DC Deciphered

One aspect of Harvey – and other major storms like it – that gets lost in all the coverage of so much devastation is the outsized impact these storms can have on people with health conditions.  I’m not talking here about the new health problems that can arise as a result of the storms (though that’s a significant concern as well).  What I’m talking about are people who already have health issues before the hurricane ever appears – particularly people with chronic health problems – and the toll a storm like Harvey can take on them & their ability to get needed treatment.

We’ve all seen the images from Texas of the shocking amounts of water that filled people’s homes, and inundated local stores, and overwhelmed Houston streets.  We watched the dramatic rescues and also learned of the people who, unfortunately, we not able to be rescued.  But now, imagine trying to escape one of those flooded homes, if on top of everything else, your body was fighting you the whole way because it was sick or injured.  Or imagine if you had to carry a piece of crucial medical equipment, such as an oxygen tank with you.  This Buzzfeed report, which isn’t even focused on the health aspects Harvey, just happens to open with a story about a woman who managed to walk a mile and a half through chest-deep water with her walker in order to get from her flooded house to safe shelter at a friend’s house.

And even for those who are not impeded physically in getting out of their homes, a storm like Harvey can dramatically affect their ability to get necessary – sometimes life sustaining – treatments after they make it to shelter.  Imagine someone who takes life-saving medicines, such as insulin, that require refrigeration but could no longer be kept cold once power was lost in the storm.   Or even more ordinary than that, think about the many thousands of people who just weren’t able to keep their prescriptions dry as they carried a few belongings with them away from flooded homes.

In this NBC News report, one terrified woman at a shelter is worried not only about the possibility of being homeless after leaving her water ravaged home, but also about the fact that she was only able to grab a “couple” of her twelve medications before leaving.   She has epilepsy and a heart condition.  Nearly 50% percent of American adults take an important medication.  Many of them need to take that medicine regularly to manage chronic pain or mental illness or an autoimmune disease, or many other sorts of conditions which would cause their health to significantly decline if doses were missed.  A study done after Hurricane Katrina found that 7 percent of emergency visits were to fill medications.

While the solution to this problem may seem as simple as “get a refill,” keep in mind that, aside from cost concerns, after such severe flooding many providers – such as doctors offices, clinics, pharmacies and even some hospitals – are closed for days or longer.  And the flooding may make it impossible to get to the ones that are open.  Additionally, some of the people who may be missing their prescriptions include people in recovery from opioid addiction, and the conditions for receiving their methadone dosage are quite strict (they need to receive their daily dose at a licensed clinic).  Those patients are finding it especially difficult to get their prescription in the storm’s aftermath.  For obvious reasons this could prove to be incredibly destructive to their well-being.

In addition to the aforementioned concerns, there are even more dire concerns for patients who need to stay on a regular regime of therapy such as chemotherapy, or life-sustaining treatment such as dialysis.  Dialysis patients generally need the treatment every 2 to 3 days, and if they go longer without it, they can get very sick very quickly.   Four days after Harvey hit, one of the nation’s leading dialysis providers had only about a third of their centers in the Houston area open.  And this company typically provides dialysis to about 6,700 people in Houston.  So in the immediate aftermath of the storm, resources were quite limited.  Then add to that the difficulty of actually getting people to and from the treatment centers while flood waters were still high.

There is a bit of good news in all of this, however.  States that deal with lots of hurricanes and big tropical storms do seem to be learning something from the past, particularly from Hurricane Katrina.  And so are the health organizations that operate in these states. They’re all trying to do as much as they can to prepare in advance of the storms, as well as to help their constituents afterward.  The Texas Department of State Health Services is working with various pharmacies to try to simplify the task of refilling prescriptions.  They are also – according to this article – making sure there are doctors on site at shelters to fill prescriptions.  It’s unclear as of now whether this has actually been happening, as it appears there are still people at shelters having difficulty with prescriptions.

That large dialysis provider mentioned above is proactively reaching out to patients to make sure they’re getting the needed treatments – whether it’s trough them or with another provider.  They said that while the streets were still flooded they did what they could to arrange transportation for patients who were having trouble getting to a center.  And they were called in staff from other cities and states – along with finding ways to get their Houston employees to work – in order to make sure they were able to keep all of their centers open.

