Federal Officials Assess Medical Needs in the Wake of Hurricane Katrina
CDC Director Julie Gerberding on Sunday met with federal health officials and medical experts in New Orleans to assess the risk of disease outbreak and environmental health threats at shelters set up to house those affected by Hurricane Katrina, the Atlanta Journal-Constitution reports. Gerberding, who called conditions in the city "very grim," toured refugee shelters and mobile hospital units with CDC Division of Global Migration and Quarantine Chief Martin Cetron and senior specialists in infectious disease, environmental health and engineering.
The officials discussed strategies for dealing with Katrina's "most feared possible consequence: an invasion of a packed shelter by large outbreaks of fast-moving disease," the Journal-Constitution reports. Gerberding also met with HHS Secretary Mike Leavitt and Surgeon General Richard Carmona, along with mental health, minority health and CMS officials, for a "lightning tour" of affected areas, according to the Journal-Constitution (McKenna, Atlanta Journal-Constitution, 9/5). Leavitt on Aug. 31 declared a public health emergency in Louisiana, Mississippi, Alabama and Florida to speed medical care efforts (CQ HealthBeat, 9/1).
Leavitt on Sunday declared a public health emergency in Texas to allow Medicaid beneficiaries arriving from other states to continue to receive coverage from Medicaid. HHS officials shipped 90,000 doses of tetanus vaccine, 22,000 doses of hepatitis A vaccine and 36,000 doses of hepatitis B vaccine to the areas over the weekend and are also providing medication for chronic conditions (McKay et al., Wall Street Journal, 9/6).
HHS has deployed more than 5,000 medical workers to the area (Connolly, Washington Post, 9/6). The agency said it will open 40 medical shelters throughout the area to provide 10,000 beds. Federal officials added that they have identified 2,600 additional beds in the region and 40,000 beds nationwide that can be used to provide care to evacuees (CQ HealthBeat, 9/1).
NIH is creating a telemedicine consultation and triage facility that will link the "sickest of the sick" to expert care at NIH and other facilities, according to an HHS release. NIH also is organizing volunteers to aid with medical care (HHS release, 9/2). CDC is helping to establish mosquito control programs to reduce the risk of a West Nile virus outbreak, which is associated with standing water (CQ HealthBeat, 9/1).
The agency also is urging shelter residents to get vaccinated against infectious diseases unless they have records to prove they have already received shots. In addition, CDC is monitoring the "wide range of health problems in the storm's aftermath," including environmental health threats, the organization of doctors to care for evacuees, mental health effects and the distribution of medical supplies from the Strategic National Stockpile, the Journal-Constitution reports.
Cetron said, "I'm worried about measles. I'm worried about pertussis. Imagine the effect in one of those shelters of one patient with multi-drug resistant TB." CDC has sent 108 staff members to address medical issues in Alabama, Louisiana, Mississippi and Texas, with more scheduled to leave this week (Atlanta Journal-Constitution, 9/5).
Leavitt said the "health care needs in the region are immense, and we are working as quickly as we can to get the medical care and supplies to the people who so desperately need them." He added that the medical shelters will "augment the medical services being provided and nearly 100 tons of supplies this department has shipped already to the Gulf region. Additional shelters will open in the coming days" (HHS release, 9/2).
Meanwhile, "[l]egions of doctors and nurses are frantically patching together a new medical care network to handle the swelling flow" of evacuees, the Post reports. According to the Post, the "emergency medical challenges are compounded by longer-term issues of managing chronic conditions" such as high blood pressure, heart disease, diabetes and mental illness. In addition, patients at makeshift hospitals and clinics are predominantly low-income residents in poor health.
According to Louis Minsky, medical director of the Baton Rouge, La., emergency response unit, Baton Rouge hospitals will be able to provide beds to serve 400,000 evacuees anticipated in the city but will need as many as 2,000 more nurses and 200 more physicians to accommodate the patient growth (Washington Post, 9/6). Officials also acknowledged that they had not yet addressed issues associated with transferring patients from a makeshift hospital at the New Orleans airport to hospitals in other areas in Louisiana or states such as Arkansas, Missouri and Texas. Such issues include the inability of medical staff to contact patients' doctors, lack of access to medical records and the inability to contact relatives to let them know where patients have been taken.
Another concern is determining who will monitor patients' care and who will pay for treatment, the Chicago Tribune reports (Graham, Chicago Tribune, 9/4). About 20,000 "sick, wounded and homeless people" were flown from the airport over the weekend to refugee centers across the country, but "rescue helicopters continued to arrive steadily with people who were being rescued more than a week after the storm hit," according to USA Today (Levin, USA Today, 9/6).
The AP/Washington Times reports that red tape is preventing "hundreds" of medical volunteers from reaching hurricane survivors as health problems "escalate." Among those who are unable to reach New Orleans are 100 surgeons and paramedics in a state-of-the-art mobile hospital (AP/Washington Times, 9/5). Health care providers traveling with the hospital say they have not received an assignment from government officials to participate in the relief effort in Louisiana.
