Of the many heart-wrenching images from hurricanes Helene and Milton, one sticks with me: A white building immersed in muddy brown water with people sheltering on the roof. A rescue helicopter is trying to land in high winds. The building is the Unicoi County Hospital in Erwin, Tenn., and among the 54 stranded were patients in need of medical care. Thankfully, all were rescued.
It’s easy to think that is the end of the story. However, as a physician, I think about all the follow-up impacts we are not seeing in the news footage: The many other health care facilities in southeastern states that had to evacuate, outpatient services that were canceled, chemotherapy that was postponed, dialysis that could not be delivered due to a lack of power, essential prescriptions that were not filled.
Many pharmacies across seven states remained closed for days after Helene raged. Baxter International’s North Cove plant in North Carolina, which makes 60 percent of the nation’s supply of IV fluids, announced a temporary closure, prompting some hospitals to ration supplies. Patients as far away as California and Alaska may suffer because of a storm that hit North Carolina.
As communities struggle with the reality of lives lost and the damage inflicted, it can be hard to bring up the suffering that is yet to come — but being clear-eyed about the challenges ahead requires acknowledging the vulnerabilities of our health care system and committing to make it better.
From hurricanes Katrina to Sandy to Rita, we now have ample evidence of the longer-term health impacts of severe storms. These range from higher levels of stroke to increased risk of preterm births to elevated levels of post-traumatic stress disorder and anxiety in the weeks and months that follow. A new study in Nature reported that more people died between 1930 and 2015 in the United States from hurricanes and tropical storms than from motor vehicle accidents.
The aftermath of Hurricane Maria in Puerto Rico in 2017 provides a stark example of how this is possible: The official death toll after the storm was reported to be 64, but a landmark study later found that this was likely closer to 4,645 — more than 70 times the original estimate. Reasons included elevated rates of heart attacks and strokes as well as loss of continuity of care essential to people’s health. Unsurprisingly, disrupted health care systems can’t deliver the care people need.
We can, and must, do better to prepare our communities for the short- and long-term impacts of severe weather events. We can get better at reducing the harmful health effects of major storms, even as the size and ferocity of these storms grow.
So what must be done?
First, there must be a recognition that the impact of climate change will increasingly be felt in places long considered safe, and in ways that communities haven’t anticipated. Consider that Erwin, Tenn., is located more than 1,600 feet above sea level. Few expected such catastrophic flooding to ever hit at that elevation. People were similarly caught off guard by the devastation that reigned across the western North Carolina mountains. There will be more of this “unexpected” climate impact in the near future — which is why our health systems need to be climate-proofed now.
Climate-proofing includes building resilience into our physical infrastructure. Hospitals need to be able to continue functioning after major storms. The same is true for factories and transportation systems that make up the nation’s medical supply chain.
Practically, this means equipping health care facilities with extreme weather-durable infrastructure and renewable energy backup systems. States that are new to preparing for and responding to these risks can learn from places like Tampa General Hospital, which built an energy source that can withstand a Category 5 hurricane and deliver power and hot water to the hospital during a crisis.
Second, states need to be innovative and flexible in health care delivery. This includes being ready to temporarily lift state licensure laws so that health care providers from out of state can temporarily relocate into the area to meet the increased care needs. After Helene hit in North Carolina, emergency policy allowed out-of-state physicians to more easily obtain temporary licensure in North Carolina. It is essential that we streamline this process and make it a standard everywhere.
After Hurricane Sandy, nurses proactively went door-to-door to check in on patients and provide services as needed. This type of innovation is essential to ensure that patients are receiving adequate care, even when getting to a hospital or doctor’s office may be difficult
States also need to adopt and streamline laws related to emergency prescriptions so that patients can be prepared with an adequate supply of their medications prior to an emergency. There are currently 16 states that do not have any regulations related to emergency prescriptions, and some states’ laws are ambiguous, insufficient, or inconsistent.
Third, health care providers should take responsibility for reaching out to their high-risk patients before a major storm approaches. To ensure continuity of care for those with chronic conditions, patients should be guided toward treatment centers and providers outside of the impacted area that have the capacity to treat them. The provider should also ensure those facilities receive patients’ medical records or at least that the patient has remote access. This process should be intentional and well thought out to prevent delays or interruptions in life-saving care.
The photo of the people on the roof of Unicoi County Hospital speaks to all of this: How climate change is changing severe storms, but also how we must adapt and build resilience. As we send hope and help to the millions whose lives have been upended by these storms, we must also recognize it is well past time that policymakers prepare public health and health care systems to protect people and livelihoods in this new world.
Dr. Ashish K. Jha is dean of Brown University School of Public Health and a Globe Opinion writer.