After the Hurricane: An Overview of Hidden Health Risks

The following post is written by Reade Bush, PA-C, Assistant Medical Director, Generali Global Assistance on behalf of the GBTA Risk Committee.

Three recent hurricanes that struck Houston, Florida and Puerto Rico, have left many short- and long-term health effects which will make for a very difficult recovery process.

In the first days of a hurricane, most of the deaths are from drowning, trauma due to structural collapse or downed trees, electrocution, or fire, which may be fed by natural gas leaks.

As the floodwaters recede, residents contend with the effects of infectious agents, particularly bacteria, parasites and mold that are prevalent in dirty water.  Cholera, E. coli, salmonella, Hepatitis A, cryptosporidium, giardia and typhoid are the most common infectious agents, all of which are easily transmitted by water.  Public water systems may get contaminated, or an insufficient supply of fresh water can leave people washing clothes, cleaning food, or bathing in dirty water which easily spreads disease.  This, in part, is why over 15,000 people died in Haiti after the 2010 earthquake. These infectious agents cause fever, diarrhea, vomiting, and dehydration, and most are treatable if the infected reach the hospital quickly.

Mold is the most insidious health concern.  It grows in damp, warm areas.  Inhalation of mold spores can lead to a variety of health problems including respiratory and neurological symptoms.  Mold can hide in crawl spaces, behind walls, and other areas that are hard to locate, making it a difficult, long-term health problem.  Mold presents health-related problems for years after a hurricane strikes.

Residents also face hazards of broken glass, downed power lines, chemical leaks, natural gas leaks, or injury from structural collapse. The lack of power and refrigeration can lead to people suffering from heat-related illness or illness related to eating improperly stored food.  There were a number of elderly residents who died in Florida due to heat exposure at a nursing home which lost power for its cooling system.

There are also the hazards of bites from snakes, rodents and mosquitoes.  Mosquitoes, in particular, thrive on damp environments and can multiply rapidly in standing water.  They are vectors for Zika virus, which has had limited effects on the US mainland in recent years, West Nile, dengue and chikungunya virus.  Zika is a relatively new threat in the United States. It can cause significant birth defects when pregnant women become infected.

Other health issues arise from the stress that is put on the health care system.  Hospitals often lack sufficient staff to function, as regular staff members are displaced by the storm.  In many cases, health care workers from other states are called in to provide staffing. However, there were hospitals, especially in Puerto Rico, that had limited functionality and could not perform surgery due to power interruption.  In addition, hospitals and pharmacies face shortages in drugs or supplies, while at the same time, the interruption in transportation routes may cause delays in their supply chains.

Residents whose medical problems are generally managed on an outpatient basis, such as those on dialysis or home oxygen, face their own crisis when dialysis centers are closed by the storm or they run out of oxygen.  This is especially common due to electrical interruptions, since dialysis machines and home oxygen concentrators require power to operate.  The centers may have backup generators, or oxygen-dependent persons may store extra oxygen cylinders at home. However, backup generators requiring fuel may not be available.  Typically within 24 to 72 hours after a hurricane strikes, these residents may show up at hospitals, placing an added burden on hospitals that are already overtaxed.

In some cases, such as in Houston, the area affected by the path of the hurricane was so large that residents were told to shelter in place. But after the hurricane struck, some residents faced emergency evacuations due to rising water levels, threat of dam failure, or lack of power.  Institutions such as hospitals or nursing homes may be forced to evacuate large numbers of residents emergently, which places a huge burden on emergency responders.

Mental health is another area of concern as people who lose their homes, belongings, or experience deaths of loved ones may experience depression, anxiety or post-traumatic stress disorder.  The havoc of a hurricane may lead to mental health issues for years after the storm is gone.