Monday, March 3, 2008

Chapter Forty-Three

Clean up from the Hurricane Josephine continues and probably will for quite some time yet. Despite storm-related damage, Tampa’s infrastructure did not further destabilize though hospitals did have some setbacks. Tampa General Hospital (TGH) received some ground floor damage to their lobbies and waiting areas. Some of the diagnostic areas were also damaged, but most of these aren’t being utilized anyway due to lack of electricity to run the diagnostic equipment. University Community Hospital (UCH) and St. Joseph’s hospital complexes had to move all of their patients back indoors during the storm but suffered little structural damage. All hospitals had a spike in patient deaths, likely due to the additional stress of being moved. As far as the rest of the city, due to the depravation already caused by pandemic economics, people have been forced to return to a way of life that demands more self-sufficiency and personal resiliency. It is a life that demands more patience. Personal property damage is dealt with as it best as can be.

There is little federal government assistance in storm clean up efforts. All government resources are going towards pandemic related issues and food supply chain rebuilding. The Gulf hurricanes have not helped fuel supplies and refining, but then again, higher fuel costs and business closings have also reduced demand. The federal government – temporarily anyway – nationalized most fuel production about four months into the pandemic after many of the big name fuel companies began shutting down due to lack of manpower. The Army Corps of Engineers now has a division exclusively charged to oversee national fuel production. The Coast Guard and Navy have also been called in to protect off shore oil platforms and ports from piracy.

So, despite the appearance that the government has abandoned its people, the reality is that they are taking care of the macro issues and are just as restricted by lack of manpower and resources as everyone else. It is up to the local governments to again be responsible and realistic with local needs. Some areas have better leadership than others.

Clean up is roughly organized by neighborhoods. Where large trees are down, people strip the tree of limbs back to the trunk, primarily using hatchets and axes and a few saws. The wood becomes cooking fuel and a potential source of heat for this winter after it cures. Then the tree trunk is maneuvered out of everyone’s way and left wherever it can be pushed.

The utility company crews are doing their best to restore lines; however a shortage of supplies means they have to do a lot of splicing and jury-rigging. This takes more thought and effort and therefore more time, delaying service restoration.

Neighbor is helping neighbor. Those homes with compromised structures are exchanged for abandoned housing, that might need a little rehab but which is still habitable. Vandalism, an ever-present problem, is still rampant but back under control and down to pre-hurricane levels. Some structures, too damaged to remain standing, are stripped of any potentially useful items and are then razed to the ground; through demolition or by controlled burn. All of this occurs without the permits and oversight that would have been required in prepandemic times. This is a new era. People have no choice but to do things for themselves, or through cooperative effort. There isn’t any one else to do it for them.

The demolition of unsalvageable buildings begins to address the increasing problem of rodent and insect infestation. Flooding in the Port of Tampa and other areas has driven large rats further into the city. The problem has become such that the county is offering a bounty for each rat caught and killed. Animal control heads this project up as well as the hunting and destruction of violent dog packs. Dog pack hunters have to have special licenses issued by the city, but are paid well for their service.

Scott and Sissy keep up-to-date listening to local radio broadcasts, which occasionally have installments from their favorite reporter at-large, Devon McLoud. They also have a small, battery-operated television that picks up the local public broadcast channels and the three remaining for-profit TV stations. Cable television went off the air long ago. The reception is poor and broadcasts are intermittent; but, the family is still getting more reliable news than a lot of other people. They purchase a converter for the television so can receive broadcast signals where they are digital or analogue.

Speaking of Devon McLoud, his eagerly awaited installment reveals that he did indeed make it down the Mississippi on a paddle wheeler. His reports continue to chronicle the mundane and the extraordinary of the country’s pandemic landscape. One of his most recent segments covered the demolition of uninhabitable structures in New Orleans.

"The rats sho done inherited the Earth," or at least that’s how it feels on some days according to Max Thibodaux . "No matter how many we trap, kill, or burn out more just take their place. And they’s sho vicious. Everyday we send folks to de clinic wit bites. Even wit gloves on they can give you a bruising pinch wit dem teeth they got."

