Researchers from the Climate and Health Observatory of Fiocruz's Institute of Communication and Information in Health (Icict/Fiocruz) warn, in a technical note, of an increased incidence of respiratory diseases (COVID-19, colds and flu and tuberculosis), gastrointestinal diseases (hepatitis A and infectious diarrhea), vector-borne diseases (mainly dengue) and leptospirosis among the population affected by floods in Rio Grande do Sul. Another danger of this post-flood period is the increased number of accidents involving venomous animals, which can appear inside houses as the water recedes.
"Historically, the valley regions (including the Metropolitan Region of Porto Alegre), the Central Depression and the northern coast of the state have a higher incidence of accidents involving venomous animals. With the rise of water levels, there may be more accidents involving spiders and snakes, as well as an increased risk of diseases transmitted by contaminated water and vectors, such as leptospirosis, diarrhea and dengue fever. These diseases and illnesses occur more frequently in the summer, but could spread over the coming months due to the changes in the original environment caused by heavy rains and floods," explains Diego Xavier, a researcher at the Climate and Health Observatory. "The overlapping of these risks, in the same areas and in the same period, requires that the health system be better able to make differential diagnoses and identify the most serious cases, those which will require hospitalization or specialized treatment," adds Christovam Barcellos, also a researcher at the Observatory.
In a technical note, the researchers draw attention to another important issue at this stage of the tragedy: the mental health of the displaced people, professionals and volunteers working in the emergency. Material losses and/or losses of relatives and friends can cause an increase in cases of post-traumatic stress disorder, depression and anxiety.
According to the study published by the Climate and Health Observatory, chronic diseases such as diabetes, hypertension, cardiovascular diseases and mental disorders can decompensate due to interrupted access to medication and ongoing medical care.
The crowding of people in shelters, the recovery work in the affected cities and contact with contaminated water are among the reasons that can cause an increase in most health-related problems. At a time when the streets are full of garbage and debris awaiting collection, physical injuries such as cuts, fractures, bruises and even burns are also common.
The technical note also points out that there are 1,518 potentially polluting establishments within the area that was flooded. These are industries, transportation terminals, civil works, shops and warehouses that, when invaded by floods, can expose the population to toxic substances in the months following the disaster.
"We know that this is a difficult time and that many services still need to be re-established, but to reduce the risks to the population, it is important that the health system implements collective care initiatives, such as vaccination campaigns, the provision of drinking water and adequate sanitary facilities in shelters, vector control, ongoing access to medication and medical care for the chronically ill, as well as mental health support services for the population and the people working in the emergency," Xavier emphasizes.
The technical note was drawn up by cross-referencing data from the Notifiable Diseases Information System (Sinan), the Brazilian Institute of Environment and Renewable Natural Resources (Ibama) and the flood grid provided by the Hydraulic Research Institute at UFRGS (IPH/UFRGS).
Situation room
On May 6th, the Presidency of Fiocruz set up an internal situation room to support the actions of the Emergency Operations Center (COE) of the Ministry of Health (MS) in Rio Grande do Sul. Researchers Christovam Barcellos, member of the Climate and Health Observatory, and Carlos Machado, from the Sérgio Arouca National School of Public Health (Ensp/Fiocruz), are Fiocruz's representatives on the COE.
Fiocruz's coordinated action aims to contribute to emergency and structuring actions in the field of health, in the medium and long term, together with the Ministry of Health and local governments, based on the institution's accumulated experience in dealing with emergencies and disasters, including those caused by dam collapses.
"The studies that the Climate and Health Observatory is producing are currently intended for guidance. They indicate the flooded areas, map health units, pharmacies, those that are working and those that are in flooded areas. Then we will use it for monitoring and we will be able to know which health units are back up and running, what they are managing to produce, how many appointments and/or hospitalizations they are performing... This way we will be able to assess how the health system reacts in the coming weeks and months," explains Barcellos.