Infections require three elements to occur:
Source: The environment where the infectious agent is present. This can be a sewer, street, doorknob, or human skin. Any surface or zone where germs tend to gather and multiply can be ground zero for an infection. Rigorous sanitation is important in healthcare settings to prevent germs from accumulating on bed rails, equipment, counter tops, sheets, indwelling devices such as catheters, and so on. Wet areas in particular are suspect, including sinks, leak sites, stagnating pools, and so on.
Susceptible Person: The host of the infection, a person who is either not vaccinated or otherwise immune to the particular germ, or has a generally weakened immune system. Patients in healthcare settings with underlying conditions are at increased risk, especially if an indwelling device is providing a potential route for germs to take. Outside healthcare, unprotected people in high-risk areas are at certain degrees of risk based on their personal factors and the nature of infections in their area.
Transmission: Finally, the germs need to be able to get from the source to the susceptible person. Germs cannot move under their own power, they need an intermediary. Liquid is a popular mode of transmission, since it absorbs easily into the body. Germs can be carried by moving water, but they thrive in still pools that collect in disaster zones and impoverished areas. Other modes of transmission include human-human contact, human-animal contact, inhalation (for airborne pathogens), and puncture wounds.
Infection control is crucial to combating these threats, and this page is devoted to providing resources and the best products for your needs. There are two basic tiers of infection control protocols:
Standard Precautions: The standards are based on risk assessment and common sense, providing a framework for understanding the basics of infection control to minimize spread among patients and staff.
Basic hand hygiene is the first step, with the CDC estimating that healthcare providers clean their hands less than half as often as they should. Wash with soap and water when hands are visibly dirty, as well as at other obvious points (before eating, after restroom, etc). It’s recommended to use alcohol-based hand sanitizer for everything else, and consistent supplies of high-quality sanitizer should be near at hand in any healthcare facility. We carry sanitizers in bottles, dispensers, and in various types including foam.
Personal protective equipment (PPE) is necessary when infectious material is known or expected to be in an area. PPE is our bread and butter here at Enviro, and we carry hundreds of products that can protect from the whole range of threat levels. Isolation gowns are a must for protection from infectious fluids. Respirators range from base-level N100s to full-blown powered air-purifying respirator (PAPR) units. There are many other options to explore in our inventory besides those representative examples. We also carry many varieties of disposable gloves suited for a range of needs.
Cough etiquette is necessary to minimize the spread of infectious material expelled from the body by coughing. Covering your mouth and nose and washing your hands immediately after is the best way to avoid infection spreading by cough.
Proper patient placement is important as well. The potential for transmission between patients must be taken into account when positioning patients in medical spaces. Particularly contagious patients should be isolated, and patients shouldn’t be placed in the same room or waiting area unless their infections are the same or similar.
Disinfecting the environment covers the all-important issue of sanitation. Any surface or non-disposable item that an infected patient touches must be disinfected as soon as practical. The process should ideally be centralized in a processing space to ensure thoroughness, but such an arrangement isn’t always practical.
Textile and laundry handling is crucial when infected patients are staying in beds. Germs can easily live in the folds of fabrics, so they should be bagged and washed according to facility policy.
Safe injection practices as defined by the World Health Organization provide a common sense process for injections. Safe injections do not harm the recipient, do not expose the provider to any avoidable risks, and do not result in hazardous waste. Injections can be rendered unsafe in various ways: unsterilized needles, poor preparation of the body part that is receiving the injection, and filling the syringe incorrectly can all contribute to an unsafe injection.
Sharps handling is a gravely serious matter. Approximately 385,000 sharps-related injuries occurring each year, and that’s just in hospitals. These injuries most often result in the transmission of hepatitis B, hepatitis C, and HIV, but over 20 other pathogens have been documented. It is absolutely critical that sharps be handled with extreme care, and that a clearly marked disposal container be available in all rooms where procedures are performed.
Transmission-Based Precautions: Situational standards based on the presence of particular risk factors.
