Earthquake: The Long Road Back : Illness Spreads at Camps for Quake Victims

Colds and coughs have spread rapidly among earthquake victims living outdoors, adding to the misery of those displaced from their homes and prompting some health officials to worry that outbreaks of more serious diseases could follow.

Although no statistics are available, doctors say they are seeing a high number of flus, colds, digestive ailments, ear infections and bronchitis among earthquake victims, especially small children.

And they are sending more people to hospitals for what should be minor ailments. Mark Perez, a doctor with El Proyecto Del Barrio in Pacoima, said of the children he has diagnosed with flu, an usually high number--about 5%--have been hospitalized for dehydration, a result of being in camps where water was in short supply.

Perez and other health workers say they are also concerned that the camps may be fertile ground for chickenpox because of the difficulty of quarantining children living in the tents.

In an attempt to stave off such problems, Kaiser Permanente announced an emergency $120,000 grant to six local health clinics Friday.

The Kaiser grants will be used for extra doctors and supplies, such as injectable antibiotics. The demand has been great for antibiotics in pill form, which must be refrigerated, and many earthquake victims have no way to keep them cold, Perez said.

So far, Los Angeles County health officials have treated more than 10,000 earthquake victims at local clinics and mobile emergency medical units. Medical services have also been provided through a wide array of volunteer efforts organized through local hospitals and medical groups as far away as New Mexico.

Those seeking help included Pacoima resident Maria Esther Diaz, who fled her home the night of the earthquake clutching a naked baby in her arms.

A night outdoors without proper coverings was too much for 11-month-old Everett Diaz.

“In two days he started this cough, very bad, this agh . . . agh . . . agh ,” Diaz said. Everett developed such a severe case of asthma and bronchitis that when Diaz brought him to a clinic, doctors rushed to strap his small face onto an oxygen mask, she said.

For doctors, medical practice in the camps has meant dealing with extreme forms of ordinary complaints.

Perez shook his head as he examined the leg of an elderly Panorama City woman who nearly developed gangrene after receiving a deep gash while escaping her home during the quake.

The woman, Beatriz Navarros, waited five days to go to a doctor, and in the meantime developed a severe infection that spread rapidly down her leg.

“This is not something we usually would have seen,” Perez said. Speaking in Spanish, Navarros said she didn’t have the time or money to deal with the cut after the quake left her homeless. Charged with caring for her 89-year-old mother outdoors, she simply poured hydrogen peroxide on the wound and hoped for the best.

Despite these miseries, some public health officials are counting their blessings.

Although the camps have bred colds aplenty, there has been no outbreak of any severe intestinal illnesses, always a danger when clean water is in short supply.

But the real test of health conditions in the camps is still weeks away, according to some doctors and nurses working in the camps.

More serious infectious diseases, such as hepatitis A and chickenpox, take several weeks to incubate. So for the moment, their spread in the camps is invisible, said Kaiser Permanente doctor Linda Croad, who specializes in infectious diseases.

Croad and others are already anticipating new outbreaks of chickenpox resulting from the camps, and they say influenza cases may also rise.

The threat of a chickenpox outbreak was downplayed by Caswell Evans, director of public health programs and services for Los Angeles County Department of Health Services, as he breezed through Valley emergency health clinics Friday as part of a fact-finding tour with Philip R. Lee, U.S. Department of Health and Human Services assistant secretary for health.

Evans dismissed the concerns, adding that there is “no more likelihood of children catching chickenpox in camps than if they were in school.”

But his statements were belied by his own staff in the field, who maintained that kids stay home from school if they’re sick, but can only be removed as far as the next tent in a camp.

Perez, the doctor in Pacoima, said that he has already seen at least 20 cases of chickenpox in east San Fernando Valley camps. In many cases, the victims were not quarantined until well after the infection had set in and were living in close proximity to other children in the meantime, he said.

A child infected with chickenpox will not show symptoms for two to three weeks. Moreover, the disease can be transmitted before any spots appear on the skin, so even quarantining the visibly sick won’t keep it from spreading, said Bernie Nelson, director of nurses for the Mid-Valley Comprehensive Health Center.

Nelson said that other ailments, such as hepatitis A, take two weeks to a month to incubate. Because people in camps are using outhouses and have fewer opportunities to wash their hands than if they were living indoors, there is a greater likelihood that hepatitis will appear and spread, she said.

Croad said she is also worried that the camps may promote the spread of tuberculosis, already increasing at epidemic rates in California.

Rates of tuberculosis are high among immigrants and homeless people, groups that are thought to be well-represented in the camps, she said. Tuberculosis can be transmitted by exposure to airborne microbes over days or hours. Children and the elderly are particularly vulnerable.

“There are a lot of people out there with coughs, right now. This is something we are very worried about,” Croad said.

Tuberculosis carriers may assume they have a minor cold and cough all night in crowded tents without realizing they risk exposing their neighbors, she said.

Shirley Fannin, director of disease control programs for the county health department, said such risks are decreasing hourly as the camps empty out and medical services become progressively more organized.

But for some, even fear of illness cannot conquer their dread of returning indoors.

Aseda Corona, who brought her 3-year-old son, Mario, to Perez’s clinic for treatment for a cough and ear infection, said she knew that living more than a week outdoors was hurting the boy. But going back indoors is no simple matter. The boy still cries with fear as soon as he crosses the threshold, she said.