers in Louisiana, Mississippi, Tennessee, and Texas.[4] The diarrheal disease had spread across four different states allowing it to gain the status of an epidemic. Hurricane Jeanne forced the people of Haiti to deal with meningitis and the people of Central America had to endure cholera as a result of Hurricane Mitch.[6] The spread of disease across an entire country or region of the world certainly causes worry as infectious diseases can easily transform from small outbreaks to epidemics if the population and officials are not careful.

The flooding that results from hurricanes has hazardous effects such as increased risk of vector-borne diseases and mold. Standing water can lead to the accumulation of carriers of Malaria and the West Nile virus in surrounding areas.[6] The flooding that occurred because of Hurricane Flora led to an outbreak of over seventy-five thousand cases of Malaria.[5] Mold is another issue that results from flooding. Hurricane Katrina left eighty percent of New Orleans, Louisiana submerged in water.[4] Therefore, it is not shocking that visible mold growth was found in forty-five percent of homes inspected after Hurricane Katrina. The indoor air levels of mold were elevated which means there was more airborne mold, and therefore, more reason for concern about respiratory health.[5]

The extent of flooding after Hurricane Katrina

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Physical damage and health concerns are not the only dangers presented by hurricanes. By not actively preparing for how to deal with hurricanes, people put themselves at an even greater risk of trauma. Across cultures, natural disasters like hurricanes greatly affect distributions of people in different ways. After massive storms like Hurricane Katrina, legions of studies are often conducted to identify all the ways in which the population is affected. It has been found that being exposed to disease as well as the innumerable ethical dilemmas that come with attempting to solve such a large-scale problem, can have severe and lasting impacts on the culture of the region affected.

Culture is defined through material and non-material things, which hurricanes often destroy, leaving behind unparalleled destruction in their wake. Factors that can influence cultural and psychological well-being include time taken to return to normal life, the extent of damage done by the natural disaster, and effectiveness or ineffectiveness of help received. Oftentimes, these cultural effects vary between races of people. When Hurricane Katrina hit New Orleans in 2005, the disproportionate suffering was clearly attributed to the “economic and social stratification that was present in New Orleans before Hurricane Katrina that became magnified after the storm.”[7] The great losses suffered by the people of New Orleans “exacerbated the uses of substance dependence, psychiatric disorders, child molestation, domestic violence, and other relational difficulties.[7] News coverage highlighted the social stratification in New Orleans during the aftermath of Katrina and served to differentiate the vulnerable African-American poor from the rest of the population. The media mainly covered matters of welfare dependency, crime, and familial dysfunction rather than focusing on the real issues at hand like the lack of disaster relief coming into New Orleans.[8]

Culture is incredibly important when considering the normative experience of families in America. It is the moral backbone that our nation is founded on, the glue that holds societies together. Without culture, there would be no common connection between people in the same geographical area, or even connections between people of potentially similar upbringings or backgrounds. In instances involving natural disasters, culture can be deeply affected through the devastation of homes and personal items, as well as the natural social order in towns and urban areas. Often natural disasters destroy deeply personal items that cannot be replaced, which impacts the owners of the personal items. They may become extremely upset or angry because they have lost such a deeply personal keepsake. Hurricanes are not known to show anyone any mercy and will leave nothing but paths of destruction in their wake.

Hurricane Katrina brought tremendous loss upon people and left them forever changed

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The elderly and children are often disproportionately affected when considering the rest of the population in the area of displacement and damage to property. Displacement and property damage were actually seen to cause a spike in rates of PTSD and general psychic morbidity among the elderly affected.[9] Following Hurricane Katrina, there was a rate of PTSD among children as high as sixty-two percent of those who remained in the affected area. There were also similar rates of comorbid disorders such as oppositional defiant disorder and separation anxiety disorder.[9] The impact of national disasters culturally can be shown through the destruction of property, social order, and high rates of PTSD and other relational difficulties.

