Danger remains even after the storm has passed

By KENYATTA ESTERS | Emergency Preparedness Manager, LDH Office of Management and Finance

Did you know that after a storm such as a tropical system has passed, many people are injured or die from hazards that are not directly associated with the storm?

In a 2016 study, researchers Dr. Edward N. Rappaport, former acting director of the National Hurricane Center, and Dr. B. Wayne Blanchard, retired Higher Education Project Manager at FEMA, analyzed 50 years of tropical cyclones and found that there were over 1,400 indirect deaths associated with these storms. These deaths included heart attacks, electrocutions and car accidents.

Let’s look at some of these “indirect hazards” of tropical systems and ways that we can prepare for them.

Credit: Rappaport and Blanchard (2016)

Cardiovascular incidents

Rappaport and Blanchard found that heart-related problems resulted in about 34% of all indirect deaths associated with tropical cyclones. Both the physical and emotional stress of dealing with a storm’s aftermath may result in a worsening of symptoms for those with heart disease.

Tips:

• Take breaks during strenuous post-storm activities such as debris removal.
• If possible, work in groups or utilize community resources to assist in post-storm cleanup.
• Ensure that all heart medications are refilled before a storm arrives, and check with your health insurance company to see if extra refills can be authorized before the storm.
• Stay aware of stress levels after the storm. If you are overwhelmed with feelings of anxiety or depression, seek medical care and try to stay connected with friends and family. You can also use resources such as the Disaster Distress Helpline, a crisis counseling and support line for those experiencing emotional distress related to disasters.

Vehicular incidents

After a storm has passed, our first instinct can be to get in our vehicles to tour damage in neighborhoods. This can be a very dangerous action, as many roadways remain hazardous well after a storm has passed due to floodwaters and debris. Traffic lights may not function, and street and road hazard signs may be displaced. These hazards can result in dangerous traffic accidents.

Tips:

• Always remained sheltered after a storm until authorities tell you it is OK to leave your home.
• When you are allowed to leave your home, always yield the right of way to any emergency vehicles that may approach.
• Stay aware of road conditions through local news and radio stations and through the 511 travel information line.
• Never drive around barriers or through flooded roadways, and be aware of downed trees and power lines.
• If a traffic signal is not operating at an intersection, treat the intersection as an “all-way” stop.

 Visit 511LA.org or call 511 for travel information in Louisiana.

Power problems

Power outages can be an inconvenience for some, but may result in serious medical consequences for others. Many storms have affected Louisiana in the months of August and September, a period when the state experiences high and humid temperatures. The lack of cool air can make heat-related illness in vulnerable populations worse.

Power outages can be especially dangerous for citizens who use electricity-dependent medical equipment such as oxygen concentrators, feeding pumps and nebulizers. Injuries from falls can occur due to the lack of light, and frozen and chilled foods can become contaminated due to lack of refrigeration. Unsafe generator usage during power outages can lead to deadly carbon monoxide poisoning.

Tips:

• If you or your loved ones are sensitive to heat or use electricity-dependent medical equipment, be sure to plan for evacuations well in advance of a storm.
• Instead of open flames as light sources, use flashlights and battery-operated lanterns to prevent fires.
• Purchase battery-operated fans to use in homes.
• Stay away from downed power lines that could still be electrically charged.
• Heed any boil water advisories.
• Never use a generator inside your home. The CDC recommends using generators more than 20 feet away from your home, doors and windows.
• To prevent foodborne illnesses, discard refrigerated foods when the power has been off for four or more hours.

With a little preparation and awareness, you will be capable of keeping yourself and your loved ones safe before, during and after a storm.

