One Million Cholera Cases in Haiti

While the Pan American Health Organization (PAHO) asserted today that Haiti’s cholera epidemic is now “less lethal,” with a smaller percentage of cases dying today than at the start of the epidemic, a different, and probably more accurate view, comes from Dr. James Wilson, executive director and co-founder of Praecipio International, an NGO focusing on “operational biosurveillance” from the standpoint of national security.

As one Canadian doctor put it, Haiti has only seen the first wave of the cholera “tsunami.”

Dr. Wilson, who has attacked USAID and the incompetent and negligent U.S. government response to Haiti, warns that “the upper bound of the estimated total (sub-clinical and clinically apparent) case counts to be nearly one million,” adding, however, that “from a practical operations point of view, these estimates are academic. The bottom line is the epidemic continues to spread completely out of control.”

This figure is based on information gathered by HEAS, the Haiti Epidemic Advisory System, a network of Praecipio’s “operational biosurveillance” partners who are on the ground in Haiti. There is a big discrepancy between what HEAS’s partners report and the official numbers coming from PAHO, WHO, et al.

What is not reflected in the official numbers, Wilson argues, “is the continually documented ‘first contact’ pattern of daily clinical mortality seen by rural communities and urban environments such as Gonaives.” There remain “vast areas of the mountainous, rural areas of Haiti (i.e., two-thirds of the country) that are ‘off the grid’ where people die in their homes without access to care. Forced walking distances from 8 hours to infinity are the reality for these people. Being forced to walk on a difficult mountain trail while medically deteriorating with cholera is a major facilitator of death…. A silent death where lack of reporting does not indicate ‘no death.'”

“In some areas of Haiti, we have confirmation that in-patient statistics are under-reported by as much as 400%,” Wilson reports. “In many areas of Haiti, we are documenting outbreaks that are not being accounted for in the official statistics…. We err on the side of over-estimating because this is a ‘virgin soil’ epidemic and expected to aggressively spread throughout the country….”

A HEAS map of Haiti’s cholera epidemic, found on Praecipio’s website, divides the country into red, orange, and yellow regions. Of the three, HEAS describes yellow—Haiti’s southern peninsula—as the “next battle front.” Cholera has been confirmed there at multiple sites, but the majority of the international response is focused on Port-au-Prince, Artibonite, and more recently, the North. “The South is relatively untouched in terms of response,” but HEAS suspects “far more activity than what is reported because of very low NGO presence. We also note very large time lags in official reporting from this area. The southern peninsula is the next battle front, where we expect the ‘war’ to go very badly given the low availability of response assets.”

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