Contact precautions require that patients be appropriately placed based on their needs and that transportation of patients be kept to a minimum. When a patient must be moved for medically necessary reasons, the infected or colonized areas of the body must be covered or otherwise contained. PPE should be used and disposed of appropriately, and rooms should be frequently disinfected.
Droplet precautions involves the respiratory secretions generated by a patient when they cough, sneeze, or talk. These droplets can be highly infectious and contagious, and must be effectively contained. Coughing patients should wear masks and providers that interact with them should wear appropriate PPE.
Airborne precautions involve patients known or suspected to be infected with airborne pathogens, such as tuberculosis, measles, and chickenpox. Such patients must be masked and ideally placed in an airborne infection isolation room (AIIR), from which they shouldn’t be taken unless absolutely necessary.
The Plague of Justinian, 541-542, 100 million (half the global population at the time). The Black Plague, 1346-1350, 50 million. The Third Plague, 1855-1960, 12 million. Spanish influenza, 1918, 20 million. 12 million. HIV/AIDS, 1960-now, 39 million. The list goes on. These disastrous tragedies have become one of the frameworks through which we understand history. Every new outbreak plays a part in defining the story of its age, with West African Ebola being the most recent and dramatic example. That wasn’t an epidemic on the mass scale of the historic plagues, but it thrust the severity of these threats into the harsh light of the 21st century.
On this page, we’ll be looking at the most prominent infectious diseases and what can be done to combat them.
Ebola: Everyone remembers the West African Ebola outbreak, one of the biggest stories of 2014. But what exactly is it, and could it resurface again? It was discovered in the mid 1970s near the Congo’s Ebola River, and has reared its head now and again ever since. There are six identified variants of Ebola, found in different regions, with two out of the four only infecting animals (as far as is currently known). It spreads through direct contact with infected bodily fluids, entering the body through broken skin or an orifice.
Symptoms include fever, severe headache, muscle pain, weakness, fatigue, diarrhea, vomiting, abdominal pain, and hemorrhaging. The virus usually takes a week or two to exhibit symptoms. Healthcare facilities caring for Ebola patients must be extremely vigilant to keep the space sanitized to prevent further spread. There is no approved vaccine at the present time.
Flu: Influenza, flu for short, comes around every year. It spreads mainly through droplet contact when an infected person coughs, sneezes, or talks. Everyone 6 months and older should be vaccined early in flu season. This is particularly critical for people with chronic illness, which can easily escalate when a person has flu. Most adults are contagious a day before symptoms develop and up to a week after.
Symptoms include fever, cough, sore throat, runny or stuffy nose, muscle or body ache, headache, and fatigue. Vomiting and diarrhea can also occur, mostly in children. Complications can take the form of sinus and ear infections, tissue inflammation, and pneumonia. Seniors, children, and pregnant women are particularly susceptible to flu-related complications.
West Nile: This virus spreads primarily during mosquito season, which runs from summer through fall (with varying degrees of severity depending on region). The most effective way to avoid infection is to deter mosquito's by the standard methods: repellent and long sleeves. If you’re traveling during the season, make sure to sleep under a net and diligently protect yourself. The EPA has a resource for helping you find the right repellent for you, and a special chemical (permethrin) can be used to treat clothing.
Interestingly, most people who contract West Nile do not develop symptoms. About 1 in 5 will develop fever, body aches, and other flu-like symptoms. About 1 in 150 can develop high fever, stiffness, disorientation, tremors, and numbness that can indicate encephalitis or meningitis. No vaccine or specific treatment exists at this time, and the only solution is to wait it out.
Tuberculosis: TB is a bacterial infection that usually attacks the lungs, but can spread from there to affect the kidney, spine, brain, and other parts of the body. The bacteria transmit by air when an infected person coughs or talks, and nearby people breathe the bacteria in. It is possible to have the bacteria inside you but for your immune system to suppress it so you have no symptoms and aren’t contagious (latent TB). For those who do develop the disease, they’ll tend to spread it to people they encounter every day.
