The Cholera Blame Game

In this cholera pandemicthe seventh since the first recorded in 1816one strain of the bacteria reached this hemisphere in 1991,probably in an Asian freighter dumping its bilge tanks in a Peruvian harbour. When it reached the Mexican highlands a few months later,South American cocaine smugglers were suspected.

Now,more than 1,000 Haitians have died. Some experts concede that the Nepalese soldiers are the most likely suspects. Nepal had an outbreak in August,from the strain that is now in Haiti. But officials are dead set against announcing what they find,since scapegoating provokes violence. Angry Haitian crowds have already stoned Nepalese vehicles and the peacekeepers have shot back.

Naming individual countries is not productive, said Scott F. Dowell,chief of the response to the Haitian epidemic at the United States Centers for Disease Control and Prevention. Were focused on this really unacceptable number of deaths.

From our point of view,it really doesnt matter, said Imogen Wall,the United Nations spokeswoman in Haiti.

Any transfer of a disease from one place to another is unfortunate. But it often cant be foreseen. And the faultif thats the wordoften lies just as much with the victims as with the vectors,since,as in syphiliss case,they are careless about whom they cavort with,and with cholera,they must lack good sanitation for it to spread.

Experts are divided over whether cholera will now spread. Dr David M. Olson,a medical adviser to Doctors Without Borders,called that pretty likely. Dowell of the CDC said he thought that the republic has good enough water and sanitation to keep it from taking hold.

All agreed that the US is not at risk,because most Americans have flush toilets and chlorinated tap water. No other Caribbean country is as vulnerable as Haiti,where more than a million people now live in tent camps and rainfall leaves them wading through a deadly brew of mud and feces.

In the worst imaginable case,Dowell said,the epidemic will stop only after infecting all 10 million Haitians. Most of those can be saved with prompt oral or intravenous rehydration. But even if the fatality rate is pushed down to 1 per centless than half of its current ratethat could still mean up to 25,000 deaths.

None of that has to happen,insisted Dr Fred Gerber,Haiti director for Project Hope which has brought a team of cholera experts from Bangladesh to coach Haitian doctors.

This team is freaking incredible, Gerber said. They treat 30,000 cases a month in Bangladesh,and nobody dies.

The key,he said,is teaching people to avoid untreated water,and to start rehydration at the first sign of diarrhea. Its the people who wait too long that end up dying, he said.

There is much about the disease that scientists admit not knowing.

The bacteria first emerged from the Ganges Delta in 1816,but light concentrations can be found in many places,including the Chesapeake Bay. They cling to copepods,tiny waterborne crustaceans,and outbreaks in Bangladesh have been slowed by simply pouring water through sari cloth to filter the copepods out.

They can infect shellfish and sicken just a few people or can,for unclear reasons,suddenly explode,as they did in the Artibonite River in Haiti.

And an epidemic can suddenly crash. It may happen when enough survivors have partial immunity,or with a change in weather and water conditions,or because a bacteria-killing virus has its own growth explosion.

Whatever the reason,experts hope that it happens soon.