Author: Bryan P. White
Original Publication: 08/03/2019
Disaster preparedness and management is a critical goal of public health workers and emergency response teams alike. In the event of a hurricane, a well-prepared response plan can mitigate many of the health consequences that can arise from both the destruction of infrastructure and subsequent exacerbation of the remaining health infrastructure. In this paper I make specific recommendations to the governing body of a recently hurricane-impacted island nation. With an emphasis on infectious disease control and management, I discuss some of the most likely diseases that might gain in prevalence following a natural disaster such as a hurricane and offer treatment plans to mitigate those diseases. I also make recommendations for clean food and water preparation, improving the overall sanitation of camps housing displaced persons, and some suggestions for those suffering from major chronic diseases. There is no perfect plan or response to a natural disaster such as a hurricane, but with proper preparedness and swift action following the event, many human lives can be saved, the living quality during the recovery period can be improved, and the stage can be set for rebuilding infrastructure after the disaster without the major health burden of disease and outbreaks.
Following a natural disaster, for example, a hurricane or typhoon, a series of critical infrastructures can be damaged or destroyed in a city which can lead to a public health crisis. In this report I will outline some of the damage that has likely occurred in your city and offer recommended protocols for dealing with the public health consequences of that infrastructure loss. The time period these recommendations are for is during the post-impact phase (4 days to 4 weeks) and recovery phase (4 weeks+) (Kouadio et al., 2012). During this time diseases and infections acquired due to the disaster may begin to manifest themselves and so implementing a public health response during this phase is critical to returning the community to normal following a disaster.
With the advent of damaged water infrastructure systems, diseases that are spread through untreated water and destroyed sanitation systems may begin to manifest almost immediately after the event (in this case, a hurricane). One of the most critical actions will be to secure the water supply for the affected regions and cities to reduce the risk of experiencing cholera, dysentery, hepatitis and other water-borne diarrheal disease (e.g., Leptospirosis). Following a hurricane and destruction of water treatment facilities, its likely that typical sanitation routes (e.g., sewers) will contaminate local water supplies rendering them unusable. In this scenario, disaster responders will need to establish a source of clean water for the population. Water treatment options can include boiling water for at least 1 minute (in which case citizens can be provided fuel or electricity to boil water), emergency treated water (e.g., using diluted bleach or iodine tablets), disinfected wells, and the use of protected water supplies that have not been contaminated (e.g., water bottles) (EPA, 2019a). In the case of disinfected well water, the source water should be tested for contamination following disinfection procedures (EPA, 2005).
In addition to establishing protocols for ensuring safe water-drinking practices are being employed after the hurricane, safe food practices should be monitored as well. Food that has unusual color or is perishable and lacking refrigeration for 4 hours or more should be thrown away (CDC, 2019a). Canned food that is bulging or dented, canned at home, food with twist/screw caps, and food not in waterproof containers should also be thrown away (CDC, 2019a). Food containers used for preparation of food should be sanitized before use, except for wooden cutting boards that should be discarded (CDC, 2019a). Common foodborne illnesses that might spread as a result of contaminated food supplies include Norovirus (a viral disease which is spread via direct physical contact of contaminated food or infected persons and can cause diarrhea, vomiting, and stomach pain), Salmonella enterica (a bacterial disease spread through infected or contaminated food products causing diarrhea, chills, fever, and pain) , and other diarrheal disease (Kouadio et al., 2012).
Relief workers should be prepared to issue large amounts of antibiotics to quell any potential outbreak of bacterial disease and supplies for treating the symptoms of diarrheal disease. Additionally, latrines and soap (hand and body) should be distributed to camps housing displaced individuals and hash washing protocols should be encouraged throughout. Contrary to popular belief (or urban legend), human corpses do not themselves typically carry disease following a natural disaster such as a hurricane (Kouadio et al., 2012), but sanitary burial protocols should be implemented to mitigate any secondary types of contamination that might occur.