Pulling down the buildings, some leftover from the devastation this area suffered at the hands of Hurricane Katrina back in 2005, takes away some of the rats’ sanctuaries and helps to interrupt their breeding cycle. It also makes them more vulnerable to predators. But rats are not the only vermin problem facing the city. Roaches and snakes also occupy these buildings as well as the occasional maggot covered corpse. But there is one foe that really worries the neighborhood clean up crews.

"You been in de South any amount a time, you get used to most o’ de creep crawlie critters. You get used to ‘em or you move back where you came from. But that mess we ran into las’ month has us all running cautious," Thibodaux said.

"That mess" was a swarm of Africanized Honey Bees. This fierce hybrid strain is better known as "killer bees." They have the same strength venom as honey bees, but attack in groups. Africanized honey bees are the result of an experiment to increase honey production in Brazil. A swarm escaped a lab and headed north. When they mated with native strains of bees, their offspring proved to be as aggressive as their African parents. They reached the US in 1990 when they were found in Texas; they’ve continued to spread ever since.

And where one hive of bees is found, you known there are others waiting to be found. During last month’s incident, two workers died after they were stung in excess of 800 times each. Most non-allergic people can survive up to 10 stings per pound of body fat. But its not unusual for the amount of venom from a swarm attack to quickly overwhelm a person’s autonomic functions.

"We found two otha hives since in de same general area. We was lucky as no one died dem times. We got some stings, but most folks made it to cover befoe de bees could git ‘em. Once day settle down, usually de next day, we jus’ burn de house down. No sense taking changes you ain’t go to."

But taking chances they don’t have to is what these neighborhood work groups are all about. The unsung heroes. Without them many towns across America would be much worse off. Its doesn’t matter whether they are pulling buildings down or helping to rehabilitate existing structures; delivering food to the hungry or growing food in victory gardens; volunteering in neighborhood schools or helping to retrain thousands of workers that are desperate for jobs; or any of the numerous other unpaid, but very needful, jobs. These people may never have a statue erected in their honor, or have their name engraved on a plaque, but they are heroes nonetheless.

During this time, James’ birthday comes and goes and Sissy surprises everyone by making vegan burgers, baked beans, home fries, and fresh baked buns. The burgers are grilled over a small wood fire. But the highlight of the day is when they use some of their precious ice reserves to make "Kick-The-Can Ice Cream."

It is amazing how uplifting a celebratory meal can be. The food doesn’t have to be fancy, just filling. And good company, even during sober times, can bring smiles.

The Chapman’s neighborhood has gone from weekly "Stone Soup" gatherings to almost daily ones. Parents pick up meals to take home to their children. People take meals to their homebound neighbors. The effort is shared and food and fuel are used more efficiently. So far the neighborhood remains diligent and there are no food borne illnesses or other infectious outbreaks.

A local newspaper ran a story on successful neighborhood ventures. The Chapman’s neighborhood is mentioned, though not by exact location for security reasons. For once the author of the piece is both realistic and objective, mentioning both the good and the bad. Some city planners come out to view the set up in hopes of replicating similar ventures in other neighborhoods. Scott muses that it is better late than never, but maybe the hurricane will bring about some good.

With most of the ground now dry enough to replant, people quickly return to their gardens. This month Sissy plants garbanzo beans, lima beans, several varieties of shelling beans and peas in several large barrel halves. She replaces the chayote vine that was on the fence with several yard-long snap bean plants. In freshly prepared window boxes she plants carrots and beets. She also plants broccoli, burdock, cabbage, celeriac, collards, bush cucumbers, garden huckleberries, husk tomatoes (aka ground cherries), Jerusalem artichoke, lettuce, mustard greens, okra, parsnips, salsify, crookneck and zucchini squash, and more tomatoes. She plants more potatoes as well as she is quickly coming to the end of her other main source of dietary starch – rice. This is also the month to start the strawberry plants in hanging baskets. It’s a great deal of work, but the potential pay off is huge.

