#Lessons from #Hurricane #Katrina for predicting the indirect #health #consequences of the #COVID19 pandemic (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Lessons from Hurricane Katrina for predicting the indirect health consequences of the COVID-19 pandemic

Ethan J. Raker, Meghan Zacher, and Sarah R. Lowe

PNAS first published May 18, 2020 https://doi.org/10.1073/pnas.2006706117

Edited by Kenneth W. Wachter, University of California, Berkeley, CA, and approved May 7, 2020 (received for review April 9, 2020)



Beyond their immediate effects on mortality, disasters have widespread, indirect impacts on mental and physical well-being by exposing survivors to stress and potential trauma. Identifying the disaster-related stressors that predict health adversity will help officials prepare for the coronavirus disease 2019 (COVID-19) pandemic. Using data from a prospective study of young, low-income mothers who survived Hurricane Katrina, we find that bereavement, fearing for loved ones’ well-being, and lacking access to medical care and medications predict adverse mental and physical health 1 y postdisaster, and some effects persist 12 y later. Adjusting for preexisting health and socioeconomic conditions attenuates, but does not eliminate, these associations. The findings, while drawn from a demographically unique sample, suggest that, to mitigate the indirect effects of COVID-19, lapses in medical care and medication use must be minimized, and public health resources should be directed to those with preexisting medical conditions, their social networks, and the bereaved.

disasters – COVID-19 pandemic – Hurricane Katrina – mental health – physical health

Keywords: SARS-CoV-2; COVID-19; Hurricanes; Society; Poverty; Disaster preparedness.


#Cognitive #Development of #Infants Exposed to the #Zika Virus in #PuertoRico (JAMA Netw Open, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

JAMA Netw Open. 2019 Oct 2;2(10):e1914061. doi: 10.1001/jamanetworkopen.2019.14061.

Cognitive Development of Infants Exposed to the Zika Virus in Puerto Rico.

Valdes V1, Zorrilla CD2, Gabard-Durnam L1, Muler-Mendez N2, Rahman ZI1, Rivera D2, Nelson CA 3rd1,3.

Author information: 1 Laboratories of Cognitive Neuroscience, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts. 2 Obstetrics and Gynecology, Maternal-Infant Studies Center, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico. 3 Harvard Graduate School of Education, Cambridge, Massachusetts.




Existing research has established a causal link between Zika virus (ZIKV) infection and severe birth defects or consequent health impairments; however, more subtle cognitive impairments have not been explored.


To determine whether infants of mothers with at least 1 positive ZIKV test show differences in cognitive scores at ages 3 to 6 months and ages 9 to 12 months.


This cross-sectional study recruited infants enrolled in existing ZIKV study cohorts associated with the Maternal-Infant Studies Center and the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico and from the broader San Juan metropolitan area. The study took place at the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico. Participants were recruited through convenience sampling if their mothers underwent ZIKV testing prenatally and were at the target ages during the study period. Infants who were born preterm (<36 weeks’ gestational age), with low birth weight (<2500 g), or with a known genetic disorder were excluded. Infants were tested from ages 3 to 6 months or ages 9 to 12 months from May 2018 to April 2019. Data analysis was performed from March to April 2019.


Zika virus status was measured prenatally and in the early postnatal period using real-time polymerase chain reaction or a ZIKV IgM antibody capture enzyme-linked immunosorbent assay.


The infants’ development was assessed using the Mullen Scales of Early Learning (translated to Spanish and adapted for Puerto Rico), and assessors were blinded to each infant’s ZIKV status.


A total of 65 study participants were included. The mean (SD) age of the infants at the time of cognitive testing was 8.98 (3.19) months. Most of the infants were white (55 [84.6%]) and Puerto Rican (64 [98.5%]); 38 of the infants were male (58.5%). General cognitive and domain-specific scores did not differ significantly between prenatally ZIKV-positive and ZIKV-negative infants except for receptive language score (mean difference = 5.52; t = 2.10; P = .04). Exposure to ZIKV (B = -5.69; β = -0.26 [95% CI -11.01 to -0.36]; P = .04) and a measure of Hurricane Maria exposure (time without water, B = -0.05; β = -0.27 [95% CI, -0.10 to -0.01]; P = .03) were both independently and significantly associated with receptive language scores after adjusting for key confounders.


Although infants exposed to ZIKV prenatally showed unaffected motor and visually mediated cognitive development, they did show deficits in receptive language scores. Receptive language skills were also associated with the degree of exposure to Hurricane Maria, with those who spent more time without water after the hurricane having lower receptive language scores.

