Jennifer Fisher Wilson
Potential Financial Conflicts of Interest: None disclosed.
Sidebar: What Happened to Research
Hurricane Katrina flooded the lab of John A. McLachlan, PhD, professor of environmental studies and pharmacology at Tulane and Xavier Universities, and caused electricity outages that doomed much of his work at the Tulane Health Sciences Center. Dr. McLachlan has been starting over. The storm ruined his laboratory and many of the reagents and animal models that made up his active research. Before he can restart one animal study that used a chemical against breast cancer in a novel mouse model, he must first repeat the painstaking efforts of isolating the promising antiestrogen from soybeans. He must also recreate the mouse model, which had human breast tumors growing on one side of a mouse and murine tumors growing on the other side. “The model took a long time to set up and then grow, and we spent a really long time purifying all of this product from soybeans. We have to go back and do it all over again,” he said.
McLachlan lost a lot, but not everything. “Lots of people lost more,” he said. He stored some of his reagents in nitrogen tanks, and he kept much of his data on a laptop computer that he carries with him. “We were prepared in some ways for a disaster like this, but after a few days, the level of preparation went down,” he said. “For instance, some of the freezers could run on backup generators, but then there was no way to get extra fuel in to keep them going.” To continue his work, McLachlan has set up a temporary laboratory at Baylor College of Medicine in Houston, Texas, staffed by some of his postdoctoral students. Similarly, other researchers have set up temporary laboratories while waiting for Tulane to restore its facilities.
Clinical researchers also lost track of study participants in the aftermath of the storm. David C. Goff Jr., MD, PhD, professor of public health sciences and internal medicine at the Wake Forest University School of Medicine, noted that 2 major studies—the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial, which includes a clinic at Tulane University School of Medicine, and the REGARDS (REasons for Geographic And Racial Differences in Stroke) study, which is based at the University of Alabama at Birmingham—lost track of hundreds of participants. Many of their clinical records were also lost. “The status of their medical records is unclear, but in many cases, they were presumably destroyed—even electronic medical records because hard drives were damaged,” Goff said. It was late October before Goff and his colleagues in the ACCORD trial acquired updated cell phone numbers for many study participants; they found about 150 who had been missing, but they still have not located about 40. Most of the participants have remained in the New Orleans area, but others are scattered across the United States.
Some of the patients in the ACCORD trial, which is investigating ways to prevent heart disease in adults with type 2 diabetes, lost access to diabetes and heart medications when they were evacuated. The study organizers tried to help those who needed assistance with their medication by posting contact information on the ACCORD Web site. The REGARDS trial, a population-based study tracking risk factors for stroke among people living in the southern “Stroke Belt” and elsewhere in the United States, may end up also teaching physicians about the long-term health effects of the hurricane and flooding, according to Goff. The ongoing study includes about 700 patients in the Gulf Coast area whom the researchers have followed through regular telephone contacts for the past 2 years. They will continue to follow these patients for at least 2 more years.
Sidebar: Basic Facts on Mold
The National Institute of Environmental Health Sciences has posted the following information about mold:
There are various types of mold fungi that can be found in homes after flooding. Many of them produce spores that are allergens or irritants, and some also produce spores that are toxins (mycotoxins), which may have biological effects in humans.
Exposure to molds can cause a variety of symptoms that range from aggravated allergies to asthma attacks. Allergic symptoms could include wheezing, sneezing, itchy/watery nose and eyes, and hives (skin rash). Because the effects of molds are not restricted to allergic reactions, individuals without allergies may also experience problems, such as irritation in the respiratory tract, eyes, and skin, and sometimes also headaches. The most susceptible people to the adverse effects of molds are those who already have an existing respiratory condition (for example, asthma) or are immunocompromised in some other way.
To avoid potential adverse health effects, people should minimize exposure to mold. It is essential to immediately remove soaked and moldy materials from the home. All affected materials should be cleaned and dried when possible. However, porous materials (for example, upholstered furniture, mattresses, carpets, dry wall, and insulation) are nearly impossible to clean. Building materials and furnishings that are not salvageable should be discarded and replaced. The goal is to remove the mold and not just kill it because fungal spores/fragments do not need to be viable to cause allergic symptoms or irritation.
When people clean and handle moldy materials, there can be exponentially more spores in the air than usual. In order to limit inhalation and skin/eye contact with molds, people should wear protective clothing (for example, disposable coveralls, gloves, and goggles) and respiratory protection (for example, an N-95 or HEPA [high-efficiency particulate air] respirator).
Sidebar: Caring for Patients during a Disaster
The disaster recovery team at the Ochsner Clinic Foundation in New Orleans drilled on ways to maintain health care delivery during an emergency, but Hurricane Katrina taught them that it is not possible to anticipate everything, said Sandra Kemmerly, MD, medical director of infection control at Ochsner Clinic Foundation and hospital coordinator for physician deployment during disaster recovery. “We've always planned for this storm, year in and year out,” said Kemmerly, who is also president of the Louisiana chapter of the American College of Physicians. “But as much planning as everybody did, nobody could have planned for everything that happened.”
They did not anticipate losing transportation for moving health care professionals back and forth between a satellite clinic in Baton Rouge and the New Orleans clinic; they ended up renting a limousine company with buses available to do the job. They did not expect to lose phone and e-mail service, but these were frequently unreliable in the wake of the storm; luckily, the hospital's internal telephone system remained continuously available. They did not expect so many patients to disperse all over the country, but electronic medical records facilitated patient requests for medical records and prescription refills. They did not plan on dealing with so many rumors and fears about outbreaks of cholera and other infectious diseases, which never did actually happen.
The ability to cope with the disaster even when it brought unexpected challenges helped the New Orleans location of the Ochsner Clinic Foundation to remain open continuously throughout the hurricane and flooding, even after many staff members left the area. The organization set up a temporary primary care clinic in a separate pediatric building to provide emergency services under the protection of armed guards and members of the National Guard. Less than a week after the crisis began, clinic physicians even performed some scheduled surgeries, including a transplant surgery, and provided subspecialty care.
Now, patient demand is beginning to return to normal levels with the slow and steady repopulation of the city, according to Kemmerly. “The patients are returning, and we're seeing a typical patient load. We have plenty of physicians available to provide care,” she said. “Our biggest challenges now are nursing and ancillary support and housing for our employees who have lost their homes.”
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Jennifer Fisher Wilson. Health and the Environment after Hurricane Katrina. Ann Intern Med. 2006;144:153–156. doi: 10.7326/0003-4819-144-2-200601170-00029
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Published: Ann Intern Med. 2006;144(2):153-156.
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