Three months have passed since Hurricane Sandy hit the East Coast. And while the number of people displaced by the storm has gone down from tens of thousands to the hundreds in different communities, some people are still without power or a permanent place to live. Others face the daunting task of rebuilding businesses and homes while protecting against mold and dust, which can cause or exacerbate respiratory problems. For many, the stress has rekindled mental health issues that might have been at bay, or created new ones or just made tough times even worse.

NewPublicHealth spoke with Patricia Yang, DrPH, Chief Operating Officer and Executive Deputy Commissioner at the New York City Department of Health and Mental Hygiene.

NewPublicHealth: Hurricane Sandy hit just over two months ago. How’s the city doing now?

Dr. Yang: There are people in parts of the city for whom the storm is a distant memory, and their daily lives are virtually unaffected apart from what they might hear on the news or read in the papers. But in the areas that were most directly affected by the hurricane, life for many is far from normal and may never return to what it was pre-storm. Those areas in particular are parts of the Rockaways and Coney Island and Staten Island. So there are still thousands of people who don’t have basic utilities and for whom grid power and heat have not returned. And we’re heading into the coldest winter months.

NPH: What’s the role of the public health department both now to help people deal with the aftermath, and looking ahead to prepare for the next disaster?

Just several weeks after Hurricane Sandy hit the New York City area, New York State Governor Andrew Cuomo appointed Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health, to co-chair the New York State Ready Commission. The role of the Commission is to determine ways to ensure that critical systems and services are in place to respond to future natural disasters and other emergencies.

The specific areas for which the commission was asked to make recommendations include:

• Addressing vulnerabilities in the state’s health care, energy, transportation, communications and other systems
• Ensuring that new, modified and existing construction is resilient
• Ensuring the availability of adequate equipment, fuel, food, water and other emergency supplies
• Ensuring that first responders and other critical personnel are able to communicate efficiently and have access to adequate resources
• Ensuring the availability of reliable real-time information for decision-makers
• Ensuring that lines of authority are clear and officials have the authority to react rapidly to emergency situations

Both the Ready Commission and the 2100 Commission, which was tasked with finding ways to improve the resilience and strength of the state’s infrastructure in the face of natural disasters and other emergencies, submitted their reports to the governor earlier this week. Recommendations of the Ready Commission included:

• Create a statewide network of unified emergency training, coordination, protocols and communication
• Update the New York State Building Code
• Expand use of Vulnerable Populations Databases so first responders; outreach workers; and health care and human services personnel can find and serve those who may need assistance
• Require that gas stations in strategic locations have access to onsite back-up power capacity

NewPublicHealth spoke with Dr. Redlener about the Commission and the storm’s impact on New York residents.

>>Read about the 2012 edition of its Ready or Not? report from Trust for America’s Health, which looks at strengths and vulnerabilities in each state’s emergency preparedness status.

NewPublicHealth: You were appointed to co-chair the Ready Commission by Governor Cuomo in November. What is the specific focus of the Commission?

Redlener: What we are going to do is assess the current resilience of the city in terms of its preparedness efforts. Are we ready? Are we prepared? What are the missing elements right now in trying to make us more prepared for the next events than we were for this one? Some of this is not all that complicated and unfortunately these are problems that we have seen in prior disasters. Some of the things that we are seeing here were basically exactly what we saw in the Gulf and in New Orleans after Katrina. It isn’t like we haven’t been thinking about these things. I think that is why we were able to provide some reasonable recommendations, because these are not altogether new problems or challenges.

NPH: How strong is disaster preparedness training at schools of public health and within governmental public health?

Preparing for disasters like Hurricane Sandy is critical, even more so because of the massive devastation this storm has brought to Staten Island, New York, where hundreds are still without power, and thousands must rebuild their homes and businesses. Thanks to some critical partnerships that have developed among non-profits and businesses in Staten Island in the last few years, some vital relationships that help to facilitate rapid response were already in place when the super storm hit.

NewPublicHealth spoke with David Sorkin, executive director of the Jewish Community Center of Staten Island, who is a also a founding board member and past president of the Staten Island Not-For-Profit Association and former chairman of the Staten Island Economic Development Corporation Business Council.

NewPublicHealth: How did prior relationships help you serve the community when the hurricane hit?

