It has been nearly a month and a half since Hurricane Maria hit Puerto Rico as a Category 5 storm. Current estimates indicate that a disturbingly high number of citizens are still without drinking water, and an even higher number are without power. The disbelief we might have at this happening on U.S. soil in 2017, while substantial, isn’t really the point of this post. I’d like to discuss two numbers: 76 and 911.
First up? Seventy six. While most of us working in infectious diseases fully anticipated an increase in illness among Puerto Rican citizens in Maria’s wake, very few of us anticipated 76 leptospirosis cases. This disease is spread via contact with contaminated water, and ranges from a flu-like illness to a hemorrhagic fever featuring jaundice to meningitis. Infection of the occasional patient with Leptospira species isn’t drastically unusual, but an outbreak of this size is. This is for one simple reason: when a patient presents with leptospirosis (or a water source tests positive for it), the water source is immediately identified and closed off to the public until the bacteria are eliminated. In Puerto Rico, citizens were reduced to drinking from streams and wading through standing water. There were no options. On some parts of the island, there still aren’t. Leptospirosis is neither quick nor painless as a fatal infection; however, it
doesn’t usually come to that in Western countries. It is highly treatable with a very inexpensive course of antibiotics (most commonly doxycycline). The hitch here is that patients have to have access to physicians and medication to receive treatment, which has been logistically difficult in the aftermath of Maria. On two fronts, this should not be happening. Leaving citizens without potable water after so long should not have happened. People dying of a treatable infection acquired by lack of potable water because they can’t access the treatment is salt in an unnecessary wound. The current estimate is 76; it is undoubtedly going to go up.
This brings us to the second number: 911. This is the number of people deemed to have died of “natural causes” following Maria. These folks will not be included in the official death toll from the storm (currently 51 deaths), but they in all likelihood should be. Dying of appendicitis is perfectly natural. Dying of appendicitis because the only hospital you could get to had a disabled operating room due to lack of electricity? Natural, but highly avoidable. The same could be said for those who died of complications from diabetes because they could not keep their insulin cold, or those who died of relatively mild cardiac episodes in the absence of modern healthcare, or those who died of infection because they could not get antibiotics dispensed. All of those are natural causes, yet all of those were avoidable. As a reminder, 70% of the island is still without power and about 1 million people are still without drinkable water. Nearly half of the 70 hospitals are still closed. The number 911? It will get larger.
We should never forget that it didn’t have to.
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Images should be credited to Marcus Santos (1) and the Bergey's Trust (2)