5 Things to Watch for After a Hurricane

Bruce Y. Lee, MD, MBA

Disclosures

September 28, 2018

The Scorpions once sang "Rock You Like A Hurricane." You may like the song. You may even like real-life scorpions. But being rocked by a hurricane in general can be a very bad thing, and its effects can last for quite a long time.

Damage from hurricanes can continue long after the "main show" has ended. News coverage of hurricanes tends to be most intense right before and during the actual storm. But after the wind and rain recede, the theme song for doctors, nurses, or other health professionals may be "We've Only Just Begun."

The coastal and southeastern portions of North Carolina are still battling flooding and power outages.

It can take years for a community to recover from a hurricane. New Orleans still has not returned to what it was before Hurricane Katrina struck in 2005. The same can be said for parts of New York and New Jersey since Hurricane Sandy in 2012, and for Houston since Hurricane Harvey and for Puerto Rico since Hurricane Maria, both in 2017.

Now, a week after Hurricane Florence pummeled the North Carolina coast in September 2018, the coastal and southeastern portions of the state are still battling flooding and power outages. Who knows how long it will take communities to fully recover from Florence?

In the meantime, health professionals need to be on the lookout for symptoms of these five after-effects.

1. Contaminated Food, Water, or Air

A hurricane can damage food and water sources and supply systems. Food and water don't just magically appear in your refrigerator and faucet. (Note: If food is appearing in your faucet, there is a problem.) For example, for water to get to your faucet, it has to run through a complex system of holding tanks, water treatment centers, and pipes.

After a storm has hit, a community can't possibly inspect and repair the entire water system immediately. Moreover, many food and water systems and their defenses depend on electricity, another complex system. Electrical outages are also quite common during hurricanes.

Broken pipes and water tanks, malfunctioning water treatment plants, damaged food storage equipment, malfunctioning refrigerators, and other holes in the food and water systems can allow many different microbes that aren't visible to go bathing and munching in what you eventually drink and eat. The result can be a variety of gastrointestinal illnesses, which can not only make people feel like (and need to) poop but can be deadly to those with weakened immune systems.

Damage to equipment and structures can also release a variety of toxic substances, such as fuel, plastics, industrial chemicals, and garbage, into the environment, contaminating what you eat, drink, breathe, or otherwise contact. Imagine swimming in a landfill. Flooding can bring a landfill to you.

Advice to health professionals: Have a higher degree of suspicion if someone gets diarrhea, because it may not be just a simple case of the runs. Make sure to report all cases of infectious diarrhea to the public health authorities. One case may be the sign of a larger outbreak. Stay aware of any advisories that may affect health, such as those about sewage systems, waste sites, chemical plants, or fuel storage being compromised. Work with community leaders to provide health advice on how to recover and clean up after a hurricane.

2. Subpar or Unhealthy Living Conditions

Damp environments make prime growing conditions for mold. Mold can irritate the skin, eyes, upper respiratory passages, and lungs. Much remains unknown about the relationship between mold and respiratory diseases and other illnesses. But suffice to say, if you have the choice between a moldy house and one that is not moldy, choose the latter.

In general, hurricanes can damage living quarters and their vital elements. It may take years for those who lack resources—such as lower-income populations—to make the necessary repairs.

Be on the lookout for allergic symptoms, eye or skin problems, breathing issues, or persistent unexplained symptoms.

Lack of reliable power can be life-threatening for those who rely on electronic medical devices. Lack of adequate air conditioning or heating can put people at risk for temperature-related health problems such as heat stroke or frostbite. Damage to the integrity of a building structure can result in exposure to a variety of hazards, such as gas leaks and insects (more about insects later).

Advice to health professionals: Be on the lookout for any symptoms that may indicate unhealthy living conditions, such as allergic symptoms, eye or skin problems, breathing issues, or persistent unexplained symptoms. Ask patients about their living conditions and help them contact local housing and environmental authorities if needed. Be prepared to advocate for your patients who are forced to live in unhealthy conditions.

