Hurricanes, Pandemics, Floods, Frail Systems, and Failed Responses

Hurricanes, Pandemics, Floods, Frail Systems, and Failed Responses

Imagining a post-Harvey, post-Irma, post-Hanna, post-COVID-19 world of pandemics, natural disasters, and U.S. resiliency

The photo shows a torn U.S. flag blowing against a dark grey sky.
A tattered U.S. flag damaged in Hurricane Harvey, flies in Conroe, Texas, on August 29, 2017. REUTERS/Carlo Allegri

The coronavirus pandemic continues to unfold as the swells begin to subside from Hurricane Hanna, whose landfall was centered not far from Houston where we both attended university. We are left with little appetite for taking a fresh, cleansing breath. The global count of COVID-19 infections exceeds 10 million, and our nation’s shortcomings are becoming increasingly clear.

We are left with little appetite for taking a fresh, cleansing breath

There are more than 50,000 new coronavirus cases per day in the United States. To honor the lives lost and the sacrifices of those on the frontlines, we must learn from this crisis and meet tomorrow’s challenges at the scale required. We must buttress the shaky foundations of the systems that have made the jobs of health-care heroes so difficult and address the factors driving disparity. Through dramatically reimagining our health care and public health infrastructure, we can keep health systems from becoming overwhelmed, promote community health, and protect individuals from illness in the first place. We can achieve this through expanding health capacity, improving access to prevention and intervention, and addressing the social determinants of health.

The photo shows a number of people on a beach amid huge waves.
A hurricane approaches Texas during the time of coronavirus—beach-goers play in high swells from Hurricane Hanna in Galveston, Texas, on July 25, 2020. REUTERS/Adrees Latif

To prepare for the challenges ahead, we must first increase hospital capacity with awareness of our changing world. Driven by these factors and by the growing climate crisis, we will face more pandemics, hurricanes, landslides, and other disasters. Vector-borne pathogens are likely to become more prevalent and spread more rapidly as well.

We watched our city reel as it struggled to address food and drug shortages, staffing problems, and overrun health care and social services

During our undergraduate days in Houston, we confronted one of these disasters, Hurricane Harvey. Making landfall in August 2017, Harvey caused catastrophic flooding, resulting in the death of dozens and the destruction of homes and businesses, resulting in over $100 billion in damages. We watched our city reel as it struggled to address food and drug shortages, staffing problems, and overrun health care and social services. Two other historic hurricanes followed weeks later, pushing the already-strained local, regional, and national disaster response capacity to the brink. Hurricane Maria leveled Puerto Rico, taking nearly a year to get electricity back to its residents. Hurricane Irma hit Southern Florida as the most powerful Atlantic ocean hurricane in recorded history. As much as we prepare for future storms, what if events like these happened at the same time in the same place?

The photo is a split screen showing three men in orange jumpsuits scaling a landslide and a highway interchange flooded so much that an 18-wheeler truck is submerged to its cab.
After a hurricane and a landslide: rescue workers atop a landslide in La Paz, Bolivia, on February 21, 2019, and Interstate 45 submerged after Hurricane Harvey in Houston, Texas, on August 27, 2017. REUTERS/David Mercado

As we’ve seen in Michigan where, earlier in the COVID-19 crisis historic rainfall led to the failure of a dam and severe flooding, this possibility is very real in many places. Be it Typhoon Haiyan in the Philippines during COVID-19 or the ongoing cholera outbreak and flooding in Somalia in recent years, we ask ourselves whether our hospitals are prepared to face natural disasters and a global pandemic concurrently?

Are hospitals are prepared to face natural disasters and a global pandemic concurrently?

How would local governments in other hot parts of the United States or the world prepare to provide cooling centers to protect against heat-related deaths in a time that calls for social distancing? Hand-washing protects against COVID-19, but how would a state encourage citizens to abide by these guidelines amid a historic water shortage as faced by South Africans just two years ago? We should take COVID-19 as a costly warning. Moving forward, we must expand national stockpiles of ventilators and other crucial supplies, invest in expanded bed capacity, and better support local health departments to meet the needs of their communities. Our disaster preparedness plans must be driven by evidence and science, both of which point to a future that will force us to prepare for worst-case scenarios and then consider that these multiple disasters for which we prepare might just happen together.

The dramatic photo shows a large mud plain dried to a cracked finish by drought and sun under a grey cloudy sky.
Aftermath of a major drought—clouds gather but produce no rain as cracks are seen in the dried up municipal dam in drought-stricken Graaff-Reinet, South Africa, on November 14, 2019. REUTERS/Mike Hutchings

Prevention and Coverage

Expanding capacity is insufficient. We must also address illness before it strikes and provide affordable, accessible care when it does. In the United States, health insurance coverage gaps challenge effective prevention and disease management.

