Special Report - US: Healthcare Delivery Normalizing in Southeastern Texas following Passage of Hurricane Harvey
Healthcare delivery systems in southeastern Texas have begun to normalize following the passage of Hurricane Harvey, which made landfall on Aug. 25 and caused catastrophic flooding, especially in the Greater Houston area. Despite widespread reports of medication shortages and severe impact to local pharmacies and clinics, the rapid implementation of mitigation strategies appears to have been largely effective. Furthermore, healthcare facilities have generally been able to service patients despite adverse conditions, and aid organizations have assisted efforts to ensure that acute and chronic healthcare needs are met. Healthcare delivery systems will likely continue to improve in the coming weeks as floodwaters recede, while the risk of infectious diseases could become more severe.
- Multiple hospitals and pharmacies remain open in southeastern Texas, and additional facilities are expected to open in the coming weeks.
- Individuals who use medical devices that require electricity, such as ventilators and dialysis machines, should prepare for unexpected power outages.
- As the demand for replacement of lost or damaged medications and durable medical equipment (DME) increases, shortages could occur. However, these shortages will likely be short-term.
- The risk of infectious diseases will likely become more severe in the coming weeks due to the threat posed by floodwaters and the increased potential for disease transmission at emergency shelters.
Healthcare facilities in southeastern Texas continue to normalize following the passage of Hurricane Harvey. According to the SouthEast Texas Regional Advisory Council (SETRAC), an organization that supports hospital preparedness programs and manages responses during emergencies in the region, only 25 of the approximately 120 hospitals in southeastern Texas had been evacuated or closed as of Aug. 31. SETRAC expects that nearly all Houston-area hospitals will be fully functional by the end of September. Despite this anticipated progress, the situation remains fluid due to the threat of flooding from nearby reservoirs, contamination of local water supplies, and other possible scenarios. For example, on Aug. 31, Baptist Hospitals of Southeast Texas announced that they were discontinuing all services, including emergency services, due to the failure of city water pumps in Beaumont. Furthermore, hospitals that reopen may not be offering all services. Therefore, individuals should call the hospital or clinic before visiting to confirm that the facility is open and ask which services are available. For medical emergencies, call 911. It is important to note that first responders could be delayed by congestion from debris, volunteer vehicles, or other impediments on residential roads.
Pharmacies and Medication Safety
Many pharmacies in southeastern Texas have remained open since the passage of Hurricane Harvey. According to data from Rx Open, an interactive tool showing open pharmacies during disasters, most of the counties in the region had more than 90 percent of participating pharmacies open, as of Sept. 1. Counties reporting fewer than 75 percent of participating pharmacies open were Aransas, Duval, Gonzales, Jefferson, Live Oak, Orange, Refugio, Sabine, Somervell, Tyler, and Willacy (map). Since the situation in southeastern Texas remains fluid, individuals should call the pharmacy before visiting to ensure it is open and verify that the medication they need is in stock. To prevent a medication shortage, some pharmacies may only dispense a limited amount of a full prescription.
Personal medications and prescriptions may have also been lost or damaged during Harvey. According to the Texas Pharmacy Association, pharmacists are allowed to dispense up to a 30-day supply of prescription medication, except Schedule II-controlled substances, during a natural disaster, without prior authorization from a doctor. Schedule II-controlled substances include, but are not limited to, various types of depressants, narcotics, and stimulants. The US Food and Drug Administration (FDA) recommends that individuals practice the following precautions to ensure their medications are safe for use after a natural disaster:
- Medications Exposed to Unsafe Water: Discard any medications that may have come into contact with flood or contaminated water - even medications that are in their original containers with snap lids, screw-top caps, or droppers or medications placed in other storage containers.
- Lifesaving Medications Exposed to Unsafe Water: Medications needed to treat a life-threatening condition should be replaced as soon as possible. However, if a replacement is not readily available, the medication can be used if it looks unchanged. For example, pills in a wet container that appear dry can be taken; however, pills that are wet are contaminated and should be discarded.
- Medications Needed to Be Made into a Liquid: Use only purified or bottled water for drugs that need to be reconstituted; i.e., made into a liquid.
- Medications that Need Refrigeration: If a medication that requires refrigeration has been unrefrigerated for an extended period, discard and replace the medication. However, if the medication is absolutely necessary to sustain life, such as insulin, use the medication until a new supply is available. For more information about insulin storage and switching between products during an emergency, click here.
