A day at the beach is all about sunshine and rainbows, but for some beachgoers the effects of climate change turned what was to be a fine day into one of the last of their lives.
Several of the people who died during the weeks after Hurricane Ian made landfall in Lee County on Sept. 28, 2022, began showing signs of illness a week or two into October. Most report visiting the beach after Ian or working inland where storm surge had been trapped in swales or drainage ditches.
Many infectious disease researchers agree that Ian’s strong storm surge had mixed with the Vibrio vulnificus bacteria in the brackish backwaters among clams and oysters and churned inland for quite a distance.
When the hurricane, made stronger by the record-hot waters of the Gulf of Mexico, started to pull away it took with it the feet-deep surge now polluted with chemicals, trash, and organisms, back through the bays, over the beaches, and into the Gulf of Mexico.
Hurricane Ian’s 15-foot surge left behind big piles of sand blocking shoreline roads, a hazard beachgoers could navigate.
Impossible to avoid was the deadly microscopic bacteria mixed within the sand and floating in area waters.
Vibrio vulnificus can enter a body through a shaving cut or scrape. Inside, it produces toxins that turn the skin red, hot and painful. Then blood-tinged blisters form on the skin.
Necrotizing fasciitis, also known as "flesh-eating bacteria," rapidly destroys skin, fat and tissues covering muscles, causing intense pain and swelling as the skin turns black. A fever spikes.
“The key to this is it's progressing rapidly. So, within minutes, it's doubled in size,” said Norman Beatty, a professor at the University of Florida's College of Medicine. “And the pain. Some of these toxins that are being produced trigger your free nerve endings to really, just to, to tell your brain, hey, something is wrong here.”
Medical treatment at a clinic or hospital is crucial by the 24-hour point. A doctor must cut away the dead tissue to prevent further skin death while also pumping the patient full of the proper antibiotics.
If untreated or misdiagnosed, the infection can escalate to sepsis, then organ failure. The pain is mind-numbing. A doctor may amputate a limb in a last-ditch effort to save the patient.
Several victims of Ian’s infectious legacy died within two days of the start of their symptoms. Six more people would succumb shortly. How many knew of what they died?
“Vibrio vulnificus is an emerging infectious disease here in the United States, especially in the southwest portions of Florida,” said Beatty, who is also a global infectious disease specialist at UF in Gainesville. “I don't think we should shy away from talking about this because it's going to infect somebody, and they could die.”
Milton now worries Beatty
Southwest Florida is still grappling, in ways, with the aftermath of Hurricane Ian. Houses are still being rebuilt. People are still homeless. Insurance rates are skyrocketing.
Hurricanes Helene and Milton have Beatty worried not about financial matters, but those of life and limb. Milton, especially, has once again created ideal conditions for the spread of Vibrio vulnificus along Florida's beaches after making landfall as a major hurricane near Siesta Key two weeks ago.
“Southwest Florida had a significant storm surge and as a result the risk of Vibrio will be striking," he said. "It's undoubted that we're going to start seeing some of these cases."
Beatty is certain that Category 4 Milton's powerful storm surge did the same as Ian, mixing seawater with brackish bay water contaminated with Vibrio vulnificus and spreading the bacteria-filled mixture far inland.
“I mean, it's Milton, it pretty much has done very similar things that Hurricane Ian did,” Beatty said. “I am specifically concerned about the southwest part of Florida given what we know. Vibrios should be a national pathogen of concern. We need to recognize that this is a very deadly infectious disease.”
Beatty said the balance between warning and empowerment is crucial in addressing the threat posed by Vibrio vulnificus.
The Florida Department of Health reported a significant spike in Vibrio vulnificus cases with Ian, with 74 confirmed cases statewide.
The statistics from the 2022 outbreak are sobering. Because they represent a stark increase from previous years, highlighting the impact of Ian on the spread of the bacteria.
And that Milton did the same. And so will the next tropical system made stronger by the Gulf of Mexico's record-high temperatures.
