Like an Air Force smart bomb, Hurricane Katrina made a direct hit on a hideously vulnerable spot on the nation's underbelly. Overnight, she turned New Orleans, one of America's most charming and seductive cities, into a festering lake of filth.
The aftermath of Katrina could present Louisiana and Mississippi -- which are hardly paragons of health outcomes on their best days -- with monumental public health problems. The nation's public and private rescue workers will cope eventually, but like a military campaign of massive proportions, the effort moves slowly at first.
The topography of New Orleans -- its location below sea level and a "soup bowl" configuration surrounded on three sides by water (the Mississippi River, Lake Ponchartrain and the Gulf of Mexico) -- means that unlike areas usually exposed to hurricanes, the water will not drain readily and will last for weeks, or even months, until it can be pumped out. The wide area of devastation ensures that vast numbers of survivors will suffer prolonged exposure to the water.
I use the term "water" loosely, because what fills the topographical bowl that used to be New Orleans is an unspeakably vile, toxic marinade of industrial and agricultural chemicals (including gasoline, crude oil and pesticides), building materials, cars and trucks, household products, heavy metals, sewage and rotting corpses. A few days of tropical temperatures will make the brew even nastier.
Previous hurricanes offer some indication of what to expect, but the unprecedented numbers of dispossessed persons and the huge area of devastation from Katrina will cause inevitable delays in evacuation that could precipitate unique problems. Most deaths during the first few days are usually due to drowning, and there are inevitably some storm-related vehicle accidents and other injuries, heart attacks and electrocutions. During the following weeks, there are cases of carbon-monoxide poisoning from gas-powered generators.
Although infectious disease outbreaks are seldom a major cause of illness and death following hurricanes and floods in this country, because of Katrina's extreme force, wide swath of damage, and the peculiar geography of some of the region most heavily affected -- which will delay the rescue and relocation of many victims -- the health effects are hard to gauge. Prolonged exposure to sewage- and chemicals-contaminated water and people's inability to perform normal hand-washing will cause water-borne illnesses manifested by diarrhea, fever and skin rashes and infections (a kind of "jungle rot"). In the short term, we will see deaths among the very young and old and the debilitated. Longer term -- weeks to months -- we will likely see significant numbers of cases of hepatitis caused by viruses in the flood waters.
It is unlikely that there will be large outbreaks of more severe water-borne diseases such as typhoid or cholera -- which often follow floods in developing countries -- because these organisms are not commonly found in the United States. Moreover, they can be treated with antibiotics.
In addition, we will see exposure, dehydration (think mid-summer in the Deep South), electrolyte imbalances (caused by replacing sweat with water but not the needed sodium and potassium), and heat prostration. These are life-threatening if not treated promptly and aggressively. Infected insect bites can give rise to cellulitis, a rapidly progressive bacterial infection that can be fatal if not treated aggressively. Especially at risk are those with previously existing health problems, including victims deprived of dialysis, oxygen-generating machines and essential medications for illnesses such as epilepsy, heart and lung disease, thyroid deficiency and diabetes. Many people in acute-care hospitals -- let alone in their intensive-care units -- will deteriorate during transfer to facilities dozens or even hundreds of miles away. Undoubtedly, many of these have already died, and more will do so.
The army of rescue workers from the Red Cross and military and public health agencies that has descended on the South will be working flat-out for weeks. The highest priorities will be to organize food, water and medicines supply lines similar to the ones that supplied several hundred thousand military men and women during the 1993 Gulf War. If they can do it in Iraq, they can do it in Dixie. Although it won't happen instantly, I believe we have the will and the way.
Henry I. Miller, a physician and fellow at the Hoover Institution, was an official at the Food & Drug Administration from 1979 to 1993. Barron's selected his latest book, "The Frankenfood Myth..." as one of the 25 Best Books of 2004.
To see more of the extensive coverage of Hurricane Katrina from TCS, click here.