David Sorkin: The Staten Island Not-For-Profit Association is a collective of about 150 not-for-profits on Staten Island who have been networking, training, and learning together over the past four or five years. We already had relationships and interconnections, which allowed us all to react very, very quickly to issues and concerns as well as emergencies because we have emergencies almost every day, though different from a super storm.

A “normal” emergency not related to a storm is when we have a family or an individual who’s in crisis and needs a variety of support such as economic, legal, financial, counseling or a combination of all of them. So, we work together on a regular basis. The other avenue we work through is the Staten Island Economic Development Corporation, which is a coalition of businesses on Staten Island. Because we’re a part of that, I was able to access quality services from businesses and corporations on Staten Island with good relationships already built in. So, I don’t have to worry about vetting these companies and organizations during an emergency and I know that they can come to our assistance very, very quickly.

As the year draws to a close, the most recent installment of the NewPublicHealth series on the National Prevention Strategy is especially appropriate. We spoke with Wendy Spencer, the CEO of the Corporation for National and Community Service (CNCS), a federal agency that engages more than 5 million Americans in volunteer community service. The mission of CNCS is to improve lives, strengthen communities, and foster civic engagement through service and volunteering.

 Guiding principles of CNCS that help promote the National Prevention Strategy include:

• Put the needs of local communities first
• Strengthen public-private partnerships
• Use programs to build stronger, more efficient, and more sustainable community networks capable of mobilizing volunteers to address local needs, including disaster preparedness and response
• Build collaborations wherever possible across programs and with other federal programs
• Help rural and economically distressed communities obtain access to public and private resources
• Support diverse organizations, including faith-based and other community organizations

During Hurricane Sandy, which struck the East Coast in late October, close to 900 national service members were deployed to states affected by the storm, and nearly 900 more were on standby. National service members assisted with shelter operations, call centers, debris removal, and mass care. “Before the recovery is complete,” said Wendy Spencer, “we expect thousands of national service members from AmeriCorps and Senior Corps programs to help families and local and state officials rebuild these communities.”

For its Hurricane Sandy response effort, CNCS coordinated with the Federal Management Agency (FEMA), National Voluntary Organizations Active in Disaster, the American Red Cross and state and local authorities.

NewPublicHealth recently spoke with Wendy Spencer, the CEO of CNCS, Asim Mishra, the agency’s chief of staff and Erwin Tan, MD, the CNCS designee on the National Prevention Council and Director of Senior Corps and Strategic Advisor for Veterans and Military Families.

NewPublicHealth: What is the mission of the Corporation for National and Community Service (CNCS)?

APHA Supports Measures to Protect Against Gun Violence
The American Public Health Association (APHA) has expressed its strong support for action to protect our nation’s children and their families from the growing epidemic of gun violence. “Gun violence is one of the leading causes of preventable death in our country and we must take a comprehensive public health approach to addressing this growing crisis,” said APHA Executive Director Georges Benjamin, MD. “For too long, we as a nation have failed to take on this devastating problem in our communities, and we can wait no longer.” Key steps recommended by the APHA include:

• Adopting common sense gun control legislation (such as reinstating the federal ban on assault weapons and high-capacity magazines) and closing the “gun show loophole,” which exempts private sellers of firearms from conducting criminal background checks on buyers at gun shows.
• Expanding the collection and analysis of data related to gun violence and other violent deaths to better understand the causes and allow authorities to develop appropriate interventions to prevent such violence.
• Ensuring adequate funding for critical mental health services.

Read more on violence.

FDA Expands Use of Flu Drug for Kids Younger than 1 Year
The U.S. Food and Drug Administration (FDA) has expanded the approved use of Tamiiflu, a key drug used to treat influenza, for children as young as two weeks who have had flu symptoms for no longer than two days. Eight babies have already died of flu this season, so having an approved treatment is critical. Tamiflu was first approved in 1999 to treat adults. Its approved use was later expanded to treat children a year old and older as well as to prevent the flu in adults and in children a year old and older. The new approval is for treatment only, not for prevention of the flu. Vaccination with flu vaccine begins at six months of age, according to the CDC. Read more on flu.

HUD Awards $26M to Convert Apartments to Assisted Living or Enhanced Service Senior Housing
The U.S. Department of Housing and Urban Development (HUD) has awarded $26 million in grants to the owners of multi-family housing developments in nine states to convert some or all of their apartments into assisted living or service-enriched environments for elderly residents. The funding is provided through HUD’s Assisted Living Conversion Program, which helps convert apartments into units that can accommodate the special needs of seniors who want to “age in place.” “We’re getting older as a nation and with that demographic shift, there is a growing demand for affordable housing that will allow our seniors to live independently in their own homes,” said Carol Galante, HUD’s Assistant Secretary for Housing and Federal Housing Commissioner. Read more on aging.

