Cases of severe diarrhea, often terminal, began quickly showing up hospitals across the Artibonite Valley and into the neighboring Central Plateau. Health investigators took eight stool specimens to the national laboratory in Port-au-Prince. All tested positive for cholera. Health officials' phones lit up all over the capital, then at the CDC in Atlanta, at the Haiti desk at the State Department in Washington, and at the U.N.'s WHO headquarters in Geneva. They all knew: Cholera was a remorseless killer, and it could move fast.
By weekend's end, 200 people were dead.
The cameras were back on Haiti. Brian Williams set the tone on NBC: "It's what all of us worried about when we arrived in Haiti just hours after the quake … beyond the death toll, the inevitable spread of disease. Now it's happening in Haiti, an outbreak of cholera in that nation struggling every day, still, just to survive."
But the narrative didn't make sense. If cholera was the inevitable result of the earthquake, centered 15 miles southwest of the capital, why had the first concentration of cases appeared in the countryside, some 45 miles to the north? And why had it taken nine months to appear?
After natural disasters, survivors, responders, and journalists tend to assume that a disease epidemic may be imminent, due to the collapse of sanitation or simply the feeling that misery comes in bunches.
In Haiti after the quake, there had been thousands of corpses in the streets, the stench of their decomposition filling the air. Though their fear was misplaced, already frightened survivors imagined the smell itself might prove a vector for disease. That was how a preacher convinced the people of a Port-au-Prince slum to give up their children to a group of U.S. Baptist missionaries (who would soon after be arrested for human trafficking at the border).
If the locals were scared of the dead, the foreigners were terrified of the living. The squalid camps home to millions of homeless Haitians were portrayed by the media as breeding grounds for infection, and the distribution of clean water and vaccinations there became central goals of the relief effort. Hollywood star Sean Penn -- the most famous, if unexpected, of the post-quake campaigners -- set off a panic by warning of a diphtheria epidemic after finding a single fatal case in May. After his warning proved overblown, the scares all but ended. Many aid groups began highlighting the lack of an epidemic as a rare victory for the humanitarian effort. Others called it a miracle.
In fact, researchers have consistently found that the risk of post-disaster epidemics is wildly overstated. A team of French researchers has found that out of more than 600 disasters between 1985 and 2004, only three resulted in significant outbreaks of disease. The risk is only slightly larger when large numbers of people are displaced. This was the reason the WHO and other health organizations had attempted at every turn to tone down the alarm raised by Sean Penn and the media.
Moreover, if a disease were going to spread, it would almost certainly have been already present before the earthquake. Because it spreads through contamination of food or water by human waste -- emblems of bad sanitation -- cholera is often associated with poverty. But poverty doesn't cause cholera. You can have the world's poorest people, the worst sanitation, hurricanes, earthquakes, frogs falling from the sky. Without the presence of Vibrio cholerae, the bacteria that causes the disease, you will not have cholera.
And there hadn't been cholera in Haiti for at least 100 years.
From the outbreak's first days, rumors coursed through Haiti that a U.N. base was the source. Some said they heard the sickness had begun when a U.N. soldier emptied a latrine into a water source. Others swore a white U.N. helicopter was seen dumping black powder into the Artibonite River -- shades of Haitian folk sorcery, where a kou d poud, or powder attack, can cause death or zombification.