Short-term health impact assessment after Irma in French islands

Abstract

ObjectiveDescribe short-term health effects of the Hurricane using the syndromic surveillance system based on emergency departments, general practitioners and dispensaries in Saint-Martin and Saint-Barthélemy islands from September 11, 2017 to October 29, 2017.IntroductionIn Saint-Martin (31 949 inhabitants) and Saint-Barthélemy (9 625 inhabitants) islands in the French West Indies, the surveillance system is based on several data sources: (1) a syndromic surveillance system based on two emergency departments (ED) of Saint-Barthélemy (HL de Bruyn) and Saint-Martin (CH Fleming) and on mortality (SurSaUD® network [1])); (2) a network of sentinel general practitioners (GP’s) based on the voluntary participation of 10 GPs in Saint-Martin and 5 in Saint-Barthélemy; (3) the notifiable diseases surveillance system (31 notifiable diseases to individual case-specific form); (4) the regional surveillance systems of leptospirosis and arboviruses based on the biological cases reported by physicians and laboratories of two islands.On September 6, 2017, Hurricane Irma struck Saint-Martin and Saint-Barthélemy islands. Both islands were massively destroyed. This storm led to major material damages, such as power outages, disturbance of drinking water systems, road closures, destruction of medical structures and evacuation or relocation of residents.In this context, the usual monitoring system did not work and life conditions were difficult. The regional unit of French National Public Health Agency set up an epidemiological surveillance by sending epidemiologists in the field in order to collect data directly from ED physicians, GP’s and in dispensaries. Those data allowed to describe short-term health effects and to detect potential disease outbreaks in the aftermath of Hurricane Irma. This paper presents results of the specific syndromic surveillance.MethodsBefore Irma, ED data were collected daily directly from patients’ computerized medical files that were filled in during medical consultations at ED. Among the collected variables, the diagnosis was categorized according to the 10th revision of the International Classification of Diseases (ICD-10). This surveillance system was completed by aggregated data of Emergency Medical Services (EMS), also including medical diagnosis coded using the ICD10.Because of the sudden disruption in hospital departments due to hurricane, electronic transmission was stopped. To replace it, ED data collection turned temporary into paper-forms and several epidemiologists were sent in Saint-Martin and Saint-Barthélemy to collect data directly from the ED physicians. This system remained until the end of October when connections and data transmission were restored.Because of destruction of medical structures, dispensaries were opened in different strategic areas of the island, 3 in Saint-Martin and none in Saint-Barthélemy. General practitioners have progressively reopened their practice (8 GP’s in Saint-Martin and 5 in Saint-Barthélemy) and patient's data were collected and integrated into the surveillance system.Based on a literature review and former experience, the main pathologies identified for the health risk assessment were: (1) somatic pathologies directly or indirectly related to the hurricane (trauma, wounds, cuts, burns, secondary infection); (2) infectious diseases related to the lack of hygiene partly due to damaged water and electricity networks and unavailable health care structures (gastroenteritis, food infections, respiratory diseases, skin infections, tetanus and other pathologies that may occur in the longer term linked to the incubation period especially leptospirosis and hepatitis A); (3) chronic pathologies by discontinuity of care (renal insufficiency, diabetic, cardio-respiratory decompensation, etc.); (4) pathologies related to animal bites and mosquito bites (vector-borne diseases); (5) psychological and / or psychiatry disorders.Then in the French West Indies, from September 11 to October 29,2017, data were routinely analyzed to detect and follow-up various expected or unusual variations of one or more pathology of the above list.ResultsThe following week after Irma (2017-37), the weekly number of ED visits compared to the mean activity observed in normal situation has increased: 1225 ED visits vs. 313 in 2017-35 in Saint-Martin and 227 ED visits vs. 94 ED visits in 2017-35 in Saint-Barthélemy. ED activity has gradually decreased to finally return to a based-activity as observed before the hurricane at the end of October.From September 11 to October 29, 25% of recorded emergency consultations in Saint-Martin island were trauma, wounds, burns and cuts. As in Saint-Martin, 42% of emergency visits in Saint-Barthélemy were pathologies directly or indirectly related to the passage of Irma (trauma, wounds, etc). Others major causes of ED visits were for treatment renewal (diabetes, renal insufficiency, etc.) and gyneco-obstetric activity because general practitioners had stopped their activity.In dispensaries and general practitioners, the most common pathology was gastroenteritis (11% in Saint-Martin) over the entire period of surveillance. At the beginning of the surveillance, skin infections were the most frequently found (20%) in Saint-Martin and psychological disorders (3%) in Saint-Bartélemy, while at the end respiratory infections were the most frequent (6%) in both islands.No increase in visits for chronic diseases, food-borne diseases, acute respiratory or diarrhea illness were detected. No autochthonous confirmed cases of cholera, leptospirosis, vector-bone disease, hepatitis A or typhoid fever had been reported, due to the destruction of the laboratory.ConclusionsSyndromic surveillance in the French West Indies allowed the epidemiologists to assess rapidly the health impact of hurricane in Saint-Martin and Saint-Barthélemy.The well-established relations between French National Public Health Agency and local professionals of both affected islands allowed to temporary switch from an electronic into a paper-based data transmission without any interruption of data analysis.Although several cluster suspicions have been investigated (especially of gastroenteritis, scabies, etc), no massive outbreak was detected. Then even with a degraded system, syndromic surveillance allowed to reinsure authority of the absence of major health impact due to Irma.References1-Caserio- Schönemann C, Bousquet V, Fouillet A, Henry V. Le système de surveillance syndromique SurSaUD ®. Bull Epidemiol Hebd 2014 ;3-4 :38-44.