PMID: 31651970 DOI: 10.1001/jamanetworkopen.2019.14061

Keywords: Zika Virus; Pediatrics; Psychiatry; Extreme Weather; Hurricanes; Society; Puerto Rico.


A perfect #storm in the #Caribbean requires a concerted #response (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

A perfect storm in the Caribbean requires a concerted response

Sandeep Maharaj, Terence Seemungal, Martin McKee

Published: September 17, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)31822-7


The countries of the Caribbean are facing a perfect storm of events that pose a severe threat to the health of their people. 2018 was the third consecutive year of above average meteorological activity, with several countries, including Anguilla and the British Virgin Islands, devastated by major hurricanes. The effects of climate change mean the situation can only get worse.



We declare no competing interests.

Keywords: Public Health; Hurricanes; Caribbean; Society; Poverty.


#Influenza A (#H3) #Outbreak at a #Hurricane #Harvey #Megashelter in Harris County, #Texas: Successes and Challenges in Disease Identification and Control Measure Implementation (Disaster Med Public Health Prep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Disaster Med Public Health Prep. 2019 Feb;13(1):97-101. doi: 10.1017/dmp.2018.159.

Influenza A (H3) Outbreak at a Hurricane Harvey Megashelter in Harris County, Texas: Successes and Challenges in Disease Identification and Control Measure Implementation.

Liu L1, Haynie A1, Jin S1, Zangeneh A1, Bakota E1, Hornstein BD1, Beckham D1, Reed BC1, Kiger J1, McClendon M1, Perez E1, Schaffer M1, Becker L1, Shah UA1.

Author information: 1 Harris County Public Health,Houston, Texas (Dr. Aisha Haynie is no longer affiliated with the agency).



When Hurricane Harvey landed along the Texas coast on August 25, 2017, it caused massive flooding and damage and displaced tens of thousands of residents of Harris County, Texas. Between August 29 and September 23, Harris County, along with community partners, operated a megashelter at NRG Center, which housed 3365 residents at its peak. Harris County Public Health conducted comprehensive public health surveillance and response at NRG, which comprised disease identification through daily medical record reviews, nightly “cot-to-cot” resident health surveys, and epidemiological consultations; messaging and communications; and implementation of control measures including stringent isolation and hygiene practices, vaccinations, and treatment. Despite the lengthy operation at the densely populated shelter, an early seasonal influenza A (H3) outbreak of 20 cases was quickly identified and confined. Influenza outbreaks in large evacuation shelters after a disaster pose a significant threat to populations already experiencing severe stressors. A holistic surveillance and response model, which consists of coordinated partnerships with onsite agencies, in-time epidemiological consultations, predesigned survey tools, trained staff, enhanced isolation and hygiene practices, and sufficient vaccines, is essential for effective disease identification and control. The lessons learned and successes achieved from this outbreak may serve for future disaster response settings. (Disaster Med Public Health Preparedness. 2019;13:97-101).

KEYWORDS: Hurricane Harvey; influenza outbreak; shelter surveillance and response

PMID: 30841952 DOI: 10.1017/dmp.2018.159 [Indexed for MEDLINE]

Keywords: Seasonal Influenza; H3N2; Disaster preparedness; Hurricanes; USA; Texas.


Use of #Death Counts From Vital #Statistics to Calculate Excess Deaths in #PuertoRico Following #HurricaneMaria (JAMA, abstract)

[Source: Journal of American Medical Association, full page: (LINK). Abstract, edited.]

Research Letter / August 2, 2018

Use of Death Counts From Vital Statistics to Calculate Excess Deaths in Puerto Rico Following Hurricane Maria

Alexis R. Santos-Lozada, PhD1; Jeffrey T. Howard, PhD2

Author Affiliations: 1 Department of Human Development and Family Studies, Pennsylvania State University, University Park; 2 Department of Kinesiology, Health and Nutrition, University of Texas at San Antonio

JAMA. Published online August 2, 2018. doi:10.1001/jama.2018.10929



The official death toll for Hurricane Maria, which devastated Puerto Rico on September 20, 2017, has remained at 64 since December 29, 2017. Accurate estimates of deaths from environmental disasters are important for informing rescue, recovery, and policy decisions.

