After Hurricane Harvey – Robust Public Health Response

“In the immediate emergency there’s concern around drowning, and especially for folks who are in motor vehicles where there is severe flooding, blunt trauma, fire-related injuries,” said Marisa Raphael, deputy commissioner of the Office of Emergency Preparedness and Response at the New York City Health Department.
Vulnerable populations, like the homeless, the elderly and the chronically ill, are especially at risk during and in the aftermath of a disaster…
Here’s a rundown of some of the public health concerns Texas faces in the days, weeks and months to come.
1. Inadequate access to medical care and prescriptions
2. Tight quarters promote the spread of infectious disease
3. Contaminated water can cause disease and infection
4. Rescue workers face risks associated with mold
5. Standing water may cause mosquito-borne infectious disease
6. Uncertainty takes a psychological toll
In the face of physical threats, it’s easy to underestimate the mental health toll that a disaster can take on a community. “Medical systems can deal with physical stuff quite well,” Jackson said, while noting the relative complexity of treating psychological maladies compared with an acute physical problem, like a broken leg.” (A)

“The muddy floodwaters now soaking through drywall, carpeting, mattresses and furniture in Houston will pose a massive cleanup challenge with potential public health consequences.
It’s not known yet what kinds or how much sewage, chemicals and waterborne germs are mixed in the water. For now, health officials are more concerned about drownings, carbon monoxide poisoning from generators and hygiene at shelters. In the months and years to come, their worries will turn to the effects of trauma from Hurricane Harvey on mental health.
At a shelter set up inside Houston’s George R. Brown Convention Center, Dr. David Persse is building a clinic of doctors and nurses and trying to prevent the spread of viruses or having to send people to hospitals already stretched thin. (B)

“The majority of people who die during floods drown: About 75 percent of the fatalities are drownings, per the World Health Organization. Two feet of rapid floodwater will sweep away an SUV. Just six inches of water, if it moves quickly enough, can knock over an adult, according to the National Weather Service….
Short term: Infectious disease
A flood contains more than rain. Sewage systems spill their guts. And the water can dredge up things more disturbing, if less infectious, than human waste. In New Orleans in 2005, the flooding from Hurricane Katrina exhumed corpses, sending coffins afloat through neighborhoods….
Short term: Power outages
Short term: Drug access
Short and long term: Mosquitoes
Long term: Mental health
Long term: Mold..
“All of those forces,” he explained Monday, “combine to make the Gulf Coast especially susceptible to infectious and tropical disease.” (C)

“With mosquito-borne illnesses specifically, it appears that there may be a delayed effect. In the short term, after a hurricane, there should actually be a lower risk of contracting these viruses, because the water likely washed away the existing breeding sites.
“But then over time, as the floodwaters recede, you’re left with pockets of water which are good for breeding both Culex mosquitoes and Aedes mosquitoes,” says Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine in Texas. Culex mosquitoes carry West Nile, as well as St. Louis encephalitis and Japanese encephalitis. Aedes aegypti are the primary carriers for Zika, as well as dengue, chikungunya, and yellow fever.y means introducing a new ecosystem of fungal growth that will change the health of the population in ways we are only beginning to understand. The same infrastructure and geography that have kept this water from dissipating created a uniquely prolonged period for fungal overgrowth to take hold, which can mean health effects that will bear out over years and lifetimes. (D)

The documented dangers of excessive mold exposure are many. Guidelines issued by the World Health Organization note that living or working amid mold is associated with respiratory symptoms, allergies, asthma, and immunological reactions. The document cites a wide array of “inflammatory and toxic responses after exposure to microorganisms isolated from damp buildings, including their spores, metabolites, and components,” as well as evidence that mold exposure can increase risks of rare conditions like hypersensitivity pneumonitis, allergic alveolitis, and chronic sinusitis.” (E)

“The area’s historic flooding has many of the region’s hospitals facing a monumental crisis, as more than 1,500 patients had been evacuated by Tuesday afternoon.
Twenty-three licensed hospitals across the Houston region have taken the extraordinary step of evacuating their sickest patients because of rising water or compromised services as Tropical Storm Harvey continues to lash the area…
Even worse, as many as 25 additional hospitals in the Houston area now carry “internal disaster status,” which means they are considered vulnerable to shutting down or shuttling their sickest patients to new locations, said Darrell Pile, chief executive of the Southeast Texas Regional Advisory Council, whose catastrophic medical operations center is coordinating the response to the troubled hospitals.” (F)

(A) Hurricane Harvey’s Public Health Impact Extends Beyond Flooding, “Disasters magnify fragilities that are already present in society.”, by Erin Schumaker, http://www.huffingtonpost.com/entry/harvey-public-health-impact_us_59a42136e4b06d67e33913a6
(B) Public health dangers loom in Harvey-hit areas, by By nomaan merchant and carla k. johnson, http://abcnews.go.com/Technology/wireStory/public-health-dangers-loom-harvey-hit-areas-49476410
(C) The health dangers from Hurricane Harvey’s floods, by Ben Guarino, https://www.washingtonpost.com/news/to-your-health/wp/2017/08/29/the-health-consequences-to-expect-from-hurricane-harveys-floods/?utm_term=.df3c601e3be3
(D) Will Flooding in Texas Lead to More Mosquito-Borne Illness?, by Julie Beck, https://www.theatlantic.com/health/archive/2017/08/will-flooding-in-texas-lead-to-more-mosquito-borne-illness/538242/
(E) The Looming Consequences of Breathing Mold, James Hamblin, https://www.theatlantic.com/health/archive/2017/08/mold-city/538224/
(F) Hospital crisis deepens as water rises; 1,500 patients evacuated so far, by Jenny Deam, http://www.chron.com/business/article/Hospital-crisis-deepens-as-water-rises-1-500-12159473.php

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