University of North Carolina Researchers Receive Grant to Develop Post-Disaster Recovery Benchmarks
Two University of North Carolina (UNC) researchers have received a U.S. Department of Homeland Security Grant to develop indicators of effectiveness for post-disaster recovery efforts. "This project is particularly important because it focuses on giving practitioners at the federal, state, and local levels the tools they need to measure how well a community is recovering from a disaster," said Jennifer Horney, PHD, research assistant professor of epidemiology and director of the UNC Center for Public Health Preparedness at the University of North Carolina at Chapel Hill Gillings School of Global Public Health. The grant will be administered by the Coastal Hazards Center of Excellence at UNC. Read more on Hurricane Sandy.

As we end the year and head into 2013, NewPublicHealth spoke with U.S. Centers for Disease Control and Prevention director Thomas Frieden, MD, MPH, about public health in 2012—and what’s ahead for 2013.

NewPublicHealth: What were the high points for public health in 2012?

Dr. Thomas Frieden: Two really stand out. First, public health got even better at finding outbreaks quickly and stopping them. We saw that with Listeria, E. Coli, Salmonella and with the fungal meningitis outbreak. That is important because we are seeing that there are an ever-increasing number of ways that outbreaks can start and spread and we need to be on our guard. The second highlight that comes to mind immediately was the Tips from Former Smokers Campaign. This is the first-ever federally funded national anti-tobacco campaign and it was a stunning success. We had very ambitious goals for it. We hoped that half a million people would try to quit and at least 50,000 people would succeed for good. Based on calls to quitlines—and we will know more in the next few months—it looks like the campaign probably had at least twice that impact. This is a campaign that will have saved tens of thousands of lives and probably paid for itself in pretty short order in terms of reduced medical and societal expenses. It shows that when you invest in tobacco control you can make a big difference and save a lot of lives.

NPH: And your hopes for public health in 2013?

Frieden: There are a lot of things that are important and we can make progress on in the coming year. First is to be safer from threats whether they are from this country or abroad, and public health works 24/7 to keep us safe both at the federal level as well as the state and local level. We do have challenges, though, in terms of the fiscal climate that we are in, and we need to ensure that we have the resources needed to keep Americans safe from threats.

The Trust for America’s Health (TFAH) has released the 2012 edition of its Ready or Not? report. The annual report details and analyzes state and federal public health preparedness. This year’s entry focuses on emergency preparedness, looking at 10 indicators that help reveal the strengths and vulnerabilities in each state’s emergency preparedness status. TFAH’s hope is that policymakers, taxpayers and other groups can utilize the data to shore up their programs and policies—and help ensure they are ready to support public health in the event of a natural disaster or other emergency.

Among the key findings:

• 29 states cut funding for public health from FY 2010-11 to FY 2011-12
• 35 states and Washington, D.C. do not currently have climate change adaptation plans, which include planning for the health threats posed by extreme weather events
• 21 states have not been accredited by the Emergency Management Accreditation Program (EMAP)
• 13 state public health laboratories report they do not have sufficient capacity to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A H1N1

This emphasis on analyzing emergency preparedness is especially meaningful now, with many in the Northeast still working to recover from the devastation of Hurricane Sandy. NewPublicHealth had been closely following public health’s role in responding to and recovering from Hurricane Sandy, and will continue to take an in-depth look at how this disaster continues to affect public health.

Here’s a look at some of the many ways NewPublicHealth has covered the intersection of public health and emergency preparedness:

Hurricane Sandy Recovery: New Jersey’s Health Commissioner Helms Response Roundtable
Just two weeks after Hurricane Sandy hit, the State of New Jersey held a Response Roundtable at the Jersey Shore University Medical Center in Neptune Township, N.J., to begin a review of the health department’s response to the storm. The site was an appropriate one: in the first few days of the Sandy, the medical center’s emergency room treated close to 2,000 patients with storm-related medical and mental health emergencies. A key roundtable participant was Nicole Lurie, the U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response. Leading the discussion was New Jersey’s Health Commissioner Mary E. O'Dowd.

