With the death toll from Sunday's earthquake and tsunamis in South Asia continuing to mount, world health authorities are bracing for what they predict will be a second wave of death from diseases associated with contaminated water and food shortages.

	Martha Rial, Post-Gazette Mercy Hospital's Dr. Timothy Campbell says many of the survivors now face infectious disease and nutrition problems. Click photo for larger image.

About 76,000 deaths had been confirmed in 12 nations yesterday, and the International Red Cross estimated that deaths could top 100,000. But the final toll could double in the next few weeks without an adequate public health response, according to local experts.

"That's like the population of Mt. Lebanon and Bethel Park already dead," said Dr. Timothy Campbell, an internal medicine physician at Mercy Hospital, placing the losses in Pittsburgh terms. "And the population of South Park, Peters and Upper St. Clair could be gone in the next two weeks -- all preventable deaths."

With many sources of water now contaminated with sewage, cases of dysentery, cholera and typhoid fever will be appearing in the next seven to 10 days, Dr. Michael Allswede, a disaster medicine specialist at the University of Pittsburgh School of Medicine, predicted, while hepatitis A cases are likely to begin appearing in the next four to six weeks.

Health authorities in southern India yesterday were already vaccinating thousands of survivors against cholera, typhoid, hepatitis and dysentery. Officials in Sri Lanka said they were getting reports of diarrhea and measles.

Not only are water supplies subject to bacterial contamination from backed up or destroyed sewer systems, but also leaks of gasoline from damaged vehicles and storage tanks are a threat, as is pollution from inundated chemical factories and warehouses.

Lack of shelter will leave many people vulnerable to diseases carried by mosquitoes and other biting insects.

In some areas, authorities were spraying bleaching powder on beaches where bodies have washed ashore. But World Health Organization officials stressed that dead bodies do not pose a health threat and worried that dealing with the dead would divert resources from where they are most needed.

In an admittedly cold-hearted view, Allswede said, almost all health efforts should be focused on preventive efforts now, rather than on treating people injured by the tidal waves. "Most of the people who will die [of wave-related injuries] are already dead," he said. Many more lives can be saved at this point by preventing disease, rather than treating injuries.

Mercy's Campbell said the problem now is infectious disease and nutrition.

"That's become the biggest fear," agreed Dr. Juliet Jegasothy, a Sri Lanka native who is medical adviser for quality improvement at the University of Pittsburgh Medical Center.

Just yesterday, she said, e-mails from relatives in Sri Lanka indicated gasoline was now virtually impossible to find, "so now they have to walk miles and miles just to get water."

Locally based disaster medicine teams have not been mobilized to respond to the tsunami-wracked areas. But Campbell, horrified from what he saw of the first televised reports on the disaster, said he began making calls to relief organizations to offer his services and is organizing a relief effort.

A member of the Church of Jesus Christ of Latter-Day Saints, Campbell said he has talked with Mormon leaders in Salt Lake City and with their disaster response adviser on the scene. He said he hopes to ship medical supplies and other humanitarian aid to Indonesia in the next few days.

Mercy will accept donations of goods from 7 a.m. to 3 p.m. today at the Mercy Hospital North Shore Facility, the former Mercy Providence Hospital, at 1004 Arch St. Entry is through the former emergency room entrance.

Campbell said tons of food reportedly are already arriving in Indonesia, so he suggested local donors contribute items such as bar soap, toothbrushes, toothpaste, flashlights and batteries, ponchos, candles, bandages, needles and thread, resealable plastic storage bags, water purification tablets and water-filtration bottles.

As of yesterday afternoon, Campbell had been in touch with military airlift officials and was hopeful that he will be able to arrange for a military cargo plane to deliver the supplies.

Jegasothy suggested money can reach the ravaged areas much faster. Her church, the Asian-Indian Christian Church of Pittsburgh, is accepting contributions that will be forwarded to Sri Lanka and southern India. Checks made out to "AICCP Tsunami Relief" can be mailed to the Asian-Indian Christian Church of Pittsburgh, 3487 Beechwood Blvd., Pittsburgh 15217.