After the devastation in the province of Valencia due to torrential rains and floods, other risks are beginning to appear, linked to stagnant water for days, mud and mud covering the streets and dozens of corpses, humans and animals, not evacuated. José María Martín-Moreno, doctor of 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 preventive measures must be taken, carry out epidemiological surveillance now, ensure access to drinking water and remove sludge as quickly as possible. He also emphasizes that, to volunteer, certain measures must be taken such as waterproof gloves, glasses, masks or mosquito repellent: “They must act under the control of the authorities.”
What are the epidemiological risks after the disaster?
The risks mainly come from water stagnation, contamination of drinking water and interruption of sanitation services. Stagnant water, especially those containing mud or silt, constitutes 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 make these waters a perfect “breeding ground” for different infectious agents and disease-transmitting animals.
On the other hand, there is a potential risk of sewage mixing with drinking water during a flood, increasing the risk of serious outbreaks, particularly in areas where sanitation systems are poor. compromise. Ensuring access to clean water and promoting good hygiene practices are crucial measures to prevent the spread of these diseases following a flood. Regarding the interruption or disruption of sanitation (due to accumulation of waste and lack of access to basic services, such as toilets and drinking water supply), exposure to infectious agents increases.
What diseases can appear?
This will depend on several factors and how agile or delayed the response is, but the greatest risk depends on waterborne diseases. Among the most worrying are bacterial gastroenteritis, hepatitis A or leptospirosis, all linked to the consumption of contaminated water. In addition, skin and eye infections can occur, and the risk of vector-borne diseases should not be forgotten.
In this sense, from previous experiences it is known that if stagnant water is not quickly eliminated, epidemics of diseases transmitted by mosquitoes that proliferate in these environments can occur.
How long will it take for these risks to worsen if the situation is not corrected?
Evidence shows that the risk of infection 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 health measures implemented. It is crucial that health authorities immediately implement preventive measures, such as the distribution of drinking water, sanitation of stagnant water and constant monitoring for possible epidemics. In addition, it is essential to inform the population about appropriate hygiene practices to reduce the risk of contagion and to take extra precautions when consuming food and water.
What should you do to avoid it?
The key to avoiding a public health crisis lies in the speed and effectiveness of these interventions. Disease prevention and control depends not only on the actions of the authorities, but also on the commitment of everyone to adopt the recommended measures and maintain a vigilant attitude, as well as 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 offered to the population, such as purification tablets or educationally transmitted instructions for boiling water in safely before consuming it. Along with the above, it is essential to restore and ensure sanitation (sewerage systems and waste management 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 transmitting infectious diseases. Additional disinfection of affected areas should also be carried out, including public and residential spaces that have been in contact with floodwaters. In addition, it is important that the population cleans and disinfects their homes and belongings using appropriate products. In this sense, education and awareness of the affected population is essential, and they must be informed of the health risks and necessary hygiene practices, such as frequent washing of hands with soap, especially before eating or handling food, and after contact with food. flood water. It is also important to avoid eating foods that have come into contact with contaminated water.
Along with all of the above, authorities and professionals must ensure good vector control, which consists not only of draining stagnant water, but also of taking fumigation measures in the areas most at risk to reduce the population of adult mosquitoes. These actions must be carried out periodically in the weeks following the flood.
Finally, we must 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 epidemics.
Is it a good idea to send thousands of volunteers there?
This can be helpful and necessary, as any help is minimal. But it must be managed carefully to avoid additional complications and ensure the safety of 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 firstly assessing the risks to volunteers. Indeed, areas affected by flooding can present physical and health risks, including contaminated water, weakened infrastructure and hazards. On the other hand, coordination and training are necessary, especially in terms of personal protection and procedures to avoid accidents or infections.
In this sense, priority should be given to trained and specialized personnel. And for those without disaster experience, they may be most helpful by collaborating at resource collection and distribution points, coordinating aid at the local level, or providing psychological support to distance, without the need to enter risk areas.
What risks do departing volunteers take? How to protect them?
The protection of volunteers is essential to ensure their safety and enable them to provide effective assistance. By following these recommendations and acting under the control of the authorities, the risks to which they are exposed can be considerably 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, floodwaters may have been mixed with chemicals, oils or fuels, which can result in dangerous exposure, including to the skin and eyes. The possibility of physical injuries and accidents should also not be overlooked, since flooded areas can hide debris, glass, nails and other dangerous objects that can cause cuts and injuries which, upon contact contaminated water, present a high risk of infection. . Additionally, there is a risk of slips and falls on wet and unstable surfaces.
Regarding personal or personal protective equipment (PPE), footwear must be suitable (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, as well as masks and protective eyewear in case of contact with chemicals or to reduce the risk of inhaling particles in dusty or dusty environments. debris.
In addition to the above, collaborative coordinators of these programs should ensure that volunteers are up to date on their vaccinations, especially against diseases such as hepatitis A, tetanus and, if possible, leptospirosis. This can reduce the risk of serious illness if exposed. Additionally, they should be provided with insect repellent on exposed areas of skin, especially during periods of high mosquito activity, or a first aid kit (including disinfectant, gauze, bandages, scissors and ointments antibiotics to immediately treat cuts and scrapes). .and reduce the risk of infection).
Are there precedents in other health emergency outbreaks or past examples that should be considered?
Of course. These experiences include 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 in Germany and Belgium in 2021, or in Pakistan in 2021. 2022.
Lessons learned or generated by the evidence include the importance of a rapid and organized response ensuring access to drinking water, sanitation, medical care and health education for affected populations. , as well as psychological support to affected populations 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 Spain as effective as possible in mitigating this catastrophe.
