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DISASTER
RECOVERY

people with immunocompromising conditions such as HIV/AIDS,
or contagious infections like tuberculosis (MTB) or chicken pox. Pa-
tients with stigmatizing diseases are reluctant to self-identify when
confidentiality is compromised by a chaotic environment. Because
interruption of treatment for either HIV or MTB can lead to drug
resistant organisms and subsequent public health consequences,
every effort should be made to provide patients with a modicum of
privacy despite the environmental upheaval. Extra efforts are neces-
sary to assure non-interruption of treatment for patients with HIV
and/or MTB, including help from state and local health authorities.
According to the Centers for Disease Control (CDC), one month
after Hurricane Katrina, only 71 percent of known TB patients
from Louisiana had been located, though most were believed to
have been non-contagious at the time of evacuation (MMWR Sept
30, 2005. Vol 54(38);961-964). Interruption of HIV care for the dis-
placed of New Orleans was problematic in the early days after the
hurricane, as many reported taking a subset of medications every
other day, trying to make them last as long as possible before seeking
refills in an unfamiliar city (New England Journal of Medicine
2006;354, 1549-22). Post-Katrina follow up studies have observed
that “the change in CD4 counts of non-returning evacuees dropped
more sharply than those of the returning [persons living with
HIV/AIDS] PLWH/A or non-residents. …results [which] … pro-
vide important data on the effect that large-scale disasters and
stressful life events may have on individuals with chronic disease.”
While CDC and health officials play primary roles in tracking pop-
Short term challenges: ulations with chronic infectious diseases, alert first responders can
1. Medicine reconciliation, and identification of immuno- greatly enhance outcomes with careful history-taking, and respectful
compromised hosts in an environment of confidentiality: attitudes. In the immediate disaster aftermath, public health infra-
When a volunteer doctor arrives at a shelter to care for displaced structure is often disrupted, which necessitates non-standard mech-
people, the first order of business is situational assessment, emer- anisms for disease reporting. In post-Katrina New Orleans, the
gency triage, and first-responder mobilization. Triage of the criti- CDC sent officers to meet weekly with first responders. Non-stan-
cally injured is usually addressed by pre-shelter emergency dard mechanisms were the only means of reporting disease trends
personnel. My observations on short-term challenges pertain to for months, illustrating the critical value of local health professionals
evacuees seeking medical attention in short-term shelters. Nearly 7 who volunteered for the recovery effort.
in 10 American adults take a prescription medication, with 20 per-
cent using five or more of these (Mayo Clinic Proceedings 2013, 2. Infectious Disease Threats for evacuees and
Vol 88(7);697-707). When they show up in a shelter, evacuees almost rescue workers:
never have their pills with them, nor do they recall dosages. Some In the early aftermath of a flood, water, sanitation and hygiene
patients will have been precipitously discharged from medical facil- limitations are problematic. Access to flush toilets and potable water
ities in anticipation of evacuation orders, and will present with con- is limited (New Engl J Med 2005. Vol.353;1550-1), and flooding in-
fusion and anxiety about care plans. A majority of U.S. disaster creases the risk of waterborne pathogens. Skin and soft tissue in-
evacuees need prescriptions renewed, replaced, or re-explained. Es- juries become easily infected when submerged in contaminated
pecially helpful to me in Texas were H-E-B pharmacists who pro- floodwater (Am J Clin Dermatol. 2015 Oct;16(5):399-424); a Dallas
vided immediate information from prescription records, facilitating evacuation facility after Hurricane Katrina reported a cluster of 30
accurate and prompt prescription renewals. patients with Methicillin-resistant Staphylococcus aureus (MRSA)
In shelters for disaster victims, it is especially important to spot skin/soft tissue infection; there were 24 cases of hurricane Katrina-
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