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Hurricane Katrina Creates Public Health Crisis on U.S. Gulf Coast

Posted on: Friday, 7 October 2005, 03:00 CDT

By Late, Michele; Krisberg, Kim

Health, medical workers responding

A woman is carried from her home in New Orleans Aug. 30 after being trapped by the aftermath of Hurricane Katrina.

IN THE WAKE of Hurricane Katrina's destruction and flooding along the Gulf Coast in August, public health workers from around the nation are working to address the health needs of millions of affected people and to restore the region's public health infrastructure.

Foremost among the public health concerns for federal, state and local health officials who were responding to the public health crisis in mid-September - just weeks after the Aug. 29 hurricane hit were preventing and controlling infectious diseases and providing health services for survivors.

Health officials have predicted that public health concerns will be a priority for months to come in both the devastated region and in shelters around the country - where thousands of Gulf Coast residents relocated following the hurricane.

Daryl Thompson and daughter Dejanae wait for a way out of New Orleans on Aug. 31 in the wake of Hurricane Katrina, which devastated the city and displaced its residents.

Two days after the hurricane hit, U.S. Health and Human Services Secretary Michael Leavitt declared a public health emergency existed in Louisiana, Mississippi, Alabama and Florida. The emergency was later extended to nine other states where survivors had evacuated to, allowing the states to qualify for federal funding assistance to care for evacuees.

"We have a great deal of work to do to help the victims of Hurricane Katrina get back on their feet and begin recovering from this tragedy," Leavitt said on Sept. 4.

Federal emergency officials - in particular, the Federal Emergency Management Agency - were widely criticized for being slow to respond to victims, especially in New Orleans, where many displaced residents were without food, water or medical assistance for days after the storm hit. The situation clearly illustrates the critical role preparedness planning and funding plays, said APHA Executive Director Georges Benjamin, MD, FACP.

"Unfortunately, the devastation caused by Hurricane Katrina was compounded by the delayed response that occurred soon after," Benjamin said. "It was disgraceful, and must never be repeated."

The situation improved in the weeks that followed, with supplies and funding pouring into the Gulf region. Public health workers were in particular demand, with state and federal officials issuing calls for veterinarians, mental health workers, epidemiologists, environmental health workers, nurses, dentists and others. APHA is helping link public health workers with organizations seeking help by publicizing volunteer opportunities and hurricane-related resources online at . Volunteers can also reach HHS directly at (866) 528-6334 or online at .

Offers for help have already been made by thousands of public health and disaster workers from around the nation and world. As of Sept. 9, HHS had registered more than 17,000 medical volunteers to assist in recovery assistance. The agency is establishing a network of up to 40 medical shelters, staffed by 4,000 medical personnel and with the collective capacity of 10,000 beds.

In shelters across the country in early September, public health workers were preparing for the possibility of infectious disease outbreaks. Diseases related to crowded conditions were of top concern, such as diarrhea, the common cold, tuberculosis and influenza, said Centers for Disease Control and Prevention Director Julie Gerberding, MD, MPH, during a Sept. 6 news conference.

In anticipation, public health workers at largescale shelters in Louisiana, Mississippi and Texas set up a disease screening process and offered immunizations, vaccinating anyone they suspected was not up to date. At press time, there was an investigation into potential TB cases as well as reports of diarrheal illness in the shelters.

Mental health needs were also a concern for hurricane survivors, as many will need assistance dealing with their losses. Federal crisis emergency teams were sent to assist evacuees at Houston's Astrodome and other shelters and to provide support for first responders who needed help coping with the stress of recovery efforts.

Through experience with previous disasters, mental health workers have learned the "very simple but profound lesson that mental health care must be an essential part of the overall medical response, the overall public health response," said Thomas R. Insel, MD, director of the National Institute of Mental Health during a Sept. 7 news conference.

"We need to make sure that the needs of people with mental distress are front and center," Insel said.

However, among the biggest challenges was maintaining chronic care services for those in shelters, which put pressure on local hospital systems. As of early September, 200 hospital organizations had committed to move in and support local hospital efforts, according to Leavitt.

