Dear Lebanon, The Garbage Crisis Is Not Giving You The Flu

Lebanon Garbage - 3

In the context of a country with any ounce of self-respect, speaking about a garbage crisis that has been going on since July would not only be old news by now, it would be solved old news. Except we don’t live in a country with an any amount of self-respect, and as such Greater Beirut’s garbage situation is still a topic, albeit less hot, of discussion.

A few months ago, when people were actually interested in the garbage crisis, which is to say when the garbage was visible on their streets and not tucked away in some valley somewhere or in a makeshift pyramid near the port, I wrote an article on this blog (link) about the health risks that the crisis might involve especially with the rain season.

As a very brief summary, in theory the garbage crisis and the many variables around it would cause the following:

  • Many types of bacterial infiltration of the waters,
  • Many heavy metals and other elements-related pollution,
  • Burning it will increase the amount of carcinogens in the air, as well as exacerbate respiratory conditions in people who have pulmonary disease when they have it.

As long term effects, we could be looking at an increased cancer incidence as a study after Italy’s waste management crisis in 2004 showed.

What the garbage crisis is not doing, however, is giving you the flu or other common infections that we encounter yearly.

Over the past few weeks, which happens to be the yearly flu season in Lebanon, everyone and their mother decided that whenever they got sick, it was because of the garbage crisis in Beirut. H1N1 – or as it’s more commonly known in the country now H1 and 1 – has become so commonly associated with the garbage crisis that the scientific community is probably considering whether to reconsider all the details surrounding H1N1 altogether.

We’ve also heard about “new” viruses attacking the country, such as metapneumovirus B, causing severe respiratory diseases.

This is, quite simply, incorrect.

For starters, metapneumovirus B is not a new virus. It’s been known for at least 40 years now and is actually one of the leading causes of respiratory infections in children worldwide. Lebanon has had this virus before, and it gets treated the same way we treat most viral infections: address the symptoms and provide the patient relief while their ailment resolves.

The case illustrated in this eTobb article (link) about a 25 year old who had a devastating respiratory infection secondary to the aforementioned virus remains, as it stands, a case that fell through the cracks of medicine in the sense that some people will get complications from common infections and we have no way to predict who would be the victim of such complications.

When it comes to H1N1, this is the current state worldwide:

Outbreaks are being reported in Bulgaria, Canada, Ireland, Ethiopia, Pakistan, etc. What do these countries have in common? Nothing, which is precisely the point.

Every year, the world is swept up by a strain of the Influenza virus which, when a person infected, gives them what is referred to as the flu: runny nose, sore throat, sneezing, fatigue, feeling pain all over your body for a few days, etc…. These symptoms usually resolve in a few days and you’re off on your merry way to health.

Some people may also be infected and not show any symptoms. The way this occurs is in sort of a pyramid fashion:

Assume 100,000 people in Lebanon got infected this year. 10,000 of those would show symptoms of the flu. Out of those 10,000 maybe around 100 would require hospitalization. And out of those 100 that needed hospitalization, 1 might die because of complications.

The garbage crisis overtaking Beirut has nothing to do with this. This will happen again next year, with or without a garbage crisis, and it will also happen the year after as it also took place in the years prior. Having a new shiny ribbon of erroneous but appealing explanation to wrap this whole thing with won’t make it go away. People are getting sick all over Lebanese territories simply because this is an infectious disease, not a garbage-related disease; the garbage does not cause H1N1 or the flu. It’s really that simple.

At this rate, getting the first case of Zika virus infection in this country will also be attributed to the garbage.

Therefore, I’m sorry to say that the answer to your question “how did I get sick” is simply “this is how things are,” and not “it’s the garbage that’s killing you.”

You can, however, protect yourself by practicing as much hygiene as possible. Thorough hand-washing is key to prevent the transmission of the influenza virus. Avoid sick contacts if you can. If you’re sick, don’t be a jerk and go around contacting others. Don’t trust your local pharmacist to start you on Tavanic or Klacid or whatever other medication he feels like giving you. This is a virus and antibiotics don’t work. Rest as much as you can, you’ll get better in a few days.

