Dr. Kevin Most: Hurricane Harvey Health Concerns
With the recent hurricane in Texas we start to see the impact weather can make on the health of a community and in this case a large portion of the state of Texas. The Death toll continues to increase and the impact will cause deaths in the future. Texas hospitals will be dealing with the aftermath of the flooding for months to come. We have all seen the pictures of devastation from the winds and the tornadoes, but the larger concerns are following the amount of rain that fell and the impact it can have.
The obvious initial medical and health concerns are about how do the hospitals stay open, how do physician offices stay open. Remember women are still having babies, people are still having appendicitis and injuries from the storm are occurring. Now couple that with the inability to drive on flooded streets and washed out roads to get to the hospital. Let’s say you have the ability to get to the hospital on safe roads, what happens when you get there. The difficult time you had getting to the hospital is the same difficult travel the staff of the hospital has to make. This same staff is dealing with the impact in their own homes and communities.
The staff is dealing with devastation, disruption of everything, even as simple as what to do with the kids as schools are closed, yet they are needed to be at the hospital to help provide care. The staff live in the community and many of them probably have homes under water and did they evacuate? Do they have a home to come back to.
Many hospitals have not been able to stay in business and have had to evacuate. Let’s put this in some perspective, Cook County has 73 hospitals, not all acute care hospitals, imagine if between 25- 50 of them had to close. This is a huge county and moving thousands of hospitalized patients would end with displacements well beyond the collar counties.
Most hospitals run between 75%- 95% full thru most of the year. When a hospital is full they often have to send an occasional patient to the next closest hospital for care, an inconvenience but often only a few miles. In Houston last week 23 hospitals were forced to evacuate patients and 25 more are on the verge of doing the same. Imagine what is happening, you don’t have the luxury of sending your patient to the nearest hospital as it may be evacuating their patients as well. The patient in the middle of care, be it post-surgery or pneumonia is now being transferred to a hospital a great distance from this mess and in most cases getting a new doctor and care team.
The hospitals they are sending individuals to are often operating close to capacity already, so the ability to move he patients to multiple hospitals is a logistic nightmare as 23 hospitals are all looking to place patients, and 25 more are hesitant to accept any patients as they be closing and need to evacuate. This is all occurring at the same time so the stress on the 911 service and ambulance services to do this safely is enormous. You don’t have to travel very far out of Houston before you are in rural Texas.
Couple this with the hospitals attempting to stay open financially running on razor thin margins as we have discussed before. Now the 20 plus hospitals that were forced to evacuate will not be able to just walk back in and start services again. They will need to be cleaned and disinfected, restocked and more importantly find appropriate staff. This storm will close hospitals forever, as they will not have the finances to clean and open the hospital and in many cases will not have the patients needed to seek care as the homes are not inhabitable, many needing to be reconstructed. Talk about a perfect storm.
What about the individual hospitals , how do they normally run?
Each hospital has enough supplies on hand to run the hospital for a minimum of 3 days without getting any supplies delivered. Most hospitals probably have closer to 4-5 days of supplies. With 30-60 inches of rain falling you can imagine that suppliers are having difficult times getting to their distribution centers or to the hospital directly. Knowing what supplies are needed and ordering them at appropriate times is a science. This assures that the hospital does not run out of any supplies that could impact the lives of patients in the hospital.
All hospitals have backup generators, many are fuel or gas based. They are tested on a regular basis and are in place for short term power outages due to storms. The need to replenish the fuel to keep the generators running as power is being restored will be difficult and life threatening if they are unable to keep the generators running. Getting food and water will be as big a struggle for the hospitals as it is for the general public. Remember during Katrina, they were doing water drives in Chicago to bring clean bottled water to the area. This storm hit a larger and more populated area
We all have seen the photos of the streets being flooded which not only impacts the staff and suppliers but also impacts the 911 System. This system is being inundated with phone calls to help with rescue from flooded homes, couple that with the inability of ambulances to get from point A to the hospitals in a standard time. Getting the heart attack or stroke patient to the hospital quickly has a major impact on the outcome of the patient. The efficiencies of the 911 System are based on road and air travel in good conditions. With the amount of flooding and rain the disruption impacts not only ambulances but also helicopters taking advanced illness patients to tertiary health centers.
Now let’s touch on the health concerns
We have talked in the past of the need to keep a list of your medicines and allergies on your cell phone. Conditions and incidents like this just highlight that. Individuals forced from their homes, physician offices flooded and closed, pharmacies closed a recipe for disaster. Patients may have thought ahead and grabbed their medication as they left but many did not and without the information on paper or in their phone they are being forced to try to remember the medication, the strength and the timing. Take a moment and make a list of your medications and keep it up dated on your phone or more importantly ask your doctor about a mobile application that links with your medical record in the office.
One can only imagine what will happen as the water recedes and the heat increases to norms for this time of the year, mold, bacteria and insect borne illness will skyrocket. Couple that with the stress related illness that one can expect including anxiety and depression from those displaced by the damage to their homes or places of work. The flood water will be contaminated with raw sewage and toxic chemicals that would normally not be exposed to water. Think about your own garage and the chemicals that you have there. Many of these will be seeping out into the water adding to the contamination. This can result in gastrointestinal illnesses as well as skin conditions.
Many towns currently do not have clean water or even have the water system functional. So they will be relying on bottled water for drinking and even bathing. The impact of water rationing will impact many of these patients as well, dehydration being the main condition associated with GI infections. Remember the ability to have clean drinking water will probably not be available for quite some time as the rains had continued and impacted the water supply. Workers helping with the cleanup in hot environment will need fluids and dehydration cases will elevate in these individuals as well.
Mosquito borne illness will see a spike just as we did with Katrina. In The case of Katrina we saw the number of West Nile cases double shortly after the hurricane, this is due to the amount of standing water that will be present. This is perfect breeding grounds for mosquitos. This impact will felt as funding cuts have eliminated mosquito abatement efforts. Remember Zika is a mosquito borne illness as well so an increase in cases of Zika in this area would not be surprising.
Mold will grow quickly in an area with moisture and heat, there will not be time or ability to dry things out before mold sets in. Mold can cause a trigger of allergy related upper respiratory illness and trigger asthma as well. There will be no way that the area will be able to be cleaned in time and correctly to slow the growth and impact of mold on the community.
Although this was a single event that impacted a large portion of Texas, reviewing the impact of the global weather changes will have far reaching impacts for years to come. If anyone really thinks that global warming is just a fad they should look at the increases in vector borne illnesses, such as Lyme disease or West Nile virus. Even more compelling is the concerns recently raised over the spread of Zika into the US. Dramatic increases in the number of these cases is explained with just a few simple facts, warmer winters allow for birds to stay north longer and return earlier, these are the vectors for the West Nile virus. Rising temperatures and extreme weather events allow for mosquito and virus reproduction rates to increase. Couple these together and you will see the increases we are seeing.
We will spend more time in the future looking at the health impact of global warming, it more significant than one would think.
We should all be praying for the Houston residents and be thankful for all of their caregivers.