Doctors Debate Tsunami Health Impact

Jan. 6, 2005 — -- As the world grapples with the enormous carnage from the earthquake and tsunami in South Asia, health officials are warning the death toll could rise even higher if the disaster spawns widespread outbreaks of disease.

But some experts are concerned about misconceptions and inaccurate information regarding threats -- real and imagined -- to public health.

Dr. David Nabarro, head of crisis operations at the World Health Organization, has been widely quoted as stating the death toll from the tsunami may double as a result of 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," Nabarro told The Associated Press.

But some in the medical community believe comments regarding a high death count from diseases like cholera, typhoid fever and malaria may be difficult to substantiate.

"It's impossible to make a prediction like that," said 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.

"I do think that the point the WHO is trying to get at is the potentiality for these diseases, especially infectious diseases, to become major problems if we don't anticipate and manage these diseases," Morse said.

"I am not sure where the gloom and doom stories of massive epidemics killing more people than the tsunami come from, but they are off the mark," said Dr. Duane Gubler, chairman of the Department of Tropical Medicine and Medical Microbiology at the University of Hawaii's John A. Burns School of Medicine.

Gubler notes that for diseases like dengue fever and malaria, the greatest health risks are to the relief workers. "Most of the adult population in these countries are already immune," Gubler said.

Other experts, however, believe the WHO's estimate is entirely accurate.

"It's on target," said Dr. William Greenough of the Bloomberg School of Public Health at Johns Hopkins University in Baltimore. The incidence of certain diseases, Greenough says, often occurs several weeks after a natural disaster. Cases of cholera, for example, "would peak in about 12 weeks."

Human Remains Not an Immediate Risk

While local officials have made the disposal of bodies a high priority following the Dec. 26 tsunami, "it's not an immediate or large public health risk," said Greenough.

"You do need to dispose of them [bodies] as quickly and efficiently as possible," said Gubler, "but there's no immediate threat of epidemic disease. They didn't die of an infectious disease.

"The biggest risks are from water- and food-borne disease," he said.

While the threat of mosquito-borne illnesses like malaria is real, most of the mosquito population has been wiped out -- for now.

"The risk of mosquito-borne diseases is relatively low," said Morse, who noted that flooding by salt water would wipe out the mosquitoes' freshwater breeding areas. "But it's something to be very careful about later on."

As the monsoon season begins, the opportunities for mosquito-borne diseases to spread will increase, Morse said. With proper planning, however, there is reason to be optimistic.

"Sometimes these things don't happen because we anticipate them," Morse said.

Crowd Control

One of the biggest risks to public health is based on assumptions about shelter, according to Gubler. Crowded shelters and refugee camps greatly increase the risks of communicable diseases.

"When you start putting people into shelters and crowding them in, that's exactly what you're going to see," Gubler said.

He adds that local knowledge and resources may be the best way to manage any disease outbreaks.

"We frequently go in as do-gooders and assume [locals] can't do anything for themselves," he said, "but there are many local experts in these areas who are very resourceful."