Better positioned to both manage chronic needs and confront crises

Our health-care systems should be universally accessible and proactive, not reactive and restrictive. Worldwide, we’ve seen how countries with health-care systems rooted in collective and communal values are better positioned to both manage chronic needs and confront crises. For poor people in Canada, their chances of receiving better health care is 36 percent greater than those of their American counterparts. COVID-19 has exacerbated coverage challenges as the economic effects of COVID-19 drive unemployment to unprecedented highs, stripping employment-based insurance from more Americans, particularly low wage earners. 

The photo shows people waiting in line while others leave with armloads of food from the other side of a plate glass storefront on which is scrawled in hand-written green letters "Free Food Every Monday."
A food pantry in Chelsea, Massachusetts, which is across the Mystic river from Boston and has the highest coronavirus infection rate in the state as well as ongoing economic hardship—on July 6, 2020. REUTERS/Brian Snyder

While the uninsured and underinsured have always weighed the financial consequences of seeking care, COVID-19 has highlighted the public health and societal costs of settling for a system that has pushed so many to forgo testing, treatment, and life-saving intervention over concerns over the cost of said care.


Those hospitalized with COVID-19 could pay as much as $74,310 if uninsured or out-of-network

One uninsured woman was charged nearly nearly $35,000 for a COVID-19 test and related outpatient emergency room visits. Lawmakers have since made coronavirus tests free (with certain stipulations), but those hospitalized with COVID-19 could still pay as much as $74,310 if uninsured or out-of-network. These examples are not isolated to the current crisis; more than half of Americans avoid needed needed medical care due to costs. If we hope to defeat COVID and future health challenges, Americans must seek testing and care when they need it to protect their personal health and community health. In this sense, our inability to achieve universal health care is not only a moral absurdity but a public health liability.

The picture is an aerial photo of a large parking lot with cars snaking along in line.
Tests are free, but lines are long—residents line-up in their vehicles to be tested amid the global outbreak of the coronavirus disease (COVID-19) in Houston, Texas, on July 7, 2020. REUTERS/Adrees Latif

Social Determinants of Health and the Built Environment

As we expand health-care capacity and access to care, we must also mitigate the environmental exposures, built environment, and other factors that predict health outcomes and drive disparities. Health disparities observed during COVID-19 illustrate how disasters impact different communities in profoundly different ways.

The conditions in which people are born, grow, live, work, and age, can point us to the root causes of these disparities

Social determinants of health, the conditions in which people are born, grow, live, work, and age, can point us to the root causes of these disparities. Better preparation for the disasters of tomorrow depends on addressing social determinants of health today. Access to clean air is one of these determinants that drives health. Champions of environmental justice have long sounded the alarm to pollution’s detrimental health impacts. From increased health-care costs to lost worker productivity and increased rates of school absenteeism, our inability to secure clean air for all communities has a real cost. A foundational study published in 1979 found that air pollution in Allegheny County, Pennsylvania cost residents $9.8 million in annual hospitalization costs. These trends have not changed, and this disparity for environmental justice communities is not unique to the United States. The cost of air pollution to the United Kingdom’s National Health Services and social care will be 6.52 billion in U.S. dollars from 2017–2025.

The photo shows the torso and legs of several people walking across a street over a decorative swirl pattern of paint on the crosswalk.
Pedestrians cross the road near an event organized by the Green Party, to highlight their demand for air pollution action from the government, in Brixton, London, Britain February 24, 2018. REUTERS/Paul Hackett

It’s also important to recognize the links between people's living environments and their health. Recognition of the inseparable ties between health conditions and the built environment is nothing new. Researchers have long found that access to green space in one’s neighborhood improves mental health, physical health, and social cohesion.

In New York City during the pandemic, the authorities acknowledged this relationship by closing some streets to car traffic entirely to encourage socially distant exercise. However, many communities have limited access to these spaces. To create healthier communities moving forward, we must create environments that promote good health with a deep appreciation for addressing longstanding disparities.

The photo shows a street with a big red barricade in the foreground.
Closed for business—a barrier marks a street closed to car traffic for social distance dining and pedestrian activity on a street in lower Manhattan in New York City on July 4, 2020. REUTERS/Caitlin Ochs

During the COVID-19 pandemic, overwhelmed infrastructure, challenges to access to care, and disparities in health outcomes have underscored the need for change. Community resilience requires the expansion of public health infrastructure and health-care systems, insurance coverage, and access to care. Moreover, these changes should be implemented with the awareness of how where we are born, live, and work affects health.

One person cannot stop a pandemic from infecting a population, and one neighborhood cannot protect itself from a hurricane, but if we acknowledge the realities of tomorrow with a shared commitment to one another, our nation can weather any combination of storms. 

Hannah Todd is a medical student at Baylor College of Medicine. 

Justin Onwenu is a Detroit-based environmental justice organizer with the Sierra Club. He fights for clean air and clean, affordable water for all communities.

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