Saturday, September 2, 2017

Houston, We Have A Problem, Con't

The effects of Hurricane Harvey will be felt in the Houston region for years, but the short-term effects are still potentially lethal.  The rains may have stopped, but history tells us that with infrastructure critically damaged for millions and the sheer scale of how widespread toxic waters are, the threat of a public health nightmare scenario is almost assured.

For the thousands of people traveled through Harvey’s flood waters to Houston’s George R. Brown Convention Center, safety was not yet at hand. Although delivered from the worst of the storm, the packed masses were one of the loci of another brewing problem, one that officials expect might last a year or more after landfall.

Every flood disaster is also a public-health disaster, and even as Harvey dissipates over the Gulf Coast, the beginnings of that secondary calamity were on display in the Houston area. During the worst of the flooding, hospitals faced critical shortages of food and medicine, people with serious chronic diseases had to make difficult decisions between evacuation and sheltering in place, and hundreds of victims faced prescription shortages and mental-health issues. And based on the health problems people in New Orleans and elsewhere in the region faced after Hurricane Katrina, experts expect major public-health emergencies, environmental illnesses, and outbreaks will only intensify in the aftermath of Harvey.

Those challenges are already taxing the city’s health infrastructure. According to Bill Gentry, a professor at the University of North Carolina School of Public Health and a former emergency management official, one key public-health issue that attends the early stages of any disaster is the set of risks facing people who are disabled or elderly and face special health needs. “With our push towards home health-care and taking care of more Americans in the home,” Gentry said, “it quickly turns into 'can we get their home health-care needs taken care of,’ with everything from oxygen to prescription meds to getting them clinical access, especially for dialysis. Those types of clinical worries compound as many days as the water stays up.”

Dialysis is a special concern, and for residents in Houston, already approaching crisis. As NPR reports, it’s important for patients with kidney failure to receive dialysis services every two to three days. But local dialysis centers are struggling with the demand, and with shortages of qualified staff, since several nurses who’d normally work in the centers are themselves displaced by the flood. And while companies like the DaVita Med Center and its locations around the Houston area are working around the clock to meet the area’s dialysis needs, as patients go longer without regular services and appointment reminders, the only solution to keeping them alive may be taking them to one of the area’s hospitals.

And the hospitals are running up against their limits, too. When I spoke to Mary Brandt, a pediatric surgeon at Texas Children's Hospital, she was driving home through receding floodwaters after five straight days of work. She and her colleagues had just completed the first shift of what she described as a “military kind of operation,” and fittingly had just been relieved by a team of reinforcements. “Texas Children's Hospital has leadership that has just gotten this down to an art,” Brandt told me. “Everything was covered.”

That military-like response among Houston-area hospitals was largely effective in dealing with some of the most immediate effects of the storm. Brandt’s team saw mostly children who’d faced non-life-threatening injuries and illnesses. Meanwhile, kids with ailments requiring management, like asthma, or those with fevers and other serious conditions were airlifted to the Texas Children’s Hospital building in The Woodlands, a suburb north of Houston. The triage and logistics systems in place for Houston’s hospitals helped ensure that patients with the most sensitive conditions received treatment and resources on time.

Still, there’s reason to suspect that effective disaster-management system will be stressed in the days to come. As Brandt notes, the bulk of patients with conditions directly related to the floods haven’t yet made it to hospitals. “Since the water's just subsiding,” Brandt said, “we're expecting there's going to be a huge number of patients that are going to come in today and tomorrow with problems that they needed to have taken care of in the last few days, but just couldn't get to us.” That “huge number” might be more than hospitals can handle, as Texas Children’s is already near its bed capacity, and local general hospitals like Ben Taub Memorial have already faced food and drug shortages.

Residents of the area will be facing major physical and health issue in the days and weeks ahead, and the misery will only be compounded by the austerity cuts and poor public planning of Texas officials.  The bill for that shortsightedness will come due, and the cost will most likely be hundreds if not thousands of lives.

Where the area goes from here, we don't know.  Americans pull together the most in times like these, but we're about to see if the nation's fourth largest city can hold itself in one piece in a worst-case public health scenario.

I don't have much hope.  I want Houston to prove me wrong, believe me.

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