In Baton Rouge, La., the population increased from 500,000 to 850,000 within days, Leavitt said during the Sept. 6 news conference, and "hospitals are under significant pressure." Uniformed health officers from the U.S. Public Health Service Commissioned Corps were dispatched to shelters in Texas, Louisiana and Mississippi to ensure medical needs were communicated and ascertained, Leavitt said, and were helping hospitals re-establish supply chains.

In Mississippi, state and regional health workers were receiving assistance from federal relief workers as well as health volunteers from states such as New York, South Carolina and Florida, according to Roger Riley, past president of the Mississippi Public Health Association, who was assisting in relief efforts in early September. The Florida Department of Public Health was a particular "godsend," Riley said, as the department provided employees, mobile clinics and other vital support.

"It is truly amazing to see how many people have stepped up to the plate to assist in whatever form possible," Riley said.

Long-term, Mississippi health officials expect they will need help stabilizing the state's public health infrastructure, restoring health facilities and communication, replacing medical equipment and serving the health needs of residents, according to Riley.

In New Orleans, which experienced extensive flooding, environmental officials urged people to avoid contact with the water that filled the city's homes and streets. Preliminary EPA test results of the floodwaters covering the city, released Sept. 7, found E. coli bacteria as well as worrisome lead levels. CDC in early September linked four Gulf Coast deaths to infections caused by flood waters.

Medical workers from a Disaster Medical Assistance Team evaluate the health needs of a New Orleans man as he is readied for evacuation from the city Sept. 2.

New Orleans officials predicted that it would be months before the city was able to pump out flood waters and fully restore basic services such as water, sanitation and electricity. In the wake of the devastation, APHA announced in September that the Association's 133rd Annual Meeting, which was scheduled to be held in New Orleans in November, would be rescheduled for Dec. 10-14 in Philadelphia (see below).

To monitor the public health situation in New Orleans and determine when the city is safe to reinhabit, federal officials created a joint task force with members from CDC, the Environmental Protection Agency, Department of Defense and Department of Energy as well as New Orleans and Louisiana public health officials.

Routine health services such as restaurant inspections and birth certificates were temporarily interrupted at many health departmerits along the Gulf Coast. Officials in many states adopted special measures to assist hurricane victims: In Alabama, the governor signed a proclamation to ensure that storm survivors would be able to refill their prescriptions, and the state extended immunization deadlines for children entering schools or daycare.

A member of the Ohio Disaster Medical Assistance Team 5 inoculates a Biloxi, Miss., resident on Sept. 4.

"We want to help our neighbors in need and have adopted flexible criteria to accommodate displaced people who need public health services," said Donald Williamson, MD, Alabama's state health officer.

Besides mobilizing members to volunteer their time, APHA has been active in assisting hurricane relief efforts on a number of fronts. To assist CDC workers as they deployed to help people in the Gulf Coast, the Association provided copies of its communicable disease manual and sent more copies at CDC's request once teams had arrived in the field. A second APHA book, focusing on disaster relief, was offered for download for free from the Association's Web site.

In September, APHA created a relief fund to which members and Annual Meeting attendees can donate, and to which the Association donated $5,000.

The Association has been using its advocacy strength on Capitol Hill to ensure that the Gulf region receives the funding and health workers that it requires to meet the needs of its residents. APHA's executive director met with key senators in September to discuss \health concerns related to the hurricane and participated in a news conference in Washington, D.C., on the issue. When the Annual Meeting convenes in Philadelphia in December, many of the meeting sessions will be used to focus on issues that have arisen from the hurricane, including the need for preparedness. The Association will be bringing some of the vendors it had contracts with in New Orleans to Philadelphia, including the meeting photographer, daycare provider and security company.

In the long term, an Association task force has been created to identify further actions that APHA can take to address the public health impact, with a focus on rebuilding the public health infrastructure.

"The devastation wrought by Katrina will not be going away any time soon, and neither will we," said APHA's Benjamin. "APHA and the public health community are committed to helping for as long as it takes to bring the Gulf Coast back on its feet."

For more on the public health response to Hurricane Katrina, visit or .

- Michele Late and Kim Krisberg

Copyright American Public Health Association Oct 2005

Source: Nation's Health, The

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