Beware the Flu, Part Three

Flu season is in full, deadly swing in the U.S., with terrible stories popping up; like this 6-year-old child who died soon after paramedics told her parents that trouble breathing was a common symptom of the flu and to keep her hydrated. Her parents also want people to know that their daughter did not receive a flu vaccine and they are encouraging children to be vaccinated. While this year’s flu vaccine is not a perfect match, it can still reduce the severity of the symptoms.

The flu is so rampant it led to a misdiagnosis for this woman, who actually has necrotizing fasciitis, a flesh eating bacterial infection. The woman is expected to survive, but doctors had to remove 30% of the skin on the left side of her body.

Hospitals in California have had to set up giant medical tents intended for major disasters to handle the influx of patients.

“It’s like trying to surf a tsunami,” said Dr. Brian Johnston, an emergency medicine doctor at White Memorial Medical Center in Boyle Heights. “Maybe the wave has crested, one hopes.”

Another complication to this year’s flu is that many of the IV saline bags used to treat flu patients are made in Puerto Rico, which is still recovering from Hurricane Maria. Hospitals have resorted to two other methods: the “IV push” in which a nurse directly injects the drugs into an IV line (time consuming), and using “an old-fashioned system known as a buretrol device”, also time consuming because many younger nurses need to be trained in this outdated method.

There are only a handful of manufacturers in the US, and one of them – Baxter International – has all of its mini-bag factories in Puerto Rico…Though the federal government has worked with Baxter to get the plants back online, and to allow it to import IV fluids from abroad, serious shortages persist.

Earlier:
Beware the Flu
Beware the Flu, Part Two

Is the Water Safe to Drink?

That’s the question many in Puerto Rico still have. Safe drinking water is more widely available now, but less so for those in more remote mountainous areas. From the Miami Herald:

Although government officials say they’ve distributed water purification tablets and bottled water throughout the island, by late October there were still places where residents said the help hadn’t arrived.

The mountainous area outside Utuado in central Puerto Rico was one of those places. Gambo Rodríguez and his family said they hadn’t gotten any bottled water or purification tablets from the government and couldn’t afford to buy their own.

Leptospirosis, a bacterial disease spread through contact with contaminated water, is a concern. There have been at least 18 confirmed cases, and are likely more that haven’t been accounted for in remote areas.

In the town of Humacao on the eastern edge of the island, local officials were still concerned about getting clean drinking water to the surrounding area in late October.

“I have 58,000 inhabitants and only one truck to take water to the upper areas,” said Ramon Díaz, the assistant director of the local emergency management center. Díaz was meeting with a water and sanitation expert from the nonprofit Oxfam, which was trying to identify the nearby areas in most desperate need of water purification systems.

“Which ones should we prioritize?” water expert Andrea Chaves Arana asked, listing off the names of several places.

“All of them, because they don’t have water,” Díaz responded.

When Death Lurks in the Water

Two people have died from flesh-eating bacteria (necrotizing fasciitis) believed to be caused by the Hurricane Harvey floodwaters. A 31 year old man who was working on recovery projects in the area and a 77 year old woman who contracted an infection when cleaning debris have died.  From CNN:

Necrotizing fasciitis spreads quickly, destroying the body’s soft tissue, and can become lethal within a very short time, according to the Centers for Disease Control and Prevention. However, treatment with antibiotics can prevent death if diagnosed quickly. In some cases, surgery is needed to prevent the spread of this infection, which can be caused by more than one type of bacteria.
“The bacteria that caused necrotizing fasciitis are not strange or unique bacteria,” said Dr. David Persse, public health authority for the city of Houston. He explained these bacteria can live in swimming pools or natural bodies of water, and the flood waters, contaminated by sewage and fecal matter, just “happened to have more” bacteria than other bodies of water.
Meanwhile in Puerto Rico, where many people still don’t have access to clean water over a month after Hurricane Maria, an outbreak of leptospirosis is feared. Puerto Rico has reported at least 76 cases of suspected and confirmed leptospirosis, including a handful of deaths, reports Dr. Carmen Deseda, the state epidemiologist for Puerto Rico. On average, 60 cases are usually reported in a whole year. From the Huffington Post:
Leptospirosis is spread through the urine of infected animals, including rats, pigs, dogs and horses. When a person comes into contact with water, mud or soil that has been contaminated by an infected animal’s urine, the bacteria can enter the body through open abrasions or mucous membranes in the eyes, nose and mouth, according to the U.S. Centers for Disease Control and Prevention. The current conditions in Puerto Rico are ripe for this type of infection…leptospirosis can be treated early on by using antibiotics. If left untreated, in some strains of the disease, patients may hemorrhage in the lungs or experience kidney failure and die.

Snapshots of Despair and Resiliency in Puerto Rico

Over a week ago, Hurricane Maria made landfall as a Category 4 hurricane in Puerto Rico. Maria was the strongest hurricane to make landfall in Puerto Rico since 1928. Only a week before, Hurricane Irma, a Category 5 hurricane, skirted past Puerto Rico lashing it with rain and wind, and leaving millions without power. The situation is now nothing short of dire.  PBS has a good list of places to donate.

From the LA Times:

The scale of the devastation is mind-boggling. The main island of Puerto Rico is about 500 square miles smaller than Los Angeles County, and about a third of the population. At this moment, relatively few of those people have sufficient shelter, access to potable water, or food, or even the ability to travel to find supplies. One mayor warned that “hysteria is beginning to spread.”

People are stranded in high-rises, and few have power for air conditioning to counter the tropical heat and humidity. Those relying on medicines that must be refrigerated (about 14% of the islanders suffer from diabetes; insulin must be refrigerated to maintain its potency) or treatment systems requiring electricity are particularly vulnerable. Local officials report there are still parts of the island from which they have not received damage and casualty reports.

From The Washington Post:

But the scope of the devastation is so broad, and the relief effort so concentrated in San Juan, that many people from outside the capital say they have received little to no help.

“Nothing, nothing, nothing,” said 58-year-old retiree Angel Luis Rodriguez. “I’ve lost everything, and no one has shown up to see if anyone lives here.”

From The New York Times:

For the sick and the elderly, heat can be deadly. Without sufficient power, X-ray machines, CT scans, and machines for cardiac catheterization do not function, and generators are not powerful enough to make them work. Only one in five operating rooms is functioning. Diesel is hard to find. And with a shortage of fresh water, another concern looms: a possible public health crisis because of unsanitary conditions.

The potential for a public health crisis is a big concern, he said. Rats and decomposing animals can spread disease, the doctor added. Without running water, people are probably not washing their hands or boiling water often enough, or cooking their food well enough. This could lead to gastrointestinal outbreaks.

“This is like in war: You work with what you have,” said Dr. Carlos Gómez-Marcial, the emergency room director.