Lingering Effects of Hurricane Katrina on Vulnerable Populations

A Category 3 hurricane made landfall in the Gulf Coast of the United States near Grand Isle, Louisiana on August 29th, 2005. Named Hurricane Katrina and hitting winds of 127 mph the storm caused fatalities, flooding, and severe property damage in the Gulf Coast from New Orleans, Louisiana to Biloxi, Mississippi. Due to the aggressive nature of the storms and flooding, numerous levees failed around the New Orleans area, causing additional devastation to those communities (C.N.N. Library, Hurricane Katrina Fast Facts, 2018). The impact of the storm along the Gulf Coast was further enhanced by the arrival of Hurricane Rita a few weeks later. Residents were initially evacuated from Eastern Louisiana to Western Louisiana, and then had to be relocated again, due to the geographic location of Hurricane Rita's landfall as well as structural damages caused to existing shelter locations. As temporary housing for evacuees became challenging, many makeshift locations were utilized in areas less affected by flooding. In one case of sheltering, evacuees taking shelter at a sports complex had to relocate due structural damage to the building's roof. The associated storms caused 1,822 fatalities recorded in 5 different states and approximately $125 billion in damages, according to 2005 prices. (C.N.N. Library, Hurricane Katrina Fast Facts, 2018). Although recovery efforts in the affected areas have been made with success; the lingering effects of Hurricane Katrina which manifested in communities, present pervasive public health concerns, especially in those individuals considered to be from vulnerable populations.

An estimated population of 1.7 million in Louisiana required evacuation prior to the unforgiving weather (storms and floods) affecting the area. Only about 1.5 million people were able to be relocated in other areas that were deemed not affected. Several hundred thousand people either decided against relocation or were unable to move out of the area and stayed behind due to limited capabilities, such as individuals in hospitals. Although several shelters capable of housing hundreds of thousands were set up in multiple locations, the addition of Hurricane Rita in subsequent weeks after the flooding, further taxed resources and made additional relocation to other safer areas inevitable (Institute of Medicine, 2007).

The initial recorded population of New Orleans, L.A. was 450,000 prior to Hurricane Katrina. According to data gathered within 4 months post disaster, approximately 378,000 residents were still displaced from the New Orleans metropolitan area. The demographic data showed that the majority of those able to remain in the area during and post storm, were primarily of a socioeconomically stable, and predominantly White and non-Hispanic demographic, at 54%. After the storm, this demographic population increased to 68% in New Orleans from the original 54% (Whoriskey, 2006).

To analyze data gathered regarding fatalities caused during the original storm and the subsequent flooding; 971 Louisiana deaths and associated causes were documented and organized for use in future disaster mortality reduction stratagems in 2008. Sources used to verify this information were Katrina related death certificates from 8/27/2005 to 10/31/2005 and the Disaster Mortuary Operational Response Team victim database in pertinent parishes in Louisiana (Brunkard, Namulanda, and Ratard, 2008). The resulting information indicated three primary causes as well as demographic data showing the mortality rates were higher in men at 53%, African Americans at 51%, and Caucasians at 42%. Additionally, another vulnerable population documented, lay among residents over 75 years of age. This number is likely caused by factors that include the elderly in residential and nursing homes, hospitals, and those with limited mobility. Other information of note were the causes of death, listed as 40% drownings, 25% injury and trauma, and 11% heart conditions (Brunkard, et al, 2008).

According to a study published in 2012 and based on data gathered by the American Community Survey (Sastry and Gregory, 2013), a significant increase of 4% disabilities were documented among residents a year after Hurricane Katrina. These metrics can be observed through data comparison. The information was compared to previous metrics gathered in New Orleans a year prior to the event. The data included demographic data collected among various ages, races, and genders. Some of the findings included a marked increase in mental health needs and a limited increase in physical disabilities. Most notably, the disabilities appeared to affect young to middle aged African American women (Sastry and Gregory, 2013). It is speculated the changes in circumstance can be attributed to living in homes located in areas highly damaged by the event. Children were also more likely to experience separation in the household dynamic and be of more susceptible predisposition to stressed conditions. Although, it is likely most disaster survivors will experience some sort of psychological trauma from displacement and witnessing the destruction of a disaster, many studies that are published focus on victim mortality rates and pathogenic infection that affect public health. From a public health perspective, these areas must be focused on to prevent and mitigate outbreaks of disease after disasters. Studies such as this one published by Sastry and Gregory, show a holistic picture of disaster survivor trends that include the psychological components along with the physical and physiological. This study correlates the disparity in psychological wellness of displaced New Orleans residents and in more detail, that the African American demographic is markedly more affected. This study along with the disaster mortality rate study published by (Brunkard, et al, 2008), highlight that vulnerable populations, such as: the elderly, minorities, and children, experience increased detrimental physical and mental health effects after disasters.

