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Thursday, September 7, 2017

Houston we have a problem

Challenges and lessons from the aftermath of Hurricane Katrina
By Adrienne Katner, James Diaz, Susanne Straif-Bourgeois, Kelsey Pieper, Kari Brisolara and Marc Edwards for The Daily Climate
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EDITOR'S NOTE: With three major hurricanes on the map - Irma, Jose and Katia - we all need to get better at understanding the causes and effects of extreme weather.  W. Collette

Houstonians warmly welcomed thousands of New Orleanians during the mass evacuations before and after Hurricane Katrina. 

Harvey has done to Houston what Katrina did to New Orleans—completely devastated large portions of the city.  

Outlined here are two major challenges encountered in the aftermath of Hurricane Katrina—infrastructure and health—and lessons learned which may help Houstonians as they begin to recover and rebuild. 


Infrastructure

A superfund cleanup site flooded by Hurricane Harvey
Flooded Houston area Superfund toxic waste site
Resources necessary to survival and functioning were in short supply to survivors and returning evacuees—things like gasoline, transportation systems, food, and water. 

In many ways, the streets of New Orleans turned into the wild, wild west, as street lights were out and street signs were gone, power lines and trees blocked streets and sidewalks, floodwaters hid open sewage covers and new sinkholes, and boats and cars were overturned or left adrift in trees or on house tops. 

Treks for supplies and gasoline required long drives through debris-filled streets, with tires requiring frequent patches.

Survivors and returning residents faced power outages and water shortages. These outages also impacted the treatment of drinking water and waste water. Loss of power to lift stations caused sewage overflow, causing contamination of source waters and water distribution systems. 

The U.S. Centers for Disease Control and Prevention (CDC) estimated that about 90 percent of New Orleans’ tap water was contaminated shortly after Katrina, and this lack of clean water was associated with dehydration, diarrhea and gastrointestinal disorders. 

Populations served by large and well-funded community water systems (CWS) made a full and rapid recovery. However, small CWSs struggled to recover, while private well users were solely responsible for the safety of their water supply.

Based on U.S.Geological Survey data, approximately 10 percent of the population in the 38 impacted Texas counties affected by Hurricane Harvey rely on private wells (an estimated 970,208 people). 

Although the CDC recommended that residents disinfect water before consumption or switch to bottled water, acquiring resources for such strategies may be challenging in the hardest hit areas.

After Katrina, U.S. Environmental Protection Agency emergency response, research, and water program personnel worked with local health and environmental officials to expedite the supply of safe drinking water to city residents. 

Health

One of the challenges of conducting surveillance in a hurricane or flood-impacted area is a mobile population, which makes accurate accounting and rate calculations difficult. Despite these challenges, the CDC worked with hospitals, disaster medical assistance teams, and military aid stations to develop an active surveillance system. 

During Hurricane Katrina, New Orleans was inundated with tidal, saltwater, and brackish water due to the breakdown of the city’s levee system and the failure of water pumps. Drowning was the most common cause of death during Hurricane Katrina, accounting for 40 percent of all fatalities. 

Rescuers and survivors were wounded and injured as they waded through floodwaters filled with building debris, downed trees, poles, and structures. At least a quarter of Katrina-related case reports and fatalities were injury- and trauma-related. 

Open wounds, cuts, and abrasions exposed many to marine pathogens and infections of the skin and soft-tissue. In the week after Hurricane Katrina, 22 persons who had waded through floodwaters were diagnosed with Vibrio vulnificus wound infections and 5 of them died of septicemia based on CDC’s post-Katrina surveillance data. 

Power outages, along with prolonged exposure to high temperatures resulted in heat exhaustion and stroke. Rashes, acute respiratory illnesses, and toxic exposures were not uncommon and increased over time as recovery commenced. 

Rashes were frequently caused by such things as heat, arthropod bites and wet clothing. The “Katrina cough”, a persistent dry cough, was among one of the most common symptoms observed. 