Resources

For more information on how to stay safe from both direct and indirect hazards of tropical systems, visit these links:

• CDC: Be Safe After a Hurricane
• CDC: Preparing for a Hurricane or Tropical Storm
• National Weather Service: After a Hurricane
• National Weather Service: What to Do Before the Tropical Storm or Hurricane

Emotional and psychological disaster preparedness

By DR. JAMES E. HUSSEY | Medical Director, LDH Office of Behavioral Health

Tropical weather in the Gulf this week has us on our toes, ready to spring into action if things get nasty. While here in Louisiana we’re always ready for the possibility of high winds and torrential rains, we usually look to the practical side of things: Did we stock up on food and water? Is the generator ready to go?

Those things are undeniably important, but it’s also a good idea to be prepared mentally and emotionally. Natural events such as a storm can unfold in minutes to hours, yet the feelings and emotions they evoke can linger for weeks, months and even years after.

Psychological preparedness can help you think logically and wisely during and after disasters, helping to keep you physically safe while also weathering the emotional storm.

Disaster-related stress can affect anyone, but some people may be more vulnerable than others. They may include those with disabilities, existing mental health issues, children, the elderly and those who have been previously impacted by floods, hurricanes and other disasters.

VIDEO: Dr. Hussey on emotional and psychological disaster preparedness

Recognizing disaster-related stress

FEMA has some online resources aimed at coping with disaster. First, it is important to be able to recognize signs and symptoms of disaster-related stress, and to seek counseling or assistance. According to FEMA, some symptoms may include:

• Difficulty communicating thoughts
• Difficulty sleeping
• Difficulty maintaining balance in their lives
• Low threshold of frustration
• Increased use of drugs/alcohol
• Limited attention span
• Poor work performance
• Headaches/stomach problems
• Tunnel vision/muffled hearing
• Colds or flu-like symptoms
• Disorientation or confusion
• Difficulty concentrating
• Reluctance to leave home
• Depression, sadness
• Feelings of hopelessness
• Mood swings and easy bouts of crying
• Overwhelming guilt and self-doubt

It’s OK to seek help

If disaster-related stress starts wearing you down, it’s perfectly normal and OK to ask for help. Here are some helpful resources:

• The Disaster Distress Helpline, 1-800-985-5990, is a 24/7, 365-day-a-year national hotline dedicated to providing immediate crisis counseling for people those in emotional distress related to any natural or human-caused disaster.
• The National Suicide Prevention Lifeline: 1-800-273-TALK.
• For non-emergencies, check the Office of Behavioral Health directory for local community behavioral health services in Louisiana.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) has a Disaster Kit for recovery workers, which includes wallet cards, guides for parents, caregivers, teachers and others. There is also a SAMHSA Disaster App.

Contact your primary care doctor and/or your insurance plan for referrals to behavioral health specialists.

Physical and emotional health

FEMA also recommends that you take steps to promote your own physical and emotional health and healing by healthy eating, rest, exercise, relaxation and perhaps even meditation. It is important to maintain a normal family routine as much as possible and to lean on your existing support groups of family, friends and religious institutions.

Be prepared

For many people, having a disaster supply kit stocked and a family disaster plan ready is a great comfort. When the storm comes, you’ll be ready to go. For more information, click here.

Beach Monitoring Program helps keep your summer safe

Before you hit the beach for your summer vacation, you may want to have a look at the Louisiana Department of Health’s Beach Monitoring Program website to see if any advisories have been posted for your vacation destination.

The program tests the water at 24 beaches along the Louisiana coast to determine if those beaches meet quality standards set forth by the U.S. Environmental Protection Agency. All 24 beaches are along the state’s coast and are tested weekly. Those beaches include:

• Constance Beach
• Cypremont Point State Park
• Elmer’s Island
• Fontainebleau State Park
• Grand Isle State Park (four sites)
• Grand Isle Beach (three sites)
• Gulf Breeze Beach
• Holly Beach (six sites)
• Lake Charles’ north and south beaches
• Little Florida Beach
• Long Beach
• Martin Beach
• Rutherford Beach

The program tests these waterways for bacteria from human or animal waste that could potentially cause disease, infections and/or rashes. Whenever these bacteria are above an acceptable level, a swim advisory is issued. Advisories are posted at the beach with a diamond-shaped sign and on the program’s website.