During the flooding in Louisiana, levee systems failed around New Orleans further increasing water levels. An evaluation of the water quality was conducted to determine what chemicals and toxins were present in the water that flowed into the adjacent body of water (Lake Pontchartrain) (Institute of Medicine (US), 2007). The sewer and waste water systems in New Orleans were compromised and in need of repair as they were under several feet of water. The quality of potable water and waste systems are always areas of concern to public health, especially after flooding of metropolitan areas. Symptoms that are examined in the population after such an event may include: diarrhea from exposure to contaminated food or water, respiratory distress due to mold and other microorganisms found in dwellings and the air, and additional anomalous systemic issues that may appear viral or bacterial in nature.

In 2005, elevated amounts of microbial and toxicant contamination were found the residual flood waters in New Orleans (Sinigalliano, Gidley, Shibata, Whitman, Dixon, Laws, Hou, Bachoon, Brand, Amaral-Zettler, Gast, Steward, Nigro, Fujioka, Betancourt, Vithanage, Mathews, Fleming, and Solo-Gabriele, 2007). Fecal coliforms and Escherichia coli amounts showed that waste and associated harmful lifeforms were present in the water.

Although tests were not conducted to detect Vibrio vulnificus, the conditions of the water were encouraging for their development (Sinigalliano, et al, 2007). According to a Center for Disease Control (CDC) report, 5 deaths were attributed to Vibrio vulnificus which were contracted from Hurricane Katrina flood water. Vibrio vulnificus is a type of cholera and can be introduced to the body through a wound that has encountered contaminated water (Katrina Disease Kills Five, 2005). Vulnerable populations, such as the elderly, and those with compromised immunity are especially at risk of infection.

An additional issue of concern during the recovery phase after any major flooding, is the growth of molds and other organisms thriving in homes that have experienced significant flooding and have been left vacant for a period. Evacuees sometimes have difficulty returning to their place of origin due to the lack of habitability of their home and in some cases, financial resources to return to their respective places of origin. Molds grow quickly in the right environments and must be mucked and gutted with personal protective gear by individuals who have debris and mold removal knowledge. There are various barriers that may prevent home occupants from the immediate removal of moldy materials, followed by sanitation methodology before a rebuild can begin. A study conducted from material samples obtained in New Orleans, inside homes that had not yet undergone the process of sanitation in the affected areas in 2007, showed the presence of several microorganisms. Aspergillus, Penicillium, Cadosporium were found inside dwellings, as well as other molds and fungi in elevated amounts (Bloom, Grimsley, Pehrson, & Larsson, 2008). These findings were consistent with recorded findings in dwellings after exposure to flood water and the materials tested had not yet been compromised by sanitation procedures. The mold amounts in air particulates tested in these dwellings were similar to the material samples tested from within the home. The study showed the importance of utilizing the appropriate protective equipment for individuals conducting the sanitation and rebuild of the affected homes in this area, for mitigation of health hazard exposures (Bloom, et al, 2008).

According the CDC, cases of West Nile neuroinvasive disease also significantly increased in the year following Hurricane Katrina. For the analysis, the data compiled in the affected Louisiana areas was compared to information previously recorded. Although, cases of West Nile had already begun to be reported prior to the storm, it was speculated that the spike in cases were attributed to an increase in medium for mosquito reproduction (stagnant water, quality of living conditions, etc.) (Caillou?«t, Michaels, Xiong, Foppa, and Wesson, 2010). West Nile is a virus most commonly spread to people by mosquito bites and no immunizations are currently available (CDC.Gov, 2018).