As residents returned home, they were faced with environmental contamination as floodwaters mixed with toxic household and industrial chemicals, sewage and fuel. 

During the recovery and rebuilding phase, there were increases in carbon monoxide poisonings from improper use of generators, respiratory illnesses related to formaldehyde gas buildup in unventilated Federal Emergency Management Agency (FEMA) trailers, and sulfur emissions from imported contaminated drywall. 

Inhalation of mycotoxic mold was one of the most widespread common occurrences, which was a particular challenge to immune-compromised individuals. Mold spores can trigger upper respiratory diseases, allergies, invasive infections, and exacerbate asthma. 

Mold-exacerbated asthma was the most common emergency room condition after Katrina. Many cases of respiratory and gastrointestinal distress, however, were mild and unlikely to have been picked up by ER-based surveillance systems. 

Many others died due to dehydration and chronic illness.During the evacuation phase, many residents lacked access to their regular medications. Katrina shut down hospitals, clinics and pharmacies, compounding medical emergencies for people with chronic diseases like diabetes, respiratory, heart and psychiatric conditions.

Without access to electricity or gasoline to run generators, residents on intermittent hemodialysis or mechanical ventilation were especially at risk and needed urgent evacuation. Perhaps the longest lasting impact on the health of evacuees, returning residents, and survivors were the mental and physical health impacts from prolonged stress. 

Recommendations for Houstonians

Educating residents, responders, and recovery workers can go a long way to addressing and preventing the challenges described here. 

Agencies and residents should be aware of potential exposure to water pathogens and necessary steps to disinfect water supplies. Additional information should be provided to private well users, as water system recovery is ultimately their responsibility. Information should cover water testing locations, water treatment options, well repair and maintenance strategies. 

Everyone, whether on wells or not, should thoroughly flush out their water lines at high flow for at least 30 minutes to remove any lead or microbial contamination that may have built up in their premise plumbing. 

Residents should also be educated on how to operate generators properly, how to aseptically clean wounds and proper hygiene, and about the risks of walking through flood waters. 

Residents should be cautious during cleanup and protect themselves from exposures to mold, toxic building materials like asbestos and lead, cleaning supplies, and other household chemicals. 

Handy resources to provide returning or surviving residents include: alcohol hand sanitizer, insect repellent, infection control kits, and Personal Protective Equipment like N-95 masks, gloves, and disposable clothing and shoe covers. 

Health officials should stock up on supplies of antibiotics and tetanus booster shots for puncture wounds. 

Residents, health care personnel, and shelter operators should be alerted to the signs of the most likely infections. 

Daily surveillance of emerging diseases among responders and evacuees at staging areas and shelters is recommended to enable rapid identification, response and prevention. Officials should be aware that the damage to infrastructure is critical, and it will take years to rebuild. 

While smart rebuilding is essential, it is also necessary to keep residents engaged in the planning decisions to come. Efforts should be taken to support vulnerable populations, including those without transportation, with mobility problems, those in hospitals, and with long-term care needs. 

After Katrina, immigrant populations were some of the first to arrive to support us in our rebuilding efforts. The needs of this population should be monitored by the public health community, and action should be taken to protect the health of all residents and workers at the front lines of cleanup. 

The less visible impacts of prolonged stress on the population’s mental health will be harder to address. 

Community is key to recovery—it is already being seen in the rescue and response phase currently underway.  

A community can overcome any of the obstacles ahead, if they work together and hold tight to the things that define them: culture, altruism and humanity.

Adrienne Katner, James Diaz, Susanne Straif-Bourgeois and Kari Brisolara are with Louisiana State University Health Sciences Center, School of Public Health. Kelsey Pieper and Marc Edwards are with the Virginia Tech Department of Civil and Environmental Engineering.

The Daily Climate is an independent, foundation-funded news service covering energy, the environment and climate change. Find us on Twitter @TheDailyClimate or email editor Brian Bienkowski at bbienkowski [at] EHN.org