After the devastation in the province of Valencia due to torrential rains and floods, other risks are beginning to emerge related to having stagnant water for days, mud and mud covering the streets and dozens of corpses, human and animal, not removed. José María Martín-Moreno, doctor in Epidemiology and Public Health from Harvard University and Professor of Preventive Medicine and Public Health at the University of Valencia, warns in an interview (at the request of the expert, in writing) that measures must be taken preventive measures, carry out epidemiological surveillance now, provide access to drinking water and remove sludge as soon as possible. He also points out that, to volunteer, some measures must be taken such as waterproof gloves, glasses, masks or mosquito repellents: “They should act under the supervision of the authorities.”
What epidemiological risks are there after the catastrophe?
The risks arise mainly from water stagnation, contamination of drinking water and interruption of sanitation services. Stagnant waters, especially those that contain mud or sludge, are an ideal environment for the proliferation of vectors (mainly mosquitoes and cockroaches), rodents and microorganisms that can cause infections in humans. This is due to a series of biological and environmental factors that turn these waters into a perfect “breeding ground” for different infectious agents and disease-transmitting animals.
On the other hand, there is the potential risk of sewage mixing with drinking water during a flood, increasing the risk of serious disease outbreaks, especially in areas with compromised sanitation systems. Ensuring access to clean drinking water and promoting proper hygiene practices are crucial measures to prevent the spread of these diseases following a flood event. Regarding the interruption or disruption in sanitation (due to accumulation of waste and lack of access to basic services, such as bathrooms and clean water supply), exposure to infectious agents increases.
What diseases can appear?
It will depend on multiple factors and the agility or delay in the response, but the greatest risk is conditioned by water-borne diseases. Among the most worrying are bacterial gastroenteritis, hepatitis A or leptospirosis, all related to the consumption of contaminated water. In addition, skin and eye infections can occur, and we must not forget the risk of vector-transmitted diseases.
In this sense, from previous experiences, it is known that if stagnant water is not eliminated promptly, outbreaks of diseases transmitted by mosquitoes that proliferate in these environments may arise.
How long will it take for these risks to worsen if the situation is not addressed?
Evidence shows that the risk of infections begins to increase between 24 and 72 hours after flooding. This period depends on factors such as ambient temperature, how quickly basic services are restored, and the sanitation measures implemented. It is crucial that health authorities immediately implement preventive measures, such as the distribution of safe drinking water, sanitation of stagnant water, and constant monitoring for possible disease outbreaks. In addition, it is essential to inform the population about appropriate hygiene practices to reduce the risk of contagion and take additional precautions when consuming food and water.
What needs to be done to avoid it?
The key to avoiding a public health crisis lies in the speed and effectiveness of these interventions. The prevention and control of diseases depends not only on the actions of the authorities, but also on the commitment of each person to adopt the recommended measures and maintain a vigilant attitude, and on the collaboration of the community.
The main thing would be to guarantee access to drinking water, to avoid water-borne diseases. Drinking water distribution points must be installed and, in cases where this is not possible, alternatives must be provided to the population, such as purification tablets or pedagogically transmitted instructions to boil water safely before consuming it. Along with the above, it is essential to restore and ensure sanitation (sewer systems and manage waste as soon as possible). For areas where sanitation has not yet been restored, it is advisable to use portable toilets and temporary waste disposal systems to reduce population contact with waste and contaminated water.
The streets are still full of water and mud…
Regarding the drainage of stagnant water, the sooner the better, to prevent it from becoming a breeding ground for mosquitoes that transmit infectious diseases. Complementary disinfection of affected areas must also be carried out, which includes public and residential spaces that have been in contact with flood waters. In addition, it is important that the population clean and disinfect their homes and belongings using appropriate products. In this sense, education and awareness among the affected population is cardinal, and they must be informed about the health risks and necessary hygiene practices, such as frequent handwashing with soap, especially before eating or handling food, and afterward. from being in contact with flood water. It is also important to avoid eating foods that have been in contact with contaminated water.
