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The Real Cause of Disease Outbreaks
Other Myths About Touching
When You Need To Be Careful
The Bottom Line

A few years ago, I read a news story about the earthquake in Haiti. Thousands of bodies were being buried in a mass grave. According to the reporter, there was a sense of urgency as masked, gloved emergency workers prepared to dispose of the bodies before the "outbreak of disease." I imagined myself providing care amidst the devastation and wondered, "What disease are survivors and emergency workers trying to avoid?"

The need to avoid contact with the dead after a natural disaster is largely myth. Here's why.

The Real Cause of Disease Outbreaks

It's true that there can be important disease outbreaks days or weeks later. In most cases, these outbreaks are related to the health and circumstances of the survivors, not the dead.

They're usually due to contaminated water, lack of immunizations, overcrowding and mosquito-borne infections (due to standing water and use of contaminated water containers).

Examples of these diseases include:

Diarrheal illness (such as cholera, E. coli, vibrio and salmonella)
Infectious diseases (such as measles and respiratory infections) due to overcrowding
Mosquito-borne diseases (such as malaria and dengue)

The truth is that there is no compelling health reason to avoid all contact with the dead or hurriedly bury victims into mass graves. But the fear that they pose a threat can create unnecessary problems. For example:

The emotional toll on surviving family members can be enormous when they're not able to bury loved ones according to cultural or religious customs.
There can be legal complications when rushing to bury victims before they have been appropriately identified.
When disinfectants are sprayed over an area, survivors may suffer with breathing problems and allergic reactions.

It may be better to devote resources to finding and supporting survivors rather than rushing to bury the dead due to a fear that they will cause illness.

Anyone who handles bodies should follow standard "universal" precautions, such as wearing gloves and practicing good hand hygiene. These steps help to prevent the spread of hepatitis, diarrheal disease and other infectious diseases the victims may have had at the time of death.

Other Myths About Touching

There are some other equally misguided warnings about the dangers of touching a person suffering an illness or injury. Here are just a few:

Victims of lightning strikes – I was taught at camp that you should keep away from anyone who is struck by lightning because you may be electrocuted if you touch the person. In fact, you could save a life by moving the person to safer ground and performing CPR.
Sleepwalkers – The idea that you shouldn't touch a sleepwalker probably comes from the fact that an awakened sleepwalker may become confused, agitated or even aggressive. In fact, you may be able to save the sleepwalker from injury by gently guiding them back to bed.
Lepers – These individuals are infected with a bacteria that is related to tuberculosis. You can protect yourself by avoiding close contact with someone with untreated infection. It's unnecessary, however, to quarantine an infected person, especially once treatment has started.

When You Need To Be Careful

There are times when even minimal contact with others can be dangerous. Examples include:

Methicillin-resistant staphylococcus aureus (MRSA) – Because this infection is difficult to treat, avoiding its spread is a priority. Therefore, special precautions are warranted (such as caregivers wearing gloves and gowns, use of antiseptics, and placing patients in private rooms) when people with MRSA get medical care.
Clostridium difficile (C.Diff) – This diarrheal infection is highly contagious. It tends to spread in hospitals, especially among older individuals who have been taking antibiotics. Special contact precautions are important to prevent spread.
High-dose radioactive iodine therapy – This is a treatment for thyroid cancer that has spread. It temporarily exposes people near the patient to radiation. The exposure can also come from the treated person's stool, urine, saliva and sweat. Therefore, treatment occurs in the hospital where the patient stays in a shielded room for up to three days (until detectable leakage of radiation has diminished).
Chicken pox or shingles – A person infected with the varicella virus is highly contagious until the rash has crusted over. Those who have never had chicken pox should avoid exposure to someone with shingles.
Influenza – Flu is another highly contagious viral infection. Most people recover without complications. However, people whose immune defenses are weak should get vaccinated and avoid exposure to anyone who has the flu.

The Bottom Line

For those infections that are highly contagious and dangerous, it makes sense to take appropriate precautions. But, in a disaster with mass casualties, actions based on medical myths can make things even worse. Only education and a skeptical eye can change behavior based on misconceptions. We may not be able to prevent the next natural disaster, but we should make sure we respond to it in the best way possible.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

Natural Disasters -- Sources of Disease?