Powerless in the Virgin Islands: Emergency Department and Wound Care Clinic Utilization Following the 2017 Hurricanes Irma and Maria on St. Thomas, U.S. Virgin Islands

“…Significantly, more visits after the storms were among patients with a primary diagnosis of injuries to the head, wrist and hand, ankle and foot, knee and lower leg, abdomen/lower back/spine/pelvis, neck, thorax, and elbow/forearm (Figure 1). This finding is consistent with prior studies, 17,20,24,[26][27][28][29][30] and is possibly because residents devoted considerable time attending to their damaged homes between storms and engaged in recovery activities known to produce injuries and health conditions in the aftermath of the hurricanes. 17,28,48…”

“…The U.S. Virgin Islands population has higher rates of chronic diseases, such as diabetes and cardiovascular disease, than the national averages. 42,43 The increase in visits among this population may represent the prevalence of hypertension, diabetes, asthma, chronic obstructive pulmonary disease, and allergy cases, which were reported in previous studies to be aggravated by the storms, 6,14,26,27,44 and may also reflect visits among a population more likely engaged in home repairs and outdoor activities in the period between and after the storms. Previous studies show patients with respiratory complications, [17][18][19]24,26,27,30,45,46 and allergies, 47 were at an increased risk during hurricanes, and the risks were closely associated with environmental exposures.…”

“…Our finding of increased ED utilization among the elderly is consistent with previous hurricane studies, which attributed such upsurges to exacerbations of chronic diseases and disrupted access to care. 14,[17][18][19][20]22,[24][25][26][27][28]34 An intriguing finding was the escalation of ED visits by middle-aged persons. The U.S. Virgin Islands population has higher rates of chronic diseases, such as diabetes and cardiovascular disease, than the national averages.…”

“…Substantial evidence shows the effects of power outages on healthcare delivery, home healthcare services, the public health infrastructure, and adverse health outcomes. [8][9][10][11][12][13] The effects of hurricanes on the increased utilization of EDs in New York, [14][15][16][17][18][19] New Jersey, [20][21][22] and Texas 23 ; across 9 U.S. states, 24 among Caribbean islands, [25][26][27][28][29][30] and the impact of a category 5 tropical cyclone on disaster related wounds, 31 have been recently investigated. The hurricane studies attributed the increased ED visits to disrupted access to care for a range of chronic diseases and conditions, including cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease (including ventilator dependence), renal disease, dementia, and mental disorders; disaster-related conditions (such as hypothermia or environmental exposures); carbon monoxide-related accidents; and a lack of prescription refills.…”

Emergency department visits associated with satellite observed flooding during and following Hurricane Harvey

“…Several studies have documented the association between flooding and diarrheal diseases [8,27,[48][49][50][51]. The present analysis suggests a 39% increase in ED visits for intestinal infectious diseases in flooded tracts, and the rate ratio was higher in moderately flooded tracts than in the low flooded tracts.…”