Symptoms include coughing up blood, chest pain, poor appetite, fever, night sweats, and fatigue. The vaccine should be administered only to select people that meet particular criteria for susceptibility. As with all infections, measures should be taken in a healthcare setting to minimize the spread of TB by rigorous sanitation processes and masking infected patients.
Staph: Staphylococcus aureus, or staph for short, is carried by about 25-30% of people in their nasal cavities. It can also be found on skin and hair, and in the throat, and is typically benign. It can cause bacteremia, sepsis, endocartitis, or osteomyelitis if it gets into the bloodstream, and trigger pneumonia in patients with underlying lung disease.
Symptoms include nausea, vomiting, diarrhea, poor appetite, abdominal cramps, and fever. It tends to only last one to two days, and can be treated by drinking plenty of fluids and getting rest.
Malaria: A particular parasite carries malaria and transmits it through mosquito hosts, usually female Anopheles mosquitos. About 1700 cases of malaria are diagnosed in the US annually, typically in people returning, immigrating, or traveling from abroad. It is particularly prevalent in Sub-Saharan Africa and South Asia. Malaria is not spread by casual contact with an infected person, only through blood.
Symptoms tend to be flu-like, including chills, headache, muscle ache, and fatigue. It can cause anemia and jaundice due to how it affects the read blood cells, and if untreated can lead to kidney failure, seizures, and death. If you’re traveling to an infected area, consult your doctor to prescribe preventative drugs. A vaccine does not presently exist due to the complicated nature of the parasite.
Dengue: This virus is a leading cause of illness and death in tropical and subtropical areas. While extremely rare in the US, it is endemic in Puerto Rico and many popular tourist destinations. Like West Nile, it is typically transmitted by mosquito bite, and the only way to prevent it is to deter mosquito's from biting you in an endemic area. Use repellent, wear long sleeves, and sleep under a net while traveling in infected regions.
Symptoms include high fever, severe headache, join pain, muscle pain, bone pain, rash, and mild bleeding. A severe form of the infection can develop as dengue hemorrhagic fever (DHF), with comedown symptoms that include vomiting, severe abdominal pain, and difficulty breathing. In the most extreme cases, circulatory failure can occur that will cause death unless corrected immediately.
Hepatitis-B: Hepatitis is an inflammation of the liver that is transmitted by infected bodily fluids. It can be spread from an infected mother to her newborn, between sexual partners, between drug users sharing needles, and direct contact with a patient. Hep-B can begin as a short-term infection but may become chronic or lifelong depending on the body’s response. The younger the patient is, the higher the change of it becoming chronic. Completing a vaccine series will prevent infection.
Symptoms include fever, poor appetite, nausea, vomiting, fatigue, abdominal pain, and jaundice. There are many blood tests that can diagnose the disease even if you aren’t symptomatic.
Hepatitis-C: Hepatitis is an inflammation of the liver that is transmitted by infected blood, typically through needle-sharing. Hep-C can begin as a short-term infection but may become chronic or lifelong depending on the body’s response. The younger the patient is, the higher the change of it becoming chronic. Unlike Hep-B, there is currently no vaccine for Hep-C, and reinfection is possible.
Symptoms include fever, poor appetite, nausea, vomiting, fatigue, abdominal pain, and jaundice. There are a few different blood tests that can diagnose the disease even if you aren’t symptomatic, though in those cases the virus tends not to go unnoticed until the patient gets screened for blood donation or in a routine exam.
Swine Flu: H1N1, better known as swine flu, is a respiratory disease common in pigs. It usually doesn’t affect humans, but outbreaks have occurred. Those with high risk factor for flu and flu-related complications should avoid pigs.
Symptoms are mostly the same as flu, including fever, fatigue, poor appetite, and coughing. Runny nose, sore throat, nausea, vomiting, and diarrhea have also been reported. Antiviral medication can be subscribed to infected patients after consultation and diagnosis.
Avian Flu: H5N1, better known as avian flu, appears in wild and domestic birds worldwide, and can occasionally spread to people. It can be transmitted in airborne droplets and possibly dust, which is inhaled by a human and develops into an infection. Avian flu infections are not common in humans, but enough of a concern that they merit discussion. It can only be tested by analyzing a throat swab in a lab.
