Tropical storm Tomas “is on a path toward the island of Hispaniola and is expected to strengthen into a hurricane and make landfall Friday, with possible winds of 74 mph and heavy rains,” PBS’ NewsHour reports.

“The storm could worsen the sanitation situation and accelerate the spread of cholera, which is highly infectious and waterborne,” the news service writes. “If the storm hits Haiti, it’s obvious that [it] will make a difficult situation even worse,” said Jon Andrus, PAHO’s deputy director. “The bad sanitary conditions in many areas, combined with what the hurricane poses as huge amounts of rain and possibly flooding, are very likely to accelerate the spread of infection” (Miller, 11/4).

Tomas “drenched Haiti on Thursday, threatening fragile, crowded earthquake survivors’ camps,” where an estimated 1.3 million survivors are still living in tents, Reuters reports. According to the U.S. National Hurricane Center, the storm was carrying “top sustained winds of 65 miles per hour (100 kph) and could be near or at hurricane strength – 74 miles per hour (119 kph)” by Friday, when it is expected to pass Haiti, Jamaica and eastern Cuba, the news service writes (Bigg, 11/5).

According to the U.N. News Centre, on Thursday, the U.N. said it needed emergency supplies and equipment to prepare for the tropical storm and estimated that it could affect up to half a million people in Haiti (11/4).

Questions Remain Over Source Of Cholera Outbreak

The Associated Press/Seattle Times examines the growing questions emerging over the source of the cholera outbreak in Haiti that “has killed at least 442 people and hospitalized more than 6,742 with fever, diarrhea and vomiting since late October. It is now present in at least half of Haiti’s political regions, called departments.” According to the news service, “[t]he epidemic has diverted resources needed for the expected strike of a hurricane this week, and could spread further if there is flooding.”

Although “[t]he CDC, World Health Organization and United Nations say it’s not possible to pinpoint the source and investigating further would distract from efforts to fight the disease,” the AP/Seattle Times reports several “leading experts on cholera and medicine” disagree with this position and are speaking out about the importance of getting to the bottom of the source of the outbreak.

The article notes how the CDC’s report on Monday that the Haiti outbreak’s strain was similar to cholera strains found in South Asia served to deepen “[t]he suspicion that a Nepalese U.N. peacekeeping base on a tributary to the infected Artibonite River could have been a source of the infection … [N]othing has been proven conclusively, and in the meantime the case remains politically charged and diplomatically sensitive. The United Nations has a 12,000-strong force in Haiti that has provided badly needed security in the country since 2004. But their presence is not universally welcomed, and some Haitian politicians have seized upon the cholera accusations, calling for a full-scale investigation and fomenting demonstrations,” the news service writes.

The article includes comments by Paul Farmer, a U.N. deputy special envoy to Haiti and co-founder of the medical organization Partners in Health, and John Mekalanos, a cholera expert and chairman of Harvard University’s microbiology department, who address the importance of understanding the source of the outbreak from a public health perspective and the political and diplomatic sensitivity involved an investigation into the validity that U.N. base was the source of the outbreak. “Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, said it is clear that the disease was imported to Haiti but that it is still not clear by whom or how,” the news service writes. Additionally Garret “said the epidemic will contain lessons for humanitarian relief work and disaster relief around the world,” AP/Seattle Times writes.

The article notes additional tests that may be conducted in the future to identify the source of the outbreak and includes statements on such matters by WHO spokesman Gregory Hartl and CDC spokeswoman Kathryn Harben (Katz, 11/3).

Science magazine also looked at the question of whether Haiti’s cholera outbreak was imported and examines some of the concerns for the future. “For cholera experts, it was a familiar debate that often takes place when cholera pops up in a new locale. ‘People always assume cholera had to come from somewhere else. It’s usually local,’ contends Rita Colwell, a veteran cholera scientist and former head of the U.S. National Science Foundation, who had put her money confidently on the environmental route,” Science writes (Enserink, 11/5).

Agence France-Presse reports that Haiti has experienced “105 more deaths since Saturday and more than a 40 percent jump in new cases, officials said.” The announcement came Wednesday during a news conference with Health Ministry official Jocelyne Pierre-Louis, the news service reports.

“[H]ospitals have been overwhelmed by cholera cases despite intensive efforts to respond to a disease that aid groups fear could spread like wildfire if it reaches densely populated Port-au-Prince,” AFP adds. “International aid group Save the Children said last week the outbreak was threatening some 25,000 new mothers and their babies in and around the capital,” the news service writes (11/3).

IRIN looks at how Haiti’s weak sanitation and health systems could hinder the country’s ability to address the outbreak (11/4).