Local hospitals had their staff working around the clock (and only taking rests on premises) in order to insure they’d have the manpower to be able to care for all their patients.  This Atlantic article tells of one pediatric surgeon who worked a shift of five straight days.  Also, as a result of lessons learned from Katrina, most of Houston’s hospitals are protected with submarine doors, flood gates, and above ground generators, which allowed almost all of the city’s hospitals to remain open & functional throughout the hurricane without having to evacuate patients.

But one of the best, and most interesting, success stories to come out of the hurricane is the use of electronic health records.  This was another lesson learned from Katrina, and it can offer a bit of sunshine for all those with health needs who are having a difficult time finding their footing after the storm.   After Katrina, thousands of people discovered that their health records, which were almost all on paper back in 2005, had been destroyed by the flooding.  Many people moved away from Louisiana after Katrina, and they had no health records to hand over to their new doctors. This could cause dangerous disruptions in treatment:

Katrina, for example, disrupted treatment for thousands of people. Most if not all diabetic patients lacked records of their care when they were evacuated to shelters, forcing doctors to select their drugs based on what was available.

Cancer care was also problematic. A doctor quoted in a Time magazine article said he couldn’t tell whether a lesion in one patient’s lung was new or not. The patient would probably have had “a little bit longer and better quality of life” with continuous care, the doctor said.

In 2009, partially in response to this problem, Congress passed the HITECH Act as part of the stimulus package.  Its purpose was to promote electronic health records (EHR). It’s taken years to get the millions of files fully (or near fully) online. So Hurricane Harvey was a big test of the EHR system.  Would the system hold up during the next “Katrina”?  And the answer, at least this time around, is yes.

Politico spoke to several major hospital systems around Houston, and for each one, their IT systems remained in tact throughout the storm. (This may not sound like much, but when Superstorm Sandy hit New York, numerous hospitals were unable to access their electronic records due to power outages and flooding inside the hospitals).  So in Houston, they were able to access their health records during the storm, and they can access them for their patients now post-storm.   This will help enormously for patients’ continuity of care, and can even help outpatients locate prescription and other useful information.

The only thing still lacking in these EHR systems – and it’s significant – is the ability to share the records between different systems, so that if a patient ends up in a new location after the storm, a new hospital system can easily access their records.  However, a solution to that may be on the horizon.  This fascinating Wired article tells of a pilot project called Pulse that’s been running in California for the last year:

Started in 2014 with nearly $3 million in grants from the US Department of Health and Human Services, Pulse builds a data-sharing network that can be switched on during a crisis. Imagine a world where every health care provider in the country is connected to Pulse, either directly or through existing channels, for secure health information exchange. Those connections wouldn’t be live all the time. An emergency would activate only the relevant nodes—say, the Gulf Coast during a hurricane event or Northern Rockies during wildfire season.

Then any registered doctor, nurse, pharmacist, or EMT accessing Pulse in that geographical area could look up a patient (first name, last name, birth date, and gender), and they’d get records for every area clinic and hospital where the patient had received care.

The availability of electronic health records will improve post-storm care for many of the people dealing with chronic (and other) health conditions – if they’re still being treated in a system where they can be accessed.  And the behind the scenes efforts of so many people – the doctors, the nurses, the people who keep the hospitals and the dialysis centers running, the IT professionals who make these EHRs happen & seem to work like magic – appears to be making things run smoother this time around than in previous storms.  But even with all of that, natural disasters still bring exponentially greater challenges for people with health issues than they do for the average person.  And those challenges don’t end once the storm moves out and gets cleaned up.

So if you’re one of these people, try to do what you can to prepare in advance.  Talk to your doctor or case manager before the storm arrives about making a contingency plan.  Make sure your health records are online.  Know which prescriptions you’re taking and in what dosages, and if possible, keep a list of your prescriptions numbers somewhere that will be safe from flood waters or other disaster effects.  There are additional suggestions in the tweet link above.  And if, on the other hand, you’re lucky enough to be healthy & strong, then look out for your friends, family or neighbors who might be struggling. They’re dealing with an extra dose of hardship – maybe you can take some of it off their plate.