Among the many heartbreaking photos from Hurricanes Helen and Milton, the ones that stand out to me are white buildings submerged in brown muddy water and people taking shelter on rooftops. A rescue helicopter is about to land in strong winds. The building was Unicoi County Hospital in Irwin, Tennessee, and among the 54 people stranded were patients in need of medical care. Thankfully everyone was rescued.
It’s easy to think that’s the end of the story. But as a doctor, I think about all the fallout that you don’t see in news footage. Many other medical facilities in southeastern states were forced to evacuate, outpatient visits canceled, chemotherapy and dialysis postponed. Those that could not be delivered due to power shortages, those that required prescriptions that were not filled.
Many pharmacies in seven states remained closed for several days after Helen’s outrage. Baxter International’s North Cove plant in North Carolina, which produces 60% of the nation’s IV fluid supply, announced a temporary closure, prompting some hospitals to ration supplies. Patients as far away as California and Alaska may also suffer from the storm that hit North Carolina.
As communities grapple with the reality of the lives lost and the damage done, it can be difficult to bring up the suffering that is yet to come. However, in order to clearly see the challenges ahead, we need to recognize the vulnerabilities of our healthcare system and take steps such as: Please do better.
From Hurricanes Katrina to Sandy to Rita, we now have ample evidence of the long-term health effects of severe storms. These range from increased levels of stroke, to increased risk of premature birth, to increased levels of post-traumatic stress disorder and anxiety in the weeks and months that follow. A new study published in the journal Nature reports that between 1930 and 2015, more people died from hurricanes and tropical cyclones than from car accidents in the United States.
The aftermath of Hurricane Maria in Puerto Rico in 2017 provides a clear example of how this is possible. The official death toll after the storm was reported at 64, but groundbreaking research later found that this was likely closer to 4,645, or more than 70. That’s double the original estimate. Reasons include increased rates of heart attacks and strokes, and loss of continuity of care essential to people’s health. Understandably, when health systems are disrupted, they are unable to provide the care that people need.
We can and must better prepare our communities for the short- and long-term impacts of severe weather. Even as the size and ferocity of major storms increases, we can continue to improve ways to reduce their negative health impacts.
So what should we do?
First, we need to recognize that the effects of climate change will increasingly be felt in places long considered safe, and in unexpected ways by communities. Consider that Irwin, Tennessee is located over 400 feet above sea level. Few expected such devastating flooding to occur at that altitude. People were similarly caught off guard by the devastation that spread across North Carolina’s western mountains. In the near future, this “unexpected” climate impact will become even more significant. That’s why we need to make our health systems climate resilient now.
Climate action includes building resilience in physical infrastructure. Hospitals need to be able to continue functioning even after a major storm. The same applies to the factories and transportation systems that make up the nation’s medical supply chain.
In practice, this means equipping healthcare facilities with infrastructure and renewable energy backup systems that can withstand extreme weather events. States that are new to preparing for and responding to these risks could learn from places like Tampa General Hospital, which withstood a Category 5 hurricane and built an energy source that could provide hospitals with power and hot water during a crisis.
Second, states need to be innovative and flexible in their healthcare delivery. This includes preparing to temporarily lift state licensing laws to allow out-of-state health care providers to temporarily relocate to the area to meet growing care needs. After Helen was attacked in North Carolina, an emergency policy made it easier for out-of-state doctors to obtain temporary licenses in North Carolina. It is essential to streamline this process and make it standard everywhere.
After Hurricane Sandy, nurses proactively went door to door to check on patients and provide services as needed. This type of innovation is essential to ensuring that patients receive appropriate care even when it is difficult to get to a hospital or clinic.
States also need to enact and streamline emergency prescribing laws to ensure patients have sufficient supplies of medicines in advance of an emergency. Currently, 16 states have no emergency prescription regulations, and some states’ laws are vague, insufficient, or contradictory.
Third, healthcare providers must take responsibility for reaching high-risk patients before a major storm approaches. To ensure continuity of care for people with chronic conditions, patients should be directed to competent treatment centers or health care providers outside the affected area. Healthcare providers should also ensure that their facilities receive patients’ medical records or at least allow patients to access them remotely. This process must be intentional and well-thought out to avoid delays or interruptions in life-saving care.
Photos of people on the roof of Unicoi County Hospital show not only how severe storms are changing due to climate change, but also how we must adapt and build resilience. It says it all. As we send hope and aid to the millions of people whose lives have been upended by these storms, we also hope that policymakers are building public health and health systems to protect people and livelihoods in this new world. We must also recognize that the time to prepare is long past.
Dr. Ashish K. Jha is dean of the Brown University School of Public Health and a writer for Globe Opinion.