Power Outages and Medical Device Safety
Estimates indicate that more than 168,900 customers were without power in southeastern Texas as of Sept. 1, with Aransas, Harris, Nueces, Orange, and Tyler counties reporting most of the outages (map). This is a significant improvement compared to the more than 300,000 outages reported on Aug. 28. Although authorities are making progress toward restoring power, outages will likely continue in the region and could persist for several days. Individuals who use medical devices that require electricity should prepare for unexpected outages. For example, determine if the device can be used with batteries or a generator, and ensure access to such back-up equipment during an outage. If the device cannot be used with batteries or a generator and provides lifesaving support, individuals should seek emergency services immediately during a power outage. Since medical devices often reset to default mode when power is interrupted, individuals must ensure the settings on their device are correct when power is restored.
Like Hurricane Harvey, Hurricane Irma has the potential to cause catastrophic property damage, life-threatening flooding, and widespread power outages. Hurricane Irma is currently on track to impact the Leeward Islands, the US and British Virgin Islands, Puerto Rico, Turks and Caicos, Dominican Republic, Haiti, Cuba, Bahamas, and southeastern US. Individuals in the path of Hurricane Ima should ensure they have at least a 30-day supply of necessary medications and medical supplies prior to forecast inclement weather since these may be in short supply following the storm. Keep a list of all medications. This list should include the name of the medication, dose, frequency, and physician's name and phone number. Consider storing medications in their original containers in a "dry bag" or waterproof container. If a waterproof container is not available, store medications in several ziplock bags to keep them as dry as possible and away from potential contaminants. The US Federal Drug Administration (FDA) has created a comprehensive booklet for individuals who use medical devices that require electricity to help those users prepare for and handle power outages. To access this booklet, click here.
Infectious Disease Risks
Following the passage of Harvey, floodwaters, have increased threats from mosquito-borne diseases, mold, waterborne diseases, and water contaminants. The threat of mosquito-borne diseases will likely also increase as floodwaters recede, and the impact of water contaminants on public health may not be known for years. Furthermore, respiratory and gastrointestinal illnesses could spread rapidly in crowded environments, such as emergency shelters, if control measures are not quickly and fully implemented.
The threat of mosquito-borne will persist for several weeks due to standing water, which provides ideal environmental conditions for mosquito breeding. Although health officials in Texas have reported locally acquired cases of dengue fever, chikungunya, St. Louis Encephalitis, and Zika virus, reporting of these diseases was negligible prior to Hurricane Harvey, and will likely not pose a great risk. West Nile virus (WNV), on the other hand, is more prevalent in Texas and will likely pose a greater threat. As of Aug. 29, WNV activity in southeastern Texas has been reported in Bexar, Brazoria, Ellis, Harris, Johnson, Limestone, Montgomery, Nueces, Panola, and San Patricio counties (map). WNV activity will likely increase and spread to additional counties in the coming weeks. For more information about insect bite precautions, click here.
Floodwaters can also contain infectious organisms that can become airborne, such as mold. Mold is likely the greatest respiratory risk, and people with asthma or chronic lung disease are most likely to be affected. Since mold can survive in structures that appear completely dry, individuals should wear rubber gloves, boots, goggles, and an N95 respirator (if available) or a dust mask for protection during cleanup. The US CDC and other government agencies have created a guide to help homeowners and renters clean up mold after disasters. To access this guide, click here.
The risk of waterborne diseases, such as campylobacteriosis, cryptosporidiosis, and giardiasis, has increased due to sanitation and agricultural disruptions. To mitigate these threats, individuals should drink sealed and bottled water. If sealed and bottled water is not available, there are several methods to treat water. For more information about water contamination, click here. For more information about water treatment methods, click here.
Flooding may also persist near industrial sites, raising concerns of toxic chemicals and hazards being released in an uncontrolled manner into the environment and contaminating the surrounding ecosystems. There is also a risk of release of above- or underground chemicals that could inadvertently combine, creating a compound that is immediately poisonous or poisonous after months of exposure. Tetanus, a vaccine-preventable disease, is also a high risk and can be acquired from contaminated water or soil entering broken areas of skin. The best means of preventing illness and injury is to avoid contaminated floodwaters and ensure all immunizations are up to date. However, if individuals must enter floodwaters, they should also use personal protective clothing and equipment to prevent contact with water.
Basic Health Precautions
Individuals should also maintain a good sense of personal hygiene, which is especially important for those living in crowded shelters since the transmission of many respiratory and gastrointestinal diseases can be amplified in enclosed, crowded environments. Seek medical attention promptly for any fever or gastric symptoms that last longer than a few days, despite treatment. For more information about basic health precautions, click here.
Healthcare Ready: https://www.healthcareready.org/harvey