January 05, 2005
Wednesday

You've seen the horrific images of walls of water rushing up beaches, sweeping away everything - and everyone - in its path. You've seen the dead piled up like cordwood, wounded survivors and persons collapsing upon hearing their entire family has vanished. Alas, you may not have seen the worst.

Dr. David Nabarro, head of crisis operations for the U.N. World Health Organization, warned that disease could take more lives than the waves. "The initial terror associated with the tsunamis and the earthquake itself may be dwarfed by the longer-term suffering of the affected communities," he said.

The main enemy is pestilence that can come from many different sources and cause a bewildering number of deadly diseases. Many are contracted from contaminated water that, according to Gerald Martone of the International Rescue Committee, can carry more than 50 diseases.

These include typhoid fever, dysentery and one of history's greatest killers, cholera. Cholera causes a combination of diarrhea and vomiting, and death can come within hours. Typhoid fever and dysentery can be treated with antibiotics, though such drugs have limited use with cholera. With both dysentery and cholera, the primary treatment is oral rehydration with a mixture of water, salts and sugar.

Once any of these takes hold, there can be hell to pay for years to come. The key to prevention is killing the disease-causing organisms in water, preferably with chlorine. Boiling works temporarily, but any untreated water can become quickly contaminated.

Malaria and dengue fever, both carried by mosquitoes, are already endemic in many of the affected areas and disease levels could dramatically increase as they breed in the countless pools of stagnant water left behind by the waves. Mosquitoes that carry malaria come out at night, those that carry dengue by day. They thus kill around the clock.

Draining the pools would be terribly laborious, especially since mosquitoes can breed in nothing more than a footprint. The best answer would be spraying with DDT. Unfortunately, environmentalists have demonized DDT based essentially on unfounded accusations in a 1962 book, "Silent Spring."

Yet notes Paul Driessen, author of "Eco-Imperialism" and a senior fellow with the Center for the Defense of Free Enterprise, "DDT is not only probably the most effective mosquito killer on earth, it's also been tested for literally decades and has never been shown to harm people." It's questionable whether it even has any impact on the environment. There are other insecticides available, Driessen observes, but "they don't have the repellency of DDT and a single DDT spraying lasts six months."

He says DDT should be sprayed on water pools, tents and on people themselves - as indeed was once common in Sri Lanka and throughout most of the world. "We need to ignore the environmentalists and concentrate on immediate health dangers," he says. Incidentally, by and large, environmental groups also oppose water chlorination.

Typhus, spread by fleas and lice, could also become epidemic, and DDT has an excellent track record in preventing it since it was first dusted on Italian war refugees in 1943.

One bright note is that "contrary to popular belief," according to WHO's Pan American Health Organization, "there is no evidence that corpses pose a risk of disease 'epidemics.' " That means we can have priorities other than disposal of remains. However, adds PAHO, bodies can pose a threat if cholera was the cause of death. Rapid corpse disposal would then be imperative.

It sounds trite, but every day truly counts. There is a tipping point with pestilence. Once a critical mass of illness is reached, the numbers explode. Yet the organization jostling to take the lead in providing relief, the United Nations, has in previous crises proved itself to be a snail with arthritic knees. Look at what it accomplished - or, more to the point, failed to accomplish - in Rwanda and Darfur. The more who die, the faster the world agency twiddles its thumbs.

The United States, other governments and private relief organizations must be willing to push the anemic Kofi Annan aside and deal directly with governments in the disaster areas. We can play politics later; the time to save lives is now.

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