As living conditions worsen following the aftermath of the hurricane, the density of people living together will increase, which will in turn increase the risk of the spread of endemic air-borne infectious diseases (Kouadio et al., 2012). Air-borne illnesses which may increase in prevalence include influenza (a viral disease whose primary symptoms include chills, fever, body aches, fluid loss, runny nose, sneezing, and a soar throat), measles (a viral disease marked by a red, spotty rash followed by fever, body aches, loss of appetite, diarrhea, and other flu-like symptoms), meningitis (a primarily viral disease which causes a severe headache and stiff neck, and other flu-like symptoms), and tuberculosis (a bacterial disease that primarily attacks the lung marked by painful coughing, sometimes including blood, chills, fever, potential weight loss, and other flu-like symptoms) (Kouadio et al., 2012).
Unfortunately, there are no specific treatments for viral diseases like influenza, measles, and viral meningitis – but the symptoms can be aggressively treated. On the plus side, the immediate deployment of vaccines for air-borne viruses could prevent the rapid increase of the spread of the disease and avoid an outbreak. In the case of tuberculosis, the disease can be treated via antibiotics, but relief workers should be wary of identifying either antibiotic resistant tuberculosis or immunocompromised individuals that might need extra treatment.
Following the destruction of local infrastructure and increased rain and flood waters in the city, vector-borne diseases (specifically, mosquito-borne disease). The two primary mosquito-borne diseases to be concerned about are malaria and Dengue fever. Malaria, a febrile disease caused by the Plasmodium parasite, can be fatal if left untreated. The symptoms of malaria include chills, fatigue, fever, diarrhea, vomiting, fast heart rate, mental confusion, body pain and other flu-like symptoms. There are two primary drug classes that can be used to treat malaria: Artemisinin-based combination therapies (ACTs) and chloroquine phosphate. ACTs are beneficial because they typically consist of two or more drugs of different molecular classes which reduces the potential for the Plasmodium parasites to become resistant. ACTs are typically administered first if the infected Plasmodium is P. falciparum (WHO, 2018). In the case of P. vivax and P. ovale, chloroquine (blood-cell stage parasites) can be used in combination with primaquine (liver-stage parasites) to prevent a relapse (WHO, 2018). In the case that P. vivax or P. ovale are found to be resistant to chloroquine treatments, ACTs can be used instead (WHO, 2018).
Unlike malaria, Dengue fever is a viral disease and cannot be directly treated to reduce viral load. Dengue fever is a febrile disease similar to malaria in its symptoms, but in general is less fatal. Common symptoms of Dengue include fever, rash, pain in the joints, abdomen, or back, chills, fatigue, nausea or vomiting, loss of appetite, and other flu-like symptoms. Additionally, a small percentage of cases of Dengue cases can transition into hemorrhagic fever resulting in excessive bruising and bleeding. Because of its viral nature, the best treatment for Dengue fever is fluid administration and pain relievers.
In addition to treating the symptoms of mosquito-borne diseases, proactive measures can be taken to reduce local mosquito populations. Standing water (e.g., in tires, buckets, or other small pools) can be eliminated where possible, insecticide-impregnated nets can be issued to prevent individuals from being bitten while sleeping, and active insecticide spraying indoors can be used to deter and reduce mosquito populations.
While the incidence of chronic disease will not be increased from a hurricane, those with preexisting conditions such as diabetes, dialysis, or other chronic conditions requiring routine medication or aid might suffer from an exacerbation of medical availability. Hospitals might suffer power outages and drug shortages making it difficult to supply needed materials such as insulin or run the complicated machinery required for dialysis. Since the hurricane has already occurred, disaster responders should take an immediate assessment of the current medical facilities and determine where or not they will be able to continue to supply their usual patient numbers (e.g., insulin supplies, antibiotics, etc.) If they suspect they will not have sufficient supplies, the government should request supplies from the nearest available area capable of providing relief. In the meantime, in the case of a medical supply shortage, supplies should be rationed and given in order of most need. In the event that a person needing 3-day dialysis will miss a dialysis treatment, they can follow a 3-Day Emergency Diet plan (CDC, 2019b), which will not replace the need for dialysis might prolong the number of days that you can go without treatment. Hospital or clinic facilities should follow recommended procedures to restore dialysis functionality in a safe and timely manner (CDC, 2019c).
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