One must wonder whether or not it is possible to lessen the social impacts which inevitably follow natural disasters like hurricanes. The only way it would even be possible enact change is if individuals looked at what had and had not been done in the past and learned from those mistakes. Once those responsible for the mistakes are identified, they can be held accountable. People often rely on their governments, especially in times of crisis, because they expect their government to help them. However, the exact responsibilities of the government must be established for the government to be able to effectively help its citizens.

Specifically, in relation to hurricanes and other natural disasters, the responsibilities of the government are delegated to a specific government agency known as the Federal Emergency Management Agency or FEMA. The mission statement of FEMA is “helping people before, during, and after disasters”.[10] Founded in 1988 it holds the responsibility of coordinating relief efforts after the declaration of an emergency. According to FEMA’s official website, “it is designed to bring an orderly and systemic means of federal natural disaster assistance for state and local governments in carrying out their responsibilities to aid citizens.”[10] Essentially, it is the responsibility of FEMA to ensure that people are properly evacuated, resources and aid are administered effectively, and in the aftermath of the storm, those displaced are safely removed from the area.

FEMA workers helping with hurricane recovery

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In the aftermath of a storm, the chances of an epidemic of airborne and waterborne illnesses increase exponentially. Hurricanes bring colossal surges of water that typically stand for days if not weeks in homes inhabited by countless people. Along with this water comes a myriad of dangers which only exacerbate already awful conditions. It is vital that agencies such as FEMA fulfill their duty to get people out of dangerous or contaminated environments with resources one would vitally need after a severe storm.

In the 2006 documentary When The Levees Broke, Spike Lee recounts the numerous tragedies suffered by those caught in the wrath of Hurricane Katrina.[11] Survivors recount stories of going days in shelters without electricity, plumbing, or medication for the sick and elderly. These are the stories of people who evacuated to shelters and people that stayed home to brave the storm because they did not have the resources to evacuate or relocate. Specifically, in part three of the documentary, a few children explain that their mother passed away from a lack of compressed oxygen while waiting days for aid.[11] This clearly shows that people died as a direct result of not having access to the proper resources after the storm.

The failures of FEMA are not isolated simply to Hurricane Katrina. Most recently in 2017, category 5 Hurricane Maria ravaged Puerto Rico. The storm was considered one of the worst ever recorded to hit the Caribbean islands. Keeping FEMA’s mission statement in mind, as well as the fact the agency had nine years to learn from events regarding Katrina (as well as the numerous disasters in between), one would expect FEMA to have been fully staffed and trained with resources in place for Hurricane Maria. In the year and a half since the catastrophic storm, there have been over three thousand deaths as a result of Hurricane Maria.[12] It also took nearly a year for power to be restored to the entirety of Puerto Rico,[13] and twenty-thousand pallets of fresh bottled water sat spoiling in the hot sun waiting to be distributed as countless Puerto Ricans had no access to running water.[14]

While Hurricane Katrina was neither the first nor last hurricane to hit the United States, lessons can certainly be learned from its occurrence in order to prepare in the most effective ways possible and ensure the least amount of loss of life. Following Hurricane Katrina and Hurricane Maria, there were increases in mortality by forty-seven percent[15] and sixty-two percent[16] in New Orleans and Puerto Rico, respectively. Both increases in overall mortality are certainly considered to be extreme. These statistics demonstrate that the failures of the government have real-life implications like death for hundreds of thousands if not millions of people.

Every single day millions of people count on the idea that in the event of a natural disaster or emergency, they can depend on the government for information and resources. It is not simply the obligation but the stated duty of the federal government and FEMA to take care of its people in their most desperate times of need. Without the effective distribution and management of aid and resources by FEMA, countless people will find themselves in contaminated environments with little to no access to necessities such as clean water and life-saving medications.

