In any disaster, there is a cost beyond the immediate mortality figures following a disaster due to a lack of proper medical supplies and treatment in mass care shelters. The Centers for Disease Control and Prevention publishes a weekly “Morbidity and Mortality Weekly Report,” which serves as a clearinghouse for epidemiological reports submitted by state health departments. However, a public health method must go beyond the death tolls and rates and estimate the years of life lost for people who were without medications and treatments (like dialysis) for extended periods of time during and following disasters.
Soon after a disaster, officials publish the death tolls and rates associated with the event. The severity of a disaster is often judged by the number of people who died during or immediately after a disaster. What officials have not adequately evaluated are the effects of the disaster on the lifespans of those with chronic diseases who lived through each disaster without proper care. There is a measure called Years of Potential Life Lost (YPLL), which can and should be calculated for the long-term, life-shortening health effects of disasters.
From a Federal Perspective
Even for disaster mortality rates, there has been an issue of which deaths after a disaster can be attributed to that disaster as opposed to those who would have died anyway. As an example, for Hurricane Maria in Puerto Rico in September 2017, a study was commissioned and executed by the Milken Institute School of Public Health of George Washington University after some felt that the Puerto Rican government grossly underestimated the number of deaths attributable to the hurricane. Other papers built upon this foundation to propose methodologies – for example, “Modeling Excess Deaths After a Natural Disaster With Application to Hurricane Maria” and “Differential and Persistent Risk of Excess Mortality From Hurricane Maria in Puerto Rico: A Time-Series Analysis.” These studies attempted to accurately calculate mortality rates attributable to the hurricane during and in the immediate months following the disaster, but not the YPLL for those who survived.
Many people who stayed in mass care shelters during recent hurricanes were already suffering from a number of chronic health conditions, known as comorbidities. Some of those with chronic diseases ran out of their medicines during their stay in the shelter. Others forgot their medicines at home in their hurry to evacuate to shelters. Still others may have run out of medicines while sheltering at home. People with diabetes went many days without insulin and other medicines that kept their blood sugars under control before the hurricane made landfall. People with heart, lung, and psychiatric medicines went for days and, in many cases, longer before they were given the appropriate medicines. People requiring dialysis went for days and suffered the consequences of going without timely treatment. It would seem self-evident that lack of proper care and medical treatment for these populations during a disaster could have lasting effects and potentially shortened life spans. By conducting YPLL studies, federal health leaders would be better equipped to take actions that could prevent or mitigate these devastating effects.
From a Medical Perspective
From a medical logistics standpoint, developing procedures to have medications and treatments available to mass shelter populations at the proper time during a disaster is not only possible but very doable. Recent advances in providing dialysis during and after disasters may represent a significant advancement in emergency management during future events. The next hurdle to be overcome is the ordering, receiving, and dispensing of chronic care medicines to those in mass care shelters who do not have their required medicines.
One attractive solution to determine the best mass care shelter pharmaceutical dispensing procedures could be in the form of a Federal Emergency Management Agency (FEMA) pilot program. This pilot program could also serve as a proof of concept for supplying required medicines to those with chronic conditions while residing in mass care shelters. This effort may require support from local Medical Reserve Corps chapters, and using pharmacists, pharmacy technicians, nurses, and physicians or physician extenders for prescribing medicines. The easiest way to move this idea forward is for a pharmacy retailer like Walgreens, CVS, Sam’s Club, or Walmart to sponsor and lead the pilot program.
The ultimate goal is to develop systems that ensure persons with chronic diseases never again have to go without medicines or treatments while in mass care shelters. A key tool to reach this goal is to create a more targeted public health study on the long-term effects of being without medicines and treatments for prolonged periods of sheltering. With a commitment from community leaders, public health professionals, shelter managers, federal agencies, and pharmacy retailers, this public-private collaborative effort could create this tool and together reach this ultimate goal.