Stronger hurricanes and other flood-producing storms are happening already because of climate change and more should be expected, scientists say. Hurricane Harvey, which devastated parts of Houston and other locations along the Texas coast, is a case study in how a storm boosted by climate change affects people’s health, how some of those impacts linger, and how responses can be improved.

Researchers are gathering at Baylor College of Medicine in Houston this week to discuss findings about Harvey’s public-health impacts and healthcare providers’ response. This is one of two in-depth articles by TCN contributing editor Ruth SoRelle, in which she explores some of what researchers have learned so far.

+++++

By Ruth SoRelle
Texas Climate News

The rage of Hurricane Harvey struck Texas with winds of 134 miles per hour at its zenith and dumped trillions of gallons of water up and down the state’s coastline. The record-setting storm’s costs were measured in more than dollars. It killed 68 people in Texas directly by wind, rain and floods. The Texas Department of State Health Services attributes another 26 deaths to unsafe or unhealthy conditions related to loss of electricity and clean water supplies, as well as a lack of transportation and medical care. Additional deaths from natural causes were considered indirectly related to Harvey when they were caused by medical conditions, electrocutions, traffic accidents, infections from flood waters, fires and burns.

Prosaically, the most common health problems in Harvey’s immediate Harvey were sniffles, sore throats and coughs. For some with asthma, the effect was more serious with flare-ups that impeded breathing.

However, some health issues arose later, as people dealt with mold contamination in their homes and worked to remove damaged walls, floors and ceilings.

The storm’s ebb did not mean that physical problems abated. Contaminated floodwaters remained. They carried chemicals, biotoxins, waste, sewage and debris that can cause illnesses and injury as survivors wade through them. Bacteria such as Escherichia coli, staphylococcus and streptococcus can cause a variety of ailments affecting many body systems.

In a survey conducted a year after Harvey by the Houston-based Episcopal Health Foundation and the California-based Kaiser Health Foundation, 19 of those who had homes damaged felt the structures were not safe. One in 10 of those who feared their homes were not safe reported that they contained mold, mildew or bacteria. Another 6 percent say they were living without heat in the winter and air conditioning in the summer. Five percent were concerned by insects, rodents and snakes in their homes.

In a focus group, a woman from Dickinson said, “I had to stay in my home because I had nowhere to go. I had nowhere to go until it burned down while I was in it. … It was an electrical fire. I was living in mold.”

Sixteen percent of the people in Episcopal-Kaiser survey had a household member with a new health problem or one predating the storm that had gotten worse – including respiratory conditions, mental health, high blood pressure, heart problem or stroke or diabetes.

Such existing and new health problems can represent a major issue. In the wake of Harvey and the loss of electricity, pharmacies shut down. People who did not evacuate with their medications had to find them at shelters, clinics and hospitals. Those with life-threatening chronic conditions such as heart disease, cancer, diabetes and kidney failure needed help just to survive.

“Patients had to miss dialysis appointments, and that can have long-term effects,” said Dr. Asim Amir Shah, vice chair of psychiatry and behavioral health at Baylor College of Medicine and chief of psychiatry for Ben Taub Hospital/Harris Health System.

“Those people on dialysis and diabetics are more stressed by natural disasters. One of our big challenges after Harvey was getting people on dialysis. The other was finding their medications and insulin. In the future, we need to pay more attention and evacuate these people earlier or to prepare to care for people with dialysis in an emergency,” said Dr. Joann Schulte, chief physician at the Houston Health Department, who saw the problems first-hand at the shelter in the George R. Brown Convention Center.

Tragic videos of elderly people in high water at the Cypress Glen and Lake Arthur Place nursing homes in Port Arthur point to another problem in a mammoth storm like Harvey. Such facilities must have a disaster plan, including evacuation of residents. However, even though water inundated the facilities, their staff refused to evacuate until police handcuffed one administrator who was blocking the exodus. Both nursing homes were closed as a result of the situation.

Future storms

The chemical and biological stew of Harvey’s floodwaters presented a still unquantified threat in the wake of the storm. Leaking chemicals from toxic waste sites and pollution releases from refineries and chemical plants, including those during dramatic explosions and fires at the Arkema facility in Crosby, near Houston, all contributed to the contamination. The scope of health effects on people has not been determined, although researchers are looking at the issue.

