Obviously, the primary concerns in New Orleans are to plug the levees (although it might be too late for that) and to rescue as many people as we can. Then adequate water, food, and basic health provisions are needed to prevent cholera and typhoid outbreaks. But there’s another potential longer-term microbiological problem.

I’m very concerned that in a week or two, we’re going to ‘secondary’ outbreaks of opportunistic pathogens. Let me translate that into English. A very quietly kept but very scary concern of most infectious control officers at hospitals is having a bacterial outbreak that ordinarily wouldn’t cause disease in healthly people–often these bacteria are found on and around people–but that can spread and kill seriously ill patients in hospitals (one such bacterium is Acinetobacter baumannii; another is methicillin resistant Staphylococcus aureus, which for obvious reasons is abbreviated “MRSA”). These infections can be deadly. Often, these outbreaks force hospitals to shut wards, or even the entire facility (depending on the extent of the outbreak).

Right now, we can’t afford to lose any health care facilities. Right now, there are a whole lot of factors that will make it very hard to keep these outbreaks from happening:

1. Elderly and immunocompromised patients are being moved from facility to facility. This can lead to the spread of these bacteria. In addition, these patients will need catheters and IVs replaced, increasing the chances of establishing an infection (which can then spread).
2. Given the overall crisis, it’s very hard to keep medical facilities, particularly those at the ‘point of first response’ sterile (imagine how much muck rescue workers track into a facility, not to mention some of the patients. Note: I am not blaming them, but this is an unfortunate reality).
3. Medical workers are exhausted. A lot of them have been heroic. But they’re overworked and tired. Infection control measures won’t be followed as rigorously. Again, this isn’t their fault, but it is reality.

Then there’s a long-term concern that I don’t see a way to avoid (although if you have suggestions, fire away). Some of these bacteria (e.g., MRSA, some A. baumannii) are one antibiotic resistance away from being untreatable–in the case of A. baumannii, some strains can’t be stopped at all. Doctors will do everything they can in an attempt to save their patients, and given the enormous public health burden, they will often use the antibiotic of ‘last resort.’ Once again, I’m not casting blame; in the next few weeks, medical facilities will be strained, so rapidly, highly successful treatment options must be used, but there will be consequences.

Down the road, we may have a very serious antibiotic resistance problem on our hands. This is why preparations needed to happen earlier than Monday evening: the quicker we get moving on this, the fewer long-term problems we’ll have.