Despite all the planting, harvesting is still lean. Radishes, arugula, and mesclun greens are the only fresh items on the menu. But a nice, spicy green salad always perks a meal up. A little oil and vinegar or Italian dress make it even better.

Thanks to Tom’s wife, the family now has a small fresh herb garden. Sarah and Bekah have taken this project for their own and are doing amazingly well with it after they figured out how to keep the tortoises out of their patch. The first try was a sign that showed a turtle in a pot of boiling water with the caption "Turtle Soup." When that didn’t work, much to the girls’ chagrin, James helped them build a fence from sticks and saw briar vines.

All-in-all people quickly recover from the effects of the hurricane and are now more determined than ever to overcome whatever the pandemic can throw at them. After so many slipped into apathy and discouragement, it seems that the added adversity of the storms is just enough to recharge everyone's determination.

There is some disturbing news coming in from other areas of the country though. The detrimental affects on infrastructure have not just made it hard on the economy and more difficult to address the pandemic. It has left huge gaps in the health care and hygiene industries so that illnesses that were basically eradicated in the 20th century are now making a return engagement in the 21st.

The Gulf Coast of the United States has always been susceptible to diseases. The last Yellow Fever epidemic took place in New Orleans in 1905. In 1900, Dr. Walter Reed had confirmed what had been suspected since the 1880’s; Yellow Fever was transmitted by mosquitoes. Five years later many cities were still unprepared. At the time, New Orleans continued to operate a quarantine system. They fumigated ships and sanitized clothing and bedding on board. In the spring of 1905, a smuggler's ship, loaded with bananas, avoided the quarantine requirements. That June cases of yellow fever began appearing near the Mississippi River in a community of immigrants, many of who unloaded banana boats from Central America. The city declared an emergency on June 22, after 100 people had contracted the disease, including 20 who died.

Despite the conclusions of the U.S. Army Yellow Fever Board in 1900, many people in New Orleans still did not treat the threat of mosquitoes seriously. Residents got their water from cisterns. This water storage containers were a breeding ground for the insects. Dr. Quitman Kohnke, the head of the New Orleans health board, urged the city to address the mosquito issue. "Even if you are not positive that the mosquito is the only source of the transmission of yellow fever," he told physicians, "give your city the benefit of the doubt in this important and vital matter." It wasn’t until after the outbreak began that the city of New Orleans finally mobilized.

On August 4, local officials requested and received federal assistance. Workers employed the techniques that had proven successful in Havana, another frequent location of yellow fever. They fumigated the city, screened cisterns and destroyed breeding grounds for mosquitoes. Residents who failed to comply with public health measures were heavily fined. After Archbishop Placide Louis Chapelle died from yellow fever, holy water in St. Louis Cathedral was found with mosquito larvae. The priests emptied the containers. Still, the epidemic was not immediately stopped.

On August 12, 100 people fell ill from the disease, but by September the numbers of victims diminished. Further evidence that mosquitoes transmitted the disease surfaced at Charity Hospital, which reported that no other patients or medical personnel became infected from the approximately 100 cases of yellow fever treated there. The public health campaign to address yellow fever was working in a city that fewer than 30 years before had lost thousands to the disease. October marked the end of the epidemic, with 452 deaths recorded in New Orleans. The year also marked the last time a yellow fever epidemic plagued the United States, though the disease has remained a problem elsewhere in the world.

Because many places in the world have returned to a pre-1900 technology, people are again using cisterns and other open containers for securing water. In the southern USA, this means that mosquito populations have exploded. This is further complicated by the lack of spraying for mosquitoes and the fact that many bird populations that ate mosquitoes as part of their diet (such as the Purple Martin) have been greatly reduced by avian influenza.

According to national news reports, a small outbreak of Yellow Fever has been detected along the Louisiana/Mississippi border. The months since the first case has seen additional outbreaks in several other locations. Yellow fever, which is also known as sylvatic fever and viral hemorrhagic fever or VHF, is a severe infectious disease caused by a type of virus called a flavivirus. Once a mosquito has passed the yellow fever virus to a human, the chance of disease developing is about 5-20%. Infection may be fought off by the host's immune system, or may be so mild that it is never identified or recognized.

