Hurricane Harvey’s Public-Health Nightmare

For the thousands of people traveled through Harvey’s flood waters to Houston’s George R. Brown Convention Center, safety was not yet at hand. Although delivered from the worst of the storm, the packed masses were one of the loci of another brewing problem, one that officials expect might last a year or more after landfall.

Every flood disaster is also a public-health disaster, and even as Harvey dissipates over the Gulf Coast, the beginnings of that secondary calamity were on display in the Houston area. During the worst of the flooding, hospitals faced critical shortages of food and medicine, people with serious chronic diseases had to make difficult decisions between evacuation and sheltering in place, and hundreds of victims faced prescription shortages and mental-health issues. And based on the health problems people in New Orleans and elsewhere in the region faced after Hurricane Katrina, experts expect major public-health emergencies, environmental illnesses, and outbreaks will only intensify in the aftermath of Harvey.

Those challenges are already taxing the city’s health infrastructure. According to Bill Gentry, a professor at the University of North Carolina School of Public Health and a former emergency management official, one key public-health issue that attends the early stages of any disaster is the set of risks facing people who are disabled or elderly and face special health needs. “With our push towards home health-care and taking care of more Americans in the home,” Gentry said, “it quickly turns into ‘can we get their home health-care needs taken care of,’ with everything from oxygen to prescription meds to getting them clinical access, especially for dialysis. Those types of clinical worries compound as many days as the water stays up.”

Dialysis is a special concern, and for residents in Houston, already approaching crisis. As NPR reports, it’s important for patients with kidney failure to receive dialysis services every two to three days. But local dialysis centers are struggling with the demand, and with shortages of qualified staff, since several nurses who’d normally work in the centers are themselves displaced by the flood. And while companies like the DaVita Med Center and its locations around the Houston area are working around the clock to meet the area’s dialysis needs, as patients go longer without regular services and appointment reminders, the only solution to keeping them alive may be taking them to one of the area’s hospitals.And the hospitals are running up against their limits, too. When I spoke to Mary Brandt, a pediatric surgeon at Texas Children’s Hospital, she was driving home through receding floodwaters after five straight days of work. She and her colleagues had just completed the first shift of what she described as a “military kind of operation,” and fittingly had just been relieved by a team of reinforcements. “Texas Children’s Hospital has leadership that has just gotten this down to an art,” Brandt told me. “Everything was covered.”

That military-like response among Houston-area hospitals was largely effective in dealing with some of the most immediate effects of the storm. Brandt’s team saw mostly children who’d faced non-life-threatening injuries and illnesses. Meanwhile, kids with ailments requiring management, like asthma, or those with fevers and other serious conditions were airlifted to the Texas Children’s Hospital building in The Woodlands, a suburb north of Houston. The triage and logistics systems in place for Houston’s hospitals helped ensure that patients with the most sensitive conditions received treatment and resources on time.

Still, there’s reason to suspect that effective disaster-management system will be stressed in the days to come. As Brandt notes, the bulk of patients with conditions directly related to the floods haven’t yet made it to hospitals. “Since the water’s just subsiding,” Brandt said, “we’re expecting there’s going to be a huge number of patients that are going to come in today and tomorrow with problems that they needed to have taken care of in the last few days, but just couldn’t get to us.” That “huge number” might be more than hospitals can handle, as Texas Children’s is already near its bed capacity, and local general hospitals like Ben Taub Memorial have already faced food and drug shortages.There are a myriad of other health problems to come, and they often affect the most vulnerable citizens. Daring water rescues of Houston residents from nursing homes made headlines, but the most dangerous period during disasters for seniors is actually post-evacuation. According to Gentry: “What we learned through surveys was that even if we had 100 percent of the people evacuated successfully from nursing facilities, within eight weeks they usually saw a 10 percent fatality rate. That 10 percent was due just from the stress that results from the evacuation and the moving.”

To Gentry, perhaps the most overlooked health problems in the middle of disasters, both among seniors and the general population, are mental-health crises. But time and again, studies have shown that mental-health issues are actually the most predictable and durable of health problems that follow floods. Their extraordinary prevalence makes sense: Not only can the stress and losses of flooding trigger post-traumatic stress disorder and worsen other mental health conditions; even for people with well-managed illnesses, floods often mean a disruption in therapy and prescriptions. Also, for the sizable population of peoplewho resettled in Houston after evacuating Louisiana during Katrina, the event could simply compound an existing trauma.

Ground zero for the budding mental-health disaster in Houston is the convention center, where in addition to queuing for basic needs like food and water, hundreds or even thousands of people are lining up to receive needed mental-health services from a makeshift team of professionals from around Harris County. Some patients have extremely sensitive conditions and are facing psychotic breaks on the convention floor. Some saw life-saving drugs simply dissolved by rising floodwaters, and fear losing their place in the shelter if they travel to find any open pharmacies. Some have no mental-health histories whatsoever, and many children facing extraordinary stress weren’t in line at all, but still were in need of care.

Post Author: James Bark

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