Haiti Cholera Update # 7

As of writing, MSPP (Ministère de la Santé Publique et de la Population) has not released updated information on cases/deaths. The latest figures were to be released at 1000 this morning, but I have been unable to find any information regarding them. The last report was on 30 October 2010 when 337 deaths and 4,764 were noted. According to HaitiLibre: “[T]he government has not issued (at the time this article was written) any new assessment since Saturday on the evolution of the cholera epidemic in the country because of public holidays [!], this is, despite the maximum health warning level (the holidays seem to take precedence over the government’s crisis and information to the population).”

Tropical Depression Tomas weakened significantly overnight, and is not now forecast to regain hurricane strength before making landfall on the southwest peninsula Friday morning. However, Jeff Masters writes the gravest danger is not from the winds, but the heavy rainfall, which may well be an event spread over several days:

It doesn’t take much rain to cause a flooding disaster in Haiti–ordinary seasonal heavy rains have killed 23 people in southern Haiti over the past month, including twelve people in Port-au-Prince this past weekend. According to the Associated Press, most of last weekend’s deaths occurred when surging rivers burst through houses built in ravines. With the soils already saturated from last weekend’s rains, the stage is set in Haiti for a significant flooding disaster capable of causing heavy loss of life.

[snip]

Crucially, the storm has waited too long to begin this process, and it now appears unlikely that Tomas will have time to grow beyond Category 1 hurricane strength before landfall in Haiti on Friday. NHC is giving Tomas a 5% chance of reaching Category 3+ strength, which is a reasonable forecast. With the atmosphere expected to be very moist, it is likely that Tomas will dump very heavy rains of 4 – 8 inches over much of Haiti, even if Tomas strikes as a tropical storm. Rains of this magnitude are capable of causing heavy loss of life due to extreme floods running down Haiti’s deforested mountain slopes.

In the context of the cholera epidemic, it is probably not necessary to add the much increased risk of exacerbation of contaminated water supplies. From the Pan-American Health Organization’s briefing yesterday:

We cannot overlook the vulnerable populations who do not live in these resettlement camps and may not have access to safe drinking water. The response must be comprehensive.

An emerging top priority now for all of us is preparing for Tropical Storm Tomas. We have received reports that the storm has already had a serious impact on St. Lucia, with mudslides and severe damage to the island’s water systems.

If the storm hits Haiti, it’s obvious that is will make a difficult situation even worse. Cholera is mainly being spread through contaminated water, and more water supply disruptions pose additional increased risks for cholera and other waterborne diarrheal diseases.

The bad sanitary conditions in many areas, combined with what the hurricane poses as huge amounts of rain and possibly flooding, are very likely to accelerate the spread of infection, making the overall caseload increase earlier and faster.

MINUSTAH (La Mission des Nations Unies pour la Stabilisation en Haïti — United Nations Mission for the Stabilization in Haiti) issued a statement revealing test results absolving peacekeeping troop of any role in the transmission of cholera:

La Mission des Nations Unies pour la Stabilisation en Haïti (MINUSTAH) se félicite de la contribution scientifique du Laboratoire National de Santé Publique (LNSP), en Haïti, et des Centres de Prévention et de Contrôle des maladies (CDC), à Atlanta, qui apportent des éléments de compréhension de l’épidémie de choléra en Haïti.

Selon leurs conclusions, la souche de choléra responsable de l’épidémie est identique à une souche trouvée en Asie du Sud. Toutefois, en raison de la rapidité des mouvements des souches de choléra à travers le monde – transmises par des aliments, des eaux contaminées ou par des personnes infectées – des spécialistes de la santé ont souligné la difficulté, voire l’impossibilité de déterminer, avec précision, la manière dont le choléra est arrivé en Haïti.

La MINUSTAH continuera à prendre les mesures préventives nécessaires dans le but de protéger le peuple haïtien et son propre personnel. Des tests des échantillons d’eaux prélevés à l’intérieur de la base militaire à Mirebalais et à l’extérieur, aux abords de la rivière, ont été conduits le vendredi 22 octobre et le mardi 26 octobre, et les résultats se sont tous révélés négatifs. Des tests supplémentaires ont été effectués le mercredi 27 octobre, à la demande du Commandant de la Force, à l’intérieur du camp et entre le camp et la rivière. Ces tests ont été analysés par un laboratoire indépendant et se sont aussi révélés négatifs.

(The UN Mission for Stabilization in Haiti (MINUSTAH) welcomed the scientific contribution of the National Laboratory of Public Health (LNSP), Haiti, and the Centers for Disease Control (CDC) in Atlanta, all of which provided basic understanding of the cholera epidemic in Haiti.

According to their findings, the strain of the cholera responsible for the epidemic is the same as the strain found in South Asia. However, because of the rapidity of movement of cholera strains around the world — transmitted by food, contaminated water or by infected persons — health specialists have pointed out the difficulty or impossibility of determining precisely the means by which cholera came to Haiti.

MINUSTAH will continue to take preventive measures necessary in the end to protect the Haitian people and its own personnel. Tests of water samples taken from inside of the military base at Mirabalais and exterior to it on the banks of the river were conducted on Friday 22 October and Tuesday 26 October, and results were shown to be all negative. Supplementary tests were done on Wednesday on the order of the Commandant of the Force, in the interior of the camp and outside the camp and river. These tests were analysed by an independent laboratory and again were found negative. [My translation.])

Finally, a few excerpts from an interview with Laurie A. Garrett, Senior Fellow for Global Health, Council on Foreign Relations:

But it’s inexcusable that we cannot control cholera today. We fully understand the disease. It is generally treatable with a combination of appropriate antibiotics. But most important is heavy-duty hydration with consistently safe water. The main thing with cholera is that you dehydrate. And death is associated with massive dehydration. If the water is the source of the cholera and you rehydrate with that water, you’re simply redosing yourself with the microbe, and you subsequently die. If you have safe water, you can slow down the pace of dehydration. Then you can slam with the appropriate antibiotics.

*****     *****     *****     *****     *****

[Question.]There’s aid money flowing into Haiti, and people have known about the deplorable sanitation and water systems in Haiti for a long time.

Actually, money isn’t flowing in. Senator Tom Coburn (R-OK) has held up more than $1 billion dollars for Haiti because he is unhappy with the State Department appointment for an individual who will play a key role in relief operations. So while dollars have been committed, they’ve not flowed at a rate that would allow us to feel comfortable that there is sufficient funding. Bulldozers and heavy lifting equipment to deal with the debris and to destroy shattered buildings only started moving really in the last couple of weeks on a major scale.

It’s shocking how far down the road we are without doing what you would do in any American city in a similar situation–mow down anything that would have been declared unsuitable for habitation and then start rebuilding. But most of Port-au-Prince is still debris, and it’s hard to build plumbing systems, sewer systems, water treatment systems when the debris is sitting in the way. However, I have to say that it’s my understanding that most of the water being distributed in the form of drinking water in Port-au-Prince is actually coming from specifically pumped water stations. That may actually protect Port-au-Prince from a serious outbreak.

More resources:

Haiti: Operational Biosurveillance (Twitter)

H5N1

HaitiLibre (English) (français) (Twitter — English and French)

Mediahacker: Independent multimedia reporting from Haiti (Twitter)

PAHO’s Haiti Cholera page. (PAHO Situation Reports and other documentation.) (Blog.)

On the ground, good sources of information and of course needing donations:

Partners in Health (Twitter).

Médecins sans frontières

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