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.

The Golden (Brown) State

Harvey dumped a good 4-5 inches of rain here in the Cincy/NKY area over the last 24 hours and of course things are nightmarish in southeastern Texas and western Louisiana, but out on the West Coast the problem is record-smashing heat across California, spawning tinder-dry wildfire conditions as San Francisco and Los Angeles are baking in triple digit temps.

In almost 150 years of record keeping, it has never been as hot in San Francisco as it was on Friday.

Amid a brutal heat wave that has broiled California for a week while intermittently knocking out power to thousands and fueling more than a dozen wildfires, downtown San Francisco hit 106 degrees.

“San Francisco continues to climb. Latest high temperature for downtown is an incredible 106 degrees!” the National Weather Service’s Bay Area station tweeted Friday.

The previous record was 103 degrees, set in 2000. San Franciscans got creative on social media to document their pain.

But that was not even the worst of it for Northern California. By 3 p.m., the East Bay valley cities of Livermore and Pleasanton were at 110 degrees. Livermore was expected to flirt with its all-time record of 115 degrees Saturday — but came up short Friday, reaching 109 degrees.

“When we’re approaching all-time record highs, that’s very unusual,” said Steve Anderson, a meteorologist with the National Weather Service.

The temperature reached 108 degrees in San Jose, breaking the city’s record for Sept. 1 of 101 degrees, set in 1950.

The heat wave marks the finale for what has ended up being the state’s hottest summer on record, UCLA climate scientist Daniel Swain said.

All-time record highs in California, all-time record flooding in Texas, and more hurricanes on the way.   And it's not just America seeing awful weather, either.  As much as a third of Bangladesh is underwater with 1,200 dead and the toll rising dramatically as monsoon flooding in South Asia has inundated tens of millions from Nepal to Pakistan.

Welcome to the age of Chinese hoaxes climate change, guys.  As Captain Barbossa said in the first Pirates of the Caribbean movie, "Ye best start believin'" in climate change stories.  "Yer in one."

General Chaos In The White House

I will be mildly surprised if Kelly lasts to the end of the month. I don’t see the point in what he is trying to do, and I doubt he’ll be able to see any point in it for much longer. He can’t save this administration or even keep it afloat. And I don’t think Trump will stop disrespecting him in front of the staff, so unless he enjoys being treated like Reince Priebus he’s going to take a walk or get himself fired before too much longer.

Things might be different if the administration were not taking on water faster than Kelly can bail it out, or if September were not set up as a crucible custom-designed to destroy the illusions of Republicans and Trump supporters everywhere. But playtime is over and the grim waiter has brought the check. Failure will begin to roll down like waters, and haplessness like a mighty stream. Brother shall deliver up brother, and the father the child: and the children shall rise up against their parents, and cause their political death.

Through it all, for as long as he lasts, Kelly will vainly try to steer the ship away from the shoals, and he’ll take the blame for errors not of his making and decisions made against his advice.

The real issue is what happens after Kelly departs, depending on how much damage is done with Trump ending DACA, possibly shutting down the government and wrecking the country's credit rating over the debt ceiling, botching tax reform, and running out of time for whatever hail Mary play on Trumpcare happens before September 30.

The same goes for Rex Tillerson, by the way.  He's not much longer for this State Department job in this dumpster fire of an administration, and neither is Treasury Secretary Gary Cohn.  It's possible and even likely that the three of them (along with Gen. Mattis at the Pentagon) get a hold on the country and run things as best they can for a while, but eventually they will realize that Trump is headed for history's septic tank and anyone along with him will be covered in crap.

It's even more likely that Mueller will come along and pull the plug anyway.  Where the country goes from there, I can't tell you.  Trump won't go quietly or peacefully and things could get violent pretty fast.  But Kelly could be a big part of directing the country towards the lifeboats.


We'll see. 
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