Saturday, 4 November 2017

Severe health hazards in post-hurricane Puerto Rico

Mold is blanketing Puerto Rico 

making it difficult for many to 


breathe.

According to the National Institute of Health (Clinical Microbiology Rev. July 2003; 16(3):497-516. Mycotoxins. By J.W.Bennett and M. Klich), “Mycotoxins are secondary metabolites produced by microfungi that are capable of causing disease and death in humans and other animals.  Mycoses range from merely annoying (e.g., Athlete’s Foot) to life-threatening (e.g., invasive Aspergillosis). Primary pathogens affect otherwise healthy individuals with normal immune systems. Opportunistic pathogens produce illness by taking advantage of debilitated or immune-compromised hosts……  The majority of human mycoses are caused by opportunistic fungi.”
“Mycoses are frequently acquired via inhalation of spores from an environmental reservoir. Skin contact with mold-infested substrates and inhalation of spore-borne toxins are also important sources of exposure.” (Bennett and Klich, ibid).
Diseases associated with inhalation of spores include toxic pneumonia, hypersensitivity pneumonia (characterized by inflammation of the lungs which can lead to scarring of the lungs, an irreversible condition that decreases lung capacity), sinusitis, tremors, chronic fatigue syndrome, kidney failure, biofilm, hair loss, skin conditions, vision disturbances, neurologic disturbances, diarrhea, nausea, vomiting, internal hemorrhaging, and abnormal liver levels. Exposure to mold, according to the Florida Department of Health, can cause cognitive problems such as memory loss and mood swings. In some individuals, these can lead to depression, fatigue and loss of interest in everyday activities. Mycotoxins can cause sleep disturbances and if left untreated, can lead to neurological problems such as impaired balance and difficulty walking.
31 October, 2017


The unfolding humanitarian crisis in Puerto Rico after Hurricane Maria barreled over the island is only getting worse. Alarm bells are being rung from humanitarian organizations on the ground that the deteriorating conditions are seriously impacting human health and survival. Warnings from the front lines are summarized in the excerpts below.


It’s an emergency that a month in should not be an emergency--but it is,” said Thompson, presenting a series of real-life scenarios that Puerto Ricans have been grappling with since driving rain and winds of 155 miles per hour took down the island’s entire electrical grid on Sept. 20. Without electricity, a great deal of daily life grinds to a halt: there’s no light at night, no fans or air conditioners to cool sweltering rooms, no easy way to charge phones or access the internet, no reliable way to keep hospitals running--the list goes on.


What would you do, Thompson asked, if your elderly mother, wheel-chair bound and desperately needing food and water, was stuck on the 17th floor of an apartment building in San Juan with no working elevator?


Or, what if the hurricane had drenched everything inside your house including all the mattresses, forcing you and your children to sleep on the floor where rats could be scampering? Or what if you lived in the countryside, stuck on the far side of a collapsed bridge, and you had no way to get drinking water because the storm knocked out your community’s delivery system? There’s no bottled water anywhere and a relief convoy hasn’t visited in days. What would you do?


Not everyone is suffering, Thompson pointed out. Those with money have options: They can get a hot meal in a restaurant; they can buy fuel for their cars and generators; they can purchase dry sheets and towels for their homes--and their homes, better built to begin with, may still have their roofs.


It’s hard to describe the complexity of it,” said Thompson. “Parts of San Juan look normal; parts look ravaged.”


According to the National Institute of Health (Clinical Microbiology Rev. July 2003; 16(3):497-516. Mycotoxins. By J.W.Bennett and M. Klich), “Mycotoxins are secondary metabolites produced by microfungi that are capable of causing disease and death in humans and other animals. Mycoses range from merely annoying (e.g., Athlete’s Foot) to life-threatening (e.g., invasive Aspergillosis). Primary pathogens affect otherwise healthy individuals with normal immune systems. Opportunistic pathogens produce illness by taking advantage of debilitated or immune-compromised hosts…… The majority of human mycoses are caused by opportunistic fungi.”

Mycoses are frequently acquired via inhalation of spores from an environmental reservoir. Skin contact with mold-infested substrates and inhalation of spore-borne toxins are also important sources of exposure.” (Bennett and Klich, ibid).

Diseases associated with inhalation of spores include toxic pneumonia, hypersensitivity pneumonia (characterized by inflammation of the lungs which can lead to scarring of the lungs, an irreversible condition that decreases lung capacity), sinusitis, tremors, chronic fatigue syndrome, kidney failure, biofilm, hair loss, skin conditions, vision disturbances, neurologic disturbances, diarrhea, nausea, vomiting, internal hemorrhaging, and abnormal liver levels. Exposure to mold, according to the Florida Department of Health, can cause cognitive problems such as memory loss and mood swings. In some individuals, these can lead to depression, fatigue and loss of interest in everyday activities. Mycotoxins can cause sleep disturbances and if left untreated, can lead to neurological problems such as impaired balance and difficulty walking.

