Healthcare providers in Texas should brace for the expected and the unexpected
by Joyce Frieden, News Editor, MedPage Today
Jerome Paulson, MD, FAAP
As millions of people struggle to recover from the damage caused by Hurricane Harvey, physicians and other healthcare providers will need to be on the lookout for health conditions that result from being exposed to rising floodwaters and other dangers, experts said.
What exactly could that exposure entail? Remember that “anything that’s in commerce can now be in the water,” said Jerry Paulson, MD, emeritus professor of environmental health at George Washington University in Washington, in a phone interview. “Think about somebody’s garage and what they store in their garage — whether it’s motor oil, a can of gasoline, fertilizer, pesticides, drain cleaners, laundry detergent, and on and on. And then think about that in however many thousand, or tens of thousands, of garages, may be involved.”
Or consider the local home improvement store, he continued. “If you did a walk-through of [such a place], how many of the items on their shelves have warning labels on them? Ant killer, roach killer, paint, paint thinner, all sorts of solvents, lawn chemicals, plumbing chemicals. All those things will get washed into the water. A can of paint, if it’s not jostled too much, maybe it won’t open up, but a bag of fertilizer — eventually the paper and whatever else the bag is made of is going to give way.”
Much of this stuff doesn’t get absorbed through the skin and is therefore not going to be particularly dangerous, Paulson noted. “But when people are wading through this water, or being evacuated on a boat, or they get surprised when a wall of water comes through the door, how do they keep from drinking that stuff? If people are exposed to large volumes of water by mouth, that’s something on an individual basis they may need to be concerned about.”
Paul Spiegel, MD, MPH, director of the Johns Hopkins Center for Refugee and Disaster Response at the Bloomberg School of Public Health in Baltimore, said one of his biggest concerns is that “very quickly there are going to be issues with the environment, particularly with water and sanitation. Depending on what people are drinking, the water can easily become contaminated. The big issue will be the sewers, and depending on how well-contained the sewers are, [the concern about] feces getting into water system.”
“Everyone should be drinking bottled water if they have that available,” since any mixing of the sewage system into the water could cause diarrheal outbreaks, he continued. Skin rashes are another concern with the petrochemicals and other things mixing in the water and people using water that’s contaminated.
Technically speaking, “the number one cause of death in flooding like this is actually drowning,” said Janyce Sanford, MD, chair of emergency medicine at the University of Alabama at Birmingham. “The second thing to think about with this is exposure to the elements. Even though it’s warm in Houston, people running around in floodwaters are still subject to hypothermia, and that should be taken into consideration for elderly people and young children being seen in the ER.”
In addition, “There is a high incidence of trauma in these kind of events … The floodwater submerges items like broken glass, so we see a large number of lacerations, wounds, and regular orthopedic injuries also are much higher,” she said. There is also the danger from downed power lines — “we see people experience significant electrical shock, up to electrocution.”
And although people worry about animals in the water, such as snakes or alligators, “there are also displaced animals who are terrified,” so a person who goes to rescue a dog or cat may end up getting bitten, Sanford pointed out.
Being in a shelter has its issues as well; “people who are in shelters are at higher risk of developing viral illnesses because they are in close proximity to each other,” she said. “And if they try to stay in their homes, mold can develop very quickly when it gets into walls and carpets, and that can unfortunately cause major exacerbations of asthma, and patients with allergies can develop significant respiratory symptoms.”
Once the floodwaters recede and people start getting back into their homes, “everything that touches floodwater we have to consider contaminated,” said Michele Fanucchi, PhD, associate professor of environmental health sciences at the University of Alabama at Birmingham. “You can’t just dry things out because there is potentially raw sewage and different chemicals. So suppose you have a can of food that looks like it’s okay; you’ll have to sanitize it, because you wouldn’t want to open it up and get E. coli and hepatitis into the food inside.”
As a result of the contaminants, physicians might see more of what might look like food poisoning due to the E. coli exposure, she said. And, as people come back to their homes and are anxious to get them clean, they might mix chemicals that shouldn’t be mixed, such as bleach and ammonia, “so there might be inhalation of toxic fumes.” As the floodwaters drop and the water starts moving, “there might be more mosquito-borne diseases,” including West Nile virus and Zika, she added.
“Generators can produce as much carbon monoxide as 100 cars; they should be used out in the open air” rather than in a garage or carport, said Funk, who spoke during a telephone interview at which a public relations person was present. “A lot of times people won’t realized they’re being poisoned,” and they may present for medical care with what seems to be confusion, as well as sleepiness, she said.
There are other hazards developing too: ExxonMobil has announced that the hurricane had damaged two of its refineries, resulting in hazardous chemicals being released, the Texas Tribune reported.