Naegleria fowleri was also the culprit of a recorded death of a child, even years after Hurricane Katrina. Naegleria is an amoeba that mostly inhabits fresh bodies of water such as lakes and rivers. The organism thrives in warm climates and usually does not infect hosts through ingestion of water, but instead N. fowleri (the species type that is communicable to humans) enters the nasal cavity and travels to and infects the brain. The host is usually infected during contact with contaminated water during participation in recreational water sport in lakes and rivers, however cases have occurred of people becoming contaminated in chlorinated pools and in this case, a slip in slide. N. (2018, July 17). ParasitesNaegleria

Reports of brain eating ameba related deaths have surfaced over the years in Louisiana since Katrina. The initial presumption is that waterborne illnesses are related to contaminants from flood waters or excessive heat conditions in rivers and lakes, but organisms such as N. Fowleri, can reside within city plumbing and thrive there because of lack of pipe flushing (Fox, 2017). In anticipation of disasters, residents are evacuated and do not return to these locations until after some time, giving these organisms a warm and sedentary medium to grown in (Cope, J. R., Ratard, R. C., Hill, V. R., Sokol, T., Causey, J. J., Yoder, J. S., . . . Beach, M. J., 2015). In 2013 a case of Naegleria fowleri in tap water was reported to have infected a 4-year-old boy playing on a slip and slide. The tap water had undergone the U.S. standard water treatment. The patient in this case died of meningoencephalitis of unknown etiology but the Cerebral Spinal Fluid and brain samples were cultured and confirmed the presence of N. fowleri, changing the final diagnosis to Primary Amebic Meningoencephalitis. Testing of the associated water supply and sources also confirmed the presence of the organism (Cope, J. R., Ratard, et al, 2015).

There have been reforms and revisions to many federal documents and policies since Hurricane Katrina in response to after action reports from the disaster. In current events, the handling of Hurricane Maria is also facing criticism for a response slower than expected in resource aid, as well as lack of resources, or resources not being provided in a timely manner from government contractors. Conducting studies and analyzing data related to public health and welfare (acquired through government and nonprofit agencies) immediately following disasters, is imperative for mitigation of other events in the United States. The Administration of Children and Families when engaged, can provide essential demographic data in regard to immediate needs of disaster survivors, to include mental health needs, physical, and basic needs (Kramer, Finegold, Kuehn, 2008).

This data is usually collected in the commission of assisting to address said needs by linking disaster survivors to community resources able to provide tangible goods and services. Metrics gathered include trends that transcend geography for persons that relocate after disasters, the changing of immediate needs to long term needs, and various other information pertinent to the improvement of human health and welfare (Kramer, et al, 2008). Analyzing this data can assist with the creation of new programs and improvement of existing programs in these communities to enhance public health and other human service programs.

In conclusion, it is imperative to compile data and complete analysis and/or correlation studies to identify gaps in services and resources comparatively; prior to and after natural and anthropogenic disasters. Doing so can establish accurate baseline models in neighborhoods and cities with socioeconomic disparities and specific demographic data for the purpose of addressing challenges that may arise during and after emergency events. When building community resilience in the mitigation phase of emergency management, it is essential to bridge these gaps to lessen burden of resources and loss of life in the future. Based on historical and geographical information of water source contamination, public health issues, and populations most affected by disaster; emergency managers can learn to anticipate areas that will require swift remediation, especially in areas that are frequently impacted by hurricanes and storms. Vulnerable populations such as the elderly, minorities, and children experience additional needs and difficulties daily. Throughout this analysis of events in the aftermath of Hurricane Katrina, studies have shown that vulnerable populations in New Orleans, Louisiana have had significant increases in geographical displacement and public health concerns consistent with their susceptibility. The elderly residents experienced increase mortality rates, women and children experienced an obvious increase in psychological health and wellness, and pathogenic organisms are especially fatal to the immunocompromised and children.

References

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Sinigalliano, C. D., Gidley, M. L., Shibata, T., Whitman, D., Dixon, T. H., Laws, E., . . . Solo-Gabriele, H. M. (2007, May 22). Impacts of Hurricanes Katrina and Rita on the microbial landscape of the New Orleans area. Retrieved September 30, 2018, from https://www.pnas.org/content/104/21/9029

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