What are the Health Risks for Puerto Ricans?

The devastation of Puerto Rico from Hurricane Maria has so many dimensions that it is hard to even know where to begin. However, most people are concerned first with their health. There have been heart-warming stories of people stepping in and stepping up to evacuate very sick people to the mainland, and of course a lot of otherwise healthy people are self-evacuating in order to ensure themselves and their family members of food, clean water, and sanitation. Those latter two things are the tricky things for those staying behind because polluted water and lack of toilets and sewage can lead to serious health issues.

The biggest concern for most people is cholera, because it doesn't just give you diarrhea, it can kill you. As a news story this week in Nature points out:

In Yemen, cholera has killed more than 2,000 people and infected nearly 700,000 in the past 5 months alone, eclipsing the post-earthquake outbreak in Haiti. Haiti still battles with the disease 7 years after its reintroduction. Meanwhile, Somalia is experiencing its worst outbreak in five years. South Sudan continues to fight its worst outbreak since it gained independence in 2011. If nothing changes, cholera will continue to claim some 100,000 lives a year and afflict around 3 million people, many of them children.

Now, to be sure, the problem in Haiti was caused by Nepalese soldiers brought in by the UN to help after that country's huge earthquake, as I noted at the time. With any luck, no one in Puerto Rico has cholera and, if not, the island will be spared that disease, but not necessarily spared others.

As Puerto Rico struggles to recover from Hurricane Maria, sanitation is a concern. Fifty-five percent of the island lacks running water, according to the governor's office, and Bloomberg reported that residents are bathing and washing clothes in rivers. Many people are getting water from roadside springs, according to NPR, or hoping their hoarded supplies from before the storm don't run out before tap water is restored.

Even without cholera, if any of these ad hoc water sources become contaminated with feces, it could mean a major public health problem. According to the CDC, diseases such as hepatitis A can spread through contaminated drinking water. So can other diarrheal illnesses, including enteroviruses, Giardia and Campylobacter. Standing water after the hurricane may also become prime breeding ground for mosquitos. Zika virus, which causes mostly mild fever in adults but severe birth defects in developing fetuses, is already found in Puerto Rico and spreads via mosquito bites.

It is going to take a lot more than President Trump tossing paper towels to the crowd to keep Puerto Ricans healthy over the next few months until everything is finally cleaned up and working again. The latest issue of the PRB's World Population Data Sheet shows that life expectancy for females in Puerto Rico before the hurricane was actually slightly higher than on the U.S. mainland--83 years for females (compared to 81 on the mainland), while being just the same for males (76 years in both Puerto Rico and on the mainland). We can anticipate that those figures are likely to suffer this year.