Fearing a Second Wave of Devastation Post-Tsunami

Jan. 27, 2004 — -- In the tense days following the Asian tsunami, as the death toll climbed into the tens of thousands, health experts feared the disaster could spawn a second wave of deaths from disease.

"Unless the necessary funds are urgently mobilized and coordinated in the field we could see as many fatalities from diseases as we have seen from the actual disaster itself," Dr. David Nabarro, head of crisis operations at the World Health Organization, told The Associated Press.

But one month later, with just a handful of disease cases coming from the region, it appears that statements like Nabarro's may have helped to mobilize the health efforts that successfully prevented massive outbreaks of diseases such as cholera and typhoid.

"People had a high level of awareness," said Dr. Stephen S. Morse, epidemiologist and director of the Center for Public Health Preparedness at the Mailman School of Public Health at Columbia University in New York.

"That awareness and that mobilization is very important," said Morse. "It paid off, then, with people acting rapidly and doing immunization to prevent that spread [of disease]. Some of it is good prevention, some of it is good luck."

A number of factors contributed to the relatively low incidence of disease seen following the tsunami, including the generosity of donor nations and individuals worldwide.

"It's the result of an enormous international effort," said Dr. Robert Edelman, professor of medicine and associate director for clinical research at the University of Maryland's Center for Vaccine Development. "We've been lucky, we've been proactive, and the outpouring of international aid has been tremendous."

Edelman also credits the fact that many residents of the areas affected by the tsunami did not collect in densely populated refugee camps, where the spread of disease likely would have been rapid.

"People were kept in isolated villages -- that reduced the overall impact," he said.

Dr. Martin J. Blaser, chairman of the Department of Medicine at New York University School of Medicine and president-elect of the Infectious Diseases Society of America, believes the spread of disease was thwarted by the stable health systems in many areas affected by the tsunami.

"The most important factor is that these communities were previously healthy," said Blaser, adding that if cholera had been a problem before the tsunami, many more cases would be seen now.