As if the people of Haiti didn’t have enough to worry about, this weekend news of a new and unexpected threat emerged from the country’s Artibonite River valley: cholera.

With public health officials working overtime to contain the outbreak and inform Haitians about the best ways to avoid contracting the disease, the situation already seems to be stabilizing. Still, now that it has gained a foothold in the population, they expect to be seeing cases for years to come.

The bacterium Vibrio cholerae lives naturally in exoskeltons of types of plankton and shellfish found in brackish water. In humans is passed primarily through contaminated water sources, first from the plankton, then through the untreated waste of the sick.  

Only about 5% of those infected contract the severe form of the disease. In those unlucky intestines, it causes intense diarrhea and vomiting; left untreated, it leads to catastrophic dehydration and electrolyte imbalance. It can kill within hours -- but, caught early, it can also easily be treated with oral or IV rehydration. With treatment, 99% of vicitims recover.

Cholera was first recognized in humans around 1817, along the Ganges River in Bengal. Traveling aboard ships plying flourishing trade routes, it quickly spread around the globe. Tens of millions of people died in at least six major pandemics between 1826-1926, including more than 250,000 Americans.

Few diseases have inspired such fear. Outbreaks came and went without warning and struck seemingly at random. A person could be perfectly healthy in the morning and dead by nightfall.     

“King Cholera,” as it came to be called in the wake of the first major European pandemic, occupies a unique place in epidemiological history. Like most infectious diseases in the 19th Century, cholera was attributed to “miasma,” or “bad air.” But by the 1850s, a few physicians were beginning to doubt the bad-air theory -- among them Dr. John Snow of London.

He put his theories to the test in a severe outbreak along Broad Street in Soho in the summer of 1854. Through investigation, he traced the beginning of the Broad Street’s woes to a sick baby whose mother had washed her infant’s soiled diapers near the steet’s main well....the community’s most frequently used source of drinking water.  

Snow removed the well’s pump handle, forcing people to use other water sources, and the disease quickly faded from the area. It was too late for 616 residents in and around Broad Street, but it was the beginning of a new era in disease prevention. Over the next half-century, as urban areas began installing municipal water and sewer lines, deaths from cholera and other waterborne scourges plummeted.

Cholera all but vanished from the United States around 1911, at the point when most major cities had established clean water and sanitation systems.

Since then, there have been only a handful of diagnosed cases: 1 in Texas in 1973; 11 in Louisiana in 1978; 2 in Texas and 16 on a oil rig in the Gulf of Mexico in 1981; 1 in Maryland in 1984. Almost all these cases were traced to undercooked crab. In 1991, three people in Maryland fell sick after using contaminated coconut milk from Asia. Very few cases in the past 100 years have been traced to water contamination.  

But Haiti reminds us that V. cholerae still lives in this hemisphere, and can still strike a population without warning.  

Coincidentally, Bob Herbert devoted his column in the New York Times today on the utterly decrepit state of our national water system.

He reminds us that on a “report card” issued by the American Society of Civil Engineers, drinking water came in at a solid, depressing D-. “Many local systems are so old and inadequate — in some cases, so utterly rotten — that they are overwhelmed by heavy rain,” he notes.

Somewhere in this country, right this minute, a water main is breaking. We lose an estimated 7 billion gallons of clean drinking water per day to breaks and leaks. Some systems still have portions of pipe dating back to the Civil War era, and even much younger systems have far exceeded their design life. Capacity is maxed out, even as the population continues to rise. And the billions needed to make even the most fundamental repairs is lacking.  

Herbert quotes Jeffrey Griffiths of the federal National Drinking Water Advisory Council: “We’re relying on water systems built by our great-grandparents, and no one wants to pay for the decades we’ve spent ignoring them. There’s a lot of evidence that people are getting sick. But because everything is out of sight, no one really understands how bad things have become.”   

Herbert focuses on the economic possibilities of fixing this system, but there are other hidden benefits. At the International Conference on Emerging Infectious Diseases this summer, researchers from the Centers for Disease Control presented a report finding that the U.S. health system spends upwards of $539 million annually on hospitalizations for three major waterborne diseases: Legionnaires’ disease, cryptosporidiosis and giardiasis.

And that’s just hospitalizations; the cost of lost productivity from less severe waterborne illnesses like simple diarrhea has to be in the billions.   

On our national hierarchy of concerns, cholera should be pretty low on the list. Public health officials do a good job of monitoring outbreaks of waterborne illnesses, and most of our water is very safe.

But as we’ve seen with food safety, we can’t afford to be complacent. Some 70% of Americans polled admit they take clean water for granted. We need to stop that.

Clean water is not, unfortunately, a right. It’s an investment in our health and our welfare. We need to demand that our public representatives make that investment, and make it today.