In human hosts who develop a full-blown case of yellow fever, there are five distinct stages through which the infection evolves. These have been termed the periods of incubation, invasion, remission, intoxication, and convalescence. Yellow fever's incubation period (the amount of time between the introduction of the virus into the host and the development of symptoms) is three to six days. During this time, there are generally no symptoms.

"Invasion" lasts two to five days, and begins with the onset of symptoms, including fever and chills, intense headache and lower backache, muscle aches, nausea, and extreme exhaustion. The patient's tongue shows a white, furry coating in the center, surrounded by a swollen, reddened margin. While most other infections that cause a high fever also cause an increased heart rate, yellow fever results in Faget's sign. This is the simultaneous occurrence of a high fever with a slowed heart rate. Throughout "invasion" there are still live viruses circulating in the patient's blood stream. A mosquito can bite the ill patient, acquire the virus, and pass the infection on to others.

The next phase is called "remission." The fever falls, and symptoms decrease in severity for several hours to several days. In some patients, this signals the end of the disease; in other patients, this proves only to be the calm before the storm. "Intoxication" represents the most severe and potentially fatal phase of the illness. During this time, lasting three to nine days, degeneration of the internal organs (specifically the kidneys, liver, and heart) occurs. This fatty degeneration results in what is considered the classic triad of yellow fever symptoms: jaundice, black vomit, and the dumping of protein into the urine. Jaundice causes the whites of the patient's eyes and the patient's skin to take on a distinctive yellow color. This is due to liver damage. The liver damage also results in a tendency toward bleeding; the patient's vomit appears black due to the presence of blood. Protein, which is normally kept out of the urine by healthy kidneys, appears in the urine due to disruption of the kidney's functioning.

Patients who survive "intoxication" enter into a relatively short period of convalescence. They recover with no long term effects related to the yellow fever infection. Infection with the yellow fever virus results in lifelong immunity against repeated infection with the virus.

The course of yellow fever is complicated in some patients by secondary bacterial infections. Even under the best of conditions there are no antiviral treatments for Yellow Fever. The only treatments for yellow fever are given to relieve its symptoms. Fever and pain should be relieved with acetaminophen, not aspirin or ibuprofen, both of which could increase the already-present risk of bleeding. Dehydration (due to fluid loss both from fever and bleeding) needs to be avoided. The risk of bleeding into the stomach can be decreased through the administration of antacids and other medications. Hemorrhage may require blood transfusions. Kidney failure may require dialysis (a process that allows the work of the kidneys in clearing the blood of potentially toxic substances to be taken over by a machine, outside of the body). With no modern medical interventions though, blood transfusions and kidney dialysis are impossible for cases that extreme.

Under the best conditions, five to ten percent of all diagnosed cases of yellow fever are fatal. Once jaundice occurs, a patient’s chances for recovery drops to only fifty percent. A very safe and very effective yellow fever vaccine exists, but is currently in limited supply due to pandemic economics. The Arilvax vaccine is made from a live attenuated form of the yellow fever virus, strain 17D. Yellow Fever Vaccination Centers, authorized by the U.S. Public Health Service, have been set up through out – and in – areas that are seeing active cases of Yellow Fever. About 95% of vaccine recipients acquire long-term immunity to the yellow fever virus.

Broadsides are being printed and handed out telling people how to protect their area from a Yellow Fever outbreak. Now, in addition to warnings on how to prevent pandemic flu, there are public service announcements on the prevention of other infections. It isn’t just Yellow Fever making a come back; its cholera, typhoid, measles, TB, chicken pox, and many other diseases that had nearly been eradicated in the US.

It isn’t just the southern states that are suffering. Other areas of the country, as well as Canada and Mexico, are facing the rise of other infectious diseases. According to news bulletins, Los Angeles is still under quarantine for Cholera.

Cholera is a severe diarrheal disease caused by the bacterium Vibrio cholerae. Transmission occurs by ingesting contaminated water or food. It is extremely deadly.

