How the Centers for Disease Control and Prevention responds to a hurricane like Florence

Benjamin Landero tries to shoot video as hurricane force winds pound the Comfort Suites in Wilmington, N.C. Thursday Sept. 14, 2018 as Hurricane Florence makes landfall. (Chuck Liddy/The News & Observer/TNS)

September 15, 2018

By Melissa Healy

For all the political chatter about hurricane response and the human toll of such disasters, one lesson of past monster storms is clear and getting ever more urgent as they get more frequent: Hurricanes claim lives and erode health before, during and after the water, wind and rain hit.

To reduce the short-term and long-term health toll of these storms, emergency planners need to anticipate how the threats to life and health unfold, and get ahead of them.

They may even use such disasters as opportunities to boost communities’ health in a storm’s wake.

On Wednesday, the Centers for Disease Control and Prevention set up a roughly 50-person Emergency Operations Center at its headquarters in Atlanta. From it, experts have traced the arc of dangers to affected populations. Working through medical communities and with state and federal disaster relief agencies, the CDC says it is executing an unfolding campaign to prevent injuries, detect and respond to the emergence of disease, and foster physical and mental health before, during and after Hurricane Florence.

“There are definitely behavioral patterns we recognize,” said Donna Knutson, the CDC’s incident manager for the Hurricane Florence response. People evacuate without all their prescription drugs, she said. They cut themselves trudging unprotected through floodwaters tainted by industrial and household pollutants. They take their chances on dicey stored food, inviting gastrointestinal misery, and use generators too close to their homes, risking asphyxiation. They stay too long in homes contaminated by mold and, in their urgency to regain their sense of normality, may overlook a family member’s gnawing despair.

These threats to life and health are preventable, said Knutson. But it takes more than drills and exercises to prepare first responders and medical communities to prevent them. Where frequent first-hand experience may be missing, the CDC can provide expertise in what to expect, she said.

In the run-up to Hurricane Florence’s arrival in the Carolinas, the CDC issued injury-prevention messages, warning people in flooded areas not to take refuge in their attics, touch downed power lines or drive into moving water — one of the most frequent causes of drowning.

Its public health experts have calculated the safe ratio of shelter seekers to bathroom facilities in public buildings, and briefed hospitals and first responders on the types of injuries they’re likely to see, and when.

They’ve lined up booster shots against tetanus for evacuees with open wounds, and laid in pneumonia inoculations to offer at shelters. Knutson said that the CDC is dispatching flu vaccine to many shelters to capitalize on these facilities’ captive populations.

And, as waters subside, evacuees returning to homes that have stood in water for more than 48 hours will get detailed instructions in how to clear and clean to prevent mold, which can cause and exacerbate respiratory and allergic reactions. The CDC is also readying environmental health officers to assess mold, drinking water threats and the escape of hazardous materials, as well as epidemiologists to detect exploding populations of rodents and mosquitoes and outbreaks of the diseases they carry.

Knutson said the CDC will be vigilant for outbreaks of plague, transmitted when rat populations surge and people get bitten by rodent fleas carrying the Yersinia pestis bacterium.

“Plague we still get from squirrels in downtown Denver,” said Knutson. The likelihood that this now-treatable ancient scourge could re-emerge from rat infestations of sodden debris is hardly inconceivable, she said. Infected patients experience a sudden onset of fever, headache, chills and weakness and one or more swollen, tender and painful lymph nodes.

West Nile virus, which can cause potentially fatal brain inflammation in one in 150 of people stricken, has been marching west-to-east across the county, and in the wet conditions likely to linger behind the storm, the mosquitoes that spread it — Asian tiger (or Aedes albopictus) mosquitoes — are likely to thrive. North Carolina has also had outbreaks in recent years of the chikungunya virus, spread by the Aedes egyptii species of mosquito, considered “very likely” to live and reproduce in the Carolinas. Fever and joint pain, as well as headache, rash and joint swelling develop three to seven days after a person is bitten by an infected mosquito.

Knutson said the CDC’s task force on “flying and walking disease vectors” expects more “nuisance mosquitoes” than virus-carrying ones. The Carolinas’ salt-marsh mosquitoes are vicious biters and could cause no end of misery for those engaged in cleanup efforts. But Knutson said the CDC will be watchful for evidence that disease-carrying mosquito populations are proliferating.

Finally, the CDC has made plans to recruit community members to conduct “behavioral health checks” in their neighborhoods as the rebuilding begins. In doorstep conversations, survey takers would ask residents about their anxieties, fears and levels of hope as they confront the task of rebuilding their homes and neighborhoods.

“It’s a really good way to get a handle on what an entire community feels,” said Knutson. She said that hiring local residents to do door-to-door visits is the best way to take the mental health pulse of a community.

“People want to open their door and talk to someone they’ve seen in the supermarket,” said Knutson. The CDC would then analyze the data they collect, and share it with state and local community managers.

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©2018 Los Angeles Times

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