Global & Disaster Medicine

Archive for August, 2017

TS Harvey: Forecasters predict another five to 10 inches of rain could fall in western Louisiana

Washington Post


Harvey: Some of the volunteer boat rescues in Texas were being coördinated on a walkie-talkie app called Zello. Trapped people unable to get through to a 911 operator were trying Zello’s “Cajun Navy” or “Texas Navy” channels, and asking for help from citizen dispatchers and boaters. Early this afternoon, the requests for help—most of them less than thirty seconds—were relentless; there was rarely any dead air.

New Yorker


Texas Hospitals in the middle of Harvey

Texas Hospital Association

UPDATE: 5:25 p.m. Sunday 08/27/2017

Emergency Preparedness Critical for Texas Hospitals’ Harvey Response
As the devastating flooding from the remnants of Hurricane Harvey continues along the Texas coast and parts of central Texas, Texas hospitals are drawing on their emergency preparedness training, skills, resources and experiences to provide life-saving care to residents.
Read the press release.

UPDATE: 4:24 p.m. Saturday 08/26/2017

Approval of request to waive certain requirements of Section 1135 of the Social Security Act:
Waiver of Requirements Under Section 1135 of the Social Security Act governing Medicare, Medicaid and CHIP in Texas 

UPDATE: 2:44 p.m. Saturday 08/26/2017

Points of contact at the Texas Medical Board and the Texas Board of Nursing who can expedite requests for temporary out-of-state licensure/permit. The Governor’s office has contacted each of these agencies and they are aware of your request.

Medical Board

Board of Nursing
Licensing: Mark Majek 512/305-6801
Backup: Veronica Robertson 512/305-7675

Emergency dispensing:

The Governor’s proclamation:

UPDATE: 2:20 p.m. Saturday 08/26/2017

Gov. Greg Abbott approves emergency prescription dispensing protocol.  More information.

UPDATE: 1:58 p.m. Saturday 08/26/2017

Gov. Greg Abbott approves request from TDSHS to waive hospital licensing rules related to bed capacity limits.

Agency  Administrative Rule Purpose/Scope of Suspension Special Considerations Statutory Reference Duration
DSHS 25 T.A.C. §133.21, 25 TAC §133.26(A), and 25 TAC §133.163(B) Suspend the hospital licensing requirements related to limits on bed capacity and/or number of beds in patient suites. This enables hospitals to house and treat more patients than allowed by their license. Suspension is sought to allow hospitals to admit patients that have been evacuated from the affected counties and/or accept new patients in greater numbers than allowed by their license. HSC Chapter 241 30 days (through 9/25/2017)

UPDATE: 12:45 p.m. Saturday 08/26/2017

Due to Harvey emergency, Public Health Emergency declared in Texas and Section 1135 waivers approved. For more information go to:

The U.S. FDA today granted accelerated approval to benznidazole for use in children ages 2 to 12 years old with Chagas disease — the first treatment approved in the United States for the treatment of Chagas disease.



The U.S. Food and Drug Administration today granted accelerated approval to benznidazole for use in children ages 2 to 12 years old with Chagas disease. It is the first treatment approved in the United States for the treatment of Chagas disease.

Chagas disease, or American trypanosomiasis, is a parasitic infection caused by Trypanosoma cruzi and can be transmitted through different routes, including contact with the feces of a certain insect, blood transfusions, or from a mother to her child during pregnancy. After years of infection, the disease can cause serious heart illness, and it also can affect swallowing and digestion. While Chagas disease primarily affects people living in rural parts of Latin America, recent estimates are that there may be approximately 300,000 persons in the United States with Chagas disease.

Adult Rhodnius prolixus taking a blood meal through human skin

“The FDA is committed to making available safe and effective therapeutic options to treat tropical diseases,” said Edward Cox, M.D., director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research.

The safety and efficacy of benznidazole were established in two placebo-controlled clinical trials in pediatric patients 6 to 12 years old. In the first trial, approximately 60 percent of children treated with benznidazole had an antibody test change from positive to negative compared with approximately 14 percent of children who received a placebo. Results in the second trial were similar: Approximately 55 percent of children treated with benznidazole had an antibody test change from positive to negative compared with 5 percent who received a placebo. An additional study of the safety and pharmacokinetics (how the body absorbs, distributes and clears the drug) of benznidazole in pediatric patients 2 to 12 years of age provided information for dosing recommendations down to 2 years of age.


The most common adverse reactions in patients taking benznidazole were stomach pain, rash, decreased weight, headache, nausea, vomiting, abnormal white blood cell count, urticaria (hives), pruritus (itching) and decreased appetite. Benznidazole is associated with serious risks including serious skin reactions, nervous system effects and bone marrow depression. Based on findings from animal studies, benznidazole could cause fetal harm when administered to a pregnant woman.

Benznidazole was approved using the Accelerated Approval pathway. The Accelerated Approval pathway allows the FDA to approve drugs for serious conditions where there is unmet medical need and adequate and well-controlled trials establish that the drug has an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit to patients. Further study is required to verify and describe the anticipated clinical benefit of benznidazole.

