Dirty water, hygiene and sickness

Open water carries sickness, cuts go bad, and a dirty camp makes everyone in it ill. None of it comes out of nowhere: you get a warning first, the first symptom tells you what it probably was, and there is always something that fixes it.

Water

Untreated water can make you ill, and how likely depends on where it came from. Look before you drink: at the water's edge, use the third eye and pick Look at the water.

• Fast, cold mountain streams are the safest open water, then rivers and lakes. Still ponds, the Alamo Sea, the swamp at Lago Zancudo and anything in the city (pools, drains, the river channel) are the worst.
• The sea can't be drunk and you can't fill anything from it.
• Rain off a tarp is nearly clean, and rain that has stood in a barrel less so. Collectors now give you rainwater: boil it or treat it.
• Boil it on a fire or a stove (bottles of dirty water, an unboiled canteen, rainwater), run it through a filter straw (good for about 32 gallons before it clogs), use a purification tablet, or let a still clean it. Any of those makes fresh water safe.
• With a filter straw in your pack you can drink through it straight from the water.

Getting ill

An illness takes a while to show. A line tells you when your stomach starts to turn, and another when it takes hold, with what it is and what treats it.

• Giardia is slow and drags on. Metronidazole cures it; ordinary antibiotics don't.
• Dysentery brings fever and cramps. Antibiotics cut it short.
• Cholera drains you of water fast and can kill you through thirst. Drink clean water with rehydration salts (stir a sachet into a quart of clean water), and take antibiotics if you have them.
• Bad food, like a swollen can, gives you food poisoning, and the worst of it is botulism: double vision and weakness until it passes.
• Raw meat and fish can make you ill: raw fowl often gives food poisoning, raw feral hog and game can give you trichinosis (aching muscles and a fever for hours), and raw sea fish can carry the herring worm (anisakiasis: sharp stomach pain and vomiting). Albendazole tablets cut both short; cooking through prevents all of it.
• Intestinal worms settle in slowly from raw or undercooked pork, wild boar and bear (tapeworm), and from untreated water, food gone off or eating with filthy hands (roundworm). Your belly aches, you stay hungry because the worms eat first, and a heavy load brings diarrhea. Your body won't clear them: albendazole (antiparasitic tablets) kills them within minutes, though an old pack may only kill most.
• While you're ill you get thirsty and weak, and every few minutes you'll need to go. You get a minute or so of warning: find somewhere with the third eye (Find a spot and go, or Use the latrine at one), or it happens where you stand. It takes a few seconds, you can't do anything else, and the infected can hear it.
• Rehydration salts can be mixed from salt and sugar. Haven's clinic sells them, metronidazole and the tetanus shot.

Colds and chest infections

Colds spread between survivors. You catch one by standing close to someone who has it, more easily indoors or in a car, and most of all when they sneeze or cough near you. Being cold and wet for a long time can also let one take hold. Hunger, exhaustion, stress and another illness make you catch things more easily; a multivitamin helps.

• A cold starts with a runny nose and sneezing, then a cough. Everyone near you hears every sneeze and cough, and so do the infected, so a cold can give away where you're hiding.
• A face covering cuts how much you spread and how much you catch: a respirator or a gas mask most, a bandana, a scarf or a balaclava a fair part of it. Wear one when you're sick and around others.
• Rest at a fire or sleep, keep warm and dry, and keep drinking: a cold clears much faster. Painkillers take the edge off the fever and the aches, codeine quiets the cough, and honey or a hot drink soothes your throat. Antibiotics do nothing for a cold.
• A cold you neglect (cold, soaked, hungry, exhausted, never resting) can turn into a chest infection: a deep cough, fever and short breath. Antibiotics clear it.

Dust

In a desert dust storm, the grit gets in your eyes and lungs. Your eyes water and blur unless you wear goggles or glasses, and you start coughing unless something covers your mouth and nose. Get under a roof or into a closed vehicle and it clears in a minute or two. Breathe enough of it and you can catch valley fever, a fungus in the desert soil: weeks of cough, aches and fatigue. It doesn't spread, antibiotics don't touch it, rest gets you through it, and nobody gets it twice.

Wounds and tetanus

• A dirty wound goes red and hot after a while: that's a local infection, and cleaning it still stops it. Leave it and it spreads; then only antibiotics will do, and it leads to sepsis, fever, delirium and death. Triage shows each stage.
• Wounds left open pick up dirt, and a rag dressing is dirty. A sterile dressing keeps a wound clean.
• Cuts from rusted metal (scrap blades, shanks, a spiked bat, a slip while rummaging a wreck or a scrap heap without gloves) can give you tetanus. Disinfect the cut within half an hour and the risk is small. A tetanus shot protects you for weeks and stops tetanus even after it starts. Sedatives hold its spasms off.

Keeping clean

You get dirtier with time, blood, mud and messy work. Dirty wounds go bad more often, eating with filthy hands can make you ill, and the infected smell a filthy survivor from further away. Wash in open water, in a shower, a basin or a bath. Soap in your pack makes the wash count for more and leaves your hands clean for a while.

Camps

A base is only as healthy as its sanitation. Build a Pit Latrine (one for about ten people), keep the dead out of the fence, don't overcrowd, and set up a clean water supply. Use the third eye on a latrine to check the camp's sanitation. A dirty camp can start an outbreak that passes between everyone who lives there, and settlements have outbreaks of their own: you'll hear when there's sickness somewhere.

Carry a filter straw or tablets, a sachet of rehydration salts and some soap, and dress every cut. That covers almost all of it.