Disastrous hurricanes, fires and floods put strain on US physicians, hospitals and patients

By John Murphy, MDLinx
Published October 13, 2017

Key Takeaways

As fast-moving Northern California wildfires raged into Santa Rosa, CA, in the early morning hours of Monday, October 9, the staff of Santa Rosa Kaiser Permanente Medical Center evacuated its 130 patients, shutting down the hospital and its emergency department. News footage showed nurses and emergency workers wheeling out patients in beds, while fires burned down the street coming closer.

Patients were transported—some by city bus commandeered for the evacuation—to Kaiser Permanente in San Rafael or other local hospitals and health care centers.

“There’s certainly been a strain on some of our facilities,” Josh Weil, MD, chief of the Emergency Department at Kaiser Permanente Santa Rosa, told the Los Angeles Times. “You keep thinking…‘All right, we’re through this.’ And then we’re not,” he said. “You think it’s safe, and then it’s under threat again. You think it’s safe…and then it’s gone.”

Like many other hospital employees, Dr. Weil lost his home to the fire. Meanwhile, the Santa Rosa Medical Center remains shut down until further notice. Health officials in the area advised residents to keep their windows closed and air conditioners on to avoid breathing in smoke. The air quality in Napa County reached unprecedented, hazardous levels as more than 20 wildfires burned in the area, filling the skies with smoke and fine particulate pollution.

Smoke inhalation is particularly harmful to children, elderly, and people with respiratory conditions such as asthma, COPD, emphysema, and heart disease, advised the Bay Area Air Quality Management District, which has issued air quality alerts for several days running.

The hazardous conditions could continue for days to come, the organization warned.

Struggling with shortages

As the West Coast copes with the health care crisis posed by wildfires, residents on the hurricane-battered islands of the East Coast continue to struggle with barely manageable conditions weeks after devastating damage caused by Hurricanes Irma and Maria.

If not addressed quickly, the health situation in Puerto Rico and the US Virgin Islands could become much worse, authorities warned.

“Infectious disease risks in the wake of these hurricanes include exposures to waterborne pathogens, the spread of infections in crowded shelters, food-borne illnesses, mosquito-borne infections and mold-related illnesses. Reliable access to medicines for patients with HIV and tuberculosis is also critical to preventing treatment disruptions that increase patients’ risks of serious illness, disease progression, and to avoid the emergence of drug-resistance or transmission of these infections,” advised Paul Auwaerter, MD, president of the Infectious Diseases Society of America, and Melanie Thompson, MD, chair of the HIV Medicine Association, in a joint statement.

“Health workers in the affected areas struggle with shortages of antibiotics and hydration solutions, and they are bracing for potential infectious disease outbreaks. Ensuring that basic needs are met including access to clean water, safe food, and sanitation as essential for infection control,” they added.

Indeed, Puerto Rico Governor Ricardo Rosselló recently announced that 10 potential cases of leptospirosis, including four deaths, are under investigation.

Dr. Auwaerter and Dr. Thompson pleaded in their statement for an immediate infusion of emergency funds to provide essential medicines and fundamental health care supplies on those islands. They also appealed for support to rebuild critical health infrastructures in devastated areas.

Critical infrastructures

As of October 10, 65 of 67 hospitals in Puerto Rico are open, and 43 of the island’s 48 dialysis centers are operational, according to US Department of Defense. More than half of the hospitals (36) are receiving electricity through a power grid that’s proven to be unreliable, while the 29 other hospitals are running on generators. Only 15% of the island’s residents have electricity, but more than half (57%) have drinking water, although boil-water advisories remain in place.

Power has been restored to about 14% of customers on the island of St. Thomas and 12% on St. Croix, and hospitals and airports have been reopened on both islands, the Federal Emergency Management Agency (FEMA) reported on October 7.

For people lacking prescription drugs because of the disaster, the federal government activated its Emergency Prescription Assistance Program (EPAP) for Puerto Ricans without health insurance. Eligible residents can get a 30-day supply at participating pharmacies and can renew their prescriptions while the EPAP is active.

Widespread effects

The effects of devastation in Puerto Rico reach far beyond the shores of the island. Pharmaceutical products manufactured in Puerto Rico make up nearly 10% of all drugs consumed by Americans, according to data from the Bureau of Economic Analysis. The Food and Drug Association is closely monitoring about 40 critical pharmaceutical and biological drug products—a shortage of any of these could have substantial impact on the public health.

“In urgent cases, when critical products are at issue, we’ve intervened over the past 2 weeks to help firms secure fuel to maintain production lines, get clearance to move logistical support into the island or finished goods to their recipients,” noted FDA Commissioner Scott Gottlieb, MD, in an October 6 statement.

How you can help

American Red Cross seeks volunteers to help evacuees affected by Northern California wildfires

American Diabetes Association has emergency resources for people with diabetes in disaster-stricken areas, including ways to donate extra diabetes supplies

Center for Volunteer & Nonprofit Leadership is seeking volunteers to assist wildfire victims and is collecting donations for relief efforts in the area

Sandwiches for Sonoma County Firefighters is raising money to feed firefighters battling the blazes

United for Puerto Rico, created by Gov. Rosselló’s wife, Beatriz Rosselló, is asking for donations, 100% of which will go to helping victims

Physician resources if a disaster strikes in your area

Pharmacy and provider access during a federal disaster or other state or public health emergency

Initiate same-day temporary Medicare billing privileges over-the-phone

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