The WHO's nuclear update: Trouble ahead?

On January 27, 2023, the World Health Organization (WHO), which keeps a list of what it considers essential medicines for times of trouble, updated its recommendations for what should be stockpiled for nuclear emergencies.  Specifically mentioned are drugs that either prevent or reduce harm from radiation.  This is the first such update since 2007 and is meant to reflect advances in emergency treatment for radiation sickness.

One WHO official, Dr. Maria Neira, stated: "It is essential that governments are prepared to protect the health of populations and respond immediately to emergencies.  This includes having ready supplies of lifesaving medicines that will reduce risks and treat injuries from radiation."

The organization also includes policy advice for developing and maintaining national stockpiles for dealing with nuclear emergencies.

The recent update includes events such as emergencies at nuclear power plants, hospitals, and medical labs; accidents involving radioactive materials; and, of course, intentional use as a means of destruction.

Now, I don't know about you, but I doubt this update comes because the WHO is worried about a nuclear reactor meltdown.  I'm guessing Vladimir Putin has something to do with it.  His threats to use nuclear weapons likely triggered the update.

The WHO sometimes cries, "The sky is falling!," as it did during the COVID pandemic.  Russia, however, seems determined to make Ukraine a wasteland these days, even the parts it claims to actually be Russian territory.  Anyone who rejects the possibility of escalation from the Russians is in denial.

In its update, the WHO suggests practices for establishing and managing radiation-protection stockpiles in selected countries, most of which would be involved in an expanded Ukraine war or a future war over Taiwan.

Having had experience designing medical kits for disaster settings, I can give you an idea of what should be at hand in a radiation emergency.  The generic things like gloves, masks, and more advanced personal protection equipment are imperative.  Next, supplies to treat burns, nausea and vomiting, diarrhea, and other signs and symptoms of radiation sickness should be available in quantity.  Given the weakened immune system in these patients, antibiotics to combat bacterial infections are also important.

There are specific drugs known to prevent damage from the common radioactive product of a nuclear event: radioiodine.  After the Chernobyl meltdown in 1986, radioiodine exposure led to thousands of cancers involving the thyroid gland, mostly in young people.  This could have been prevented by the use of a compound known as potassium iodide.  It's a nonradioactive form of iodine.  Taken as soon as exposure is identified, potassium iodide prevents the absorption of radioactive iodine, protecting against thyroid cancer.

Children should be treated first, as they're most likely to end up with cancer later.  Usually, radioiodine concentration drops relatively quickly, however, so the course of therapy may not require the full ten days.

The WHO suggests other agents like Prussian blue to remove radioactive cesium from the body and a calcium/zinc compound to treat internal contamination with a number of other radioactive elements.

Unlike potassium iodide, not all of the WHO-recommended substances are available to the general public.  Prevention of radiation damage to the body can, however, be obtained by the preparation of a "shelter."  I'm not talking about an underground bunker, although I won't complain if you invite me to yours in a nuclear emergency.

Shielding will decrease exposure exponentially, so it's important to know how to construct a barrier between your people and the radioactive source.  Denser materials will give better protection.

Shielding effectiveness is measured in terms of "halving thickness."  This is the thickness of a particular material that will reduce gamma radiation (the most dangerous kind) by one half.  When you multiply the halving thickness, you multiply your protection.

Hopefully, the world isn't heading in this direction, but the World Health Organization isn't wrong to update its nuclear precautions in today's world.  If the wrong finger hits the button, you'll be glad you prepared medically for the consequences.

Joe Alton, M.D. is the N.Y. Times bestselling author of books on medical preparedness, including The Survival Medicine Handbook: The Essential Guide for When Help Is NOT on the Way.

Image: WHO.

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