A ‘second wave’ of medical issues may slam the region in Helene’s wake, disaster response officials caution

by ANDREW R. JONES

After the floods come the waves.

Following the initial health crises in the aftermath of tropical storm Helene, Buncombe County and others inundated by the storm may be facing a secondary medical surge, one driven by infections and diseases and potentially exacerbated by a lack of running water, emergency response officials warned.

Helene’s initial devastation in Western North Carolina sent hundreds to the hospital with needs for everything from oxygen to traumatic wound care. Now, two weeks after the storm, doctors, health professionals and officials in charge of disaster relief say there could be a second wave of medical concerns affecting hospitals and clinics, and it could be here soon.

“What I expect the next wave to be is primarily medical, where people are beginning to get sick from their circumstance, and they’re going to need a different kind of help,” said Dr. Raymond Barfield, a palliative care and hospice specialist at Mission Hospital. “The first one was trauma. The second one is going to be medical, with probably a lot of infection-related [cases].”

“The stressors, the physical and medical stressors on the community after a disaster, they come in waves,” said Richard Hess, Ohio team commander with the federal Disaster Medical Assistance Team, which is helping ease the influx of patients at Mission, the largest hospital in storm-battered Western North Carolina.

While the next surge of medical issues isn’t guaranteed, studies show they do come in waves following flooding.

“The health consequences of flooding may be described in terms of time as immediate, medium-term, and long-term,” a 2009 study on the health impacts of floods said. “[I]mmediate is considered as the period when the flood is present, medium is the immediate recovery phase (days to weeks), and long-term is the reconstruction phase (months to years) after the flood.”

Another 2018 study showed risks for respiratory and heart disease are higher following disasters similar to Helene.

“Increased exacerbations of cardiovascular disease, including worsening control of hypertension and myocardial infarctions, with an associated increased risk of death, were observed after hurricane events with associated flooding,” said one study. “Patients with chronic respiratory diseases were noted to have an increase in acute exacerbations after natural disasters, owing to disruption in maintenance therapy, loss of power, particularly among oxygen- and nebulizer-dependent patients, and overcrowding.”

Local officials say they’re prepared

Mission Health representatives, Buncombe County officials and federal agencies said they’re ready for the next wave when it hits.

“This won’t be short term. This will be long term,” Mike Wargo, HCA Vice President of Emergency Preparedness, told Asheville Watchdog during an Oct. 5 news conference. “We’ve got a team of colleagues, physician leaders, nursing leaders, infection preventionists, that are really focused on that.”

“We’ve got to really look to the integrity of the public health system, the hygiene within the community, and offer them water services that are being deployed, hygiene services that are being deployed, and just continue to assess the needs and provide those resources,” Wargo said.

Buncombe County spokesperson Lillian Govus told Asheville Watchdog during an Oct. 8 briefing that the county is making preparations for the possibility of a medical crisis. “I don’t have further information on that at this time, but the public health ramifications of this crisis and this disaster are not an afterthought in terms of what our planning includes,” Govus said.

Buncombe public health officials say hand sanitizer will be key because of the ongoing water outage. They are asking for donations of hand sanitizer.

First wave: Infections

There are several risks associated with this second wave, according to Dr. David Weber, medical director at the Department of Infection Prevention at UNC Medical Center in Chapel Hill.

The first of these are infections. Staph infections and strep come from bacteria on the skin and can affect people who have skin injuries, regardless of whether people have contact with infected water.

Someone with skin injuries who comes in contact with infected water could become infected with aeromonas or tetanus.

“If you’re not up to date on your tetanus shots, those would be most of the ones I would worry about,” Weber said.

“Most of those would occur in two to four days, pretty quickly, with the exception of the mycobacteria infections, which might take several weeks,” he added.

People could also be infected by just wading through the water, splashing it and ingesting or inhaling it, Weber explained.

Norovirus is the most common infection risk by non-injury contact with water, Weber said, followed by e. coli. These result in gastroenteritis, nausea, and vomiting.

Legionnaires’ disease is a risk with inhalation of infected water, Weber said.

Second wave: Respiratory illnesses

But there are other infectious, non-water-related risks.

“Most of the other respiratory diseases are not going to be related to water or unsafe drinking water,” Weber said. “Those would be if people are in shelters. If they’ve left their house and you pack, you know, 100 people into a high school auditorium for days to weeks, and you go in and it’s cot, cot, cot, a foot apart, that’s when you would see things like respiratory illnesses, COVID-19, influenza, RSV.”

“All it takes is one person coughing and sneezing, and everyone’s sort of packed in there,” Weber said.

Such an environment could also bring with it the risk of lice, Weber said.

There are other risks that could impact people weeks after contact with disease, including tuberculosis and hepatitis A, a liver infection spread by infected food and water. La Crosse encephalitis, an infection of the brain, is less likely, but could happen because of standing water and resulting clusters of mosquitoes, which spread the virus.

Weber also addressed numerous other threats people face following a flooding disaster: fires from candles or grills inside the house; carbon monoxide poisoning; snake bites; injuries from more fallen trees, from either cleanup or roots severely loosened by the rain and toppled by moderate wind; stress resulting in heart attacks and strokes; and mold taking over homes, even those with only minor water damage, causing asthma and respiratory illnesses.

“If you look at what people actually die of after the hurricanes, most of these infections are treatable,” Weber said. “You’re not going to see a big death rate from that, but things like cardiovascular diseases, potentially psychiatric illnesses and others would be more of an issue.”

The right tools

At Mission Hospital, a maze of tents called a decompression facility is shielding the Asheville health care hub from a potential surge. Beds there were mostly empty on Oct. 5, when Asheville Watchdog took a tour of federal, state and local response efforts.

Hess said he expected the tents to start getting more patients within about 10 days.

“If you look at disaster publications, it is predictable that you have these phases,” Hess said. “Now, you never know when those are exactly going to hit, but with some percentage of probability, you get through the acute phase, then you go into your secondary phase, [when] you’re going to get the people that are also helping do disaster response. Then you’re also going to have the increase in the metabolic type stuff, the diabetics. Like, okay, no electricity? Diabetics have had no refrigeration for their insulin. That’s a problem. It’s a huge problem.”

But the decompression facility is ready for all those patients. Stocked with state-of-the-art equipment, staffed by federal disaster response employees and Mission employees, and equipped with a mini trauma hospital, the facility provides medical workers with almost everything they need to deal with the next wave, if it hits soon.

Doctors have praised HCA Healthcare, Mission’s owner, for doing everything in its power to get necessary resources, especially after several days without water and on backup power.

But for now and for the immediate future, the risks are high, and people will be needing care for everything from cuts to mental stress to severe heart issues.

“There’s something about a huge crisis that just brings another layer of urgency and distress into people’s lives,’ Barfield, the palliative care doctor, said. “It’s not just their body that feels surprisingly unstable, which always sneaks up on us, but it’s the whole countryside.”

“You walk through the River Arts District and you realize, you know, Wow, whatever power I thought I had, that was an illusion,” Barfield said. “This river showed me that it can undo an entire lifetime of work with a bunch of rain.”

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email arjones@avlwatchdog.org. The Watchdog’s local reporting during this crisis is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.