When Hurricane Matthew made landfall in Haiti last week, the eye of the storm hit just east of the coastal community of Les Anglais on the island nation’s southwest peninsula. Thousands of homes were destroyed and dozens were killed in the 45,000-person community, which was cut off from the rest of Haiti.
It took relief workers five days to reach the town, and when they got there, they found less than 100 buildings still standing, a contaminated water source, and ripe conditions for a disease that has plagued Haiti since the earthquake in 2010.
“I put my eyes on four cholera patients, one dead, one child near death. It was crushing,” said Dr. Lynn Black, a global health disaster response team member at Massachusetts General Hospital who was on the first mission to the city.
Even before Hurricane Matthew, cholera cases were on the rise in Haiti, with more than 28,000 infections as of mid-September. Averaging 770 infections a week, the case totals for 2016 were already on track to outpace the last two years.
Cholera, a diarrheal disease that spreads to humans through the ingestion of contaminated food and water, has ravaged Haiti since a river was contaminated by foreign U.N. workers carrying the disease bacteria in the aftermath of the earthquake in 2010. More than 790,000 cases and 9,300 deaths have been reported since.
Poor water quality and sanitation play the biggest role in determining the likelihood of a cholera outbreak. In Haiti, the sanitation infrastructure is already fragile: Less than a quarter of people have access to a toilet and under half can get clean water, meaning they are drinking from rivers or other natural water sources that are likely to be contaminated.
Severe rain can initially flush out cholera-causing bacteria, but if destruction from a storm further impacts sewer services in a community where the bacteria is present, the spread of disease becomes more likely. Flooding caused by this week’s storm could contribute to overflowing sewage systems, and pools of standing water are prime containers for cholera bacteria.
Right now relief workers are attempting to deliver bottled water and chlorine tablets to prevent people from drinking or bathing in rivers or other potentially contaminated sources.
“The distribution of clean water and provision of safe sanitation becomes harder in this context,” said Justin Lessler, an infectious disease epidemiology expert and associate professor at Johns Hopkins. “That can also increase the number of cholera cases and efficiency of cholera spread.”
When Black arrived in Les Anglais, she found people with no access to clean water and very limited supplies of water-purification tablets. A person must ingest billions of bacteria to initially get sick with cholera, but once they have contracted the disease, it spreads quickly from human to human.
“Based on the fact that there is no access for these communities, the implications for diarrheal disease, or for women dying childbirth is just profound,” Black said. “And then you take the things people are usually treated for at a hospital that cannot get treatment…Those deaths are going to go up pretty significantly down the road.”
With more than 60,000 Haitians in need of shelter, crowds of people staying in close quarters will create prime environments for rapid transmission. “That’s why this disease is so, so dangerous,” said Asfar Ali, a professor at University of Florida’s department of environmental and global health. “If they are not provided with good quality of water, good sanitation [and] hygiene, it could [lead to a] massive outbreak of cholera again.”
Once cholera spread starts in these kind of situations, it’s important to separate sick people and, if possible, get them treated. Mild cases can be treated with inexpensive, over-the-counter oral rehydration salts. In more severe instances, intravenous rehydration at a clinic is essential.
“Every day that goes by increases the threat of cholera. We are in a race against time to get to these children before diseases do,” Marc Vincent, UNICEF Representative for Haiti, said in a statement over the weekend.