Global & Disaster Medicine

Archive for the ‘Tropical cyclones’ Category

Disaster Relief for Puerto Rico; Is it enough?

NY Times

“….Puerto Rico, along with the United States Virgin Islands, certainly has reason to cheer: The deal includes $4.8 billion to replenish dwindling Medicaid funds, $2 billion to restore the shredded power grid and $9 billion for housing and urban development projects.

Hurricane Maria Lashes Puerto Rico

But the funding falls tens of billions of dollars short of what Puerto Rico says it needs to come back from the devastating storm…..”


Puerto Rico: More than 1.5 million people on the island are still in the dark.

NY Times

“….Much of the island’s 2,400 miles off transmission lines, 30,000 miles of distribution lines and 342 substations were damaged in the storm….”

acquired September 27 – 28, 2017

Pinpointing Where the Lights Went Out in Puerto Rico

After Hurricane Maria tore across Puerto Rico, it quickly became clear that the destruction would pose daunting challenges for first responders. Most of the electric power grid and telecommunications network was knocked offline. Flooding, downed trees, and toppled power lines made many roads impassable.

In circumstances like this, quickly knowing where the power is out—and how long it has been out—allows first responders to better deploy rescue and repair crews and to distribute life-saving supplies. And that is exactly why teams of scientists at NASA are working long days to make sure that groups like the National Guard and the Federal Emergency Management Agency (FEMA) get high-quality satellite maps of power outages in Puerto Rico.

These before-and-after images of Puerto Rico’s nighttime lights are based on data captured by the Suomi NPP satellite. The data was acquired by the Visible Infrared Imaging Radiometer Suite (VIIRS) “day-night band,” which detects light in a range of wavelengths from green to near-infrared, including reflected moonlight, light from fires and oil wells, lightning, and emissions from cities or other human activity.

The images above show lighting around San Juan, capital of the commonwealth; the images below show the entire island. One image in each pair shows a typical night before Maria made landfall, based upon cloud-free and low moonlight conditions; the second image is a composite that shows light detected by VIIRS on the nights of September 27 and 28, 2017. By compositing two nights, the image has fewer clouds blocking the view. (Note: some clouds still blocked light emissions during the two nights, especially across southeastern and western Puerto Rico.) The images above show widespread outages around San Juan, including key hospital and transportation infrastructure.

 


Puerto Rico: The Comfort’s mission has ended, but was it adequately used during a time of desperate medical need?

NY Times

  • The ship was prepared to support 250 hospital beds
  • Over its 53-day deployment, which included travel to and from the island, it admitted an average of only six patients a day, or 290 in total.
  • An additional 1,625 people were treated aboard the ship as outpatients, all at no cost.


After the hurricanes: Inside a Senior Complex in Puerto Rico

NY Times

“…..With large areas of Puerto Rico still in the dark three months after the first of the storms — according to government reports, only 60.4 percent of the pre-storm power grid load has been restored — older residents and those with chronic medical conditions are suffering in even more ways than their neighbors. Many nursing homes have no power. The failure to re-establish functioning telephone networks and transportation systems in many areas makes it difficult to get regular medical care. Fire safety systems are inoperable, posing special dangers for those who cannot easily escape.….”


Puerto Rico: Official Death Toll: 62. Actual Deaths May Be 1,052.

NY Times

“…..The Times’s analysis found that in the 42 days after Hurricane Maria made landfall on Sept. 20 as a Category 4 storm, 1,052 more people than usual died across the island. The analysis compared the number of deaths for each day in 2017 with the average of the number of deaths for the same days in 2015 and 2016.…..”

 


More than 168,000 people have flown or sailed out of Puerto Rico to Florida since the hurricane.

NY Times

 


11/13/1970: An immense tidal wave and storm surge caused by a powerful cyclone kills over 200,000 people in East Pakistan (Bangladesh).

History Channel

 


Hurricane Sandy struck NY/NJ on Oct. 29, 2012.


CDC recommendations to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas during the period of September 2017 – March 2018.

CDC

Advice for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and US Virgin Islands

Distributed via the CDC Health Alert Network
October 24, 2017, 1330 ET (1:30 PM ET)
CDCHAN-00408

Summary
The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.

The purpose of this HAN advisory is to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. Additionally, this Advisory provides guidance to state and territorial health departments on enhanced disease reporting.

 

Background
Hurricanes Irma and Maria made landfall in Puerto Rico and USVI in September 2017, causing widespread flooding and devastation. Natural hazards associated with the storms continue to affect many areas. Infectious disease outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems are disrupted and personal hygiene is difficult to maintain. Additionally, vector borne diseases can occur due to increased mosquito breeding in standing water; both Puerto Rico and USVI are at risk for outbreaks of dengue, Zika, and chikungunya.

Health care providers and public health practitioners should be aware that post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among patients in or recently returned from hurricane-affected areas; including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. The period of heightened risk may last through March 2018, based on current predictions of full restoration of power and safe water systems in Puerto Rico and USVI.

In addition, providers in health care facilities that have experienced water damage or contaminated water systems should be aware of the potential for increased risk of infections in those facilities due to invasive fungi, nontuberculous Mycobacterium species, Legionella species, and other Gram-negative bacteria associated with water (e.g., Pseudomonas), especially among critically ill or immunocompromised patients.

Cholera has not occurred in Puerto Rico or USVI in many decades and is not expected to occur post-hurricane.

 

Recommendations

These recommendations apply to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas (e.g., within the past 4 weeks), during the period of September 2017 – March 2018.

  • Health care providers and public health practitioners in hurricane-affected areas should look for community and healthcare-associated infectious diseases.
  • Health care providers in the continental US are encouraged to ask patients about recent travel (e.g., within the past 4 weeks) to hurricane-affected areas.
  • All healthcare providers should consider less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Some particularly important infectious diseases to consider include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.
  • In the context of limited laboratory resources in hurricane-affected areas, health care providers should contact their territorial or state health department if they need assistance with ordering specific diagnostic tests.
  • For certain conditions, such as leptospirosis, empiric therapy should be considered pending results of diagnostic tests— treatment for leptospirosis is most effective when initiated early in the disease process. Providers can contact their territorial or state health department or CDC for consultation.
  • Local health care providers are strongly encouraged to report patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid, and vibriosis to their local health authorities, while awaiting laboratory confirmation.
  • Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever, and vibriosis should be immediately reported to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.

 

For More Information


Lan hit Japan, killing three people and injuring at least 90.

REUTERS


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