A third of Hurricane Maria deaths stemmed from healthcare disruption, NEJM study shows
A new and much higher estimate of the death toll in Puerto Rico from Hurricane Maria last year attributed one-third of the deaths to delayed or interrupted healthcare services. Roughly one in 10 were caused by the hurricane itself.
- The federal government’s official tally of 64 dead after Hurricane Maria hit is a “substantial underestimate” of the storm’s actual burden, the study in the New England Journal of Medicine concludes.
- Based on a random sample of households across the island, Harvard researchers estimate a mortality rate of 14.3 deaths per 1,000 people between mid-September and the end of last year — or 4,645 excess deaths during the period.
The massive storm disrupted services of all kinds. Households averaged 84 days without electricity, 68 days without water and 41 days without cell phone service. In remote areas, 83% of homes had no electricity for the entire study period.
Nearly a third of households reported difficulty accessing medical services. Most frequent were the inability to get medications (14.4%) and the need for electrically powered respiratory equipment. Other problems included closed medical facilities (8.6%) and absent doctors (6.1%). In some remote areas, 8.8% of respondents said 911 services were unavailable by phone.
“In our survey, interruption of medical care was the primary cause of sustained high mortality rates in the months after the hurricane, a finding consistent with the widely reported disruption of health systems,” the study says. “Health care disruption is now a growing contributor to both morbidity and mortality in natural disasters.”
The findings dovetail with a recent Center for Health Security Project team report, which found the U.S. healthcare system is ill-prepared to handle large-scale disasters.
That Robert Wood Johnson Foundation-funded study found the federal Hospital Preparedness Program, especially creation of healthcare coalitions, has improved the response to small-scale disasters. But preparedness for complex and large-scale disasters like hurricanes, wildfires, mass shootings and health outbreaks like the flu can overwhelm providers and communities, particularly when critical infrastructures are disrupted.
The report called for a network of disaster resource hospitals and a new program within the Office of the Assistant Secretary for Preparedness and Response that is devoted to catastrophic health planning, among other recommendations. The CHSP report also pointed to opportunities for telehealth and other technologies to connect disaster victims to real-time, remote clinical assistance.
In fact, telemedicine played a big role in the aftermath of Hurricanes Harvey and Irma, with governors from five coastal states easing restrictions on out-of-state providers. According to a Rand Corporation analysis, more than 2,000 people in the hurricanes’ paths sought services from Doctor On Demand — 63% of them first-time users. Common requests included help with chronic conditions, prescription refills, back and joint concerns and advice on treating injuries.
Doctor On Demand was just one of a number of telehealth providers that stepped in to provide nonemergency care in the wake of hospital closures, flooded roads and other issues.
Medical drones are also being used to improve response in natural disasters. In Mississippi, researchers have outfitted drones with telemedical kits that include diagnostics and medical equipment, as well as video guidance and a holographic interface that allows doctors to remotely engage with bystanders or victims.
“We feel we’re very close to a solution that can be used in the next hurricane season and, hopefully, in a variety of emergencies including tornadoes and mass shootings like we saw in Las Vegas, bombings and car accidents and remote wilderness types of emergencies,” Italo Subbarao, associate dean and disaster medicine specialist at William Carey University College of Osteopathic Medicine in Hattiesburg, Mississippi, told Healthcare Dive late last year.
- New England Journal of Medicine Mortality in Puerto Rico after Hurricane Maria