 

Jillian Araya

Tierra Faulkner

Elizabeth Allred

 

[1] Watson, John  T., Michelle Gayer, and Maire A. Connolly. “Epidemics after Natural Disasters.”  Emerging Infectious Diseases  January 2007. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/.

[2] Brunkard, Joan,  Gonza Namulanda, and Raoult Ratard. “Hurricane Katrina Deaths, Louisiana, 2005.” Disaster Medicine and Public Health Preparedness 2, no. 04 (December 2008): 215-23. https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/hurricane-katrina-deaths-louisiana-2005/8A4BA6D478C4EB4C3308D7DD48DEB9A.

3 Kouadio, Isidore  K., Syed Aljunid, Taro Kamigaki, Karen Hammad, and Hitoshi Oshitani. “Infectious Diseases following Natural Disasters: Prevention and Control Measures.” Expert Review of Anti-infective Therapy  10 (January 10, 2014): 95-104. https://www.tandfonline.com/doi/abs/10.1586/eri.11.155.

5 Ivers, Louise  C., and Edward T. Ryan. “Infectious Diseases of Severe Weather-related and Flood-related Natural Disasters.” Current Opinion in Infectious Diseases  19 (October 2006): 408-14. https://oce.ovid.com/article/00001432-200610000-00003/HTML.

4 Ligon, B. Lee.  “Infectious Diseases That Pose Specific Challenges After Natural Disasters: A Review.” Seminars in Pediatric Infectious Diseases  17, no. 1 (January 2006): 36-45. https://www.sciencedirect.com/science/article/pii/S1045187006000033.

6 Spiegel, Paul  B., Phuoc Le, Mija-Tesse Ververs, and Peter Salama. “Occurrence and Overlap of Natural Disasters, Complex Emergencies and Epidemics during the past Decade (1995–2004).” Conflict and Health,  March 01, 2007. https://conflictandhealth.biomedcentral.com/articles/10.1186/1752-1505-1-2.

7 Holiday, Bertha G. Hurricane Katrina: A Multicultural Disaster, (American Psychological Association), March 2006. www.apa.org/pi/oema/resources/communique/2006/03/katrina-special-section.pdf.

8 Mann, Nicole and Victoria Pass, The Cultural Visualization of Hurricane Katrina (University of Rochester), 2011. http://www.rochester.edu/in_visible_culture/Issue_16/articles/mann%20and%20pass/mann_pass_intro.html.

9 Jogia, J. et al, Culture and the Psychological Impacts of Natural Disasters: Implications for Disaster Management and Disaster Mental Health (The Built and Human Review volume 7), 2014. https://research.aston.ac.uk/portal/files/14837549/Culture_and_the_psychological_impacts_of_natural_disasters.pdf

10 About the Agency. (n.d.). Retrieved from https://www.fema.gov/about-agency

11 Lee, S., Pollard, S., Nagin, R., Penn, S., Sharpton, A., Marsalis, W., Belafonte, H., … HBO Video (Firm). (2006). When the Levees Broke: A Requiem in Four Acts. New York: HBO Video.

12 Fink, S. (2018, August 28). Nearly a Year After Hurricane Maria, Puerto Rico Revises Death Toll to 2,975. Retrieved from https://www.nytimes.com/2018/08/28/us/puerto-rico-hurricane-maria-deaths.html

13 Sullivan, E. (2018, August 15). Nearly A Year After Maria, Puerto Rico Officials Claim Power Is Totally Restored. Retrieved from https://www.npr.org/2018/08/15/638739819/nearly-a-year-after-maria-puerto-rico-officials-claim-power-totally-restored

14 Weir, B. (2018, September 20). 20,000 pallets of bottled water left in Puerto Rico. Retrieved from https://www.cnn.com/2018/09/12/us/puerto-rico-bottled-water-dump-weir/index.html

15 Stephens, K. U., Grew, D., Chin, K., Kadetz, P., & Greenough, P. G. (07/2007). Excess mortality in the aftermath of hurricane katrina: A preliminary report. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18388597

