Comment on Post at Effect Measure
Here's a CNN story based on an interview with Louisiana Department of Environmental Quality Secretary Mike McDaniel.
MSNBC reports 5 vibrio vulnificans deaths.
Revere(s)--
Isn't access by coliform bacteria to the bloodstream a concern here? With the crazy high levels of coliform in the flood waters (one report said 20K colonies/100 mL), wouldn't people walking around in floodwaters with open sores and wounds potentially lead to bacteremia and sepsis?
Also, people rescued from near drowning conditions may have aspirated some of the floodwater meaning gram-negative pneumonia is a concern too, no?
viget: If you mean sepsis following a wound infection, yes, that is a possibility at any time. I noted they need to be aggresively treated. But the high colony count is probably mainly non-pathogens. This water is undoubtedly loaded with pathogens and the risks might be similar to those faced routinely by those who work in sewage treatment plants, which is elevated but not stratospheric. Your bowel, skin and the environment in general is loaded with organisms. The problem here is that there are also enteric pathogens, mainly viruses and maybe in some cases V. vulnificans that make contact with this water problematic.
My post mainly dealt with highlighting E. coli here. Most E. coli is harmless, but the accompaniments of E. coli in this case--run of th mill bacterial pathogens and viruses--are what we were afraid of before and remain concerned about now. The "discovery" of E. coli is both unsurprising and expected, and in most senses irrelevant.
Okay I see then. The E. coli is just a marker. Is that why beaches are also closed when coliform levels get above a certain threshold, because they're really worried about other undetected pathogens that are associated with that level of contamination? I'm not being snarky here, I'm really just curious.
Revere et alia,
You're right on the money. Can't get the trackback to take. Mentioned you at least once, and thought of your analysis, in a longish overall critique of the Katrina disaster. Hope you'll take a look and comment. Take care,
Kaspit
viget: Yes, correct. There are some pathogenic E. coli strains (O157H7 being the most notorious, the "Jack in the Box" strain) but primarily coliforms (a heterogeneous group that includes E. coli but also many other non-pathogens) are indicator organisms. This is becuase for routine use, trying to detect small numbers of specific bacteria is chancy and difficult and requires different culture techniques for each and the viruses are very difficult to assay for routinely.
Kaspit: Thanks. I'll pop over and take a look.
Just went to look at Kaspit's post over at Quicksilver. Truly excellent. I urge you to take a look.
With 15 years as a Sanitarian, I can concur that "coliform" contamination of (especially) surface water is usually no big deal. In fact, it is to be expected. In a well, it indicates surface contamination, but that isn't the issue here.
No doubt there is a lot of sewage flowing in the streets of New Orleans. a million people make a lot of waste.
My main question is this. The MMWR case count of Hep A for the entire state of LA went from 40 to 44 during the last week. Even if that is off by a factor of 10, and there were 40 acute cases shedding virus, and even if all 40 of them lived in New Orleans, I don't think there would be enough Hep A virus in the water to pose a hazard. I say this as someone who has seen sewer workers stand up out of a flow, sit on a pipe, and open and eat a candy bar with the hands they had just had down in the raw sewage outflow. They didn't get Hep A, and that was in the middle of the largest Hep A outbreak in a decade. I just can't believe there is enough virus to constitute an infectious dose.
I think the problems are diarrheal illnesses and wound infections, including and especially MRSA. (Oh yeah, and TB in the shelters, which we should be tracking and are not. LA is 8th in the Nation with 5.2/100K and NOLA runs over 8/100K) Just what I want to do is set up a shelter with several hundred people shoved up together and have a couple of active TB cases coughing bacilli all over.
Am I missing something here?
Man of Misery: No, you probably have it about right. We'll see. There is probably a lot of inapparent Hep A around, though, and with this much exposure we are bound to see cases. But I think you pretty much have it pegged.
Man of Misery: That's something I had completely forgotten. My wife also mentioned TB, but I kind of dismissed it, and really shouldn't have. You're right, we should be actively screening people for TB right now and isolating those who are probables. Unfortunately, that's a labor intensive task, and honestly, how are you going to impose isolation conditions in the Astrodome? (or wherever) But yeah, they should be thinking about (at least) active TB cases, if they're not already.
Thanks for the kind words, "Just went to look at Kaspit's post over at Quicksilver. Truly excellent. I urge you to take a look." Not sure I can live up to it. Feedback and revisions welcome.
I've updated an item about the EPA involvement, including its testing of the flood waters, now being pumped. Ciao, Kaspit
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