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Physicians weather Isabel and respond in its wake

Early reviews indicate that anti-terrorism resources aided public health preparedness for this natural disaster.

By Victoria Stagg Elliott, amednews staff. Oct. 13, 2003.

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Seaborn Blair III, MD now commutes to his clinic by boat. Last month's Hurricane Isabel washed away the road from his home to where he works, the HealthEast Family Care office in Hatteras Village, a small town on the end of Hatteras Island off the North Carolina coast. Damage to the clinic was minimal, but numerous houses as well as the island's pharmacy were destroyed.

"The practice is fine, and we're seeing a lot of people who were injured during the storm and during clean-up," said Dr. Blair. "And we're having to fly in a lot of medicines."

Dr. Blair is just one of many physicians along the East Coast from North Carolina to Delaware to feel the serious impact of the hurricane. The storm had winds of 160 mph, greater than any hurricane in decades, and dumped more than seven inches of rain in some areas, according to the National Weather Service.

Before Isabel, physicians scrambled to fill patient requests for extra medicines and looked for safe places to store vaccines and other perishables. Many offices were closed for a day or more.

"We were also concerned about the effect of power surges on our x-ray equipment, but there was not much we were going to be able to do about that," said Mitchell Miller, MD, a family physician based in Virginia Beach, Va. "By Monday, we were back in the office. But my own home hasn't had power restored yet. We have no hot water, and I've been trying to convince my three children that we're just on an extended camping trip."

Still, the severe weather has been blamed for at least 40 deaths and left millions without electricity, according to local news reports. The power grid was destroyed in many locations, and trees were ripped out of the ground.

"On the scale of one to 10, I would put the hurricane at an 8½," said Joe Leming, MD, a family physician based in Colonial Heights, Va. "The tree damage is just astronomical, and our power infrastructure is gone."

But despite the level of destruction and disruption, physicians and public health officials say that the response to this natural disaster was better than to Hurricane Floyd in 1999 -- the last storm of note.

Improvements in weather prediction gave public health officials -- and everyone else -- several days' warning, rather than just one or two.

These officials also credit the nation's renewed interest in terrorism and disaster preparedness with improving the system's ability to respond to the crisis. Public health agencies are more integrated with emergency response systems and have better links with other community health care agencies. Also, the result of additional federal preparedness funding translated into more state health department resources and staff.

"The bioterrorism funding has built capacity in our ability to respond to communicable disease outbreaks as well as natural disasters such as this hurricane," said Leah Devlin, DDS, MPH, state health director at the North Carolina Dept. of Health and Human Services.

Affected states had funding and staff for a central command center that could be open 24 hours a day and were able to send out small regional teams to assess communities' needs rapidly. This ability may have paid off in a reduction in morbidity and mortality. In North Carolina, for example, there were three deaths linked to Isabel, compared to more than 50 associated with Floyd.

"If you make the investment in public health, we can make a huge contribution in communities," said Dr. Devlin. "We are able to prevent death by what we've learned and the messages we can get out. Preparedness saves lives."

Dealing with the hurricane is one thing, but physicians and public health officials say the real work begins in the wake of the storm.

"The hurricanes are bad but the aftermath is hell," said Dr. Leming.

Cleanup injuries and post-storm needs

A significant percentage of morbidity has been linked to the post-hurricane period rather than the hurricane itself. People have slipped on debris, cut themselves with chainsaws and tripped in houses darkened by electrical outages.

Emergency departments that saw a decline in traffic during the storm saw the number of patients skyrocket because of injuries, demand for electricity from patients on at-home medical devices that were literally powerless, and medical needs that would normally be fulfilled by the office-based practices the storm shuttered.

"People put off going to the doctor during the storm, and as soon as the sun comes out, they get on their horse and come down to the local ER," said Robert Shesser, MD, MPH, chair of the department of emergency medicine at George Washington University Medical Center in Washington, D.C. "And when the rest of the system stops, we're still open."

Office-based physicians struggled to reopen their practices, reschedule appointments and address the numerous requests from people the storm separated from their medicines. They also saw a worsening of chronic conditions, exacerbated by stress or the less healthy post-storm environment.

"I've had probably more elevated blood pressures than usual," said Dr. Miller. "Hopefully, that will wane after a while."

Public health officials closely monitored hospitals for injury and illness patterns, although those data were not available at press time, and officials assessed communities' immediate needs. They delivered thousands of tetanus shots to residents and rescue workers and reissued warnings sent out before the storm about clean drinking water, food safety and injury prevention.

And, much like the post-Hurricane Floyd period, public health officials scheduled sprayings for the swarms of mosquitoes expected after Isabel. This time, though, this effort is a little more urgent, with many nervous that more mosquitoes could lead to more West Nile virus.

"The last time we had a major hurricane, West Nile was not an issue, but we did spray because mosquitoes are a nuisance," said Dr. Devlin. "Now, they're a nuisance and they're potentially life-threatening."

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