 

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How Rain Will Make Lebanon’s Garbage Crisis Much, Much Worse

Beirut River

The political aspect of Lebanon’s Garbage Crisis has been discussed extensively. The protests around the issue and their underwritten goals have also been discussed extensively. What hasn’t been talked about in the media, however, is how this garbage crisis in Greater Beirut is affecting our health and how the first bouts of rain, set to come within the next few weeks if we go by Lebanon’s standards, will exacerbate this crisis into a full blown health crisis as well.

To be honest, this isn’t something I learned in medical school. We don’t have courses about garbage-crisis-related-health-issues. This is very short-sighted, I know.

So with a little help from my Infectious Diseases specialist-to-be friend Tala Ballouz, a little research was done and we’ve come up with the following.

So the Greater Beirut area today is essentially a very urban area that has its garbage being deposited basically everywhere. With rainfall that runs on this garbage, many of the extracts in our garbage will become dissolved and suspended in the rain, forming a liquid called leachate.

So what is leachate made of? Let’s list them.

  1. Aerobic and anaerobic bacteria (where is Abou Faour when you need him?),
  2. High concentrations of total dissolved solids, ammonia, nitrate, phosphate, chloride, calcium, potassium, sulfate, and iron,
  3. Numerous heavy metals such as zinc, mercury, cadmium, lead, nickel,
  4. Organic trace constituents: byproducts of decomposing solvents, pesticides, and polychlorinated biphenyls, a highly toxic environmental pollutant.
  5. High numbers of fecal bacteria.

Leachate occurs over landfills, dumps and essentially wherever garbage exists. In developed countries, their high level waste management systems prevent this substance from being anything worthwhile. Developing countries, however, don’t have it as easy.

How about if that developing country was a country like ours in our own garbage situation that consists of: 1) garbage being present on streets, next to rivers, next to the sea and on land where it shouldn’t be, 2) that same garbage being unmanaged and untreated for over 57 days now which means its level of decomposition is in the stratosphere and 3) when even our rivers are blocked by it?

With the formation of leachate with Lebanon’s upcoming rain season, the toxic water will do the following:

  1. Infiltrate into the underground water reserves that we have. This will lead to highly toxic water for us to use in various industries, be it in agriculture or even personal use.
  2. The rain, coupled with the fumes of the garbage along with leachate, will form acid rain. This will affect aquatic life, Lebanon’s already-fragile infrastructure and whatever plants we have left.
  3. The consumption of products that are this polluted (indirectly) with this many toxins (check the list above) serves as a massive hub for carcinogens, substances that increase the risk of cancer.
  4. The Beirut River will have unnaturally high toxic levels (remember when it was red? this will be worse), that’s if it doesn’t overflow, sending waste and toxins into the homes of those living around it.
  5. Illnesses that are not endemic to Lebanon will start surfacing, notably cholera, a bacteria that thrives on infected water.

Other infectious problems we might have are the following:

  • Amoebiasis –> causes fever, abdominal discomfort, bloating, fever, weight loss.
  • Infections with various tapeworms –> cause a wide array of intestinal disturbance and could even have neurologic sequelae.
  • Echinococcosis –> causes liver cysts, and can cause anaphylactic shocks.
  • Various bacteria that are not only cholera (C. jejuni, E. Coli, Salmonella, Shigella, Legionella) –> cause symptoms ranging from intestinal to pulmonary to neurologic symptoms.

As a country, we are not ready to handle many things, as is testament by the fact that our garbage has been on the streets for about two months. A health crisis due to this garbage crisis is also something that the country cannot remotely handle. The epidemics we can get are not fiction, but they are right around the corner.

What can you do?

Pressure your politicians to get the garbage off the streets… yesterday. And if not? Well, don’t drink the water.