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Experts: Disease outbreaks a real threat

Public health problems loom in Katrina's wake

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David Keifer leads his sister and son through flooded streets in New Orleans on Wednesday.

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(CNN) -- Survivors of Hurricane Katrina face multiple health threats such as infectious diseases and respiratory and gastrointestinal illnesses, health officials warn.

"The first thing we have to do is make sure we have good sanitation, which right now for many areas in the Gulf region we have none: no running water, no sewers," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research & Policy at the University of Minnesota.

"We have people congregated in areas [such as the Louisiana Superdome] where agents of infectious disease are at a very high risk, so the potential for disease outbreaks is real."

The Bush administration declared a public health emergency Wednesday for the entire Gulf Coast to help prevent the spread of disease and provide medical care. (Watch: Public health implications 'very severe' -- 3:05)

While some health officials have mentioned the possibility of cholera and typhoid, Osterholm said those diseases don't pose a problem because they didn't exist in the region before the hurricane.

"But a lot of other diseases which do exist in the area are real," he said, such as hepatitis A and other vaccine-preventable diseases.

"When you get that many people together under those conditions, just one person who's infected could infect many other un-vaccinated people."

Food-borne outbreaks such as E. coli and transmittable respiratory illnesses are also a threat, he said.

"The next few days, staying hydrated is the big thing and avoiding consuming contaminated foods and water. ... If you can do that, you're probably OK for a week," said Dr. Joseph Guarisco, chairman of the Department of Emergency Medicine at the Ochsner Clinic Foundation in New Orleans, Louisiana.

"Beyond that, unless we get water and electricity going, it's going to be impossible to live here. Just impossible."

Minor injuries also may turn into major issues as the days pass and infection develops.

"You could have a very healthy 25-year-old who was [slightly wounded] during the actual [hurricane] who doesn't appear to be very sick the first day or two but then actually has a life-threatening infection by day three or four," Osterholm said. "So it's important to find those people."

But dead bodies should not be a disease concern to the public, he said.

"Let's just make it real clear: Dead bodies in and of themselves -- while they are mental health issues and tragic -- they are not a public health issue from an infectious disease standpoint at all," Guarisco said.

Sick, injured expected to double

Along with contaminated water, spoiled food and potential disease outbreaks, health officials also warn those in the area about carbon monoxide poisoning, hazardous waste, wild animals and days in the boiling heat.

"It's pretty devastating out there," said Guarisco, whose hospital's higher location spared it flooding.

"We're seeing people on roofs and in attics. We have people who have no access to any type of resources," he said. "We're seeing lots of dehydration and a lot of patients with chronic medical conditions who don't have their medicines."

Guarisco said he expects to get only busier in weeks to come as floodwaters recede and the sick or injured are able to make it to health centers.

"Traditionally, cases will double within a week or two after disasters," he said. "We haven't seen a lot of the specific hurricane-related problems yet, which are going to be trauma, lacerations, that sort of thing.

"[After that] will be all the citizens coming back into the city and putting things back together and cutting off fingers, electrocuting themselves, some falls and slips -- there will be those types of injuries as people try to put lives back together."

Wild or rabid animals also may pose a threat as flooding forces close contact with humans, which usually would not happen. In rural areas, Osterholm said snake bites also could be a problem as the reptiles share watery space with people.

Mosquitoes, which could possibly spread diseases such as West Nile, most probably will be a big nuisance in places such as Biloxi and Gulfport, Mississippi, where stagnant water, not deep flooding, is pervasive, according to Osterholm.

"[Mosquitoes will] make living very difficult to the point where in the evenings you're going to have people who find it difficult to sleep, difficult to work," he said.

Meanwhile, as full power to some areas is weeks away, officials are warning that the use of generators and indoor camp stoves or grills can to lead to carbon monoxide poisoning if not handled correctly. The colorless and odorless gas can build up quickly to deadly levels.

'You don't know night from day'

The Federal Emergency Management Agency has placed all units of its National Disaster Medical System on alert and has mobilized many of them. The system consists of some 8,000 medical and support personnel from federal, state and local governments and the private sector.

The military also is sending medical help, including the Navy hospital ship USNS Comfort to reach the region in about a week. Four ships from Norfolk, Virginia, are being loaded with food, soap and medical supplies.

But even after the physical threat passes, experts said the hurricane-hit population still has to deal with the psychological effects.

"Many people will be stressed and will require support over a long period of time and will be vulnerable to psychological problems. We know this from other disaster experiences," said Dr. Irwin Redlener, head of Columbia University's National Center for Disaster Preparedness.

Guarisco said that he has been at his hospital since Saturday and that many of the staff have been stranded there since Katrina's arrival. Working in day and night shifts, they are able to take some breaks, but the stress is still there for them and the patients, he said.

"Cell phones are down, the Internet is down. Communication is really bad. There's stress not knowing what your home looks like or how your family may be," he said. "And then the stress of just being locked in to a hospital for five days -- you just go from room to room; your sleeping quarters change all the time; you don't know night from day."

In the coming weeks, as the population begins physically to reconstruct, the need for mental reinforcement will be key, according to Redlener.

"The combination of needing the mental health support and trying to re-establish some semblance of life and access to vital services creates an extraordinarily complex rescue environment that people are trying to work through right now," he said.

"We have to bring services to people pretty fast. Or they'll see big problems."

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