It's been a week since superstorm Sandy unleashed flooding, power outages and wind damage on the east coast, and although recovery efforts are underway, doctors warn that residents are not out of the woods for new health hazards.
Mold Causes Breathing Problems
With flooding comes mold, and it can make victims sick even if it's invisible, doctors warned.
"Even if you're not allergic, mold spores tend to be irritating to the airways and can cause respiratory symptoms," said Dr. David Rosenstreich, the director of Allergy and Immunology at Montefiore Medical Center. He said that an estimated 10 percent to 20 percent of the population is allergic to mold.
Dr. Christopher Portier, director of the Centers for Disease Control and Prevention's Center for Environmental Health, said mold can trigger asthma and even cause headaches when it's in a certain growth phase.
"Mold is going to be a serious problem unless you take care of it right now," said Portier, who also directs the Agency for Toxic Substances and Disease Registry. "It's very tricky to predict what's going to happen with it and the bottom line is that you really don't want it in your home."
Visible mold can be wiped away with a bleach and water mixture. Never mix bleach and ammonia because the gas it creates can be deadly.
Portier suggested removing and discarding drywall and insulation that came into contact with floodwater and discarding items that can't be washed. These include mattresses, carpeting, rugs and stuffed animals.
"It's a long-standing problem. Even if you remove the visible mold, there still might be mold growth between the walls," said Dr. Maureen Lichtveld, who chairs the environmental health department at Tulane University School of Public Health. In New Orleans, Lichtveld experienced the aftermath of Hurricane Katrina in 2005.
Lichtveld said children and elderly people with asthma and chronic lung disease are most likely to get sick because of mold. It's also possible many children lost their asthma inhalers or didn't have time to refill their prescriptions, putting them at greater risk for an attack.
In the months following Katrina, people in the gulf coast began complaining to their physicians about "Katrina cough," which was thought to be caused by extra bacteria and mold in the air after floodwaters remained for six weeks. However, Lichtveld studied the cough and debunked it as a rumor. She blamed it on the combination of flu season and the dry autumn that followed Hurricane Katrina, resulting in more dust particles in the air.
Rosenstreich said he is most worried about children's bedrooms, but Lichtveld said indoor environments at risk for mold contamination include school, day care and nursing homes.
Bacteria Causes Illnesses and Infections
Floodwaters are dangerous because they often contain raw sewage, as ABC News Chief Health and Medical Editor Dr. Richard Besser proved last week, when he tested a sample from lower Manhattan and found gasoline, e.coli and coliform.
But the health risk isn't gone when the water recedes because contaminated puddles and surfaces remain, Portier said.
People, especially children, can get sick by touching contaminated objects and putting their hands in their mouths, causing gastrointestinal problems like diarrhea and vomiting, Portier said. They can also get infections from coming in contact with the bacteria with open sores and cuts, which can be "very difficult to treat."
"Keeping hands clean is very, very important." Portier said. "If you're not sure the water is safe, boil the water before you wash your hands with it."
Rosenstreich added that people can't get sick from simply breathing near the dirty water, but they should wear a mask and gloves when they come in contact with it. Even an unnoticed paper cut can become a big problem.
"I'm looking at my hands now, and I've got a million little cuts from cleaning my backyard," he said. "People have to be really careful."
Carbon Monoxide Poisoning from Back-up Generators
Superstorm Sandy left millions of people without power Monday night, prompting many of them to use back-up generators and coal stoves inside their homes to keep warm. But without proper ventilation, a cozy, alternative heating source can turn deadly when exhaust gets trapped and causes carbon monoxide poisoning.
So far, 439 carbon monoxide exposures have been reported to poison control centers in 12 states in the week since the storm, and four people in Pennsylvania died as a result, according to the CDC.
"It's odorless," Portier said. "You can't tell it's there, and then you start getting a headache, lay down and don't get up."
Carbon monoxide poisoning affects red blood cells, which carry oxygen throughout the body. However, the blood cells pick up carbon monoxide faster than they pick up oxygen, so when there's a lot of carbon monoxide in the air, they don't pick up enough oxygen. The result is tissue damage from oxygen deprivation that can ultimately result in death.
Wood stoves, fireplaces and even generators placed outdoors can produce lethal amounts of carbon monoxide if the ventilation is bad.
Sometimes, people in apartments put the generators outside, and open enough windows to keep their homes ventilated, but the exhaust poisons an unsuspecting tenant in another nearby apartment who wasn't told to open his or her windows.
Home Repairs Gone Awry and Other Injuries
Dr. Joseph Guarisco, the chief of emergency services for Ochsner Health System in New Orleans, said he saw it all in 2005 when Hurricane Katrina filled his ER with patients for months after the storm.
"It's going to be a new environment, and you have to be really mindful and that's the key thing," Guarisco said. "There are dangers lurking everywhere that were not there before the storm."
For the first several weeks, Guarisco's patients ran into problems because they were evacuated outside their health networks and couldn't see their regular physicians or get their prescriptions. He saw many patients with chronic issues, such as renal failure, who couldn't get access to normal treatment like dialysis.
He also saw hydration and nutrition issues, as well as patients who tried to ride out being sick on their own but eventually needed to see a doctor. Some patients tried to eat contaminated or unrefrigerated food, and came down with gastrointestinal ailments.
Once that subsided, the home repair injuries started pouring in.
"As people return [home] it kind of evolves to a different nature of patients trying to put things back together," he said. "They fall off the roof into standing water, lots of eye injuries from branches and debris. Lots of soft tissue stuff."
He said people who had never used power tools in their lives suddenly felt compelled to use power chain saws, power drills and nail guns. Many of them came in with hand injuries.