August 28, 2020

How hospitals are coping with Hurricane Laura—and Covid-19

Daily Briefing

    Hospitals in the path of Hurricane Laura have had years of experience battling devastating storms—but they took new steps this time around to withstand the storm while simultaneously responding to the unprecedented demands of America's coronavirus epidemic.

    Q&As: How top health systems are tackling Covid-19

    Hurricane Laura's destructive path

    Hurricane Laura on Thursday struck the Southern United States as a Category 4 storm, killing at least six people in Louisiana and leaving more than one million people without electricity throughout Louisiana and Texas. According to the Louisiana Department of Health, as of 3 p.m. Thursday, 67 water systems in the state were out as a result of the hurricane.

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    Texas Gov. Greg Abbott (R) on Thursday said the state appears to have made it through the storm with minimal or no loss of life, thanks to evacuations done before the storm reached Texas. Abbott said around 8,500 people had been served in shelters in the state.

    Similarly, Louisiana Gov. John Bel Edwards (D) said the state "did not have the worst-case scenario develop," but he added that "there are still thousands and thousands of families whose lives are not right side up today."

    Hurricane Laura has since been downgraded to a tropical depression, and it moved into Arkansas late Thursday.

    Evacuations spark concerns of coronavirus flare ups

    Earlier this week, officials in Louisiana and Texas coordinated large-scale evacuations for area's in the hurricane's path—a move that, while necessary to minimize harm caused by the storm, sparked concerns about potential coronavirus outbreaks, especially since both states have already been hard-hit by the epidemic.

    According to Darrell Pile—CEO of Southeast Texas Regional Advisory Council, which coordinates emergency medical response along the coast of Texas—large evacuations are likely to quicken the coronavirus' spread, as it will be hard for people to maintain recommended physical distancing. In fact, as a recent study—which hasn't yet been peer reviewed—estimated, such an evacuation for a hurricane could lead to 6,000 to 60,000 new coronavirus cases.

    "In every scenario we analyzed, hurricane evacuations cause an increase in the number of Covid-19 cases," Kristy Dahl, a co-author of the study and a senior climate scientist at the Union of Concerned Scientists, said.

    As a result, according to NPR, many of the more than half-a-million people ordered to evacuate in those states stayed in government-paid hotels or motels, since officials wanted to avoid potentially crowded scenarios in emergency shelters. And places that did eventually open as emergency shelters—such as Austin's convention center—were able to house drastically fewer people than they would in pre-pandemic times, which helped to allow adequate physical distancing.

    In addition, buses arranged in Texas to help with evacuations were outfitted with personal protective equipment and ordered to run at reduced capacity to avoid crowding. Evacuees were directed to intake centers in Austin, Dallas, and San Antonio to learn where they would shelter and to undergo medical screenings, including symptom surveys and temperature checks, NPR reports.

    But despite careful efforts, officials said the overall impact of the storm on coronavirus infection rates will be unclear for a while. "We're basically going to be blind for this week because we'll have to discontinue much of our community-based testing," Edwards said.

    How Texas hospitals prepared

    To prepare for the storm, a number of hospitals in Texas temporarily closed or canceled appointments.

    For instance, Harris Health closed all outpatient facilities between noon on Wednesday through Thursday, the Houston Chronicle reports, while Memorial Hermann both closed several outpatient facilities and postponed all scheduled, non-urgent procedures between Wednesday afternoon and the end of the day on Thursday. MD Anderson Cancer Center's facility in League City shut down from Wednesday through Friday, and Texas Children's closed certain locations on Wednesday and Thursday, with plans to reschedule outpatient appointments, convert in-person hospital visits to telehealth visits, and postpone scheduled surgeries.

    Meanwhile, to ensure capacity for any people potentially injured by the storm, the two main inpatient hospitals of Christus Southeast Texas Health System in Beaumont, Texas—an area that was expected to be hit hard by the hurricane—canceled all elective surgeries, put backup power in place, and housed staff members onsite earlier this week so they didn't have to leave the hospital, according to Ryan Miller, COO for the health system.

    In addition, Miller said, everyone wore masks, and the hospitals created space for physical distancing. Further, the 30 or so patients at the hospitals who have Covid-19 were kept separate from others in the facilities.

    Separately, the Medical Center of Southeast Texas (MCST) transferred about 65% of its patients to hospitals further inland in the state, according to Gary Mennie, CMO of the hospital. That included all of its kidney dialysis patients, as well the most critically ill patients—including all patients with Covid-19 in the hospital's ICU—who were transferred to Houston. And staff at the medical center, all of whom voluntarily opted to weather the storm, spent the night at the facility.

    Mennie added that the hospital was also looking ahead to after the hurricane passes. "After storms, the hospitals become sort of like meccas that people come to," he explained, but MCST is prepared: Staff will triage anyone who presents with symptoms of Covid-19 to a separate waiting area that has negative pressure to limit the virus' spread.

    Pile said Southeast Texas hospitals have the capacity to treat a rush of patients injured by Hurricane Laura, as well as a surge of Covid-19 patients, in part because Covid-19 hospitalizations in the state have declined significantly. And if hospitals do become overwhelmed in certain areas, there are plans in pace to transfer patients to hospitals in other cities in the state, such as Houston.

    "Our hospitals are prepared for an increase in Covid cases, and the patients transported due to [Hurricane] Laura will be taken to hospitals with capacity," Pile said. "Of course, from a disaster standpoint, we are pretty experienced at this point, so there are lots of preparations in place to handle Laura."

    How Louisiana hospitals fared

    In advance of the storm, several hospitals in Louisiana also evacuated patients and closed certain departments.

    For instance, Lake Charles Memorial Health System transferred all the patients at Lake Charles Memorial Hospital for Women on Wednesday afternoon to Lake Charles Memorial Hospital. The system also shut down its EDs and canceled all of its outpatient procedures on Wednesday afternoon. For patients who could not be discharged, the health system had medical personnel sheltering in place.

    However, despite their preparations, several hospitals in Lake Charles sustained "significant damage" when Hurricane Laura hit, although Paul Salles, CEO of the Louisiana Hospital Association, noted that "none of it has been that severe that the hospital can't operate." And many hospitals, due to power outages, are running on generator power.

    According to Salles, the biggest concern for hospitals affected by the hurricane is the loss of city water. "The biggest challenge for most of them right now is utilities," Salles said. "Without utilities, particularly water, it's hard to sustain the kind of care folks are typically used to" (Bernstein, Washington Post, 8/26; Owens, "Vitals," Axios, 8/27; Hixenbaugh/Griffith, NBC News, 8/26; Gibbens, National Geographic, 8/26; Hennes, Houston Chronicle, 8/26; Baldwin et. al., CBS News, 8/27; Farzan et. al., Washington Post, 8/28; Raphelson, NPR, 8/27; New York Times, 8/28; Christ, Modern Healthcare, 8/27).

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