‘Fevered: Why a Hotter Planet Will Hurt Our Health’
And how we can save ourselves
The following is an excerpt from Fevered by Linda Marsa, an investigative journalist and contributing editor at Discover who has covered medicine, health, and science for more than two decades.
Much has been written about the colossal failures of FEMA in the wake of Hurricane Katrina. It be would be comforting to think that what happened in New Orleans was an isolated episode, the result of a perfect storm of gross incompetence up and down the line, on the federal, state and local levels, that wouldn’t be repeated should a crisis of this enormity occur elsewhere. Clearly, there were catastrophic breakdowns in communications networks, initial fumbles by government officials that fueled perceptions of callous indifference and bumbling ineptitude, and bureaucratic screw-ups that stymied rescue efforts, which caused needless suffering and deaths. Indeed, a subsequent U.S. Senate report in April, 2006 concluded that FEMA was a complete shambles and the deeply rooted failings and waste at every level of the agency were “too substantial to mend.”
But the reality is the Hurricane Katrina rescue effort was the largest and fastest response of its kind in American history. From that perspective, what happened in New Orleans and the surrounding Gulf Coast communities is first and foremost a cautionary tale of the collapse of the public health system in the wake of a natural catastrophe. Despite the heroic efforts of health care professionals and the massive evacuation and rescue operation, many people simply refused to leave, the mostly indigent population that didn’t have the resources to go somewhere else were left in harm’s way, and there wasn’t an adequate plan for making sure hospital and nursing home patients were transported to safety. In addition, much of the medical infrastructure—hospitals, clinics, doctors’ offices, laboratories and other support facilities—was damaged, some of it beyond repair, and it was years before it was rebuilt. Given the similarities in the systems from city to city, just imagine the deleterious impact to the healthcare infrastructure if a calamity of the same magnitude struck Houston, Atlanta, Miami or other large population centers on the Atlantic and Gulf Coasts in the hurricane belt, or even cities vulnerable to storm surges during heavy rains as sea levels rise, like Los Angeles or San Diego.
In fact, one doesn’t have to imagine it. What happened in New York City when Hurricane Sandy hit the East Coast in October of 2012 is a case in point. Health care officials had seven years since Katrina to enforce preparations based on the lessons that presumably should have been learned from the earlier calamity. But events occurred that eerily echoed what happened in New Orleans and revealed the Achilles’ heel in many of the best laid disaster plans, especially at facilities in low lying flood prone areas. Backup generators failed at one of the nation’s premier hospitals, NYU Langone Medical Center, a sprawling complex in lower Manhattan near the East River, forcing the evacuation of all 215 patients to nearby facilities in the midst of gusting winds shortly after Sandy made landfall on Monday, October 29th. Several blocks away, at Bellevue, the nation’s oldest public hospital, the basement flooded and the hospital had to resort to backup power. By Tuesday, all 32 elevators at Bellevue had stopped working because of flooding and the National Guard was called in to help evacuate their 725 patients—a process that took nearly two days to complete. Receiving hospitals, like Mount Sinai Medical Center in northern Manhattan and Brooklyn’s Maimonides Medical Center, strained to care for the overflow and to treat deathly ill patients who arrived with scanty medical records.
Once the storm subsided, thousands of public health nurses, who themselves had trouble navigating in the city because of lack of public transit, power outages and traffic, were deployed throughout the city. But they struggled mightily to meet the needs of tens of thousands of chronically ill patients who depend on home medical care, yet were stranded in high rises with no heat, electricity, phone or elevator services. Even going a week without proper medication can be catastrophic for frail people suffering from diabetes, asthma, high blood pressure or other silent killers. In the aftermath, many of them will probably experience the same deprivations, challenges and heightened rates of serious complications and mortality as residents of New Orleans did for years afterwards.
Much of the city slowly shuddered back to some semblance of normalcy in the days following the storm, especially in Manhattan where power was restored to the lower half of the island within the week. But in some of the hardest hit communities, in densely populated places like Far Rockaway and Breezy Point, hundreds of homes were shattered, housing projects were left without running water or power, doctors were flooded out and pharmacies were closed. As a result, scores of sickly residents were left in perilous straits, cut off from their doctors and their access to medical care. In response, for the first time in its fabled 40-year history, Doctors Without Borders, the Nobel Peace Prize-winning charitable organization that parachutes volunteer armies of health care professionals into disaster zones like Haiti, Rwanda and Indonesia to deal with medical emergencies, set-up a clinic on American soil, in Far Rockaway, to care for all the people who slipped through the cracks of the governmental safety net.
Yet even two months later, hundreds of elderly and disabled New Yorkers who had been hastily evacuated from nursing homes or assisted living facilities located in seaside communities were still sleeping on cots in makeshift quarters without regular changes of clothes at hotels, halfway houses and overcrowded rehab, adult care and skilled nursing facilities all over the city. Many of these places were swollen to double their capacity to accommodate the temporary residents. “It feels like a MASH unit here right now,” one staff member told the Associated Press. “People are working incredibly hard. The circumstances could not be more dire, and people are getting the best possible care we can manage.”
While New York City’s overall emergency response to Sandy was impressive, a disaster of this magnitude illuminates the fissures and critical deficiencies in the public health system, especially for our most vulnerable citizens. But what happens when a hurricane the size of Katrina or Sandy isn’t just a once in a decade or even an annual event? When Category 5 storms rampage across the nation’s hurricane belt with a ferocious frequency that pushes our public health system beyond its limits?
Overall, the price tag for Katrina’s massive rescue and later recovery effort exceeded $200 billion, which doesn’t include the $80 billion in damages left in the storms wake. The bill for Sandy’s devastation is already well over $65 billion and the tab for reconstruction should easily surpass what was spent in New Orleans. Since 1980, in fact, the frequency of multibillion-dollar weather disasters has at least doubled, according to the U.S. National Climatic Data Center in Asheville, North Carolina. What would happen if there was nowhere to run? What if we had no other choice but to stand our ground when 200-mile-an-hour headwinds and driving rain from Category-5 storms were barreling in our direction? What if there was nothing left in the governmental kitty to pay platoons of military troops, fire fighters, police, and chopper pilots to whisk us and our loved ones to safety? What happens when tapped out insurance companies refuse to pay homeowners for their losses? Or Americans become worn out from disaster fatigue and there’s no national outpouring of money and resources to nurse a mortally wounded city back to life? “Katrina-like disasters could become commonplace along vast stretches of U.S. coastline in the not-so-distant future,” noted Mike Tidwell in The Ravaging Tide, which deals with the coming crisis in coastal cities as the planet warms. “And evacuating inland might not be an option, no matter how bad the storm, because extreme weather events in the heartland (drought, heat waves, forest fires) will remove the welcome mat. There simply won’t be the infrastructure and surplus resources needed to absorb the overflowing humanity.”
“We all lull ourselves into a sense of complacency assuming everything is being taken care of and think ‘if this went to hell in a hand basket, the federal government would rescue me in 24 hours,’” Dr. Peter Deblieux, the ER chief who was stranded for days at Charity Hospital in the aftermath of Katrina, told me one morning while we sat in the living room of his rebuilt woodsy craftsman style home on the edge of New Orleans’ City Park. “I thought that was reasonable but I’m living proof that doesn’t happen. I don’t have faith in the existence of a safety net from the federal government anymore. Five days into this and we still weren’t evacuated, and I’m the healthcare provider taking care of people in a hospital. That’s absurd in anybody’s book. Seventy-two hours is absurd. And this will occur somewhere else, whether it’s in Florida, or Alabama or Texas. It will happen again.”