Survivors of hurricanes Katrina and Rita are leaving behind the hazards of rising flood waters and howling winds only to face new threats from mold and contaminated water as they return to what's left of their homes.
Officials list mold, injuries and accidents among workers, respiratory symptoms and rashes as the main health concerns plaguing workers and returning residents.
These problems are no small matter considering that Hurricane Katrina, which struck the Gulf Coast on Aug. 29, affected more than 90,000 square miles and caused the displacement of some 1 million people.
Thousands more were displaced in eastern Texas and Louisiana during Hurricane Rita, which made landfall Sept. 24. Rita's heavy rainfall breached the hastily patched-up levees that had been protecting New Orleans, flooding sections of that waterlogged city for a second time.
Many of those displaced by the storms are just now returning home to face the devastation.
Mold, which thrives on moisture, seems to be everywhere and, in some cases, may force the demolition of homes and other structures.
"The mold issue is something that will affect the entire Gulf Coast region, but is going to be a particular problem in New Orleans because of the flooding that's occurred there and the duration of the flooding," Dr. Stephen Redd, of the U.S. Centers for Disease Control and Prevention, said at a news conference Wednesday.
Mold can cause anything from allergic symptoms in healthy people to infection in people with suppressed immune systems and even toxin-mediated disease, although the latter has not yet been seen in the Gulf region.
"Any individual who has any underlying medical condition, especially involving the lungs or the heart, are ostensibly at risk," said Dr. Vincent Valentine, medical director of the lung transplantation program at the Ochsner Clinic Foundation in New Orleans. "Individuals with a history of asthma or any other chronic lung condition may have a problem."
Vulnerable individuals need to avoid exposure to mold, and even healthy people should take precautions when they clean up. "If you are doing it by yourself, it's important to wear respiratory protection and gloves at a minimum," said Dr. Maureen Lichtveld, chairwoman of environmental health sciences at Tulane University School of Public Health and Tropical Medicine in New Orleans. Lichtveld is currently working out of Emory University in Atlanta.
Ultimately, the only solution is to get rid of the mold and the conditions causing it.
"There is no safe level of mold," Lichtveld said. "Mold should be destroyed and taken away."
Doctors in the area have also reported various skin conditions, including a cluster of infections with methicillin-resistant Staphylococcus aureus (MRSA), in about 30 children and adults in an evacuation facility in Texas.
Other skin conditions that initially appeared to be infectious turned out not to be. "A lot of those were due to poor hygiene, and having to be in water for a period of time, and wearing clothing that was wet against skin," said Dr. Daniel Jernigan, a medical epidemiologist with the CDC and co-author of an article in the Sept. 30 issue of the agency's Morbidity and Mortality Weekly Report, which looked at some of these health problems.
In one instance, members of a group of 97 national guardsmen located in New Orleans broke out in a rash at the same time. "We thought there might be an infectious cause that was behind that, but on further diagnosis and interview we determined that all of them had been sleeping outside next to the zoo in New Orleans" Jernigan said. The rashes were probably caused by insect bites, most likely mites.
Officials are also concerned about air quality.
"We have had a number of monitors . . . to look at the particulate matter levels and we have found at certain locations on certain days, for unusually sensitive people, we found some levels that would be of concern to them, and we've also found somewhat higher levels in the unhealthy for sensitive groups range," Barnes Johnson, of the Environmental Protection Agency, said at the Wednesday news conference.
Also, clean drinking water and sewage systems "just don't exist at this time on the East Bank of the river, which is a major area of New Orleans," Dr. Fred Cerise, secretary of the Louisiana Department of Health and Hospitals, said at the same news conference. People in the East Bank are being advised to boil their water to neutralize harmful bacteria.
"As of today [Thursday], most sections of New Orleans drinking water is not potable. You can't drink it, which means you need bottled water for drinking, for brushing your teeth," Lichtveld confirmed.
Currently, there are no operational hospitals in New Orleans, although three hospitals in the surrounding areas are operating below capacity.
"The 911 system is not operational. Major trauma care is not readily available, and there's a lot of cleanup going on in the area with broken glass and things like that," Cerise said.
The USS Comfort, a Navy vessel with 250 hospital beds, is expected to arrive this week.
There is also concern about longstanding regional problems. West Nile season, for instance, is not over and infectious disease experts worry that normal prevention activities have been interrupted. "Things have been disrupted in terms of usual activities," Jernigan said. "We want to be sure that those kinds of public health interventions are initiated."
Other aspects of life most people take for granted are also in limbo.
"Is there garbage pick-up? Debris is a concern I would have. How is it handled and disposed of?" Lichtveld said. "When flood waters recede, you have sludge or sediments. You have to look at food safety, the situation with shellfish and other bottom dwellers, their edibility."
Health Tip: Rats Can Be a Health Hazard
If you live in an area where rats may frequent, here are some rodent-control tips from the District of Columbia Department of Health:
Store garbage in metal or heavy plastic containers with tight lids. Remove weeds and debris near buildings and in yards; don't give rats a place to hide. Store opened food in metal or glass containers with tight lids. Don't leave extra pet food out. Sweep up litter and trash inside and outside your home. Use mortar to seal any cracks and holes in your basement and house. Keep outside doors closed, and use metal trim to prevent rodents from gnawing and entering underneath.
Health Tip: Drink Enough Water
While you know that drinking lots of water is good for you, getting the recommended eight glasses a day may seem too much to swallow.
The key is to develop a daily routine, according to the State of Kansas:
Drink two glasses of water first thing in the morning; you'll feel energized. Drink one glass half an hour before meals. It'll help you feel less hungry and lead to fewer cravings. Drink one glass for each glass of beer or wine, and with every cup of tea or coffee.