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Disaster health risks weighed

Responders are weighing whether post-disaster illnesses need to be better tracked.

BY SUSAN KIM | BALTIMORE | March 4, 2006

Responders are weighing whether post-disaster illnesses need to be better tracked.

If people get sick after visiting or returning to a disaster area, health officials recommend they see their doctor, then report the illness to their local or state health department. Ideally, states lift significant ailment trends up to the Centers for Disease Control.

For workers who get sick in a disaster zone, illness and injury data is collected on a national level by the Occupational Safety and Health Organization (OSHA).

But those data checkpoints are not the same as a national reporting system dedicated to a specific disaster, pointed out Dr. Roger Boe, consultant for the United Methodist Fellowship of Health Care Volunteers.

In the wake of Hurricane Katrina, Boe reported that several United Methodist volunteers returning from the Gulf Coast contracted cellulitis, a bacterial infection of the skin and underlying tissues. "Some cases have been severe," he said.

The two main causes of cellulitis are strep - the same agent that causes strep throat - and staphylococcus.

"A recent problem has been the development of methicillin resistant staph, or MRSA, which causes a much more serious infection and is very difficult to treat," explained Boe. "Because of this possibility, prompt treatment is required, urgent treatment if spreading rapidly or associated with fever."

MRSA is a growing problem that's not limited to disaster-stricken areas. But post-hurricane conditions have increased the risk of contracting MRSA, said Boe.

"I think there ought to be a national tracking of this in the wake of Katrina," he said, but acknowledged that such a program would have to be well-publicized in order to work well.

"These people scatter to the four winds when they leave and get seen by local physicians," he said. "Unless they get a heads up, they're not going to report these things."

There is a precedent for post-disaster health monitoring. In the wake of the Sept. 11 terrorist attacks, the World Trade Center Medical Monitoring Program was created with support from the United Church of Christ (UCC) and other partners. The program continues to provide free, confidential medical exams to workers and volunteers who responded to the terrorist attacks in New York City.

Florence Coppola, UCC executive for National Disaster Ministries, echoed Boe's call for a national monitoring program. Coppola cited concerns not only about bacterial infections but exposure to environmental toxins.

Relief workers exposed to toxins early on might not show symptoms for weeks, months or longer, she said. "Eventually probably something will come about. I don't know what that something will be. I fear greatly for people who have been working down there, especially people who were working longer shifts that lengthened their exposure."

Boe maintains that the risks shouldn't prevent people from volunteering in hurricane-affected areas. "We've taken far worse risks," he said. "Just be careful and take precautions. My sense is the real risk is very low. Most people are doing fine. That's the bottom line."

But for one Arkansas man, symptoms appeared almost immediately. Jesse Piearcy said he has been sick since he worked at the post-hurricane debris piles in Mississippi - and he feels sure he can't be alone.

In September 2005, Piearcy's company, RMI, was subcontracted by Ashbritt - a contractor for the U.S. Army Corps of Engineers - to assist with debris cleanup near Pascagoula, Mississippi. He stayed for nearly three months.

When he returned home to Springdale - in northwest Arkansas - he developed a rash on his leg that wouldn't respond to several prescription medications. Then he became acutely ill, and was hospitalized for several days. Piearcy's doctors said they have traced a bacterial infection linked to certain areas in Mississippi.

For Piearcy, 36, that began a string of health problems for someone who had rarely gotten sick. "I now have ulcerative colitis," he said. "Then I found out I have diabetes. My liver functions were so high the doctors say it looks as if I was exposed to a lot of pesticides at some point."

OSHA is collecting data on illnesses such as Piearcy's from every government agency, including the Corps of Engineers, said Dean Wingo, OSHA spokesperson. "People who get sick should report it back to who they were working for at the time. Those companies should report it to the Corps or whatever agency contracted them. We're collecting the injury and illness data. It's all being compiled."

Whatever the tracking systems, experts agreed that the risk would be lower in the first place if volunteers, disaster recovery workers and residents received better pre-disaster training.

The Corps of Engineers requires safety briefings for all its employees, but contractors and sub-contractors are responsible for their own safety briefings and requirements, explained Doug Garman, a Corps of Engineers spokesperson.

The Corps of Engineers does not monitor air quality or ground contamination, said Garman. "That's up to the environmental departments."

In December, the Environmental Protection Agency announced that flooded areas were generally safe to return to. State and federal officials have not said there is no danger whatsoever, but said the threat appears consistent with toxic risks typical of many urban areas.

Garman joined Boe and Coppola in a call for some kind of national tracking of illnesses traced to hurricane cleanup.

"When he (Piearcy) goes to visit his physician, the doctor should have some way of marking that down. Because many residents who come back and look at the damage are being equally exposed. What are you supposed to do about it? There should be some tracking system set up."

Meanwhile, some caution will help prevent at least some illnesses in volunteers, workers and residents, concluded Boe. He recommends keeping your hands clean, covering cuts and scrapes, avoiding contact with other people's wounds, and not sharing personal items such as towels or razors.

Boe, who regularly issues health alerts to volunteers, said he tries to balance giving people the facts versus frightening them. "I've had people say: well, don't make it too drastic or people will get scared about going. I say, hey, you have to know the facts."

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