Residents wade through flood waters from Tropical Storm Harvey in Beaumont Place, Houston, Texas, August 28, 2017

commentary

(U.S. News & World Report)

September 5, 2017

Anticipating Harvey's Toll on Health and Health Care

Residents wade through flood waters from Tropical Storm Harvey in Beaumont Place, Houston, Texas, on August 28, 2017

Photo by Jonathan Bachman/Reuters

by Mahshid Abir and Richard Serino

The Department of Health and Human Services declared Hurricane Harvey a public health emergency just as it made landfall for a second time in Louisiana. In Houston, rescue efforts continue amid rising floodwaters. Thousands have been rescued and many more may need to be evacuated from impacted areas.

With each passing day, challenges to the health of affected communities and the health care systems that serve them are expected to grow. Those challenges, which include the closure of hospitals, pharmacies, dialysis centers and other facilities, are reminiscent of those that followed Hurricanes Katrina in 2005 and Sandy in 2012.

Lessons learned during the earlier disasters could be valuable to relief efforts as the flood waters recede across Texas and Louisiana. Among the key takeaways from Katrina and Sandy: expect significant health care needs from individuals with chronic diseases, including mental health, and anticipate increased demand for acute care resources in regional emergency departments and hospitals.

As in the aftermath of Katrina and Sandy, significant health care needs in the wake of Harvey will likely be related to chronic conditions such as diabetes and dialysis-dependent chronic kidney disease. Many evacuees may have left their medications behind and traveling to open pharmacies and dialysis centers may not be possible. Post-Katrina, medical relief pharmacy supplies were deemed insufficient to meet the substantial needs of disaster-stricken populations.

Primary care access was significantly impacted after Hurricane Sandy, further challenging chronic disease management. Left untreated, exacerbations of such chronic conditions can be life-threatening.

A rise in depression, PTSD, alcohol and substance abuse, and domestic violence can be anticipated.

As during the earlier disasters, a rise in depression, post-traumatic stress disorder, alcohol and substance abuse, and domestic violence can be anticipated. Individuals with existing mental health and substance abuse problems are particularly at risk. Early intervention for at-risk individuals is critical to mitigating the mental health impact of disasters.

Flood exposure was deemed to be a risk factor for anxiety, depression and PTSD in the aftermath of Hurricane Sandy. Furthermore, some opioid treatment programs faced challenges resulting in disrupted therapy with risk of relapse for involved individuals.

With closed pharmacies, dialysis centers and inaccessible primary care providers, many Katrina and Sandy victims turned to emergency departments and hospitals for their health care needs. A recent study by researchers at the University of Michigan showed that hospitalizations for older adults increased up to a month post-disaster compared to the rest of the year.

The Department of Health and Human Services established a 250-bed Federal Medical Station in Houston in order to respond to the medical needs of disaster victims. In addition to exacerbations of chronic diseases, health care providers can anticipate seeing food and waterborne diseases and lower extremity injuries.

Patients should be actively screened for and referred to mental health and substance abuse treatment as indicated. Need for supplies of antibiotics and medications for diabetes, asthma and other chronic conditions should not be underestimated. Communication between federal, state, and local governments with private dialysis vendors could facilitate providing timely dialysis to those in need.

Given local hospital closures and evacuations, emergency departments and hospitals in neighboring regions can expect to receive evacuees with medical needs and should anticipate a surge in demand for acute care resources. Emergency departments and hospitals should prepare for an increase in demand for dialysis and mental health resources and a rise in hospital admissions in the coming weeks and plan accordingly with needed beds, staff, and supplies.

The ongoing disaster response and rescue efforts by local, state and federal entities should be applauded. A vigilant and proactive effort needs to be taken moving forward to anticipate and address both the immediate and intermediate needs of affected communities and health care systems in order to secure the health of those most in need and save lives. This could involve real-time assessment of medical needs informed by lessons learned from other recent disasters. Short- and longer-term recovery will require resilience building through a whole-of-community approach involving government, private sector, non-profits, faith-based entities and community members alike.


Mahshid Abir, MD, is an emergency physician and director of the Acute Care Research Unit at the University of Michigan. She is an adjunct staff at the nonpartisan, nonprofit RAND Corporation.

Richard Serino is a distinguished visiting fellow at Harvard University's National Preparedness Leadership Initiative, the former deputy administrator of the Federal Emergency Management Agency and the chief of EMS and assistant director of health for the city of Boston.

This commentary originally appeared on U.S. News & World Report on September 1, 2017. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.