The following is an opinion article from Jaclyn Guerrero, applied epidemiologist at Metabiota. The views expressed within the article are not necessarily those of Insurance Business.
Harvey. Irma. Maria. These recent catastrophic storms have wreaked havoc on our cities and in our minds. Each hurricane will require months and even years of rebuilding efforts, costing billions of dollars to communities, homeowners, businesses and governments, and likely will result in the most expensive hurricane season to-date.
However, the ultimate damage and risk posed by these storms may reach beyond their immediate impacts on homes and infrastructure. Natural disasters, such as earthquakes, hurricanes, and floods, can promote environmental conditions and population characteristics favorable for infectious disease transmission leading to possible epidemics. While this threat (especially the risk of disease from exhumed bodies) has been often overemphasized by the media, leading to further panic and confusion, it remains a tremendous source of concern should opportune conditions arise.
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While disease outbreaks do not always occur in post-disaster settings, there are several risk factors that elevate the probability of an outbreak. These include significant population displacement, inadequate shelter, proliferation of disease vectors, compromised hygiene, overcrowding, and reduced access to medical care. Some of these conditions can result in weakened underlying immunity in the human population. Others, such as population movement, can facilitate the spread of outbreaks. Damage to basic elements of infrastructure such as sewerage, energy, roads, and health facilities, can further result in ineffective outbreak response and management.
When infectious disease outbreaks have been documented in the wake of natural disasters, large or high impact outbreaks are the exception rather than the rule. Large outbreaks typically only occur in contexts that have substantial population displacement, overcrowding, breakdown of infrastructure, or the introduction of a pathogen previously not present in the affected region. One of the most notable examples of disease introduction following a natural disaster is the cholera outbreak following the 2010 earthquake in Haiti, which continues to this day.
The catastrophic 7.0 earthquake in Haiti caused over 1.3 million people to be displaced, and it severely damaged an already marginal public health sanitation system. Within nine months of the earthquake, an outbreak of cholera was confirmed for the first time in over a century. The disease quickly spread across the country, resulting in over 800,000 cases and 8,000 deaths. The outbreak continues seven years after the inciting earthquake. Notably, cholera was not endemic in Haiti prior to the earthquake, but was introduced by foreign aid workers following the earthquake, resulting in wide exposure to a susceptible, local population with weakened sanitation, public health, and medical infrastructure.
While vulnerable populations and communities are most susceptible, developed countries are not immune to the impacts of infectious disease following a disaster, just as developed nations are not protected from natural disasters. Following Hurricane Harvey in Texas, three people lost their lives from wound infections from the floodwaters. In Puerto Rico following Hurricane Maria, there have been dozens of suspected cases of leptospirosis, a bacterial illness spread through ingestion or contact with water contaminated with rodent urine, which have resulted in at least two confirmed deaths from the disease.
Whereas natural disasters typically impact a single country or a small region, infectious disease outbreaks recognize no bounds – if conditions are favorable, an outbreak can spread across a region with the potential to spread globally. The question remains, not only how prepared are we as an international community to face natural disasters, but how equipped are we are to respond to the potential secondary and tertiary consequences and risks following an event?
There are several ways that the international community can prepare for infectious diseases following natural disasters. Governments and businesses should augment their emergency preparedness plans with procedures and insurance solutions to respond and financially protect companies from the effects of infectious disease events following a storm or event, particularly in regions that are prone to both disasters and outbreaks. Both disaster and infectious diseases risk vary greatly by geographic location, necessitating that these plans vary by event and region to ensure that areas recovering from a storm are not further crippled by an infectious disease outbreak.
Additionally, all contingency plans should contain the framework to respond to outbreaks and associated panic that could affect employees, disrupt supply chains, or close facilities already in a weakened state following a natural catastrophe. Even if an outbreak does not follow an event, there will certainly be public fear that an outbreak will occur, further disrupting normal business and government practices. Lastly, disease surveillance and detection need to withstand a crippling disaster; once an event occurs, active surveillance should begin to monitor and stop infectious disease transmission before an outbreak can occur. Awareness, preparedness, and effective response are key to minimizing the potential of an infectious disease outbreak from the consequences of a natural disaster.
While events like Harvey, Irma, and Maria have caused long-lasting damage, they remind us that not only do we need to assess and manage risk directly related to natural disasters but secondary disasters, such as infectious disease outbreaks. We must act now to ensure that further disruption does not occur following catastrophes such as these.
About the Author
Jaclyn Guerrero is an applied epidemiologist at Metabiota, the pioneer in epidemic risk modeling. Guerrero’s research and analytical work focuses on infectious disease and global health, with current projects on public sentiment on infectious disease and disease emergence, spread, and pandemic risk. She received her MPH in Epidemiology/Biostatistics and BA from UC Berkeley’s School of Public Health.
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