Tarps are desperately needed right now,” said Thompson, noting that one rural woman she encountered had relied on her sister in the Dominican Republic, where more than 40 percent of the population lives in poverty, to send her one. “Some kind of lighting system is badly needed. There are all kinds of things you can’t get--insect repellent, [a type of ] batteries.”


But with the rainy season here, tarps top the list for some community leaders who are doing all they can to help ensure people have shelter. Thompson described the efforts of one woman who has been trying to get tarps for about 800 homes in different communities outside of San Juan: The woman approached the Federal Emergency Management Agency, or FEMA, which sent her to speak to the mayors of the communities. The mayors didn’t have tarps, so she went back to FEMA. No luck again. So next she called the tarp manufacturing companies in the US, and hit a dead end there, too.


She has been up and down for these communities and has not been able to get these tarps,” said Thompson.


Those efforts are playing out against a new worry for families whose homes have been exposed to the elements: mold.


A lot of times in hurricanes people forget to talk about just how hard it is to clean out your house, and the mold,” said Thompson. “It’s an increasing problem. People are just beginning to realize it.” Chlorine is what people need to try and tackle the problem, but the supplies are restricted.


You need a whole kit to take mold off,” said Thompson. “You need to educate people about that. And so how do you do that when there is no communication?” She said the public health department will need to organize a full effort to address the mold issue.


It seems everywhere you come up against another insurmountable problem," Thompson added.


The Centers for Disease Control and Prevention (CDC) reports that just under 8% of all people in the United States currently have asthma. However, for residents of Puerto Rico, that percentage jumps to as high as 19% of the population according to some studies.


For those with asthma, managing their condition with treatment options from their healthcare provider and avoiding asthma triggers are all important steps for their well-being and long-term health. Unfortunately, due to all the damage caused by Hurricanes Maria and Irma, there are now countless residential, commercial and institutional properties across the islands that have considerable mold contamination. This is due to water damage and elevated indoor humidity levels, exacerbated by a lack of air-conditioning and mechanical ventilation caused by power outages.


Exposure to elevated levels of mold can act as an asthma trigger for many who suffer from the condition,” said Harry Pena, President of Zimmetry Environmental. “We are coming across mold and other microbial issues in many of the properties we are called upon to inspect and provide our expertise. Recognizing the full extent of contamination, writing remediation protocols, overseeing mold removal activities, and performing post remediation clearance testing are all important activities we are currently involved with. These actions help to ensure mold and other indoor air quality issues don’t become a problem a few months from now for people living, working or going to school in these damaged properties.
Homes lay scattered after the passing of Hurricane Maria in Roseau, the capital of the island of Dominica, Saturday, Sept. 23, 2017. Lives have been lost around the Caribbean, including on hard-hit Dominica. (AP Photo/Carlisle Jno Baptiste)

HMN: What was the situation on the ground?


MC: Many homes in Puerto Rico were destroyed or severely damaged, some roads remain impassable, electrical power is unavailable across most of the island, food, potable water and basic amenities are scarce, and communication by phone, text, or email is difficult or impossible.


In addition to the immediate need for food, water, shelter and communication, this situation has profound implications for the health and wellbeing of 3.4 million of our fellow Americans. Diabetes and hypertension are highly prevalent in Puerto Rico and are readily treatable with medication. But what if you can’t reach your doctor to prescribe a medication because the phones don’t work? What if you can’t fill a prescription, because you’re not receiving your paycheck, the ATMs aren’t functional and you can’t afford your prescription co-pay? What if you do obtain your insulin, but you can’t keep it cold, because refrigeration requires electricity and you don’t own a generator?


HMN: What are the long-term consequences of that lack of infrastructure?


MC: As the days and weeks pass without the restoration of electrical service and communications, Puerto Ricans are running out of medications for myriad treatable conditions. Over time, the population burden of preventable illness, including the long-term complications of diseases such as diabetes and hypertension — blindness, neuropathy, kidney failure, heart attack, and stroke – will increase. While we were there, in the very early days of this crisis, we were already seeing the harbingers of this looming health care crisis - systolic blood pressures above 250 and blood sugars above 500 in patients who simply ran out of medication. The impact of this catastrophe on the health of Puerto Ricans will be felt for years.


HMN: What kind of care do people with these chronic illnesses need?


MC: Many people require home health services to stay alive. Home ventilators and oxygen concentrators require electricity. Patients dependent on tube feedings require a reliable source of specialized food and medical equipment. Patients with end stage kidney disease require regular dialysis. How will these services be provided? In the face of a collapsed infrastructure, public health agencies in Puerto Rico have been stretched thin in their attempts to meet these needs.


Finally, because there is no power, most hospitals in Puerto Rico remain in service only with the electricity generated by diesel generators. Fuel delivery remains erratic, and generators that were never meant to operate for more than a few days have been running, sometimes continuously, for weeks. Not surprisingly, generators fail sporadically, abruptly removing entire hospitals from the health care grid and leaving acutely ill patients with limited options until fuel can be delivered or repairs can be completed.

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