3. Bugs--Lots of Them

The aftermath of a hurricane can be like an insect orgy. Warm and wet conditions can be prime breeding grounds for mosquitoes and other pests. These insects can carry and transmit infectious pathogens such as the West Nile and Zika viruses to humans.

Advice to health professionals: Have a lower threshold for suspicion about insect-borne diseases. Stay informed about the signs and symptoms of tropical disease because the conditions after a hurricane can be quite tropical in many ways.

4. Mental Health Problems

A natural disaster can leave lives in disarray. People may lose their loved ones, their house, their possessions, their job, other resources, or their trust and faith in a lot of things.

A substantial rise in stress, depression, anxiety, post-traumatic stress disorder, and other mental health issues often follows a natural disaster.

During a natural disaster, people may see things that they have never seen before: horrific images of people getting badly injured or killed; longstanding structures torn down; cherished mementos washed away; people behaving in ways that they would never expect—sometimes in good ways, sometimes in very bad, disappointing ways. They may also be left with persistent physical injuries that affect what they can do. This can all be very tough on the mind, the emotions, and the heart.

At the same time, support networks may be in disarray. Friends and family may be overwhelmed themselves or move from the area. A natural disaster can disrupt available healthcare services, including mental health support.

Therefore, it is no surprise that a substantial rise in stress, depression, anxiety, post-traumatic stress disorder, and other mental health issues often follows a natural disaster. Much of the damage from any natural disaster can't immediately be seen—even by the people who are injured—and can be particularly pernicious.

Advice to health professionals: Take time to talk to your patients and get to know their lives beyond their lab tests and physical examination findings. Ask them about their mental health. Do so in a way that is not judgmental, stigmatizing, or intimidating. Words such as "suck it up" are never appropriate unless you are asking someone to drink something through a straw.

Remember, every patient is different. People have different ways of dealing with and expressing mental health concerns. Some will be frank and direct while others may be very reluctant to discuss such things. The only way to really understand someone is to get to know that person. Also, be aware of mental health resources and professionals that are available to help your patients.

5. Chronic Diseases

Many chronic conditions, such as obesity, diabetes, cardiovascular disease, and cancer, are systems problems. A complex system of behavioral, social, environmental, economic, and other factors can affect the risk of developing these conditions, as well as their courses and impact.

For example, you may struggle to maintain a healthy weight if you are injured and can't move around or be physically active, if you are feeling stressed and can't get adequate sleep, if your social network is disrupted from the storm, if you can no longer access healthy foods and places to exercise because your community has been disrupted, or if you don't have enough money to buy fruits and vegetables.

All of these issues can lead to chronic diseases or worsen existing ones. After a natural disaster, patients with existing conditions may not be able to get adequate healthcare or continue treatments that they need.

Advice to health professionals: Perform a systems-wide disease-risk inventory. Ask your patients about their diet, physical activity, social support, stressors, environment, and economic situation. Make sure that they are taking preventive measures and getting the right testing. Check on medication adherence and the impact of physical injuries.

In general, health professionals need to remember that healthcare extends well beyond the walls of clinics and hospitals. Early estimates indicate that Hurricane Florence has already killed at least 42 people and caused at least $1.2 billion in damage, but this is only the beginning of a tough road for many. Keep in mind that many people may be moving to and from the areas affected by Hurricane Florence, so the damage will extend beyond the hurricane's path. There will be many people yearning for stability, support, and help. When a community gets rocked by a hurricane, it needs health professionals to serve as its foundation.

Bruce Y. Lee, MD, MBA, is a digital health expert, writer, executive director of the Global Obesity Prevention Center (GOPC), an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health, and an associate professor at the Johns Hopkins Carey Business School. He is a regular contributor to Forbes and has written articles for a variety of general media outlets, including Time, The Guardian, STAT, and the MIT Technology Review, as well as three books.

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