

More From Forbes

Edit Story

Hidden Health Hazards After Hurricanes: What To Expect After Harvey

Judy Stone
This article is more than 4 years old.

After the immediate damage and loss of life from Hurricane Harvey, many hazards remain, and infectious outbreaks will likely follow.

Immediate problems will be from injuries, exposure and drownings. The longer-term fallout will include stress-related illnesses, ongoing anxiety and depression among those traumatized and displaced by the hurricane.

Often overlooked are the biological effects. Infections following hurricanes are usually gastrointestinal or wound related.

All of these problems will be compounded by the neglect and dismantling of public health infrastructure.

Water-borne infections

Flood water will likely be heavily contaminated by sewage and by toxic chemicals, so diarrhea will be common.

Major GI pathogens include parasitic infections such as Cryptosporidiosis and Giardia, which cause prolonged diarrhea; viral infections from Hepatitis A, Norovirus or Rotavirus; and bacterial infections from E. coli, Shigella, Salmonella, Vibrio or leptospirosis. Except for the parasite cases, most of the infectious diarrhea will be self-limited. All of these infections are particularly problematic for those at the extremes of age and those who become dehydrated.

Cholera has not been a problem in the U.S. and is not expected to cause any outbreaks here. It is a major problem in the Middle East, India and Haiti, where it was introduced by UN aid workers following the devastating earthquake there.

Leptospirosis is an infrequently seen infection, caused by bacteria found in water and transmitted by the urine of rats, mice, raccoons and cattle, among others. It can infect dogs as well as people and can cause liver or kidney failure in both humans and pets. A fascinating outbreak occurred in Costa Rica among whitewater rafters, so those participating in freshwater sports are at risk. Outbreaks of leptospirosis occur sporadically around the world, often precipitated by flooding.

Wound infections

Further, wounds can be readily infected by the dirty water, and it is easy to cut yourself on sharp objects hidden by the water. There are some particularly virulent bacteria causing wound infections that would likely need stronger antibiotics than might typically be prescribed. These include Aeromonas and Vibrio.

The warm waters of the Gulf Coast encourage Vibrio’s growth and will likely pose a particular risk after the hurricane. As mentioned in this recent post on Vibrio, wound infections can be fulminant, characterized by sepsis and a rash with bloody blisters (hemorrhagic bullae). It’s important to recognize this, as different antibiotics are needed.

Tetanus, a deadly disease that, fortunately, is readily vaccine preventable, is also a concern as numerous puncture wounds are likely and the water and soil may be contaminated.

Trench foot is a complication of flooding made famous in World War I when such infections were common among soldiers. There can be skin and muscle damage and subsequent infection from the prolonged immersion, sometimes leading to gangrene and need for amputation.


Immediate problems from flooding include drowning (the major cause of death), electrocution and hypothermia. Orthopedic injuries tend to grow after the initial storm subsides, as people begin to rebuild their lives, and peak several weeks later.

Mosquito-borne infections

After the hurricane subsides, there will be pools of stagnant water, a perfect breeding ground for mosquitoes. This was already a disproportionate risk in poorer areas of cities like Houston.


After Hurricane Katrina, a doubling of West Nile disease cases was seen in the hurricane-affected areas of Louisiana and Mississippi.

Dr. Peter Hotez of Baylor has explained repeatedly that the poor are disproportionately affected by insect-borne diseases like Zika, dengue, West Nile and Chagas. Standing water in tires and debris in the street form breeding grounds. Many poor people don’t even have window screens, let alone air conditioning, exposing them to a variety of infections.

Drinking water

Water will be unsafe to drink after a hurricane. The CDC offers recommendations for those without bottled water, but frankly, the people affected likely won’t have electricity or many supplies. Sources of clean water in a home are the hot water tank and the water reservoir tank on toilets. Other water can be treated in one of three ways:

  • Bring water to a rolling boil for one minute.
  • Use household bleach. Add 1/8 teaspoon of new, unscented liquid bleach to one gallon of water. Stir well. Let the water sit for 30 minutes before you drink it.
  • Use water-purifying tablets.

Water from private wells may become contaminated and should be tested.

Politics and public health

There are broader concerns only highlighted by the hurricane. Public health funding has been decimated. Since the early 2000s, there has been a drop of at least 41% in the number of people doing mosquito surveillance. In other areas, too, “public health laboratory capacity for proactive surveillance is poor to nonexistent in most states,” according to the damning 2014 report by the Council of State and Territorial Epidemiologists.

I was appalled at the barbaric announcement yesterday that the Border Patrol would not close checkpoints during the hurricane, forcing people to risk their lives staying in dangerous areas threatened by the storm or face deportation if they attempt to evacuate. In contrast, in 2012 (Hurricane Isaac) and 2016 (Hurricane Matthew), ICE took a more reasoned approach, stating, “There will be no immigration enforcement initiatives associated with evacuations or sheltering related to Matthew, including the use of checkpoints for immigration enforcement purposes in impacted areas during an evacuation."

There has previously been pressure on hospitals to report undocumented people to ICE. While that has stopped as a formal policy, immigrants are delaying seeking vital health care, understandably afraid that they would be targeted. Not only is this cruel, but it is likely more costly, as waiting until an illness becomes catastrophic, and forces an emergency room visit, will be more expensive.

Further driving people underground is poor policy. Studies have shown that the criminalization of drug use has a negative effect on HIV prevention and treatment, increasing both the use of shared needles and the resulting HIV infections. Lowering the threshold for prison for minor drug offenses helps only the prison-industrial complex.

Similarly, stigma increases rates of sexually transmitted diseases at a time when health departments have suffered drastic cuts.

In order to respond effectively to disasters, we need a competent and caring response — more than the “Heck of a job, Brownie” that we got during Katrina, and more than President Trump’s lame “Good luck” as he left the White House. Trump’s FEMA director, Brock Long, has some qualifications for his role. But with climate-change deniers and those who are hellbent on undoing environmental protections at the helm of other agencies, as well as the increasingly strong-arm tactics of ICE, we’ll be hard pressed to respond effectively to this hurricane or other future disasters.