Contaminants can enter water in a number of ways. Sometimes, it is a case of sewage discharge. In other cases, it could be from large amounts of rainfall increasing runoff that enters waterways.

Swim safety

Swim advisories do not mean that the beach is closed, however. LDH recommends that anyone with a compromised immune system or open wounds not swim in the water, but the public can swim at their own risk.

If there is a swim advisory, there are a number of ways to reduce your chance of illness, including:

• Avoid putting your head under the water if you choose to swim.
• Do not get into the water if you have open cuts, sore or wounds. If you do choose to get into the water, ensure that you have waterproof bandages to cover any open cuts.
• After swimming, shower with soap and water.
• Avoid eating seafood caught from waters where there are visible chemicals, algae is present, and there is an advisory.
• Pets should not be allowed to swim in or drink from waterways that are under advisory.
• Avoid areas with visible algae. Algae can be blue, bright green, brown or red, and can have a strong odor like rotting plants.

If you feel ill after entering the water or swimming, contact your doctor immediately.

If you’d like to learn more about swim advisories, you can visit LDH’s Beach Monitoring Program website here or the U.S. EPA’s BEACH program here.

LDH, CDC partner up on histoplasmosis outbreak investigation at Louisiana campsite

By JOSE SERRANO, MPH | LDH Public Health Epidemiologist Specialist; POOJA GANDHI, MPH, CHES | CDC Mycotic Diseases Branch Health Communication Specialist; and KAITLIN BENEDICT, MPH | CDC Mycotic Diseases Branch Epidemiologist

“Fungal diseases have taken a backseat to bacterial and viral infections, to the point where mycotics are left out of many doctors’ diagnoses. Awareness efforts, such as multiple statewide surveillance projects and outbreak findings, show the growing concern of invasive fungal diseases in the general population.” 

— Jose Serrano, MPH, epidemiologist specialist and lead investigator of this outbreak from the Louisiana Department of Health

In November 2018, what seemed like a normal camping trip led to a group of campers in Louisiana getting sick with what was later discovered to be histoplasmosis, an infection caused by Histoplasma capsulatum, a fungus that lives in soil.

The Louisiana Department of Health got a call about two patients — a teenage girl who was thought to have viral pneumonia, and a middle-aged man with an unknown respiratory illness — who were hospitalized with symptoms that weren’t improving after being treated with antibacterials. After their doctors consulted with an infectious disease specialist, the two patients were eventually tested, diagnosed with and treated for histoplasmosis. Both people have recovered from the illness.

Both of them had traveled to a campsite in a rural area in southern Louisiana in the three weeks prior to falling ill. LDH contacted campsite officials to get a list of fellow campers who might have also gotten sick and began an investigation, with support from the Centers for Disease Control and Prevention’s Mycotic Diseases Branch, to figure out if others were infected and how these campers became sick in the first place.

Investigating the outbreak

LDH’s interviews with the campers revealed that about half of the people on this camping trip were sick. They asked the CDC to test the campers’ urine samples, which confirmed histoplasmosis.

“The rapid and robust public health response to this outbreak highlights the importance of partnership and enhanced collaboration between CDC and state health departments,” said Nancy Chow, PhD, a molecular epidemiologist with the Mycotic Diseases Branch. 

The fungus lives in the environment, particularly in soil that contains large amounts of bird or bat poop.  But, none of the sick people remembered any bird or bat poop at the campsite. Or, at least that’s what LDH initially believed. The team searched the entire campsite looking for clues about where these campers could have become exposed to the fungus.

After more investigation, LDH learned that the campers participated in many different activities, including hiking, collecting firewood, digging soil and geocaching. Geocaching is a digital scavenger hunt-like game played through a smartphone app. The app directed the campers to different objects and locations throughout the campsite, which soon became key to the investigation, getting public health officials one step closer to the source of the outbreak.

