Superstorm Sandy Public Health Practice and Response NJ

Superstorm Sandy: Public Health Practice and Response, NJ 4 th Annual National CSTE Disaster Epidemiology Workshop May 9, 2013

Outline • Background and NJDOH Recovery Plan • Environmental Health Task Force • Outreach and training (environmental health issues) • Mosquito-borne disease issues • Surveillance activities http: //nj. gov/health/commiss/video/sandy. html

NJDOH Recovery Plan • Ensure that people and services are connected despite the storm’s impact • Characterize environmental health issues associated with Sandy; mitigate environmental health concerns caused by Sandy • Restore NJ’s licensed healthcare and public health partners to normal operation • Provide the public and DOH stakeholders with information on recovery activities and opportunities • Identify potential mitigation opportunities to increase community resiliency • Document disaster response and recovery costs of healthcare, public health and EMS providers in order to obtain any and all available financial assistance

Environmental Health Task Force • In immediate weeks after storm, numerous meetings among partners redundancies, communication challenges identified • Recognition of need to convene partners regularly – Federal: HHS (e. g. , CDC/ATSDR, ASPR, NIH/NIEHS), FEMA, OSHA, EPA – State: NJDEP, NJDOE, NJDCA, NJDCF, NJDOL, UMDNJ-SPH – Local: health officer and environmental health associations

Outreach and Training (1) • Indoor environmental issues (namely mold) identified as priority • Agencies and stakeholders had existing training opportunities information sharing among EHTF Available at: http: //nj. gov/health/ceohs/ documents/mold_guidelines. pdf

Outreach and Training (2) • Messages to local health departments – Retail food, tanning, body art establishments – Swimming pools, natural bathing waters • Messages to youth camp operators • Identification of additional resources (e. g. , HUD/CDBG and HHS/SSBG funding, ASPR funding)

Mosquito-Borne Disease Issues: Partners • NJDEP Office of Mosquito Control Coordination (and county counterparts): mosquito surveillance and abatement (integrated pest management) • NJDA: equine/camelid/veterinary surveillance • NJDOH: human and avian surveillance • Interagency Vectorborne Disease Work Group

Mosquito-Borne Disease Issues: Planning • Identification of additional resources (e. g. , FEMA public assistance, CDBG/SSBG funding) • Enhancement of existing abatement, surveillance and education activities

Challenges to Surveillance in Disaster Settings q Infrastructure damage § Widespread power outages § Damage to phone lines q Travel challenges § Roads flooded, washed away § Roads blocked with downed trees and power lines § Gasoline shortages and rationing q Constantly changing network of shelters

Objectives q Conduct shelter-based surveillance to track morbidity and provide daily feedback q Create and implement sustainable methods to report remotely

Methods q Each shelter, 24 -hour time period q Health service visit = interaction in which medical attention provided to shelter client q Health need = injury, symptom, or chronic illness for which medical attention was sought q For each health service visit, recorded § Basic demographic information (sex, age category) § Disposition and referral information § All health need(s) addressed q Daily reports produced and distributed

Results: Shelters Included 93 NJ shelters 23 shelters closed 70 shelters 44 shelters excluded 26 shelters visited 18 Red Cross shelters 8 independent shelters 5 declined participation 21 shelters included

Demographics of Health Service Visits Characteristics Sex (n=4629) F Age group, years (n=4449) 0– 2 3– 18 19– 64 65 and older No. (%) 2384 (52) 63 295 3167 924 (1) (71) (21)

Categories of Health Needs Addressed (n=6825) Category Acute Symptoms Follow-up Care Exacerbation of Chronic Illness Injury No. 3563 2257 756 249 (%) (52) (33) (11) (4)

Most Common Health Needs (n=6825) Syndrome Pain Respiratory/ILI Medication Refill Any Mental Health No. 1161 776 750 717 (%) (16) (11) Gastrointestinal Symptoms 183 (3)

Use of Data by State/Local Health Agencies q Signage, resources for public health promotion provided q Several outbreaks suspected and/or identified reported to local health departments rapid response to disease outbreaks q Mental health and medical concerns referred to various resources (e. g. , county human service agency involvement, mobile pharmacy vans)

