Post-Disaster Medicine

By Dr. Paul Ehrlich

On the morning of September 11, 2001, normal life screeched to a halt. Like many other doctors, I made my way to the hospital where I attend, NYU-Langone Medical Center, expecting that there would be many more emergency cases than usual. They didn’t arrive. The same happened downtown, much closer to the World Trade Center, at St. Vincent’s—now closed–Beth Israel and others. This was a different kind of disaster—relatively few were injured. Now, as we know, many died. Over the months and years since, many more people have gotten very sick. I have seen some of the asthma patients, but most have been treated in dedicated facilities, and most of the firefighters and other rescue workers with respiratory disease are not allergic. The toxic clouds weren’t necessarily allergenic but they were full of asbestos and other dangerous substances. Pulmonologists and other specialists are treating the breathing disorders. Dr. Larry Chiaramonte was a consultant to groups that organized the public health response to 9/11.

This past October we experienced a different kind of disaster, Hurricane Sandy, which laid waste to much of the coastline of New York and our neighboring states, displacing hundreds of thousands of people. The lucky ones were able to return home, but now, months later, if what I am seeing in my office is any indication, it’s not clear how lucky they really were. Toxic mold took hold in their homes, and once that happens, it’s really hard to get rid of. People who never had allergies before now have allergic rhinitis. People who never wheezed a day in their life now have asthma. Those who already had these conditions are far worse. The allergist’s calendar is usually very busy in the run-up to the winter holidays followed by a sharp drop afterwards. Not this year. I am seeing six or seven new patients a day on top of my normal caseload.

If the answer to environmental allergies is to avoid your triggers, what can I say to people who live in “sick” houses? That they would be better off completing the job the storm started—tear down their houses—and starting over? That’s a hard message for a doctor to give.

Further, mold is not just a potent allergen. It is also a source of mycotoxins, which “can enter the blood stream and lymphatic system, they inhibit protein synthesis, damage macrophage systems, inhibit particle clearance of the lung, and increase sensitivity to bacterial endotoxin.”

We said in our book, “Some molds such as Stachybotrys chartarum, Fusarium, and Tricho- derma can produce very toxic compounds, which, when inhaled or ingested, may result in a poisoning known as mycotoxicosis, which is marked by respiratory, neurological, flu-like, gastrointestinal, and skin problems.”

We really don’t know what to do about the incidence of mold on this scale. In March, Dr. Eckhardt Johanning of SUNY, Albany, the top doctor on molds, is convening about 40 of us in Atlantic City for three days to talk about what to do. It’s an appropriate setting. Like New York City, South Jersey’s health crisis didn’t end when the wind stopped blowing. We’ll keep you posted.