Federal Officials Discuss Emerging Health Concerns, Disaster Response

In a Sept. 6 conference call, Mike Leavitt, secretary of the U.S. Department of Health and Human Services (HHS), Julie Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), and Vice Admiral Richard H. Carmona, MD, MPH, FACS, United States Surgeon General, detailed ongoing and planned efforts to address health concerns for the hurricane-ravaged Gulf Coast and displaced evacuees from the region.

After visiting major evacuation centers and shelters as well as affected communities in Louisiana and Mississippi, Leavitt noted a massive response with respect to healthcare, led mostly by local communities. I would judge it to have been strong and high quality, but, predictably, imperfect, he said. It has drained resources from local service providers, and they have responded in a remarkable way.

A decrease in the influx of patients will allow those in urgent need to be transferred to hospitals, and bring relief to healthcare workers. As the shelters now begin to see less intense traffic, the next wave of this will be for back-filling within those shelters, Leavitt continued. Weve identified 200 hospital organizations that have committed to move in to support the local hospital efforts so that the people who have left their stations at major hospitals to come run the shelters can return and catch their breath. Local hospitals that need similar relief will also be identified -- Leavitt mentioned Baton Rogue in particular, as that citys population has ballooned from 500,000 to 850,000.

Additionally, officials have established a plan for New Orleans to restore capacity for citizens as they return. There are over 1,000 hospital beds that are functional and operating in the New Orleans area, Leavitt said. I might also add we have about 8,000 professional volunteers -- professionally qualified volunteers that have called our 800 line and have indicated a willingness to go. Both the 200 hospital organizations and the 8,000 individual volunteers have been told that we will need them now in the second, third, and fourth waves, which will happen over the next several months as we work our way through this dilemma. Its become clear that the demand of several hundred thousand evacuees leaving the states of Louisiana and Mississippi for other states will put significant stress on the public medical capacity within major cities, and we actively pursuing strategies to bolster the community health clinics in those areas.

In terms of monitoring and dealing with potential public health issues posed by the perilous conditions in New Orleans, Leavitt noted the development of a joint task force that includes the CDC, the Environmental Protection Agency, the Defense Department, and the Department of Energy, along with the Louisiana and New Orleans public health officials. Our purpose of course is to make certain that we do not have outbreaks of disease or if there are circumstances where disease is reported, to respond in a robust and quick way, he explained. We have secured a command center at Kindred Hospital in New Orleans. They are on-site and they are working. Their task is to monitor public health in the New Orleans area and begin to make judgments as to when New Orleans is safe to re-inhabit.

Gerberding described the ongoing effort to prepare for the possibility of infectious diseases that could be spread under conditions of crowding in the shelters. There are several steps to that preparation; one is to anticipate it, because its not going to be surprising -- we see this any time people are crowded together. The second is to do an assessment of people when they arrive and screen out anyone who has an obvious infection, and thats very difficult to do when people are arriving unexpectedly in such large numbers, so we recognize that will be imperfect. The next step is to make sure that we have the personnel available to detect a problem and the laboratory support to diagnose it when it does emerge, and then the infection control methods in place to help organize people in such a way to minimize spread.

According to Gerberding, the key specific diseases of concern are those transmitted by the respiratory route, such as common colds or influenza (during flu season). The other category of infectious diseases is those that are transmitted by close contact, and any of the diarrheal diseases could certainly emerge in those environments and spread from person to person, she said. Its amazing what the shelters are doing about supplying hand-hygiene products and really helping people understand the importance of hand hygiene under the circumstances. But there is a lot more that can be done, and CDC had deployed already more than 140 people to help with these activities and we have at least eight more teams available at CDC to augment the shelter staff to help with infectious disease containment.

Gerberding noted that noro viruses can spread easily among populations in close quarters, such as those in shelters. They are so easily transmitted that it really requires almost perfection of personal hygiene to be completely safe, she said. Once these viruses get established among these populations you can expect some vomiting and diarrhea to occur. Usually this is not a serious disease or a life-threatening disease, but when you do have a vulnerable population or small children or the elderly who come in contact with any ordinary infectious virus, it can certainly lead to dehydration or more complications that would require acute-care intervention. That is what we are working hard to avoid.

Carmona pointed to the importance of many hospitals disaster planning efforts. One of the stories missing in the publics eye is the extraordinary response that has occurred. A lot of it is because of pre-existing hospital preparedness, he said. The Joint Commission now requires hospitals to have bonafide disaster lists and call-down lists. In fact, if you want to be certified as a hospital nationally, this has to be part of your strategic plan. So, I think that hospitals were prepared. They had those plans in place.

An objective that will become increasingly important in the weeks and months to come is the effort to see to the needs of hundreds of thousands of displaced citizens. Leavitt touched upon an immediate and massive undertaking in this respect to ensure that food, healthcare, mental health, education, unemployment, and other such pressing concerns can be addressed.