Summary q Project brought together partners for data sharing § American Red Cross § NJ Department of Health and local health departments § Centers for Disease Control and Prevention q q Timely data sharing fostered public health interventions Every disaster is different

Fatal Work-Related Injuries

Two Fatal Occupational Injury Surveillance Systems Census of Fatal Occupational Injuries (CFOI) Purpose: count and describe fatal work-related injuries States funded by the U. S. Bureau of Labor Statistics Fatality Assessment and Control Evaluation (FACE) Purposes: investigate factors involved in selected fatal work- related injuries, make and promote recommendations for prevention Nine states funded by the National Institute for Occupational Safety and Health (NIOSH)

Primary Sources of Work-Related Fatal Injury Data News media OSHA Death certificates/Bureau of Vital Statistics Medical Examiners

Superstorm Sandy Work-Related Fatal Injuries Six work-related fatal injuries in New Jersey Dates of injuries range from Oct. 29 to Dec. 28 All males, age range 41 -69 years Four of six deaths among landscape/tree care/cleanup workers Two deaths from tree-cutting accidents Two deaths from being struck by motor vehicles

Syndromic Surveillance and Emergency Department Uniform Billing Data

Syndromic Surveillance Data Real-time data from electronic health records (EHR) to enable health departments to detect and respond to outbreaks Epi. Center (Health Monitoring Systems, Inc. ) EHR data feeds from NJ Emergency Departments 75 facilities currently active in Epi. Center Limitation: several key hospitals in Ocean and Monmouth counties not yet active

Methods Dozens of syndromes under surveillance: Influenza-like illness Immediately notifiable diseases (e. g. , anthrax) Traumatic injuries Gastrointestinal illnesses Heat-related illness Monitors key words in patient’s chief complaint field On-going statistical analysis detects anomalies and triggers notifications and investigations

Definition of “Hurricane” Syndrome Developed in anticipation of Superstorm Sandy Requested EDs to use “Sandy” in chief complaint field for storm-related visits “Hurricane” syndrome includes visits in which chief complaint included: “sandy”; “storm”; "flood“; "carbon monoxide“; "carbon dioxide“; "power outage“; or "hurricane"

Counts of Sandy. Related ED Visits by Day and Category Data from Epi. Center Syndromic Surveillance System, Oct. 28 – Nov. 10, 2012

Daily Counts of Sandy-Related ED Visits by Category Data from Epi. Center Syndromic Surveillance System, Oct. 28 – Nov. 10, 2012

Data from Epi. Center Syndromic Surveillance System

Emergency Department UB Data for CO Data from Epi. Center Syndromic Surveillance System and 2012 UB File , Oct. 28 – Nov. 10, 2012

Future Considerations Continuing use of findings to guide communication messages and public health action Developing suite of weather-related outcomes Carbon monoxide exposure/poisoning Heat- and cold-related illness Storm-related injuries Health care system impacts (e. g. , oxygen needs, dialysis, medicine refills) Identifying potentially vulnerable populations

Summary • Post-storm period poses wide range of issues for immediate and long-term recovery • Post-storm activities require involvement of numerous partners to optimize quality of responses

Challenges • Many resources available; timely identification and utilization were issues • Characterizing requests for assistance was sometimes difficult

Opportunities • Connections among partner groups are critical to future preparedness and response efforts • Recovery activities will inform and ideally streamline future responses to natural disasters

Acknowledgments NJDOH Andria Apostolou Miranda Chan Joe Eldridge Jerry Fagliano Denise Garon Teresa Hamby Gary Ludwig Fernando Mc. Lean, Jr. Shereen Semple Faye Sorhage Stella Tsai CDC Diana Bensyl Kris Bisgard Cindy Chiu Tala Fakhouri Lauren Lewis Michelle Murti Rebecca Noe Satish Pillai Amy Schnall Alice Shumate Niu Tian Joanna Watson Amy Wolkin Ellen Yard American Red Cross Mary Casey-Lockyer Nancy Meininger Teresa Schreffler Esther Tan Jo West

Questions? Tina Tan, MD, MPH State Epidemiologist/Assistant Commissioner NJDOH Division of Epidemiology, Environmental and Occupational Health christina. tan@doh. state. nj. us 609 -826 -5967 Master Sgt. Mark C. Olsen/USAF/NJ National Guard