As a public health catastrophe unfolded Wednesday in New Orleans, hospitals in the Crescent City sank further into disaster, airlifting babies without their parents to other states and struggling with more sick people appearing at their doors.
Dangerous, unsanitary conditions spread across the city, much of which now sits in a murky stew of germs.
The federal government declared a public health emergency for the Gulf Coast region, promising 40 medical centers with up to 10,000 beds and thousands of doctors and nurses for the hurricane-ravaged area.
In a stunning example of how desperate the situation has become, 25 babies who had been in a makeshift neonatal intensive care unit at New Orleans' Ochsner Clinic were airlifted Wednesday to hospitals in Houston, Baton Rouge, La., and Birmingham, Ala. Many were hooked up to battery-operated breathing machines keeping them alive.
Their parents had been forced to evacuate and leave the infants behind; by late in the day, most if not all had been contacted and told where their babies were being taken, said hospital spokeswoman Katherine Voss.
"We actually encouraged them to leave. It would just be more people to evacuate if there was a problem," said Dr. Vince Adolph, a pediatric surgeon.
Helicopters had to land on the roof of the parking garage to get the babies because water covered the helipad at the hospital, one of the few in the area that had been operating almost normally.
"We're getting kind of at the end of our rope," with a skeleton staff of doctors and nurses who have been on duty nonstop since Sunday, Voss said.
Imperato says the floodwaters have flushed animals -- alive and dead -- into urban areas.
Officials were trying to evacuate 10,000 people - patients, staff and refugees - out of nine hospitals battling floodwaters or using generators running low on fuel. About 300 people were stranded on the roof of one two-story hospital in the New Orleans suburb of Chalmette.
Yet even as they tried to evacuate, many hospitals faced an onslaught of new patients - people with injuries and infections caused by the storm, people plucked from rooftops who are dehydrated, dialysis and cancer patients in need of their regular chemotherapy or radiation treatments.
"We have thousands of people who are getting ill ... our hospitals need to be prepared to take care of the incoming sick," said Coletta Barrett of the Louisiana Hospital Association.
Only about 150 patients were able to be evacuated Wednesday from all nine New Orleans hospitals, said Knox Andress, an emergency room nurse in Shreveport, La. He is regional coordinator for a federal emergency preparedness grant covering the state and is involved in helping place evacuees in other hospitals.
"We're ready for patients and we can't get them. We just can't get them out," he said.
The government said dozens of medical disaster teams from nearby states were moving into hard-hit areas.
"We've identified 2,600 beds in hospitals in the 12-state area. In addition to that, we've identified 40,000 beds nationwide, should they be needed," said Health and Human Services Secretary Michael Leavitt.
Storm survivors, particularly in New Orleans where floodwaters remain, face a cauldron of infectious agents, public health experts said.
"You can think of floodwaters as diluted sewage," said Mark Sobsey, a professor of environmental microbiology at the University of North Carolina.
Whatever infections people carry go into sewage and can be expected to show up in floodwaters. That includes common diarrheal germs including hepatitis A and Norwalk virus.
"We are gravely concerned about the potential for cholera, typhoid and dehydrating diseases that could come as a result of the stagnant water and the conditions," said Leavitt.
However, officials at the federal Centers for Disease Control and Prevention and other health experts said cholera and typhoid are not considered to be high risks in the area. CDC officials suggested Leavitt was simply mentioning examples of diseases that could arise from contaminated food and water.
Some experts said worries about catching illnesses from being near dead animals or human bodies are somewhat overblown.
"People who are alive can give you a whole lot more diseases than people who are dead," said Richard Garfield, a Columbia University professor of international clinical nursing who helped coordinate medical care in Indonesia after the tsunami.
Mosquito-borne diseases may start to emerge within days. West Nile virus and dengue fever are both potential risks following a situation like the one in coastal Alabama, Mississippi and Louisiana. Officials also cited carbon monoxide poisoning risks to people using generators and stoves.
"One of the things they have got to do - we've got to plead for - is to make sure that when these hospitals get evacuated, the National Guard or somebody is there putting major security around these hospitals, or they're going to get ransacked. And it's going to make a bad situation even worse," said John Matessino, president of the Louisiana Hospital Association.
He said the four hospitals in New Orleans' central business district - Tulane, Charity, University and the VA hospital - had the worst problem with would-be looters.
Days after the storm hit, many people in key positions to help were still struggling to figure out how.
The Pharmamaceutical Research and Manufacturers Association asked the government to make a public health assessment to guide drug companies.
"Once we know what is required, we can begin to donate and ship in desperately needed medicines," said a statement from Billy Tauzin, the group's president and former congressman from Louisiana.
The American Diabetes Association wants to help get insulin and syringes to diabetics and is working with the Red Cross, but the relief agency "is still very much in 'rescue mode,'" an association spokeswoman said.
Eli Lilly and Co. said it would give $1 million in cash and would match any donations by its U.S. employees to the Red Cross. The company also is donating $1 million in insulin.
The American Medical Association's Center for Public Health Preparedness and Disaster Response was trying to figure out a system to help coordinate doctors who want to volunteer.
"It's going to take years - years - to rebuild the medical infrastructure. There will be continuing health needs," said Dr. James J. James, the center's director.