HURRICANE HARVEY: SUCCESSES, CHALLENGES ......•Successes, challenges, lessons learned Hurricane...
Transcript of HURRICANE HARVEY: SUCCESSES, CHALLENGES ......•Successes, challenges, lessons learned Hurricane...
HURRICANE HARVEY:
SUCCESSES, CHALLENGES, LESSONS LEARNED
Ana Zangeneh, MPHEpidemiology Surveillance Supervisor
Surveillance & Epidemiology UnitHarris County Public Health
The National Syndromic Surveillance Program (NSSP) Community of Practice Call
June 19th
Harris County and HCPH
• Harris County, TX:
• Third most populous county with over 4.7 million people
• Geographically spread over 1,778 square miles (size of Rhode
Island)
• Home to 4th largest city (Houston), world’s largest medical center,
and one of world’s busiest ports
• Harris County Public Health (HCPH):
• Local health department for Harris County with over 700 public
health professionals and over $100 million budget & growing
• Annually, see over 100,000 patients in 16 wellness clinics & WIC
sites, inspect 7,500 food establishments, house 25,000 animals in
our shelter
• Serve unincorporated Harris County outside of City of Houston.
Provide refugee health screening, mosquito control, Ryan White
HIV/AIDS funding for entire community, including City of
Houston
Outline
• Hurricane Harvey background
• HCPH post-Harvey surveillance activities• Functional needs medical refuge (FNMR)
• Community shelter surveillance
• NRG mega-shelter surveillance
• Hospital surveillance
• Enhanced communicable disease surveillance
• Successes, challenges, lessons learned
Hurricane Harvey
• Stalls over Texas
• Extremely slow moving from August 26th – 30th
• Over 30,000 residents displaced88 deaths in Texas
• Record flooding of at least 18 inches in 70% of Harris County
Functional Needs Medical Refuge (FNMR)
• Provides care to those who require minor or continuous medical care beyond what a general shelter can provide
• Took in displaced residents with medical conditions• Hospital discharges
• Nursing homes
• Staffed with medical providers
• Open August 29th – September 2nd
Community Shelter Surveillance
• 53 community shelters identified in HCPH jurisdiction
• Utilized modified CDC shelter assessment form
• Monitored once a day in person or by phone• Shelter census
• Any illnesses/symptoms of concern
• Hospitalizations/ER visits
• Any supplies/medications needed
• EPH inspections
• Requests for supplies sent to OEM
NRG Shelter Surveillance and Response - Public Health Objectives
• Monitor health status and identify needs
• Identify infectious diseases/outbreaks,
implement control measures
• Identify severe exacerbation of chronic
conditions, mental health issues, and
provide interventions
• Timely dissemination of health alerts and services available to shelter residents
• Information sharing between HCPH and partners
• Apply One Health concept to achieve a holistic approach to public health surveillance
Hospital Surveillance
• Hospital ICPs were contacted to monitor for diseases potentially related to the hurricane/flood• Increase in diarrheal illnesses
• Injuries and insect/animal bites
• Giardia and leptospirosis (not reportable)
• Carbon monoxide
• Syndromic surveillance of hospitals (HDHHS data)• Increase in several areas compared to the week prior to the hurricane
• Rashes, GI symptoms, respiratory symptoms
• Observations were lower than same time period in 2016
Hospital Surveillance
• Syndromic surveillance, HCPH jurisdiction
• Gastrointestinal (GI) symptoms
• Syndromic surveillance, HCPH jurisdiction
• Respiratory symptoms
• Syndromic surveillance, HCPH jurisdiction
• Rash symptom
Still had regular reportable disease investigations to do
• Parasitic infections• Trichinosis
• Tapeworm
• Rabies
• Necrotizing fasciitis
Enhanced Community Disease Surveillance
• Waterborne diseases• Cryptosporidiosis
• Free-living amoeba
• Shigella
• STEC
• Campylobacter
• Norovirus (not reportable)
• Vector-borne disease• Arbovirus (WNV, SLE, Zika)
Successes
• Timely identification and isolation of patients with ILI and GI illnesses
• No widespread outbreaks of communicable diseases during the long operation
• Exacerbation of chronic conditions and mental health issues were intervened immediately
• Additional specimens were collected by HCPH epidemiology team to confirm suspected diagnosis
• The mobile survey tool allowed for flexibility to easily modify questions concerning health conditions and residents’ needs each day
SuccessesOne Health concept
• Surveillance and response team• Epidemiologists
• Environmental sanitarians
• Veterinarians
• Communication specialists
• Epidemiology surveillance• Infectious diseases and outbreaks
• Exacerbated chronic conditions and mental health issues
• Insect and animal bites
• Control measures and interventions to prevent further spread of illness
• Environmental surveillance• Assessment of environmental risks
• Coordinated hygiene efforts• Hand sanitizers throughout NRG shelter
• Proper trash can placement
• Frequent cleaning of common areas (bathrooms, eating areas)
• Education to residents
• Veterinary surveillance• On-site animal shelter
• Routine assessment to ensure pets were vaccinated prior to entry in sleeping/dormitory areas
• Proposal to separate residents with pets from residents without pets
SuccessesOne Health concept
Challenges
• Number of surveyors changed daily depending on the availability of staff and volunteers
• Simultaneous management of multiple surveillance activities within the community
• Lack of predesigned mobile survey tool (development on-site)
• Relatively new staff without sufficient disaster response experience
• Shortage of epidemiologists
• Personal hurricane-related losses experienced by HCPH staff
Lessons Learned
• Coordination between external partners and internal departments
• Partner with other jurisdictions to develop survey tool
• Survey tool too long at first
• JITT too long and occurred every day
• Strong connectivity/good power supply
• Concern for staff/volunteers interviewing potentially contagious residents without PPE
• Safety of volunteers/staff (leaving late at night, etc.)
• FNMR training for all staff
• Mindful of staff shifts; physical and mental state of health
Sustainability should not be an afterthought, but rather incorporated into emergency response plan