The epidemiologist, professor, and researcher Carlos Álvarez explains to us what precautions to take regarding smoke, heat, and the epidemics that the El Niño phenomenon, which is already starting to be felt in the country, could bring.
It is very important to talk to you about the risks we face with the expected and very strong El Niño phenomenon, as we inherit an increasingly fragile health system. Even before its effects intensify, we already had semi-controlled outbreaks of dengue, malaria, yellow fever. How should we prepare?
The first thing we have to understand is that the health risk does not end when there is a catastrophe, when the shaking stops, or when the fire is extinguished, even if there is water around, but it is not potable and safe water. Because it could go from catastrophe to an epidemic.
Wildfires have been like the first warning bell of what may come in the next six months…
Yes, the first warning bell of the El Niño phenomenon. Those fires are already drought. We have to anticipate that others will come, as well as opposite events, such as floods.
What risks are there that these natural disasters will bring major health problems?
Definitely the risk is high. With these climate changes, like those that El Niño is beginning to produce, drought will expand, which leads to less water, and when there is less water, ecosystems change and the growth of vectors such as infections is facilitated. Not only dengue, but chikungunya, which also circulates in our country, zika, and yellow fever itself, which unfortunately we still do not have under control. It started two years ago and continues, not only in Tolima and Huila, but there have even been recent cases in Cundinamarca. And these phenomena can increase. Clearly, the possibility of having more mosquitoes due to climate phenomena will lead to outbreaks in some regions where there are not yet any, caused by heat and the smoke from the fires. Let us remember that not only people are affected in disasters. With the earthquake, for example, homes were lost, entire hospitals were lost, and in some cases only pieces remained standing.
And add to El Niño the risk from animals… How can we prevent one disaster from coinciding with another and ending up overwhelmed by the health of Colombians?
A very good strategy has been implemented in the areas affected by the earthquake, which is an example. There has been a lot of solidarity from hospitals and clinics, even from areas different from those affected by the earthquake, which has allowed people who needed medical attention to receive it. Hopefully, we can maintain that solidarity. Because in disasters, something very important to clarify that we forget is that not only physical damage occurs, but also mental damage. People lose their loved ones; everything they have worked for during their lives can be lost. That completely alters mental health.
That will be another important topic to address for the health system: the mental health of Colombians…
Of course. Part of what we need to strengthen in our system is being prepared for the increase in consultations related to mental health, and there must be a response from the health system.
Let’s talk about smoke, whose effects we also need to be prepared for. How to prevent or mitigate its health consequences?
When they occur, residents of the area will have to return to using masks. Conventional masks and cloth face coverings do not work for the smoke generated by fires. People who are a meter or kilometers away must wear masks because they can inhale that smoke which contains many microparticles that are pollutants and especially affect people with lung problems. There are also risks among asthmatics or those with heart problems.
You say that simple cloth masks we used during covid are not effective. So?
The N-95 masks, which many of us also used during covid. Those are the ones that should be used. It should also be taken into account that smoke can affect the lungs and heart. Also, the heat is starting: we often see that in Europe people die every time there is summer. We should not see the heat coming from the drought as something distant.
Consequently, there will be a severe shortage of water and, therefore, energy. Without water and electricity, how can health problems increase for Colombians?
One of the particular situations with these two phenomena is that they make us more vulnerable. Without functioning aqueducts, people start looking for water that may be contaminated, and that contamination can increase outbreaks of infectious diseases. Systemic diseases can develop, not just intestinal ones. For human consumption, sometimes it is not enough that the water is clear and seems potable. It turns out it is not; one can have transparent water with bacteria and contamination, sometimes with some chemical product that changes its color, but it is not potable. And without electricity, or with power rationing, food might not be kept in good condition or the cold chain that protects many foods could be broken; or the risk of contaminated food and thus infections within a family or sometimes outbreaks within an entire community could increase.
Does a forest fire only affect the lungs and potentially the heart?
It also affects the eyes and skin. That is important to keep in mind because sometimes we only worry about the mask. We must consider that other tissues can also be affected.
What are the warning signs after inhaling smoke?
First, people may have difficulty breathing. This could trigger a crisis in those who already suffer from some respiratory disease. It can even cause fainting. And we return to the topic of people who begin to have altered mental states. Keep in mind that it is not only the smoke but also heatstroke, which must be addressed with proper ventilation and immediate medical attention.