Vibrio vulnificus is a naturally occurring ocean bacteria, commonly found among clams and oysters in backwaters and near estuaries. The bacteria's presence in Florida's waters is not new.
What is new is the power of the hurricanes now bringing massive amounts of rainfall along with changes in sea surface temperature and salinity, and how they are driving storm surge so much farther inland.
As Beatty said: Milton did just that.
"Without appropriate antibiotics, wound infections can quickly require surgery to remove infected tissue,” Beatty said. “But early recognition of symptoms is key to preventing the need for surgical intervention or even amputation."
This race against time underscores the critical nature of public awareness and prompt medical response. The window for effective treatment is narrow, and the consequences of delayed action can be severe and permanent.
“People with the infection can get seriously ill and need intensive care or limb amputation,” he said. “About one in five people die, sometimes within a day or two of becoming ill.”
Beatty is frustrated that Vibrio vulnificus is too often being misdiagnosed by doctors and underreported by the media, despite that it is, right now, spreading throughout the region’s shoreline ecosystem.
“The reporters are talking about, you know, staying out of the water," he said. "There’s critters in the water. There are chemicals in the water, but not one person mentioned there's Vibrio vulnificus in the water."
Beatty said Southwest Florida has his attention.
“I am specifically concerned about the southwest part of Florida given what we know,” he said. ‘“ “But my hope is that we are able to raise awareness to prevent them."
More bad bacteria
The threat posed by Vibrio vulnificus extends beyond Florida, according to data from the Centers for Disease Control and Prevention. The center estimates that vibriosis causes at least 80,000 illnesses each year in the United States, with Vibrio vulnificus adding about 100 more deaths than the year prior.
Climate change may be exacerbating the problem. Warmer waters expand the habitable range for Vibrio bacteria. This could lead to increased prevalence in coastal areas previously considered low risk.
Research continues into Vibrio vulnificus and its impacts. UF scientists are studying how the bacteria spreads and survives in different environments. Their work could lead to better prevention strategies and treatments.
Vibrio vulnificus is not the only harmful bacteria that is spread when floodwaters rise in Florida.
Nearly every day it rains hard, which happens a lot during the rainy season in the region, and the Florida Department of Health or its county-level counterparts post advisories about staying away from harmful bacteria, whether in a river, at the shore or on the beach.
Most of the time, the warning is a result of regular water-quality testing that’s positive for blue-green algae or red tide, both of which have toxins that can harm animals like the family dog, or go airborne and be breathed in by people with compromised lung function or immune systems.
Other times, like this past week, the warning was for different bacterial threats also related to the flooding associated with a hurricane, according to Kristine Hollingsworth, a spokeswoman with Collier County’s health department.
“Collier County advises the public not to enter the water due to the increased risk of waterborne illnesses,” she said. “Water quality has been affected by Hurricane Milton, and swimming is not recommended."
She said sources of enterococcus and other bacterial infections include failing septic systems, water line breaks, overflowing manholes and wildlife.
Yet the releases do not ignore the reality of other bacterial infections that might be present this time of year. Hollingsworth also said to watch for redness developing around a wound.
“If you have any open cuts or sores and come in contact with floodwater," she said, "wash the area well with soap to prevent infection."
Doctors and educators said even for high school students in Florida, understanding Vibrio vulnificus is particularly relevant. It underscores the connection between environmental conditions and public health. It also highlights the importance of personal safety when enjoying the state's abundant water resources.
“Awareness doesn't mean avoiding the water entirely. Instead, it's about taking precautions. Covering wounds, wearing water shoes and being mindful of water conditions can significantly reduce risk.
In the realm of marine biology and public health, Vibrio vulnificus serves as a stark reminder. The microscopic world can have profound impacts on human health. Understanding these connections is crucial for anyone living in or visiting coastal areas.
