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Hurricanes Florence, Michael Raise the Issue of Public Health During Disaster

Flooded hog farms, dead livestock and toxic rivers are among the discussions.

An editorial in North Carolina’s Fayetteville Observer began by saying, “Hurricane Florence turned the Cape Fear River into more of an open sewer than it already was.”

Then there was the story about Florence drowning more than 5,000 pigs and more than 3 million chickens, then another about the concern of Florence leaving behind a toxic mess from hog farms.
It’s the stuff that concerns Nicolette Louissaint, executive director of Healthcare Ready, who says not enough attention is paid to public health concerns during and after disasters.

“The way, in general, that we cover disasters is way too focused on individual suffering and the acute needs and not thinking about the broader questions of ‘how did we get here,”’ she said. “What made us susceptible to this type of suffering and how do we protect people from going through it again?”

Louissaint said the issue should be taken up way before disaster strikes, like in the community planning stages. That the problem and solutions begin with infrastructure planning. “We can’t really have a conversation about disasters in isolation,” she said. “It’s an urban planning discussion, it’s an infrastructure discussion — otherwise we wind up where we are right now.”

And that is wondering about public health problems resulting from Hurricane Florence, which helped create a toxic mess in North Carolina. There are 3,300 hog lagoons, where waste is deposited, in North Carolina. According to a Los Angeles Times report, four of those lagoons suffered structural damage and some waste may have escaped from 13 others as well.

Some of the manure from the flooded farms may have escaped into the Trent River. There are other hazards too, such as coal ash basins, where power plant residue is stored, and there are other toxic sites. The floods can raise high enough to flow into these sites and then back into the rivers that provide drinking water.

Also in North Carolina, as electricity was lost, about 5.25 million gallons of partially treated wastewater was dumped into a local river before it was deemed safe for workers to repair a failed generator, The Times reported.

Power and water are top of mind right now for Louissaint and other public health officials. “What we’ve been seeing the last month with Florence and Michael is meds [will people run out of their meds?], water, power,” she said. “A lot of this pertains to critical infrastructure. There are a lot of concerns about environmental exposure, water quality and what happens to water treatment in the absence of power.”

The problem is exacerbated in the Southeast, where there are large, rural populations and people are farther from treatment and the likelihood of sustained power outages and communications challenges can be greater.

Louissaint said her biggest fear is that our cross-sector dependencies cause people to miss out on getting help. “As we’ve seen with all of the events, if you are disconnected from electricity, you don’t have a phone that’s working, and you if have a public health need, it is very difficult for your need to be identified.”

She said there is a connection between public health and environmental health, and concerns should be integrated into urban planning and infrastructure development. “Making sure you’re thinking about the threats that might impact the community and building infrastructure in a way that makes the community more resilient is an important part of mitigation and preparedness,” Louissaint said.

“We’re starting to put investments behind the conversation, and my hope is that some of those investments that will be pushed toward the locals, the counties, will allow them to make the decisions with funding dollars,” she said.

Mitigation and planning are long-term ventures, and disasters evoke concern for a short period of time and then that concern fades. “It causes the conversations on disasters to really get stunted to ‘here’s what happened, who’s suffering, let’s find stories on the suffering and then let’s forget about it in a few weeks,” Louissaint said.

Notes from the hurricanes:


  • Concerns about chronic care patients and those who experienced extended disruptions in care. While the situation is beginning to stabilize, there will be continued chronic care needs and outcomes for weeks to come.
  • Fortunately, Hurricane Michael did not impact North Carolina as severely, but there is a recognition that the second storm did cause rain and exacerbated the situation in North and South Carolina. In addition, there is a real concern that the Michael response will pull resources (and focus) away from the Florence recovery.
  • We’ve seen a sustained set of requests around behavioral health and medical professionals. There are a number of partners who are still providing medical support, and behavioral health needs continued to be flagged. This is likely related to the trauma survivors feel after navigating such an event.

  • Hospitals are working to come back online, and several are using mobile emergency departments and other solutions to meet the needs of patients. These solutions are great, but unless facilities are able to address their structural issues, they will not be able to perform the same medical functions in a mobile or limited capacity. Focusing on getting all facilities, including community health centers and free clinics, fully operational is a priority.
  • Flu vaccine – the number of requests for flu vaccine have surged. There is a need to vaccinate as many as possible, and we cannot ignore the fact that flu season is here because we are so focused on the acute response needs.
  • Opioid crisis – The number of patients needing assistance obtaining controlled substances is (again) higher than in years past. For our organization, this seems to be an upward trend, even from last year. In addition, we have been working to ensure that sufficient Narcan is present in shelters and other key locations, as there are concerns about overdosing and a need to make sure responders can avoid fatalities.
  • Chronic care – Patients with co-morbidities are of concern, especially in southwest Georgia (where sustained power outages are likely) and Florida (where infrastructure is damaged). This includes diabetic and dialysis patients.