Does the El Niño phenomenon, for the knowledge of Colombians, necessarily mean there will be drought throughout the country and abundant fires, or will we also see the opposite phenomenon? That is, floods?
Sometimes it can happen that in one area there is intense drought and in others floods, for which we also have to be prepared. When the drought ends, the La Niña phenomenon arrives, and we go from one extreme to the other. We also have to be prepared for mosquitoes.
What precautions would you recommend we take?
Hopefully, potable water could be delivered to populations. Many municipalities in Colombia do not have aqueducts, so it is always recommended to boil water for consumption, and additionally, to store non-perishable foods, which will also help us in times of energy shortage. And something I always take the opportunity to recommend is not to take antibiotics for any symptom.
And what about vaccines?
Yes, definitely. As always, vaccines save lives, that is not a minor thing. Sometimes, when these disasters occur, vaccination chains are lost. We must take advantage to get vaccinated. In Colombia, for example, we already have a dengue vaccine. We should get vaccinated before cases start to increase because when they already appear, there are not many tools to proceed. Everyone should be vaccinated against dengue, especially people under 60 years old, the age group where the vaccine has shown greater effectiveness. Children are the ones who will benefit most from these vaccines. But all under 60 should be vaccinated against dengue, as well as other infections like influenza or pneumococcus. It is not that bacteria or viruses come with the smoke, but it does predispose people to superinfections, and if they are vaccinated, we will have a lower risk of complications.
Many Colombians have been left with tremor syndrome. This is a question that may sound silly, although it is not. What should an emergency kit contain? I once heard a list of things that should be on hand, as if the recommendation was to pack the whole house in a small backpack. What is the basic content that this personal or family kit should always have ready to run out, whether there is shaking, fire, or flooding?
An emergency backpack should have a basic first aid kit: a painkiller, an antiseptic, an item for dressings. You should also put batteries, a charger, and in case people need specific medications for their health, they should have a reserve stored in that kit, obviously renewing it with the appropriate expiration dates.
What are the main myths or the most common mistakes made that we should avoid during a natural emergency?
One of the myths that most catches my attention is the relationship between the presence of corpses and the appearance of epidemics. It is the opposite: the epidemic brings the corpses, not the corpses the epidemic. It is very rare for it to be the other way around. The other myth we mentioned earlier: that when a catastrophe occurs, antibiotics should be given to the population. That makes no sense. Only people who have an infection should take them, but it is not about taking antibiotics as a sport because they lose their effect if consumed as if it were daily life. And keep in mind that antibiotics are only for bacterial infections. They do not work for viruses, fungi, or parasites. And there is another myth that El Niño only causes drought. It is not so. It depends on the season, the region, and the surrounding water.
What concrete recommendations would you give to authorities, mayors, and governors, who fortunately seem very diligent throughout the country asking about ways to protect the population? And what about those who make up the health teams? Fortunately, we have a very sharp Minister of Health…
I think for citizens the important thing is, in a natural disaster situation, prevention. The kit you mentioned is never too much. And authorities must be told about drills and evacuation plans. When the earthquake happened, I was very pleased in Bogotá to see people much better prepared thanks to the drills carried out in companies, schools, and universities. We are finally paying attention to that. It was gratifying to see that many things were done as planned and rehearsed. We must continue preparing because we live in a country with many risks. And keep in mind that what helps most is solidarity and, obviously, supporting vulnerable communities.
An important topic: instilling construction safety…
Building safe homes is a good opportunity, as many collapsed. The need to make construction safe has been demonstrated in other scenarios we have had, such as the earthquake in Armenia or what happened to us in the natural disaster of the hurricane in Providencia.
And prevention with vaccination seems to be another great goal…
Epidemiological surveillance is nothing else. As the saying goes, prevention is better than cure.
We are very grateful to those angels who are you, doctors, nurses, and health personnel, who in disasters are on the front lines and give everything they can. How should the country catch up with you?
One of the important points is precisely recognition for what is done. And hopefully, the strengthening we expect for the health system will come because it is not only about ensuring people have their timely appointments, as it should be, but that the work of each of those people in the health system is recognized, from those who help in hospitals cleaning to health personnel, bacteriologists, doctors, nurses. Being recognized for the work raises morale and also elevates the dignity of the work.
MARÍA ISABEL RUEDA
Special for EL TIEMPO