Hospital Patient Deaths After Tsunami - What to Expect

[Missouriwatcher]

24Mar2011:
At least 43 hospital patients dead, some by pneumonia according to an NHK survey of 255 hospitals in hardest hit prefectures. "Most are believed to have died because they did not receive sufficient care due to prolonged power outages and delays in the delivery of medical supplies."
http://www3.nhk.or.jp/daily/english/24_47.html

Oct 2005 article: Atypical Infections in Tsunami Survivors
Christian Garzoni, St?phane Emonet, Laurence Legout, Rilliet Benedict, Pierre Hoffmeyer, Louis Bernard, and Jorge Garbino

"After a tsunami hit a large part of Southeast Asia in December 2004, >200,000 people died and several hundred thousand were severely injured. First aid was provided in local hospitals under difficult conditions. Most patients had multiple fractures, soft-tissue injuries, and complications from near-drowning events...This article aims to raise awareness about the possibility of unusual complications and highly-resistant microorganisms that can lead to extensive illness and death in tsunami survivors.Most clinicians are probably unfamiliar with the pathogens that would be found under these conditions. Therefore, every tsunami survivor should be considered a high-risk patient, even months after the event. The severe and atypical infections they may have pose challenges for diagnosis and treatment, even for experienced infectious disease specialists."


April 2006: Negligible Risk for Epidemics after Geophysical Disasters
Nathalie Floret, Jean-Fran?ois Viel, Fr?d?ric Mauny, Bruno Hoen, and Renaud Piarroux

"After geophysical disasters (i.e., earthquakes, volcanic eruptions, tsunamis), media reports almost always stress the risk for epidemics; whether this risk is genuine has been debated. We analyzed the medical literature and data from humanitarian agencies and the World Health Organization from 1985 to 2004. Of >600 geophysical disasters recorded, we found only 3 reported outbreaks related to these disasters: 1 of measles after the eruption of Pinatubo in Philippines, 1 of coccidioidomycosis after an earthquake in California, and 1 of Plasmodium vivax malaria in Costa Rica related to an earthquake and heavy rainfall. Even though the humanitarian response may play a role in preventing epidemics, our results lend support to the epidemiologic evidence that short-term risk for epidemics after a geophysical disaster is very low..."
http://www.cdc.gov/ncidod/EID/vol12no04/05-1569.htm

 

[cartski]

Re: Hospital Patient Deaths After Tsunami - What to Expect

The above article, Negligible Risk for Epidemics after Geophysical Disasters, used a literature search for published reports and only found 3. But the discussion asked why there are not more when we generally expect disease outbreaks after catastrophic events. One possible answer is that the evidence needs to be gather using novel means:


Emerg Infect Dis. 2009 May;15(5):689-95.

Use of unstructured event-based reports for global infectious disease surveillance.
Keller M, Blench M, Tolentino H, Freifeld CC, Mandl KD, Mawudeku A, Eysenbach G, Brownstein JS.

Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Boston, USA. mikaela.keller@childrens.harvard.edu

Abstract
Free or low-cost sources of unstructured information, such as Internet news and online discussion sites, provide detailed local and near real-time data on disease outbreaks, even in countries that lack traditional public health surveillance. To improve public health surveillance and, ultimately, interventions, we examined 3 primary systems that process event-based outbreak information: Global Public Health Intelligence Network, HealthMap, and EpiSPIDER. Despite similarities among them, these systems are highly complementary because they monitor different data types, rely on varying levels of automation and human analysis, and distribute distinct information. Future development should focus on linking these systems more closely to public health practitioners in the field and establishing collaborative networks for alert verification and dissemination. Such development would further establish event-based monitoring as an invaluable public health resource that provides critical context and an alternative to traditional indicator-based outbreak reporting.

PMID: 19402953 [PubMed - indexed for MEDLINE]PMCID: PMC2687026Free PMC Article

 

[morningperson]

Re: Hospital Patient Deaths After Tsunami - What to Expect

Very interesting articles. Can we discuss them here in this thread or do we need to start a new one?

 

[Missouriwatcher]

Re: Hospital Patient Deaths After Tsunami - What to Expect

Probably start a discussion. If discussion wouldn't get too opinionated, you might comment here.

 

[JimO]

Re: Hospital Patient Deaths After Tsunami - What to Expect

I suppose that the cholera outbreak in Haiti would fall into this category. It's probably stating the obvious, but I'm sure that the quality of healthcare and the resources of the area that is affected are key factors impacting whether or not disease follows these types of events. The situation in Haiti is such because they were so poor to start with and are living in very poor conditions. Recovery there is extremely slow.

I would not expect the same thing to happen in a nation like Japan, where there is much more wealth and they have the latest in healthcare technology and facilities. I don't expect epidemics among those who lost their homes in Japan since they have the resources to help people get back on their feet more quickly.

 

[alert]

Re: Hospital Patient Deaths After Tsunami - What to Expect

I think we have to distinguish carefully between two different types of deaths that are being discussed. The cholera outbreak in Haiti is the result of an additional infectious disease being added to the mix as a result of the breakdown in sanitation due to the disaster. Other disaster hit regions have had outbreaks of dengue, leptospirosis, typhoid, and other diseases in much the same way.

Something quite different seems to be happening in the Japanese shelters. The deaths seem to be the result of illnesses the people already had (diabetes, heart disease, etc.) that can no longer be treated due to the disaster. Those patients were already in the hospital when the tsunami hit.