Along with all of the above, authorities and professionals must ensure good vector control, which not only consists of draining stagnant water, but also fumigation measures in the highest risk areas to reduce the population of adult mosquitoes. These actions must be carried out periodically in the weeks following the flood.
Finally, do not forget the need to establish a good epidemiological surveillance system and early symptomatic attention, which can prevent the spread of infections and reduce the severity of possible outbreaks.
Is it a good idea to send thousands of volunteers there?
It can be useful and necessary, because all help is little. But it must be carefully managed to avoid additional complications and ensure the safety of both volunteers and residents. Sending volunteers can be a good idea if it is done in a controlled and organized way, and always under the supervision of civil protection and public health entities. It is essential to ensure that volunteers are prepared, have the appropriate equipment and do not represent an additional burden on already affected infrastructure.
Some key considerations in this decision include assessing the risks to volunteers to begin with. That’s because flood-affected areas can present physical and health hazards, including contaminated water, weakened infrastructure, and risks. On the other hand, coordination and training is necessary, including personal protection and procedures to avoid accidents or infections.
In that sense, it is appropriate to prioritize trained and specialized personnel. And for those without disaster experience, they may be more useful by collaborating at resource collection and distribution points, coordinating aid at the local level, or providing psychological support remotely, without needing to enter risk areas.
What risks do the volunteers who go take on? How should they be protected?
The protection of volunteers is essential to ensure their safety and allow them to provide effective help. By following these recommendations and acting under the supervision of the authorities, the risks to which they are exposed can be significantly reduced. But they must know that they logically assume a series of specific risks, both physical and health. Among the main risks is exposure to stagnant and contaminated water, which increases the risk of contracting water-borne or mosquito-borne diseases.
Additionally, in some areas, flood water may have been mixed with chemicals, oils or fuels, which may result in dangerous exposure, especially to the skin and eyes. The possibility of physical injuries and accidents should also not be overlooked, given that flooded areas can hide debris, glass, nails and other dangerous objects that can cause cuts and wounds, which, in contact with contaminated water, present a high risk of infection. . Additionally, there is a danger of slips and falls on wet and unstable surfaces.
Regarding personal or individual protective equipment (PPE), footwear must be appropriate (ideally waterproof boots with thick soles), waterproof and chemical-resistant work gloves, to protect hands from possible cuts and contact with contaminated water. . Long-sleeved clothing and long pants to minimize skin exposure and reduce the risk of insect bites and contact with contaminated water, along with masks and protective glasses in case of contact with chemicals or to reduce the risk of inhalation. particles in environments with dust or debris.
In addition to the above, collaboration coordinators of these programs should try to ensure that volunteers are up to date with their vaccinations, especially against diseases such as hepatitis A, tetanus and, if possible, leptospirosis. This can reduce the risk of serious illness if exposed. In addition, they should be provided with insect repellent on exposed areas of the skin, especially during times of high mosquito activity, or a first aid kit (including disinfectant, gauze, bandages, scissors, and antibiotic ointments to treat cuts and scrapes immediately). and reduce the risk of infection).
Are there precedents in other outbreaks of health emergencies or previous examples to take note of?
Of course. Among these experiences are the floods in Mozambique in 2000, the devastation caused by Hurricane Katrina in the United States in 2005, the floods suffered in Thailand in 2011, or more recently the floods that occurred in Germany and Belgium in 2021, or in Pakistan in 2022.
Among the lessons learned or generated by the evidence, is the importance of a rapid and organized response that guarantees access to drinking water, sanitation, medical care and health education for affected populations, and also psychological support for the affected population. and mental health programs, which are crucial after catastrophic events.
These historical cases offer us valuable lessons on the main threats to public health, as well as the most effective response measures that can inspire us to make our actions in Valencia and in Spain as effective as possible to mitigate this disaster.
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