The FDA granted benznidazole priority review and orphan product designation. These designations were granted because Chagas disease is a rare disease, and until now, there were no approved drugs for Chagas disease in the United States.

With this approval, benznidazole’s manufacturer, Chemo Research, S. L., is awarded a Tropical Disease Priority Review Voucher in accordance with a provision included in the Food and Drug Administration Amendments Act of 2007 that aims to encourage development of new drugs and biological products for the prevention and treatment of certain tropical diseases.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.




Harvey-Houston Update


  • A Houston curfew will be in place from midnight to 5 a.m. every day until further notice.
  • Authorities said 9,000-10,000 people had been rescued in the Houston region since Harvey hit – 3,000 by Houston police, 3,000-4,000 by the Houston Fire Department and 3,000 by the Coast Guard in Houston, Harris County and other parts of the region reeling from the storm.
  • The Toyota Center, where the Houston Rockets play, will be a second shelter for evacuees
  • At the George R. Brown Convention Center, more than 10,000 people are being sheltered


Post-Harvey, health officials are warning about an increased risk of illnesses and hazards caused by the rising floodwaters.


  • drowning,
  • bacterial diseases,
  • carbon monoxide poisoning,
  • mosquito-borne illnesses:  Zika, ChikV, Dengue
  • floodwaters could become contaminated with chemicals



8/29/2005: Katrina makes landfall as a Category 4 storm, bringing with it sustained winds of 145 mph with gusts of up to 175 mph and massive storm surges that overwhelmed the city’s levees, flooding 80% of the city, as well as many of the outlying neighborhoods, or parishes.

History Channel

  • “…Without electricity or basic supplies, tens of thousands of people sought shelter in the New Orleans Convention Center and Louisiana Superdome. At both sites, conditions rapidly deteriorated amid overcrowding and a lack of supplies. Almost unbelievably, it took more than two days for a full-scale relief effort to be launched. In the meantime, frustration mounted as stranded residents suffered from heat, hunger, crime and a lack of medical care….”

Harvey: At least 9 nine dead


  • The administrator of the Federal Emergency Management Agency, Brock Long, said on Monday that he expected more than 450,000 people to apply for federal assistance.
  • For the time being, efforts are focused on the most basic elements of keeping people alive — plucking stranded survivors from the flood, providing shelter, food and water, and restoring electricity to hundreds of thousands of people who were left without power.

  • FEMA was shipping two million liters of water and two million meals to the region.

  • Other government agencies, charities and corporations were also moving supplies into the region.

  • Governor Abbott activated the entire Texas National Guard to aid in rescue and recovery, raising the number of troops involved to 12,000 from 3,000.

The Rohingya: An introduction

Office of Cyber and Infrastructure Analysis on HARVEY, 8-28-17

Prepared By: Office of Cyber and Infrastructure Analysis (OCIA)
As of 1100 EDT, 28 August 2017, Tropical Storm Harvey is located in southeastern Texas (TX)
approximately 25 miles east-northeast of Port O’Connor, TX. Maximum sustained wind speed is
40 miles per hour (mph) with higher gusts. Some slow intensification in storm strength is possible
during the next 48 hours. The storm is moving to the southeast at about 5 mph, with a gradual turn
to the northeast and a slow forward speed expected during the day and into the evening of Tuesday,
29 August 2017. The National Weather Service estimates additional rain accumulation of 15 to 25
inches over the upper Texas coast and into southwestern Louisiana through Friday. Isolated storm
totals could reach 50 inches over the upper Texas coast.