This hollowed-out tree was found to be the source of Histoplasma at a Louisiana campsite.

The Mycotic Diseases Branch laboratory tested soil samples from areas surrounding a few of the geocaching sites and found that one of the samples tested positive for Histoplasma. The sample was from a hollowed-out tree that reportedly had bats living inside, based on photos. This site was one of the geocaching sites many of the campers had visited, making all the more sense that it was the source of infection.

After uncovering the site of this fungus, LDH worked to identify any potential high-risk areas to prevent others from becoming exposed, and told campers to avoid activities involving soil disturbance. Additionally, a summary risk reduction document was provided to camp officials for all future campsite visitors.

Preventing future outbreaks

The investigation team recommended that future campers consider the following to help prevent people from getting histoplasmosis:

• Avoid soil disruption activities (including geocaching) and contact with hollow trees.
• Teach campers about the risks for histoplasmosis and other fungal diseases, especially those who are weakened immune systems and at high risk.
• Spread more awareness about histoplasmosis throughout Louisiana.

“Fungal disease outbreaks are relatively rare — this investigation confirmed that histoplasmosis is endemic to Louisiana, and that disruption of soil is still a significant health risk for both sick and healthy individuals,” said Jose Serrano, MPH, an LDH epidemiologist specialist and lead investigator of this outbreak.

“Once this outbreak was confirmed, every single epidemiologist dropped what he or she were doing to lend a helping hand in the investigation. Our strength comes from our teamwork, and no investigation is ever handled alone,” he said.

Learn more about histoplasmosis here.

Health equity: Informing LDH staff, practices and protocols to improve services, health and health outcomes

By DR. EARL BENJAMIN-ROBINSON, D.H.Sc. | LDH Deputy Director of Community Partnerships

In LDH’s Friday, April 26 blog, “Making 2019 the Year of Public Health for Louisiana,” Dr. Alexander Billioux noted that despite some improvements regarding Louisiana’s health outcomes and healthcare access, Louisiana continues to rank among the unhealthiest states in America. He then posed a rhetorical question: “Why does Louisiana continue to be ranked low with these improvements?” His answer: “Achieving and maintaining good health requires more than healthcare.”

Dr. Billioux’s answer is poignant and right!

Human beings cannot and do not live on bread alone, neither do they acquire or sustain wellness and well-being just by having access to healthcare. There are factors that affect people, populations and communities’ health and wellness. These factors are barriers to health, also referred to as social determinants of health: economic and social factors that contribute to and/or shape a person’s health and health outcomes. The World Health Organization defines barriers to health as “the conditions in which people are born, grow, live, work and age.”

Culture, social norms and policies affect the conditions in which people are born, grow, live, work and age. Conditions are further compounded by a society’s distribution of money, power and resources resulting in differences in health and healthcare between population groups — health disparities. Many of these health disparities occur across a number of demographics, including socioeconomic status, age, location, gender, disability status, race/ethnicity and sexual orientation. Additionally, many health disparities experienced and observed in Louisiana are seen as unnecessary, avoidable and unjust — health inequities.

Given these factors, concepts and Louisiana’s health inequities, LDH continues in its commitment to support all Louisianans in achieving their best, fullest health outcomes — health equity. According to the Robert Wood Johnson Foundation, “Health equity means that everyone has a fair and just opportunity to be as healthy as possible.” In an effort to achieve and sustain this, LDH will focus more intentionally on the words of Dr. Georges C. Benjamin, executive director of the American Public Health Association: "Eighty percent of what makes us healthy happens outside the doctor’s office.”

With this in mind, LDH is presently working to put practices and protocols in place that are informed by people, populations and communities’ behavior, social environment, physical environment and their experiences with health services.

We are excited about this work, and more equitably meeting the needs and supporting the wellness and well-being of the citizens of Louisiana. Stay tuned for more to come!