Special silicone wristbands are a key ingredient in that measurement because they collect information about certain kinds of exposures to some environmental contaminants without testing or collecting samples from study participants. Researchers from Texas A&M University are using the wristbands to measure residents’ exposures near Manchester, a largely Hispanic, working-class neighborhood, which borders industries and other pollution sources beside the Houston Ship Channel. Baylor College of Medicine and Oregon State University are using them to monitor environmental exposures across the much larger area hit by Harvey.

The wristbands will be tested at two points, said Winifred Hamilton, director of the Environmental Health Center at Baylor. One round of testing has already taken place, she said, and the other will come soon. Researchers in Oregon developed a technique to evaluate the wristbands for residential exposures to 1,500 chemicals.

“The researcher (Dr. Kim Anderson) will be measuring at levels of parts per million and parts per billion,” said Hamilton. Melissa Bondy, an epidemiology specialist in the Baylor department of medicine is leading the study.

In a separate project, Drs. Joe Petrosino and Cheryl Walker at Baylor are looking at the effect of exposures on the microbiome – the collective genetic material of microbes that live inside and on the human body, totaling 10 times as many cells as are found in the body itself.

These studies will evaluate possible associations between flooding, chemical exposures and the composition of the microbiomes of study participants. Researchers are measuring chemical levels in fecal, cheek-swab and saliva samples. Hamilton oversaw the choice of neighborhoods in which such sampling took place and analyzed residents’ stress levels regarding flooding and their educational status.

These kinds of studies can be used to give people an estimate of their risks in future floods.

Other public health preparations prompted by Harvey include more vehicles to rescue people and expanded facilities in neighborhoods.

For example, Memorial Hermann Community Benefit Corporation is preparing to ready two temporary buildings with 11 exam rooms each to deliver services at two Houston-area locations. One will be operated as a satellite of San Jose Clinic, a charitable operation of the Catholic Archdiocese of Galveston-Houston. The other will be operated by AccessHealth, a non-profit community health center in Houston, said Carol Paret, CEO of the charitable Memorial Hermann group.

Houston-area health experts recognize that monitoring the emotional health of the community will also be important as climate change increases the danger of future storms.

In the future, “you are going to have more issues with water, food and acidification of oceans,” said the health department’s Schulte. “What people are seeing now with the weather is the first thing in a series of consequences. I am concerned that people don’t understand that, that they will be in response mode all the time, living crisis to crisis. We are dealing the issue of climate change.”

Such problems are harder on the poor, who lack the resources to recover, she said.

“We are seeing a pretty extensive change in the weather for individuals, cities and nations. At a minimum, people should be aware of the need for hurricane preparedness. They need to stockpile water, medicine and food and determine their coping strategy to get through it.”

The long-term wellbeing of the population is at risk because of hurricanes like Harvey, Schulte believes. “People take a less ambitious pathway. If your home is gone and it wasn’t adequately insured, what do you do? There is less money for your children and for their education.”

“Only 47 percent the people we surveyed were prepared for a future event” such as Harvey, said Shao-Chee Sim, an author of the Episcopal-Kaiser Health survey a year after Harvey. That meant preparing a disaster supply kit, a communication plan, physical changes to their homes or purchase of additional insurance. Urban areas such as Houston are preparing infrastructure to forestall future flooding.

Coming as Harvey did in the wake of other Houston-region inundations – Tropical Storm Allison (2001), the Memorial Day flood (2015) and the Tax Day flood (2016) – the inability of area cities and counties to respond to Harvey remains a concern and a worry.

The future of Houston and its neighbors depends on factors other than hurricanes themselves, said Elena M. Marks, chief of the Episcopal Health Foundation.

“I have told others when asked about resilience that we shouldn’t think of it in terms of (or because of) storms or other emergencies. You come through a storm/emergency better or worse depending on what your overall state of community health is before the storm/emergency,” she said.

“Poverty, racism, lack of social cohesion, poor housing quality, living in a low-tax/low-spend environment, etc. all predated Harvey and because of those conditions, some groups fared worse than others during and after the storm because of these factors, more than the storm itself.

“So rather than getting ready for another storm, we should be building the kinds of communities that are strong and able to weather (pun intended) whatever the next emergency is, storm or otherwise.”

Related: Health after Harvey: The lingering stress and distress of a major hurricane

+++++

Ruth SoRelle is a contributing editor of Texas Climate News.

Image credit: Baylor College of Medicine