In its most severe forms, cholera is one of the most rapidly fatal illnesses known: A healthy person may become hypotensive within an hour of the onset of symptoms and may die within 2-3 hours if no treatment is provided. More commonly, the disease progresses from the first liquid stool to shock in 4-12 hours, with death following in 18 hours to several days without treatment.

Symptoms include general GI tract (stomach) upset and massive watery diarrhea. Symptoms may also include terrible muscle and stomach cramps, vomiting and fever in early stages. In a later stage the diarrhea becomes "rice water stool" (almost clear with flecks of white) and ruptured capillaries may turn the skin black and blue with sunken eyes and cheeks with blue lips. Symptoms are caused by massive body fluid loss. The body is "tricked" by nuerotoxins produced by the bacteria into releasing massive amounts of fluid into the small intestine; up to 20% of body weight. Radical dehydration can bring death within a day through collapse of the circulatory system.

In general, patients must receive as much fluid as they lose due to diarrhea. Treatment typically consists of aggressive rehydration (restoring the lost body fluids) and replacement of electrolytes with commercial or hand-mixed ORS solutions or massive injections of liquid given intravenously via an IV in advanced cases. But again, with the health care industry in collapse, there are few if any IV resources. Without treatment the death rate easily reaches 50%.

Although cholera can be life threatening, it is always easily prevented if proper sanitation practices are followed. In most of North America and Western Europe, because of advanced water treatment and sanitation systems, cholera was no longer a major threat. The last major outbreak of cholera in the United States was in 1911. Good sanitation practices, if instituted in time, is usually sufficient to stop an epidemic. There are several points along the transmission path at which the spread may be halted:

  • Sickbed: Proper disposal and treatment of the germ infected fecal waste (and all clothing and bedding that come in contact with it) produced by cholera victims is of primary importance.
  • Sewage: Treatment of general sewage before it enters the waterways or underground water supplies prevent possible undetected patients from spreading the disease.
  • Sources: Warnings about cholera contamination posted around contaminated water sources with directions on how to decontaminate the water.
  • Sterilization: Boiling, filtering, and chlorination of water kill the bacteria produced by cholera patients and prevent infections, when they do occur, from spreading. All materials (clothing, bedding, etc.) that come in contact with cholera patients should be sterilized in hot water using (if possible) chlorine bleach. Hands, etc. that touch cholera patients or their clothing etc. should be thoroughly cleaned and sterilized. All water used for drinking, washing or cooking should be sterilized by boiling or chlorination in any area where cholera may be present. Water filtration, chlorination and boiling are by far the most effective means of halting transmission. Cloth filters, though very basic, have greatly reduced the occurrence of cholera when used in poor villages for untreated surface water.
The source of the contamination is typically other cholera patients when their untreated diarrhea discharge is allowed to get into waterways or into groundwater or the drinking water supply. Any infected water and any foods washed in the water, and shellfish living in the affected waterway can cause an infection.

Rich or poor, it doesn’t matter. It is cleanliness that is most important. In the past many famous people have succumbed to cholera: Tchaikovsky, James K. Polk (former president of the USA), the son of American poet Robert Frost, Daniel Morgan Boone (son of pioneer Daniel Boone), both the father and son of the author Mary Shelley, and many others.

Los Angeles, California is situated in a Mediterranean climate zone, experiencing mild, somewhat wet winters and warm to hot summers. It only gets an average of 15 inches of rain per year so the city relies very heavily on local ground water and imported water sources, such as those from the Sacramento River.

It appears, from what investigators have been able to determine that local ground water supplies became compromised with the cholera bacteria. The first few cases were noted in the Hollywood District. Infected fecal matter then made its way into the storm drainage system and spread from there into other local water sources causing additional infections. Over 13,000 deaths have been directly attributed to cholera in the city. Federal agents have cordoned off the area and no one is allowed in or out; of course people do manage to escape.

