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Falling towers, crumbling levees, and viral mutations


Hurricanes Katrina and Rita destroyed an entire beloved city and shattered a large part of the US Gulf Coast. Unlike the destruction of 9/11, it is difficult to say at the time of this writing whether or not this region will ever be fully restored. In light of these and other man-made and natural disasters, the world needs to revisit its approach to disaster planning and preparedness to insure that we can best meet the needs of those likely to be affected by future calamities.

Each time I view the Manhattan skyline, part of me is convinced that the World Trade Center towers are still there, and that they are just hidden by the particular vista for the day and for some reason cannot be seen. This statement does not reflect some cheap literary permissiveness afforded to me as a result of my current generous editorial perk or the musings of a zealous yet deluded optimist in a profound and advanced state of pathologic denial. Rather, it truly represents a thought that materializes whenever I drive into New York from my home. Think about it, the towers were so ubiquitous and just dominated one's Manhattan consciousness. How, then, could such magnificent structures just disappear? How could anyone develop and culture such a vengeful hatred and channel it into such a destructive and murderous force? How could so many wives and husbands be widowed and so many children made fatherless? What providence, luck, or even quirky circumstance allowed me to witness this horror from an outlying borough yet allow me the chance to go home that night to my small child to softly cry on his shoulder, shaken from the events of the day yet relieved that I still could experience the continued joy of watching him fall off to sleep for the night, and seemingly each night thereafter.

These illogical thoughts (or silly wishes) that the towers still dominate the New York City landscape and vista do not remain for long. This is because I clearly saw and smelled the fire and smoke from the carnage, I still remember the sight and the acrid smell that lingered in the region for days afterward, and I still cannot – nor will I ever be able to – shake the image and the sound of the second plane crashing into the second tower and the ghastly fireball that erupted. At several points over the years since 9/11, I recall wondering how the events of the day will ultimately fall into my synaptic place and how they will eventually influence and shape both my personal and professional beings.

In the immediate aftermath of the attacks, I vividly recall how both the press and the lay public endlessly pontificated how the world had 'changed' since 9/11. America, so it was oft said, was now vulnerable to both attack and calamity, and thus had to mobilize its seemingly vast resources to prepare for the next terrorist attack and disaster. The 'virtues' of accruing ample supplies of duct tape were promoted, and the colors yellow, orange, and red soon assumed greater importance in the national consciousness, as they were no longer just mere refractions from crystalline prisms. On a more productive albeit somber note, medical, public health, government, military, and other organizations developed the wherewithal to visit the dust-encased and dysfunctional state of the nation's disaster plans and increasingly clamored for greater resources and improved coordination. Katrina and Rita and their aftermaths painfully showed how such efforts were suboptimal, too late, misplaced, or just downright wrong. Hence, the question with respect to future disasters is not if but when, and failure to plan for and anticipate future catastrophes will only compound and augment the damage, whether it results from a hurricane, an earthquake, a bioterrorist attack, famine, or a viral pandemic.

The carnage in New Orleans and the Gulf Coast has provided me with some proportional and sobering insight and perhaps enabled me to place the events of 9/11 into its proper perspective. Although I and other witnesses were stunned and even slammed by the events of 4 years ago in New York, the damage wrought by Katrina and even Rita completely dwarfs 9/11. An entire beloved and iconic city was decimated, and its tenuous and porous veneer of opportunity, prosperity, and equality lost. Whereas hundreds of thousands were evacuated to safe shelter (which even in the best of cases still must be deemed both an individual and collective trauma to those in the cars and buses on the roads out of the city in the days and hours before the hurricane struck), many others did not have the resources or the access to leave and thus suffered the full brunt of Katrina's winds, rains, and torrents. Floodwaters destroyed not only neighborhoods and lives but also washed away long established cultures and long-standing legacies. Tourists and conventioneers may whimsically lament the loss of favorite eateries and culinary landmarks; displaced and disposed residents, however, must figure out ways to rebuild their shattered lives and livelihoods, often from uncomfortable and crowded temporary shelters and housing in distant and unfamiliar environs.

Undoubtedly, there is something about an act of war and terrorism that causes both its victims and its aftermath to stand out and apart from natural disasters. However, although suffering and death always exert immeasurable and infinite pain independent from the number of victims, the scope, breadth, and magnitude of Katrina's damage dwarf the events and sequelae of 9/11. Manhattan may have been forever changed; New Orleans, however, was downright pummeled, flattened, and shattered, perhaps in part beyond repair. New structures may arise on the site where the Twin Towers once stood, but it remains unclear what will become of the battered Gulf Coast cities and towns, and what they will resemble in appearance, character, and spirit. As I look at my bookshelf, I cannot fail to notice the works of David McCullough and Simon Winchester, which respectfully detail the carnage of the Johnstown Flood and the Krakatoa eruption, and in this vein I cannot help but wonder what books people will be reading decades from now when historians and others have had the chance to develop and share their literary perspective.

September 11 stirred us to address our somnolence regarding the notion that disaster planning requires greater attention and potential revision. Katrina and Rita, though, have hopefully awakened us all from our deep slumber and false security that our political leaders and professional societies were capable of providing safe, effective, and coordinated disaster management. We need to heed seriously the lessons and clarions from the likes of Professors Mattox and McSwain, and the other erudite contributors to this tome to ensure that the nation and the world will be properly prepared for all future disasters, carnages, and public health challenges. If the events of 9/11 and Katrina and Rita are not enough to keep us awake and committed, then perhaps the more recent Pakistani earthquake and its tens of thousands of victims and the genetic mutations of the avian flu virus will keep us properly focused and ever vigilant.

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Correspondence to Donald B Chalfin.

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Chalfin, D.B. Falling towers, crumbling levees, and viral mutations. Crit Care 10, 106 (2005).

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