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.

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.

A new Census Bureau tool, OnTheMap for Emergency Management, was created to help prepare communities for an emergency. The tool provides information about the potential affected population size and characteristics of the people, such as age, occupation, and place of residence.  In an event like Hurricane Sandy, the tool was able to trace the path of the hurricane and update data predictions of potential impacts as the storm's path changed. Communities can use these statistics to know how many people live and work in an area where there is a disaster. Knowing these numbers and related demographics helps communities set aside resources and identify vulnerable populations that will need additional assistance, such as the elderly or disabled.

>>Read more about the OnTheMap for Emergency Management tool.

Concerned by reports that volunteers and New Jersey residents are frequently unaware of environmental dangers when cleaning up homes and communities, the New Jersey Department of Health released an advisory earlier this week with advice on staying safe while scrubbing and rehabbing. Mold and materials containing asbestos and lead-based paint are examples of potential hazards in storm-damaged buildings and the advisory urged those tackling the heavy jobs to wear protective equipment appropriate for the work they are doing such as waterproof boots, gloves, goggles, and face masks.

"Homeowners doing cleanup work and the volunteers assisting them are critical assets in New Jersey's recovery efforts, but making sure they protect themselves is equally important," said New Jersey Health Commissioner Mary O'Dowd.

NewPublicHeatlh recently spoke about Hurricane Sandy clean-up safety with Donna Leusner, director of communications for the New Jersey Department of Health; Tina Tan, MD, state epidemiologist and assistant commissioner for epidemiology, environmental and occupational health and Joe Eldridge, director of New Jersey’s Consumer, Environmental and Occupational Health Service.

NewPublicHealth: What kind of environmental concerns specifically are there for those cleaning up the community after the storm?

Dr. Tan: There are concerns about individuals coming into contact with contaminated materials, whether contaminated with chemicals or infectious agents—residuals from flood waters as well as the general debris that might be around. We encourage individuals to take the appropriate precautions to try to avoid any sort of injuries or potential illnesses that could result from contact with these contaminated materials.

NPH: Are people aware of the critical basic information for safe cleanup, such as getting a tetanus shot if they’re injured during the cleanup in such terrible conditions? 

Last Friday Governor Chris Christie of New Jersey released an estimate of the economic losses caused by Superstorm Sandy— close to $30 billion. That estimate includes the devastating loss of homes and businesses for tens of thousands of individuals, damage to transportation and utilities infrastructure, and impact on local tourism. The economic consequences are critical, but the hurricane also posed a blow to the mental and physical health of many as well. Throughout the New York and New Jersey area, mobile health clinics remain in place, operated by the local and state health departments to help provide care for people displaced from their homes, neighborhoods and regular medical care.

Recovery continues. Today, for example, additional route sections of the PATH commuter rail service, which connects tens of thousands of New Jersey residents to their jobs in New York City, reopened.

And many states, even as they continue to send aid through funds and manpower to the affected areas, are trying to shore up their own communities against storms and other natural disasters yet to come. In an editorial this weekend, the Boston Globe asked whether the city of Boston will be able to respond and adapt quickly in the event of such a devastating storm. “The short answer is: Not yet, but there’s still time to get it right.”

Getting it right is the focus of the Public Health Preparedness Summit sponsored each year by key organizations including the Association of State and Territorial Health Officers, the National Association of County and City Health Officials and the Centers for Disease Control and Prevention, to be held in Atlanta March 13 to March 15.

Follow NewPublicHealth for stories on health department recovery and resilience efforts in the wake of Hurricane Sandy.

>>Read the Boston Globe editorial.

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.

Critical responses by the health department have included:

• A Department of Health hotline, opened within days of the storm, and staffed with public health experts who answer questions on mold cleanup, food safety, and drinking water concerns. The public can reach the hotline either through the state's 2-1-1 system or by calling 1-866-234-0964. 
• The New Jersey Department of Mental Health and Addiction Services is coordinating statewide efforts to help individuals and communities manage the emotional impact of the storm, and offers assistance through a toll-free Disaster Mental Health Helpline: 1-877-294-HELP (4357); a TTY line is available for persons who are deaf and hearing impaired at 1-877-294-4356.
• The New Jersey Medical Reserve Corps (NJMRC) program is comprised of health care professionals and community health volunteers from across the state. "In the aftermath of Hurricane Sandy, the Department has received many inquiries from people looking to volunteer in New Jersey's response and recovery efforts," says O'Dowd. Every county is the state has at least one MRC unit, and all 25 NJMRC units have been active during the response and recovery efforts, according to O’Dowd. Volunteers have been serving at shelters across the state, have helped staff hotlines and have distributed food and water in local communities. New Jersey was the first state to have an MRC in every county. 
• The U.S. Department of Health and Human Services (HHS) approved the New Jersey health department’s request to ensure access to prescription medications to uninsured residents affected by the storm through its Emergency Prescription Assistance Program.  The program provides access, at any enrolled pharmacy, to necessary prescription drugs and some medical equipment for individuals in a federally-identified disaster area who don’t have health insurance.
• The Department has also assisted local and county health departments who were impacted by the storm. Many health department offices and facilities faced flooding, power outages, water shortages, wastewater concerns and communication difficulties. The state health department’s field staff has assisted with, among other issues, shelter and retail food inspections, in the weeks after the storm. 

As the recovery efforts continue in the aftermath of Hurricane Sandy, NewPublicHealth is following the work of local and state health departments in the areas affected by the storm as they help their citizens regroup, recover and build community resilience. Read more on public health preparedness and response.

Three weeks after the storm the New York City Health Department has meaningful storm-related health use data that is valuable for both current health services delivery and future disaster planning:

• Emergency room visits for both mental and physical health concerns in New York City dropped on the day of the storm but have now returned to typical levels.  
• There was a brief increase in cases of hypothermia immediately after the storm but no sustained increase since then.  
• There is a continuing modest increase in visits for prescription medicine refills.
• There has not been an increase in injuries or illnesses overall.  
• There has been a modest increase in asthma emergencies in the Rockaway section of New York, which was especially hard hit by flooding and storm debris during the period immediately following the storm, but rates seem to have returned to baseline. According to the health department, the increases likely were caused by people living in cold temperatures, using their stoves to heat their homes, dust from storm clean-up and reduced access to prescription medication for some people during the first days of the storm.  

Among the impacts of the East Coast’s Hurricane Sandy have been tens of thousands of uprooted trees, contaminated water and tons of compromised food. A recent article in the Journal of Environmental Health Natural recommends that environmental health become an integral part of emergency preparedness and that community stakeholders take a role in merging the two.

David Dyjack, DrPH, associate executive director of the National Association of County and City Health Officials, and a co-author of the study, spoke with NewPublicHealth about building momentum to include environmental health in disaster emergency preparedness.

NewPublicHealth: What does the article address?

David Dyjack: The article is the first step in a series of research steps looking at how best to integrate environmental health and emergency preparedness so that communities are more resilient and take greater responsibility for their own health and safety in the event of an environmental disaster.

NPH: What is distinct about environmental health emergency preparedness?