The two long, red scratches are a dead giveaway.
“You got snake bit,” Dr. John Twomey tells the middle-aged woman who has walked into his disaster center for care.
Twomey, a burn surgeon, is chief medical officer of a tented hospital set up by a federal Disaster Medical Assistance Team on the grounds of the West Jefferson Medical Center, just outside New Orleans proper.
The woman, who cannot be identified for medical privacy reasons, is one of the 1,500 to 2,000 patients who have been coming through the temporary facility set up last week.
Even though such cases could occur any day, accidents always increase exponentially after hurricanes and other disasters as people seek to clean up the damage.
Teams of nurses, doctors, paramedics and pharmacists from around the United States are working under the Federal Emergency Management Agency to supply emergency medical care for the people who remain in the New Orleans area.
No outbreaks yet
Investigators searching for evidence of epidemics have found plenty of stomach upset but no serious outbreaks — yet.
“We haven’t seen anything that jumps off the page,” said Dr. Carolyn Tabak. “But there are illnesses that seem to be occurring in greater numbers.”
Tabak, a pediatrician at the National Center for Health Statistics in Hyattsville, Md., is helping lead a team of researchers who will decide if any epidemics have followed the flood and damage caused by Hurricane Katrina in New Orleans.
In addition to the widely expected stomach upset caused by dirty water, skin infections appeared frequently, she said.
“Rashes are not uncommon here, anyway,” added Edward Weiss, a Centers for Disease Control and Prevention epidemiologist from Atlanta. “I think the main illness we are seeing here is the dysentery, the diarrhea.”
The CDC says 19 people have become ill from Vibrio bacterial infections and five have died in the region after Katrina. Three have died from Vibrio vulnificus and two from Vibrio parahaemolyticus, the CDC said.
Both organisms are common in Gulf waters and usually only sicken people who already have immune weaknesses.
One hospital, East Jefferson General Hospital, is reporting cases of methicillin-resistant Staphylococcus aureus, a bacterial infection that resists many antibiotics and can be hard to treat. But Weiss said MRSA, usually seen as a skin infection, has become common in many places.
'I felt something sting me'
Medical workers have seen the full gamut of medical emergencies, from stomach illness to people who stepped on nails, to the homeowner bitten by a snake as she tried to clean up from the hurricane, says Twomey.
“I was wearing gloves to clean out my refrigerator,” the woman says, somewhat embarrassed. “At least I got that right.”
But she was wearing flimsy shoes in the summer heat.
She had returned to her home in nearby Plaquemine’s Parish after having fled Katrina. Her house was in fairly good condition, but the refrigerator was full of rotten, smelly food after days with no electricity.
She dragged it out into the back yard to clean it.
“Of course the grass is tall right now,” she said, and added: “It’s usually manicured.”
She stepped back from her task. “I felt something sting me and I felt it burn,” she said. Certain it was a bee, she went to a nearby Red Cross emergency assistance center, set up to aid people from nearby whose homes were flooded.
They sent her to West Jefferson Medical Center, where she was intercepted by the DMAT team and an eager Twomey.
“I read the manual on snake bites this morning,” said Twomey, a burn surgeon from Hennepin County Medical Center in Minneapolis.
“This looks like a glancing blow,” he tells the woman. “We won’t use any antivenin now but come back if it starts to swell. He applies an antibiotic “because snakes have relatively dirty mouths," and sends a relieved patient on her way.
It could have been a water moccasin, a copperhead or a rattlesnake, all fairly common in these parts.
Beware of dirty water
So far, such cases seem to be more frequent than the feared outbreaks of infectious disease.
Although the floodwaters are a stew of sewage and chemicals, many people have been able to avoid infection so far.
Water and sewer service has been restored to some parts of New Orleans and neighboring Jefferson Parish but the CDC warns that while the water looks clean, it is not safe to drink or to bathe in.
“We have seen people who have done only one brushing of their teeth with water out of the tap and and within six to eight hours they are violently ill,” said Twomey.
He said they are treating these patients with antibiotics and Gatorade.
The CDC did not expect to see any serious, deadly epidemics after Katrina hit, and not even after some of the levees that hold back Lake Pontchartrain north of the city failed, flooding some areas with up to 20 feet of sewage- and chemical-filled water.
“The national news has people afraid they can’t even go outside without a mask and a full body suit,” said Curtis Allen, a spokesman for the CDC in Atlanta who is in New Orleans.
“There is very little disease here,” Allen said. “We have not been seeing the diseases that many people around the country feared.”