Symptoms include typical flu symptoms (fever, cough, sore throat, aching) accompanied sometimes by severe respiratory illness of failure, altered mental state, nausea, abdominal pain, diarrhea, and vomiting. Vaccine development is ongoing.
HIV/AIDS: One of the greatest tragedies in American history is the HIV/AIDS epidemic, which began in earnest in the 80s and persists to this day. No cure exists at this time, but HIV can be managed with proper and consistent medical care. It spreads through the immune system, attacking CD4 cells that fight off infection and disease. Left untreated, the virus can escalate and become AIDS.
HIV is not transmitted by air, water, saliva, sweat, tears, insects, animals, or sharing a toilet, food, or drink. It is almost always transmitted via bodily fluids or sharing needles. Treated with antiretroviral therapy (ART), HIV can be managed so that it never becomes AIDS and the patient lives a long and healthy life without transmitting. Knowing your HIV status is important for sexually active people to make wise decisions.
All places are prone to natural disasters, and they have been increasing in frequency over the last few decades. The aftermaths of these events are almost always more dangerous and fatal than the event itself, as local infrastructures either struggle to function or collapse completely.
Preventing and controlling infectious diseases after natural disasters is a crucial element of recovery efforts, and the most common category of disasters (hydrometeorological) happens to be the one that creates the prime conditions for disease to fester.
The “hydrometeorological” disaster category includes floods, large storms, tornadoes, and other weather-based catastrophes. These events often displace large amounts of water into inhabited areas, that can then stand for weeks or months at a time. Viruses, mold, and mosquito's love it. That doesn’t mean that other categories aren’t deadly as well. Those who don’t are aren’t able to evacuate prior to the disaster suddenly find themselves living in a petri dish of potential infection.
“Geophysical” disasters, such as earthquakes, have high likelihood of disease outbreak. Tsunamis, despite having a similar threat profile to hydrometeorological disasters, are categorized here because they are usually associated with tectonic phenomena such as underwater earthquakes or eruptions. Dry earthquakes can cause infectious outbreaks as well, when large amounts of people are displaced into crowded shelters. Even hospitals with rigorous sanitation standards can become overwhelmed.
All that being said, it’s important not to overstate the risk of outbreak during disaster aftermaths, as the media and health officials often do. The overwhelming majority of disaster-related deaths are caused by blunt trauma, burns, being crushed by debris or building material, etc. What the data over the years shows is that humans are astonishingly resilient even in these terrifying conditions. Still, infectious outbreak is very real and needs to be comprehensively understood and dealt with.
The outbreak process has been analyzed in three phases:
The impact phase lasts up to 4 days after the disaster itself. During this period, the bravest teams of first responders are extricating victims and initial treatment of injuries begins. Vector breeding sites for infectious insects are established and start to produce, and dangerous waste matter is often carried into public areas by water.
The post-impact phase covers the period 4 days to 4 weeks after the disaster. The first waves of infectious diseases typically emerge in this window of time. In the disaster area, they are mainly contracted through infected food, air, water, or bites. In shelters and hospitals, they are spread from person to person due to poor conditions and the crush of humanity that floods into these facilities.
The recovery phase lasts from the second month after the event to whenever normalcy is established again. At this point, any infections that are going to spread are endemic to the area, and you start to see diseases with longer incubation periods manifest.
It has to be noted that the most frequently occurring and documented diseases (over 40% of cases) are water-borne septic infections. Fecal matter gets into the water and spreads through neighborhoods, contaminating any system it works its way into. The result is typically diarrhoeal disease, which can be violent enough to cause death.
Unfortunately, the fast pace of our media cycles means that disaster areas don’t get much attention after about three months. News media begins to withdraw when the story ceases to be compelling, followed by the NGOs and most of the volunteer teams. Depending on the severity of the disaster, infrastructure may or may not be reestablished at that point, and it’s usually not. This is a disgraceful habit that may be expected from the media, but not from response teams. They should remain for as long as they have to, until the work is done.