Global & Disaster Medicine

Archive for the ‘Tropical cyclones’ Category

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.


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)

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.


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.



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.


Mammoth Typhoon Lan is closing in on Japan, hurling dangerous winds and threatening to cause major flooding and mudslides.


Today’s FEMA SitRep on Puerto Rico and USVI after the hurricanes

FEMA Sit Rep

Puerto Rico

• Shelters: 92 shelters open with 4,154 (-102) occupants
• Disaster Assistance Registrations: 792k Power Outages / Restoration
• 21.6% (+5%) of customers with power restored
• 25.4% of transmission lines energized; 36.5% substations energized
• Generator failure reported in Centro Medico; emergency generators to be installed
• PREPA estimating 95% to be restored by December 15
• 85% (+24) of population live in areas where wireless coverage is available for voice and text messages
Health & Medical
• 61 (-2) of 67 hospitals open
• 2 Federal Medical Stations operational Water Restoration
• 72% of PRASA customers have potable water service
• 65 water filter plants are operating
Guajataca Dam
• Water has stopped flowing over spillway; reservoir pool is 4 feet below spillway; there is no longer any seepage noted under spillway slabs
U.S. Virgin Islands
• Shelters: 5 shelters open with 290 (-17) occupants
• Disaster Assistance Registrations: 14.9k
Power Outages / Restoration
Customers receiving power from grid: St. Thomas: 29% St. Croix: 1.6%; St. John: no grid power, restoration expected in 2-3 weeks Communications:
• 88% of population lives in area where wireless coverage is available for voice and text
Health & Medical
St. Thomas: Schneider Medical Center sustained damage; established mobile medical facility
• St. Croix: Charles Harwood Facility closed; Governor Juan Luis Hospital partially open despite damage
FEMA Response
• NRCC: Modified Level III (day shift, 8:00 am – 6:00 pm EDT)
National IMAT East-1 & 2, & Region III IMAT deployed to PR
• FEMA Region II & X IMATs: deployed to USVI • MERS teams deployed to both USVI & PR


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