Waterborne illnesses are on the rise in Puerto Rico in the wake Hurricane Maria — and health professionals fear the storm’s aftermath could unleash an epidemic on the devastated island.
The death toll from to the storm rose to 51 on Tuesday, with the two latest victims dying of leptospirosis, a bacterial disease usually spread by contact with contaminated water, Puerto Rico Public Affairs Secretary Ramon Rosario told the Associated Press.
Authorities are investigating an additional 74 suspected cases of the infection as well, he said, and at least one additional previous death was attributed to the disease.
“It’s going to be higher, it’s like a perfect storm for leptospirosis, people are going to get sick and suffer,” said nurse Llamara Padro-Milano who returned last week from a relief trip to Puerto Rico with the American Federation of Teachers.
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A spokeswoman for the Centers for Disease Control and Prevention confirmed to NBC News on Wednesday that they had received a shipment of specimens from the U.S. territory and were currently analyzing them at their laboratory in Atlanta, Georgia, for signs of leptospira, the bacteria that causes the disease.
The disease is transmitted via exposure to the urine of infected animals but humans most commonly are infected by coming in contact with contaminated water, especially through skin abrasions and the nose, mouth and eyes, according to WHO.
The over 70 suspected incidents of leptospirosis in just a month would represent a major spike: A total of 729 cases of leptospirosis were reported from 1990-2014 to the Puerto Rico Department of Health, according to a 2016 study in the journal PLoS Neglected Tropical Diseases, of which 78 were fatal. However, the study warned that letopsirosis was under reported or misdiagnosed as dengue.
It manifests with a wide range of symptoms including high fever, headache, chills, vomiting and diarrhea, but some may have no symptoms at all, according to the CDC. Leptospirosis is treated with antibiotics, but without treatment it can lead to kidney damage, meningitis, liver failure and death, according to the CDC.
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“People are forced to sleep on dirty mattresses … if you have no place to wash your hands and you don’t have [hand sanitizer] how are you going to protect yourself?” she said. “The best that we can do was to teach people how to protect themselves the best way we knew how.”
Randi Weingarten, the president of the American Federation of Teachers who was in Puerto Rico earlier this month, said she was “alarmed” by conditions she saw on the ground, and that mudslides, plus a devastated infrastructure and destruction throughout the island created a breeding ground for contamination.
“I’ve never seen the effects of a disaster in the United States of America like this,” she said.
“You had dead animals and you had streams debris in streams … so the sanitary conditions were terrible and so you see a level of contamination as a result of this that’s terrible,” she said.
Padro-Milano said nurses were encountering many cases of conjunctivitis, also known as pink eye, as well as residents often did not have clean water to wash their hands. And mold from houses damaged by rain and floodwaters was contributing to respiratory conditions and diseases, she said.
A quarter of the island’s population still lacks access to running water as of Wednesday, according to authorities, but not all of that access is evenly distributed.
While 87 percent of the metro area and 88 percent of the south has access to running water, only 46 percent of the north, 68 percent of the west and 77 percent of the east has access, according to a government website.