Infrastructure Impact Summary – Update 4
Impacts to the Transportation Systems Sector have increased because of significant flooding, closing several major
highways and roads. OCIA assesses that local and regional impacts to all critical infrastructure sectors in the
affected area are anticipated to continue. The storm will continue to cause electrical power outages from
combined rain and wind effects. Local impacts are likely to be high for the Energy, Dams, Water and Wastewater
Systems, Transportation Systems, and Commercial Facilities Sectors. National impacts to the Energy Sector may
become apparent as rising flood waters limit the production of gasoline, diesel, and natural gas.
Tropical Storm Harvey – Dams – Update 1
OCIA assesses that the storm will continue to have moderate to high local impacts and low national impacts to the
Dams Sector. The greatest potential cause of impacts to dams is extended periods of heavy inland rainfall. As of
August 27, 2017, the National Weather Service reported 24 inches of rainfall within the last 24 hours in the
Houston area, with an estimated additional accumulation of 15-25 inches predicted through Friday, September 1,
2017. Flood warnings and watches are in effect with record flooding predicted for the area.
Tropical Storm Harvey – Water and Wastewater Systems – Update 1
OCIA assesses that the storm will have a moderate-to-high impact on the Water and Wastewater Systems Sector
as a result of power losses. OCIA assesses that heavy rainfall and flooding will be the greatest threats to Water
and Wastewater Systems Sector infrastructure. Heavy rainfall and subsequent flooding can affect water and
wastewater systems by inundating electrical components, damaging components via debris flows, or limiting
employee access.
Based on OCIA modeling, there are 19 drinking water treatment facilities—in Texas and Louisiana—serving
populations greater than 40,000 households estimated to be at risk of floodwaters of 3 feet or more. Two
wastewater treatment plants in Texas are also at risk of three feet of flooding and serve large populations.
Tropical Storm Harvey – Impacts of Riverine Flooding on Oil and Natural Gas –
Update 1
OCIA modeling shows expanded riverine flooding, indicating more oil and natural gas facilities are potentially at
risk. Eight refineries are located in areas that are modeled to receive 8 to 12 feet of flooding. Sixty-two petroleum
or petroleum product facilities (e.g., gasoline, diesel), as well as two natural gas storage facilities, were estimated to
be at risk of receiving over 8 feet of flooding. Additional refineries, natural gas processing and storage facilities and
petroleum, oil, and lubricants facilities may be impacted by floodwaters less than 8 feet, road closures, or
availability of personnel.
Tropical Storm Harvey – Healthcare and Public Health – Update 1
The potential impacts to the Sector are due to flooding causing extended electric power and water and
wastewater outages. OCIA modeling estimates 9 hospitals and 44 nursing homes could be affected by inland
flooding of 4 feet or more. About 2,372 hospital beds and 3,254 nursing home beds are in the projected affected
facilities. Some of the potentially impacted hospitals have started to discharge patients and reduce clinical functions.
Infrastructure System Overview – Extended Water Outages – Re-release
(originally released 9 March 2015)
Public health issues could arise with regard to drinking water in flooded zones. A Boil Water Advisory has been
issued for Corpus Christi’s 325,000 residents and neighboring cities as a result of power outages impacting city
wastewater treatment facilities; it is likely that more advisories will be issued if there is any change in pressure or
water quality to guard against acute microbial risks. Increased requirements for water supply treatments are also
likely as floodwaters enter wastewater treatment areas. If water treatment mitigation options are not sufficient,
the public notification would change to “Do Not Drink”, though this rarely happens. How long the advisories will
remain in effect is conditioned upon power restoration and road access to the affected facilities.
Hurricane Harvey – Transportation Systems
OCIA assesses that most transportation systems in the affected area will cease operations during the storm and
that recovery efforts may take days to weeks, depending on the level of damage and restoration priorities.
Maritime shipping disruptions may be longer than a typical storm because of the likelihood that the storm makes
landfall and then heads back into the Gulf of Mexico. Freight rail companies will divert trains, localizing any
disruptions to freight shipments. Highways and roads may become impassible due to debris or floodwaters. Storm
surge and floodwaters may also be heavily damaged and wash out roads and bridges, potentially impacting local
traffic for days or weeks following the storm. Flooding on major routes will force traffic onto alternate routes with
less capacity, creating the potential for increased congestion.
Hurricane Harvey – Government Facilities and Emergency Services
Government facilities will be impacted by sustained winds, flooding and related power outages. State and local
governments will likely be able to continue providing essential services. Non-critical facilities will be shut down and
the workforce evacuated until the storm passes.
The Emergency Services Sector is unlikely to experience significant disruptions to operations. Physical
infrastructure may be damaged by flooding, disrupted power, and loss of storage facilities. Police and Sherriff
departments may be forced to evacuate jails and prisons and transfer inmates to backup facilities. Fire
Departments and Emergency Operation Centers will relocate to backup sites as prescribed by continuity of
operations plans while maintaining readiness and response postures.
Hurricane Harvey – Oil and Natural Gas – Update 1
Oil and natural gas companies have significantly curtailed operations. OCIA assesses that the storm will have
moderate national impact to the Oil and Natural Gas Subsector and high local and regional impacts. The Gulf
Coast is the center of U.S. oil and natural gas operations, accounting for 45 percent of refining capacity. Areas
affected directly by the storm and indirectly by pipeline and barge connections have sufficient product (e.g.,
gasoline, diesel) on hand to withstand a short-term (2 weeks) disruption. Gasoline prices are rising and should
continue to rise over the next week. Petrochemical facilities, which rely on petroleum refineries and natural gas
processing plants for feedstock, may be at risk for short term curtailments. Operations will resume after oil and
natural gas facilities are operational.
Infrastructure System Overview – Extended Electric Outages – Re-release
(originally released 4 August 2014)
Based on the slow moving characteristics of the storm and its projected duration over the impacted area, affected
areas will likely experience prolonged power outages. Power outages may be in excess of 48-96 hours as
restoration efforts will be hindered until high winds and rain subside and flood waters recede. Generally, utilities
cannot restore assets when wind speeds are in excess of 30-35 mph.
Full restoration for a significant, widespread event such as a major hurricane could potentially take weeks for all
customers to be restored. Electric power service is usually restored methodically with high-priority customers
receiving immediate attention, when possible. These high-priority customers include hospitals, water supply


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