It’s important to stress that a Vibrio vulnificus infection leading to death is rare, although the ratio of those who are infected in Florida and dying from its complications is on the rise in large part due to the weeks following strong hurricanes with tremendous storm surges.
By way of comparison, the risk of catching Vibrio vulnificus and dying from it roughly equates to the chance that a speeding train will crash into a car and kill the driver. The point being neither scenario happens frequently, but when it does the possibility of a positive outcome is not good.
Vibrio vulnificus infections have a fatality rate of approximately 10% to 15%, while train-vehicle collisions in Florida have a fatality rate of around 20%, depending on circumstances.
‘Only 50 will be infected’
The medical community’s campaign to lower the number of deaths and life-altering injuries from Vibrio vulnificus is not just a public health initiative in Southwest Florida; it's also a focus of ongoing scientific research.
Paul Gulig, like Beatty, is a professor at the University of Florida’s College of Medicine. Gulig is also on staff at the university’s Emerging Pathogens Institute.
Gulig's research has contributed significantly to our understanding of Vibrio vulnificus. He credits major hurricanes with bringing the bacteria into the public consciousness.
"Hurricanes Katrina, Irma and Ian put the bacteria on the map,” he said. “When streets flooded afterward, more people were exposed to the brackish waters that Vibrio thrives in, and the number of cases increased."
However, he, too, emphasized the gripping fear often felt by the infected person watching the rapid progression of the disease.
"There is only a small window for someone to get treatment," Gulig said. "It can be frightening to hear that someone who was healthy on Saturday ends up dead on Monday."
This combination of rarity and severity contributes to the public's fascination with Vibrio vulnificus.
"Everyone pays attention. Vibrio is so fast and scary, it's considered newsworthy,” he said. “ A lot of other diseases, you have time to treat them."
Scientists at the University of Florida, including Gulig and his colleagues, continue to study how Vibrio vulnificus spreads and survives in different environments. Their work is crucial in developing better prevention strategies and treatments.
As their understanding of the bacteria grows, so too does their ability to combat its effects.
Education remains a cornerstone in the fight against Vibrio vulnificus. Florida's health department conducts extensive outreach programs to inform residents and visitors about the risks associated with the bacteria. These efforts emphasize the importance of proper wound care, safe seafood handling, and awareness of water conditions.
The message from health officials and researchers is clear: awareness doesn't mean avoiding Florida's beautiful waters entirely. Instead, it's about taking informed precautions. Covering wounds, wearing water shoes, and being mindful of water conditions can significantly reduce the risk of infection.
As people continue to grapple with the challenges posed by Vibrio vulnificus, the intersection of marine biology and public health becomes increasingly important.
Despite the alarming nature of Vibrio infections, Gulig provides some perspective on the overall risk.
"Out of millions of people who go into the water in Florida every year,” he said. “Only 50 will become infected.”
But as Gulig can personally attest, it happens to even the most cautious and knowledgeable.
"I have WHAT?"
Gulig is a rare member of the Vibrio vulnificus research community to be among the bacteria’s victims, infected in an everyday way that serves to highlight its insidious nature.
Gulig was infected with Vibrio after stepping on something in his driveway then going swimming in the Gulf of Mexico while visiting family in Pensacola. He’s rather sure it was the vulnificus strain because of the way it developed, but he doesn’t know for sure because doctors didn’t culture it. But what happened next confirmed his suspicion
"Over the next few days, I developed diarrhea,” he said. “That alone wasn't too concerning, but the cut on my foot slowly became increasingly sensitive."
He wasted no time going to a hospital, rather sure he had a tiny shard of glass lodged in his heel. Due to the nature of his work, however, he was nervous.
Gulig’s fears were confirmed when doctors discovered an infection deep in his skin tissue. It was caught early enough that a decent round of antibiotics wiped out the infection and his life was no longer at risk for it.
Gulig said the experience allows him to bettto bring both professional expertise and personal experience to the study of Vibrio vulnificus.
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