The $1.5 million emergency response hospital, developed by the Department of Homeland Security, includes 113 beds in two 53-foot trailers. The mobile hospital includes ultrasound, digital radiology, satellite Internet and a full pharmacy, allowing doctors to perform most types of surgery. The hospital currently is treating patients in Mississippi (Marchione, AP/Las Vegas Sun, 9/5).
Other doctors have also complained they were turned away as volunteers, the AP/Times reports. Jeffrey Guy, a trauma surgeon at Vanderbilt University who is in contact with the doctors of the mobile unit, said, "There are entire hospitals that are contacting me, saying, 'We need to take on patients,' but they can't get through the bureaucracy. The crime of this story is, you've got millions of dollars in assets, and it's not deployed. We mount a better response in a Third World country" (AP/Washington Times, 9/5).
Doctors aiding in relief efforts say their biggest concerns include infected wounds, gastrointestinal illnesses and contagious skin infections, the Journal reports (Wall Street Journal, 9/6). Officials say they also are concerned about outbreaks associated with flooding, such as typhoid and cholera, as well as an increasing number of asthma attacks, fevers, rashes and suicide attempts (Washington Post, 9/6).
Federal officials in Biloxi, Miss., on Saturday evacuated a shelter because of concerns about an outbreak of dysentery (Knight Ridder/St. Paul Pioneer Press, 9/4). Other doctors are concerned about the upcoming flu season and transmission of West Nile virus (Wall Street Journal, 9/6). Hospitals operating at full capacity in Baton Rouge have seen an increase in cases of pneumonia, stroke, lice, diarrhea and premature birth (Washington Post, 9/6).
Edward Hill, president of the American Medical Association, said, "The predominant problem is the lack of medication for hypertension, diabetes and people suffering from heart problems" (Wall Street Journal, 9/6). Pharmaceutical Research and Manufacturers of America officials said they will provide pharmaceutical products at no cost for use in areas most affected by the hurricane (CQ HealthBeat, 9/1).
The New York Times on Saturday examined the evacuation of hospitals in New Orleans, some of which were "surrounded by six feet of floodwater and had little or no electricity and no running water." Charity Hospital, a public facility, was among the last to be fully evacuated on Friday evening. Richard Zuschlag, president of Acadian Ambulance, said, "When we first tried to get medics there, in Fish and Wildlife boats, people shot shots at us, tried to turn our boats over. It would be OK, and then there'd be pockets of thugs where it was terrible." HCA, which operates Tulane University Hospital, began making arrangements to move patients before the storm hit, according to HCA Vice President Ed Jones. By Friday, Tulane had evacuated about 1,400 patients, employees and others, largely by using 20 leased private helicopters.
Tenet Healthcare spokesperson Steve Campanini said the hospital chain hired five private helicopters to assist in the evacuation of 3,000 patients and employees from four of its hospitals. The Times also examined conditions at University Hospital, Touro Infirmary Hospital, Kindred Hospital and the Oschner Clinic Foundation, which did not flood and remained operational. Many of the hospital evacuees from the city were taken to the New Orleans airport. The Times reports that "it was clear that some patients had died in transit, ... and there were worrying hints" about "the forgotten nursing homes of New Orleans" (Barringer/McNeil, New York Times, 9/3).
NPR's "Weekend Edition Saturday" reported on ongoing public health concerns in the wake of Katrina, including injuries, infections and access to care. The segment includes comments from Richard Besser, director of CDC's Campaign for Appropriate Antibiotic Use, and Irwin Redlener, director of Columbia University's National Center for Disaster Preparedness (Silberner, "Weekend Edition Saturday," NPR, 9/3). The complete segment is available online in RealPlayer.
In addition, NPR's "Talk of the Nation" on Friday included a discussion of the public health risks following a hurricane. Guests on the program included Ivor van Heerden, director of the Center for the Study of Public Health Impacts of Hurricanes, and John Pardue, director of the Louisiana Water Resources Research Institute (Flatow, "Talk of the Nation," NPR, 9/2). The complete segment is available online in RealPlayer.
Several NPR programs also reported on hospitals' response to Katrina:
- NPR's "All Things Considered": The program on Saturday reported on what evacuees from Katrina will mean for U.S. hospitals over the next few months. The segment includes comments from Arthur Kellerman, chair of the Department of Emergency Medicine at Emory University; Carlos Moreno, a physician at the University of Texas Health Science System in Houston; and Donald Williamson, a state health officer for Alabama (Silberner, "All Things Considered," NPR, 9/3). The complete segment is available online in RealPlayer.
- NPR's "Morning Edition": The program on Tuesday included an interview with Jeff Myers, a physician at Tulane Hospital in New Orleans, about the evacuation of the hospital (Montagne, "Morning Edition," NPR, 9/6). The complete segment is available online in RealPlayer.
- NPR's "Morning Edition": The program on Monday reported on the transformation of the Louis Armstrong International Airport into a triage unit, where thousands of patients are awaiting treatment and evacuation to hospitals around the country. The segment includes comments from medical staff working at the unit (Shapiro, "Morning Edition," NPR, 9/5). The complete segment is available online in RealPlayer.