Several smaller cholera outbreaks are being reported spreading outward into Santa Monica, Glendale, Pasadena, and Long Beach. Local governments are trying to enforce a boil-water order in effect for a two hundred mile radius around the city. On the opposite side of the Continental US Buffalo, New York is also reporting an outbreak of what appears to be cholera. Every hour on the hour in cities across the country people are reminded over and over again through public service announcements and billboards how important basic hygiene is in the prevention of contagious diseases.

Yellow Fever, Cholera, Small Pox, Chicken Pox, Measles, Polio, Tuberculosis are all making inroads into neighborhoods and cities across the country. And now Typhoid Fever are appearing.

Typhoid Fever is an acute illness associated with fever caused by the Salmonellae Typhi bacteria. The bacteria is deposited in water or food by a human carrier, and is then spread to other people in the area. The incidence of the illness in the United States has markedly decreased since the early 1900's after improved sanitation practices become commonplace. Mexico and South America were the most common areas for U.S. citizens to contract typhoid fever. India, Pakistan and Egypt were also high-risk areas for developing this disease.

Patients with acute cases of typhoid can contaminate the surrounding water supply through the stool, which contains a high concentration of the bacteria. Contamination of the water supply can, in turn, taint the food supply. About 3-5% of patients become carriers of the bacteria after the illness. Some patients suffer a very mild illness that goes unrecognized. These patients can become long- term carriers of the bacteria. The bacteria multiplies in the gallbladder, bile ducts, or liver and passes into the bowel. The bacteria can survive for weeks in water or dried sewage. These chronic carriers may have no symptoms and can be the source of new outbreaks of typhoid fever for many years.

The incubation period is usually 1-2 weeks and the duration of the illness is about 4-6 weeks. The patient experiences: poor appetite, headaches, generalized aches and pains, fever, and lethargy. Persons with typhoid fever usually have a chronic fever as high as 103 to 104 degrees Fahrenheit (39 to 40 degrees Centigrade). Chest congestion develops in many patients and abdominal pain and discomfort are common. Improvement occurs in the third and fourth week in those without complications. About 10% of patients have recurrent symptoms (relapse) after feeling better for one to two weeks. Relapses are actually more common in individuals treated with antibiotics.

Typhoid Fever is treated with antibiotics. Prior to the use of antibiotics, the fatality rate was 10%. Death occurs from overwhelming infection, pneumonia, intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, mortality can be reduced to 1-2%. The carrier state, which occurs in 3-5% of those infected, can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, will cure the carrier state.

Again, the problem with the pandemic economy is that antibiotics are in short supply. Many drug makers are totally focused on developing and manufacturing a pandemic flu vaccine. With so much of their energy focused in that one direction, antibiotic manufacturing has fallen dangerously low. This is exacerbated by the use of antibiotics to treat secondary infections in panflu cases. In 1897 an effective vaccine was developed for typhoid. Unfortunately the vaccine, like many others, is in short supply.

Like cholera, many famous people in history have died of typhoid: Pericles, Archduke Karl Ludwig of Austria, Margaret Breckenridge (highest-ranking Army nurse under Ulysses S. Grant), Benjamin Harrison's wife Caroline, Robert E. Lee's daughter Annie, Herbert Hoover's father and mother, William McKinley's daughter Katherine, Wilbur Wright (one of the famous Wright Brothers), William T. Sherman's father and oldest son, Albert of Saxe-Coburg-Gotha (British prince consort and Queen Victoria's husband), William Wallace Lincoln (third son of President Abraham Lincoln and Mary Todd Lincoln), Louis Pasteur's daughters Cecile and Jeanne, President John Adams's wife Abigail Adams, Charles Darwin's daughter Annie, and Belle Boyd the most famous female confederate spy.

Chicago is facing a typhoid epidemic. To date there have been 2,000 deaths due to typhoid fever. No one is sure if a particular carrier is involved or whether it is a matter of simple hygiene. The only good thing in this situation is that Chicago’s population was greatly reduced by the fire that razed half of the city ealier in the pandemic year. Survivors, those willing, were relocated to other population centers as quickly as possible. Typhoid is yet another disease that is preventable if good hygiene habits and conditions are maintained within communities and within homes.

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