16 Kishore, N., M.P.H., Marqués, D., PhD, Mahmud, A., PhD., Kiang, M. V., M.P.H., Rodriguez, I., B.A., Fuller, Arlan,J.D., M.A., . . . Buckee, C. O., D.Phil. (2018). Mortality in puerto rico after hurricane maria. The New England Journal of Medicine, 379(2), 162-170. Doi: http://dx.doi.org.libproxy.lib.unc.edu/10.1056/NEJMsa1803972

5 Comments

  1. Thank you for all that information on recent national disasters and illnesses that follow. It’s obvious these natural disasters heavily impact the community, surrounding communities, and the nation. What’s alarming then, is that with climate change, will come more of these types of disasters. Floods and hurricanes will become more of a common occurrence, and will hit with a higher power. The earth’s equilibrium will be thrown out of wack, and human health will pay the price. Not only will the water borne diseases shift from the global south to the global north, but it will also shift vectors like mosquitos who often carry these diseases. Occurrences like Hurricane Katrina will become common, and the effects similar.

  2. This post was extremely interesting to me because I had just recently watched the documentary mentioned in it. I decided to read this post because I realized Hurricane Katrina occured when I was only 8, so I did not know much about the disaster and its effects on the environment. The point about media exaggerating how high the risk of infectious disease outbreaks is after natural disasters is instrumental because even today, there is a debate about news: do they report to keep people informed, or do they report to create chatter and buzz to draw audiences? This post did a great job of dismantling myths such as dead bodies cause diseases. It was interesting to learn about population displacement as it is not usually discussed in relation to spreading diseases outside of an anthropology course; meaning the general public may never hear of it. My only question would be how do these waterborne illnesses affect the elderly and infants since they are most at risk for catching diseases?

  3. I think it is interesting that this post argues that there was a lack of initial disaster relief coming into New Orleans. In future research I think it would be important to investigate, to what extent was the lack of disaster relief affected by the unsafe situation the rescuers would have entered into? The post describes that the lack of relief is not purposely separated among socioeconomic barriers, but that the suffering from the hurricane was disproportionately focused on groups of lower socioeconomic status because many choices centered around lifestyle. Also, this post focuses on how there was a lack of media attention surrounding the lack of aid for lower socioeconomic groups. Similarly, in relation to my topic, the initial outbreak of HIV/AIDS was disproportionately centered around the gay community and not enough help or media coverage was initially provided, so the outbreak became more widespread. In this article, the diseases resulting from the hurricane damage, specifically those among the poorer communities, became more widespread due to the lack of initial relief for these communities from the government.

  4. I really enjoyed the different angle this took compared to some of the other posts I read. I think it is especially important to analyze the effects of natural disasters on death, just because they are so profound. It’s easy to forget how crazy the impact of hurricanes are, especially if it isn’t experienced first hand. It was very insightful to read about not only the direct effects and deaths caused by hurricanes, but also all of the indirect deaths that are caused based on living conditions and illnesses during the reconstruction phase following a natural disaster. I think this becomes even more important as extreme weather becomes prominent due to global climate change, and finding a way to reduce deaths is, and will become, increasingly important. If this is an issue in the United States where there is access to better technology and resources, I can’t imagine the effects of natural disasters in third world countries where population displacement and clean water are already issues, prior to the hurricane. Even within the United States, I feel like care differs based on cultural and socioeconomic standards, which is definitely something that I think should be improved. Your post was very clear, insightful, and merits thought about how the system can change. Great job!

  5. Wow, I had no idea how ill prepared FEMA actually is. There should definitely be some improvement there in the training and distribution aspect because what good is FEMA if they don’t know what they’re doing and their just letting water spoil? None. No good whatsoever. Also, I had no idea what a huge affect that hurricanes had on children, or natural disasters in general. The fact that 62% of kids that stay in that area develop PTSD is astounding to me.

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