Rickshaw Dumplings and Frites ‘n’ Meats might not sound like disaster response teams at first. But in a way, they are. The growing urban trend of food trucks—self-powered mobile kitchens that change locations frequently and tweet out each new sidewalk address—have been the solution for many New Yorkers in need of hot meals since Hurricane Sandy. And with more than 10,000 people still without power, many “cool” hot meals continue.

As of last week, about 230,000 meals had been served, most paid for by the Mayor’s Office and corporate contributions.

Equally trendy is a vacation stay in a rented room in a house, instead of a hotel. One site, AirBNB, which matches rentees and renters, has become a resource embraced by the Mayor’s Office. The post-Sandy twist is that the rooms are offered by their landlords at no cost to those in need of shelter. Checklists for all parties help create safe stays.

And customized disaster software, for a fee, is another way communities are bouncing back. Recovers.org was founded by two women after a tornado hit their hometown in Massachusetts. The software creates options for users that let people ask for help, donate help and see real-time information via Twitter feeds about what’s happening in their area. Several communities hard hit by Sandy—including Manhattan’s Lower East Side, Brooklyn’s Red Hook neighborhood and Hoboken, N.J.—have deployed the software.

HUD Adjusts Rent Rules to Help Families Affected by Sandy
The U.S. Department of Housing and Urban Development (HUD) is allowing public housing agencies to change the way they calculate rent in order to help families displaced by Hurricane Sandy. The changes to how payments related to “Fair Market Rent” are designed to give families more options. “We understand that in the wake of a disaster like Sandy, available rental housing becomes increasingly difficult to find, especially for lower income families,” said HUD Secretary Shaun Donovan in a release.  “Simply by giving local housing authorities greater flexibility in calculating rental assistance to these families can make all the difference in finding a suitable home or not.” Read more on Hurricane Sandy.

Study: Racial Disparities Show Need to Improve Guidelines on Treating Breast Cancer
Black women are 12 percent less likely than white women to undergo improved, less-invasive surgical procedures to treat breast cancer, according to findings to be presented at the San Antonio Breast Cancer Symposium. The treatments include sentinel lymph node biopsy, which targets and removes the lymph node that is likely to be affected by the cancer cells next. "These findings are an example of the need for continued improvements in disseminating national practice guidelines for breast cancer to surgeons and other breast cancer providers in all of our communities," said Dalliah Mashon Black, an assistant professor of surgery in the department of surgical oncology at the University of Texas M.D. Anderson Cancer Center in Houston, in a release. "When we think of disparities, it doesn't only mean that patients might be undertreated, but they could be overtreated with unnecessary and more radical procedures.” Read more on cancer.

FDA in Public-Private Partnership to Advance Regulatory Science
The new Medical Device Innovation Consortium (MDIC)—an independent, nonprofit corporation—will include the U.S. Food and Drug Administration as part of its public-private partnership to advance regulatory science. The goal is to improve patient care by speeding up the development and approval of new medical devices. MDIC was created by the biomedical science trade association LifeScience Alley. “By sharing and leveraging resources, MDIC may help industry to be better equipped to bring safe and effective medical devices to market more quickly and at a lower cost,” said Jeffrey Shuren, MD, JD, director of the FDA’s Center for Devices and Radiological Health, in a release. Read more on access to health care.

Though temperatures early this week in New York City have climbed to nearly 60 degrees, by Wednesday the overnight low is expected to drop below freezing. That’s why the city’s health department has issued a hypothermia warning to people in homes still without heat. As of last week, according to the Mayor’s Office, 11,000 people in the region still had not had their power restored. Some families have power but still no heat because pipes damaged by the storm have not yet been fixed.

“The weather is getting colder,” Health Commissioner Thomas Farley, MD, MPH, told New Yorkers. “Living in cold buildings is not good for your health. If your building heat is not going to be restored very soon, look for another warm place to live until it is. And check on your family, friends and neighbors, especially those who are vulnerable, to see if they need help getting to a warm place. Hypothermia, or very low body temperature is a life-threatening condition. It occurs when your body loses heat faster than it can produce it. Hypothermia can happen gradually and without the person realizing how serious it is.”

According to Farley, the symptoms of hypothermia include uncontrollable shivering, weakness, sleepiness, confusion, and lack of coordination. In infants, signs of hypothermia may include cold, bright red skin, or very low energy. A body temperature below 95°F (35°C) is a medical emergency and 911 should be called immediately.