HURRICANE HARVEY:

SUCCESSES, CHALLENGES, LESSONS LEARNED

Ana Zangeneh, MPHEpidemiology Surveillance Supervisor

Surveillance & Epidemiology UnitHarris County Public Health

The National Syndromic Surveillance Program (NSSP) Community of Practice Call

June 19th

Harris County and HCPH

• Harris County, TX:

• Third most populous county with over 4.7 million people

• Geographically spread over 1,778 square miles (size of Rhode

Island)

• Home to 4th largest city (Houston), world’s largest medical center,

and one of world’s busiest ports

• Harris County Public Health (HCPH):

• Local health department for Harris County with over 700 public

health professionals and over $100 million budget & growing

• Annually, see over 100,000 patients in 16 wellness clinics & WIC

sites, inspect 7,500 food establishments, house 25,000 animals in

our shelter

• Serve unincorporated Harris County outside of City of Houston.

Provide refugee health screening, mosquito control, Ryan White

HIV/AIDS funding for entire community, including City of

Houston

Outline

• Hurricane Harvey background

• HCPH post-Harvey surveillance activities• Functional needs medical refuge (FNMR)

• Community shelter surveillance

• NRG mega-shelter surveillance

• Hospital surveillance

• Enhanced communicable disease surveillance

• Successes, challenges, lessons learned

Hurricane Harvey

• Stalls over Texas

• Extremely slow moving from August 26th – 30th

• Over 30,000 residents displaced88 deaths in Texas

• Record flooding of at least 18 inches in 70% of Harris County

Functional Needs Medical Refuge (FNMR)

• Provides care to those who require minor or continuous medical care beyond what a general shelter can provide

• Took in displaced residents with medical conditions• Hospital discharges

• Nursing homes

• Staffed with medical providers

• Open August 29th – September 2nd

Community Shelter Surveillance

• 53 community shelters identified in HCPH jurisdiction

• Utilized modified CDC shelter assessment form

• Monitored once a day in person or by phone• Shelter census

• Any illnesses/symptoms of concern

• Hospitalizations/ER visits

• Any supplies/medications needed

• EPH inspections

• Requests for supplies sent to OEM

NRG Shelter Surveillance and Response - Public Health Objectives

• Monitor health status and identify needs

• Identify infectious diseases/outbreaks,

implement control measures

• Identify severe exacerbation of chronic

conditions, mental health issues, and

provide interventions

• Timely dissemination of health alerts and services available to shelter residents

• Information sharing between HCPH and partners

• Apply One Health concept to achieve a holistic approach to public health surveillance

Hospital Surveillance

• Hospital ICPs were contacted to monitor for diseases potentially related to the hurricane/flood• Increase in diarrheal illnesses

• Injuries and insect/animal bites

• Giardia and leptospirosis (not reportable)

• Carbon monoxide

• Syndromic surveillance of hospitals (HDHHS data)• Increase in several areas compared to the week prior to the hurricane

• Rashes, GI symptoms, respiratory symptoms

• Observations were lower than same time period in 2016

Hospital Surveillance

• Syndromic surveillance, HCPH jurisdiction

• Gastrointestinal (GI) symptoms

• Syndromic surveillance, HCPH jurisdiction

• Respiratory symptoms

• Syndromic surveillance, HCPH jurisdiction

• Rash symptom

Still had regular reportable disease investigations to do

• Parasitic infections• Trichinosis

• Tapeworm

• Rabies

• Necrotizing fasciitis

Enhanced Community Disease Surveillance

• Waterborne diseases• Cryptosporidiosis

• Free-living amoeba

• Shigella

• STEC

• Campylobacter

• Norovirus (not reportable)

• Vector-borne disease• Arbovirus (WNV, SLE, Zika)

Successes

• Timely identification and isolation of patients with ILI and GI illnesses

• No widespread outbreaks of communicable diseases during the long operation

• Exacerbation of chronic conditions and mental health issues were intervened immediately

• Additional specimens were collected by HCPH epidemiology team to confirm suspected diagnosis

• The mobile survey tool allowed for flexibility to easily modify questions concerning health conditions and residents’ needs each day

SuccessesOne Health concept

• Surveillance and response team• Epidemiologists

• Environmental sanitarians

• Veterinarians

• Communication specialists

• Epidemiology surveillance• Infectious diseases and outbreaks

• Exacerbated chronic conditions and mental health issues

• Insect and animal bites

• Control measures and interventions to prevent further spread of illness

• Environmental surveillance• Assessment of environmental risks

• Coordinated hygiene efforts• Hand sanitizers throughout NRG shelter

• Proper trash can placement

• Frequent cleaning of common areas (bathrooms, eating areas)

• Education to residents

• Veterinary surveillance• On-site animal shelter

• Routine assessment to ensure pets were vaccinated prior to entry in sleeping/dormitory areas

• Proposal to separate residents with pets from residents without pets

SuccessesOne Health concept

Challenges

• Number of surveyors changed daily depending on the availability of staff and volunteers

• Simultaneous management of multiple surveillance activities within the community

• Lack of predesigned mobile survey tool (development on-site)

• Relatively new staff without sufficient disaster response experience

• Shortage of epidemiologists

• Personal hurricane-related losses experienced by HCPH staff

Lessons Learned

• Coordination between external partners and internal departments

• Partner with other jurisdictions to develop survey tool

• Survey tool too long at first

• JITT too long and occurred every day

• Strong connectivity/good power supply

• Concern for staff/volunteers interviewing potentially contagious residents without PPE

• Safety of volunteers/staff (leaving late at night, etc.)

• FNMR training for all staff

• Mindful of staff shifts; physical and mental state of health

Sustainability should not be an afterthought, but rather incorporated into emergency response plan