Using preliminary death counts through October 2017, excess deaths related to the hurricane were estimated at 1085.1 However, other estimates suggest that the number of excess deaths may be as high as 4645.2 The variance in estimates is due to differences in methodology. The official government death toll includes only deaths in which documentation of “hurricane-related” as the cause of death appears on the individual’s death certificate and does not account for indirect deaths, including from infectious disease outbreaks or lack of services (such as electricity, water, and medical care). Estimates of excess deaths address both direct and indirect deaths and typically use either death counts from government agencies1 or surveys,2 which are susceptible to larger margins of error. We calculated the number of excess deaths following Hurricane Maria through December 2017, using death counts from vital statistics records, updating a previous estimate.1


Monthly death counts, from January 2010 through December 2017, including previously unavailable death counts for January through December 2017, were obtained from the Puerto Rico vital statistics system to calculate excess deaths in Puerto Rico following Hurricane Maria; this system has a 99% coverage rate based on previous analyses.3 Because these data are deidentified aggregate counts of deceased individuals, this study is considered to be research not involving human subjects as defined by US regulation (45 CFR 46.102[d]).

Consistent with prior studies,4,5 death counts from vital records from 2010 through 2016 were used to establish expected monthly deaths (mean), and historical ranges of natural variability (95% CIs). For September through December 2017, we used the difference between number of deaths from vital statistics records and the upper 95% CI bound as a measure of excess mortality. The upper 95% CI limits were calculated as: …  where x̅ is the mean value, t is the 2-sided value of the student t-distribution, α is the alpha level (.05), n is the number of observations (n = 7), and s is the standard error of the mean. The 1-sample t test was used to calculate 95% CIs around the excess death estimates. Analyses were conducted using SAS (SAS Institute), version 9.4.


The expected numbers of deaths were 2396 in September, 2407 in October, 2416 in November, and 2697 in December (Table). The upper bounds (95% CIs) for the same months were 2469, 2476, 2555, and 2824, respectively, whereas the actual numbers of deaths were 2928, 3040, 2671, and 2820. There were 1139 (95% CI, 1006-1272) excess deaths: 459 (95% CI, 425-593) in September, 564 (95% CI, 531-597) in October, and 116 (95% CI, 50-182) in November. Although August and July experienced lower numbers of deaths than expected, September and October had higher numbers of deaths than expected, the number of deaths decreased in November, and by December had returned to a level within historical variation (Figure).


Based on death records following Hurricane Maria, the estimated hurricane-related mortality burden of 1139 excess deaths through December 2017 was higher than the official death toll of 64. The estimate is conservative, because the expected number of deaths used the upper 95% CI and did not consider the population denominators, which were decreasing. The strength of the present approach is that it is based on death counts from vital statistics records and is consistent with previous estimates1 and methods.4,5 The primary limitation of the study is that the specific cause of each individual death is not known; thus only an aggregate number of deaths in excess of historical variation can be estimated. Another recent study2 suggested that there were 4645 excess deaths (95% CI, 783-8498), but it was based on a survey that underestimated prehurricane mortality, overestimated posthurricane mortality, and had a large CI, indicating a high level of uncertainty. Future studies would benefit from careful analysis of deaths from vital records rather than surveys.

Section Editor: Jody W. Zylke, MD, Deputy Editor.

Keywords: Puerto Rico; Public Health; Hurricanes; Environmental Disasters.


The #View from #PuertoRico — #Hurricane Maria and Its #Aftermath (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

The View from Puerto Rico — Hurricane Maria and Its Aftermath

Carmen D. Zorrilla, M.D.

October 11, 2017 / DOI: 10.1056/NEJMp1713196


Hurricane Maria hit Puerto Rico on September 20 and caused unprecedented damage affecting the island’s 3.4 million inhabitants (see Figure 1Figure 1 Streets in Puerto Rico Blocked by Debris from Hurricane Maria.Lourdes De Jesus. ). Though no one in Puerto Rico was spared at least some impact, the poor and vulnerable were disproportionately affected. Loss of communication and electricity, scarcity of water, isolation of some residents, slow coordination of the aid that has been sent, and the magnitude and scope of the necessary repairs all merit a call for help from and the engagement of the global community. Indeed, Puerto Ricans and U.S. Virgin Islanders are U.S. citizens and expect the same federal aid and support during natural disasters as the rest of the United States.



Disclosure forms provided by the author are available at NEJM.org.

This article was published on October 11, 2017, at NEJM.org.

Source Information: From the Department of Obstetrics and Gynecology and the Maternal-Infant Studies Center, University of Puerto Rico School of Medicine, San Juan.

Keywords: Extreme Weather; Hurricanes; Puerto Rico; USA; Public Health.