Via The New York Times: Cholera Deaths in Haiti Could Far Exceed Official Count. Excerpt and then a comment:
Deaths from the cholera epidemic that ravaged Haiti after the 2010 earthquake could be much higher than the 9,200 officially tallied so far because of underreporting during the initial outbreak, a new study suggests.
The study, by Doctors Without Borders, found that incomplete surveillance and data collection, overwhelmed health clinics, the rapid spread of the disease and cholera’s ability to kill quickly contributed to what appears to have been a drastic understating of the death toll.
Haiti was still deeply traumatized from the January 2010 quake when it was hit 10 months later by the cholera epidemic. Studies have traced the outbreak to faulty sanitation practices by a United Nations peacekeeping force.
It was the first time in a century that Haiti, the Western Hemisphere’s poorest country, was infected with cholera, which spreads through water contaminated by feces. Victims die from severe diarrhea and dehydration.
The Doctors Without Borders study, published in the March edition of Emerging Infectious Diseases, a federal Centers for Disease Control and Prevention journal, is not the first to suggest that Haiti’s cholera victims have been underreported.
But it provided a basis for calculating some new estimates that if applied nationally could multiply the known death toll by roughly a factor of three, at least in the first six months of the epidemic, when it was most intense.
In some areas, the number of deaths may have been as much as 10 times as high as that reported to the Haitian government, which derived its statistics largely from mortality information supplied by clinics and hospitals.
“The results suggest that relying on surveillance based primarily in health care facilities provides a biased picture of an epidemic and underestimates illness and death from the disease,” the study said. The risks of underreporting, it said, increase when, as in Haiti’s case, “the surveillance system has weaknesses and requires adaptation during the first phase of the epidemic.”
Doctors Without Borders was among the first medical aid groups to assist the government in assessing and treating the epidemic, which spread nationwide within a month. By April 2011, the government had improved its surveillance system and had reported nearly 4,900 deaths. Although large, the number implied only a small statistical increase when compared with the normal mortality rate for the country.
Concerned about underreporting, Doctors Without Borders’ researchers undertook their own study, with the Haitian government’s permission. They conducted surveys of nearly 71,000 people at four areas in northern Haiti — Gonaïves, Cap-Haïtien, North Department, and Gaspard and Zabricots, during the spring of 2011. Based on those surveys, which covered 4.4 percent of the population, the researchers found a nearly threefold increase in deaths, “suggesting a substantially higher cholera mortality rate than previously reported.”
The study stops short of projecting what Haiti’s cholera death toll might be today, but said that “if the estimates presented here are correct, then many deaths in Haiti were never counted in the official statistics during the first wave of the cholera epidemic, despite commendable efforts to promptly implement a national cholera surveillance system.”
Even from the safe distance of Vancouver, tracking cholera in that grim autumn of 2010 was deeply disturbing. Week after week after week the case numbers rose and so did the deaths. Cholera seemed to get into remote mountain villages far faster than doctors could. If this MSF report is accurate, we didn't know the half of it.