Improving biosurveillance after natural disasters: The Superstorm Sandy experience

In Brief

After Superstorm Sandy made landfall on the east coast in October 2012, the New York City Department of Health and Mental Hygiene used its surveillance system to monitor hospital evacuation and emerging health needs.

Background

By the time Superstorm Sandy made landfall on October 29, 2012, it was considered the largest storm in United States history to hit the east coast. Sandy caused 72 deaths in 8 states, including 43 deaths in New York City. The subsequent utility outages and destruction of buildings and infrastructure created a series of public health hazards for the residents of New York City.

Specific issues
  • Loss of basic utilities. In New York City, approximately 20,000 buildings were damaged, and 800,000 ConEd customers were without electricity or natural gas for up to 2 weeks. Owing to the loss of power, many residents living in high-rises also lost running water normally provided by water pumps.
  • Healthcare interruptions. Thousands of patients in hospitals and long-term care facilities were evacuated to areas less affected by the storm and power outages. Power loss also hindered delivery of healthcare services for people who sustained storm-related injuries, required specialized care or hospitalization, or needed medication refills.
  • Displacement. People displaced by storm damage and its effects were evacuated to 70 shelters.
  • Public health hazards. Because of falling temperatures and a Nor'easter storm that followed a week after Sandy hit, hypothermia and cold stress became concerns for people who could no longer heat their homes. The storm also led to an increase in respiratory hazards, such as mold, particles from debris and demolition, and carbon monoxide poisoning from alternative indoor heating methods.
The practice

The New York City Department of Health and Mental Hygiene implemented innovative surveillance practices during Superstorm Sandy to respond to healthcare and community needs.

Although the extent and severity of Sandy's effects were unexpected, the New York Department of Health and Mental Hygiene (NYDOHMH) implemented several innovative practices to respond to local issues. Many of these practices involved NYDOHMH's highly adaptable surveillance systems.

In the hard-hit Rockaways on Long Island, health department staff checked on health providers and facilities to make sure they were functional, including making sure pharmacies were able to provide medications. Health services were provided in the form of mobile medical vans, contributed by the New York Department of Health, and N95 respirators were distributed to those at risk of respiratory illness.

NYCDOHMH also used surveillance systems to track patients evacuated from hospitals that had lost power. Tracking systems identified locations to which all patients were transported, ensured that hospital evacuees received appropriate care, and allowed them to safely return to their original hospital when it became functional.

The city agency also established environmental and epidemiologic surveillance in shelters to assess emerging health needs and arrange care if needed. For people who remained in their homes but were without power or water, NYCDOHMH arranged door-to-door canvassing. The department was able to reach 175,000 residences in this way and made referrals for food, water, and medical help for those in need.

Most importantly, the department reached out to communities and neighborhoods via workgroups focused on long-term recovery. These workgroups provided specialized messages for specific health concerns, such as methadone treatment and dialysis. Social media allowed the agency to monitor trending topics related to health needs and communicate the availability of resources to city residents.

What made this practice possible?
  • Adaptable syndromic surveillance practices. NYCDOHMH expanded routine syndromic surveillance to monitor syndromes potentially related to Sandy's effects. Flexible surveillance systems allowed the department to create new syndromes on the fly, including specific respiratory syndromes that emerged as a result of storm conditions. Owing to prior experience with Hurricane Irene in 2011, surveillance staff had anticipated new hurricane-specific syndromes that would need to be developed and used with available codes to reprogram the system. The system was developed to be fully customizable, allowing staff to add data fields and syndromes, create custom reports for a variety of users, and monitor respiratory syndromes and emergency department needs.
  • Trained epidemiologists and analysts. The department's surveillance unit was fortunate enough to have power and focused initially on staffing the unit to keep the systems running. Epidemiologists and data analysts in the surveillance unit had prior experience in tracking down missing data from hospitals and facilities that were unable to electronically transmit health records.
Results
  • Quick response to health needs. NYCDOHMH was able to respond to emerging health needs and minimize the medical impact of Superstorm Sandy in a city of 8 million people. The experience taught department staff the importance of anticipating surveillance needs, identifying areas that are most affected by a storm's effects, and actively reaching communities to link them to available resources.
  • Improved data sharing. Since the response to Sandy, the agency has been working to improve data sharing between epidemiologists, Geographic Information System specialists, public health practitioners, and local government employees.

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