How the Centers for Disease Control and Prevention responds to a hurricane like Florence

Emmett Marshall, 4, wades in floodwaters that Hurricane Florence brought to Norfolk, Va. The Centers for Disease Control and Prevention is warning people not to use stormwater for drinking, cooking or cleaning.
(Alex Brandon / Associated Press)

For all the political chatter about the human toll of hurricanes, one lesson of past monster storms is clear and increasingly urgent: Hurricanes claim lives and erode health before, during and after the water, wind and rain hit.

To reduce the short-term and long-term health consequences of these ever more frequent storms, emergency planners need to anticipate how the threats unfold — and get ahead of them.

They may even use such disasters as opportunities to boost communities’ health after a storm has passed.


This week, the Centers for Disease Control and Prevention set up a roughly 50-person Emergency Operations Center at its headquarters in Atlanta to trace the arc of dangers to affected populations.

Working through medical communities and with state and federal disaster relief agencies, the CDC says it is executing a campaign to prevent injuries, detect and respond to the emergence of disease, and foster the physical and mental health of those affected by Hurricane Florence.

“There are definitely behavioral patterns we recognize,” said Donna Knutson, the CDC’s incident manager for the Hurricane Florence response.

People evacuate without all their prescription medicines, she said. They cut themselves trudging through floodwaters tainted by industrial and household debris and pollutants. They take their chances on dicey stored food, inviting gastrointestinal misery, and use generators too close to their homes, risking asphyxiation. They stay too long in residences contaminated by mold and, in their urgency to regain their sense of normality, may overlook a family member’s gnawing despair.

These threats to life and health are preventable, Knutson said. But it takes more than drills and exercises to prepare first responders and medical personnel to prevent them. Where frequent firsthand experience may be missing, the CDC can provide expertise in what to expect, she said.

In the run-up to Hurricane Florence’s arrival in the Carolinas, the CDC issued injury-prevention messages, warning people in flooded areas not to take refuge in their attics, touch downed power lines or drive into moving water — one of the most frequent causes of drowning.


Its public health experts have calculated the safe ratio of shelter-seekers to bathroom facilities in public buildings, and briefed hospitals and first responders on the types of injuries they’re likely to see, and when.

They’ve lined up booster shots against tetanus for evacuees with open wounds and pneumonia inoculations to offer at shelters. Knutson said that the CDC is dispatching flu vaccine to many shelters to save people the trouble of finding it later.

As waters subside, evacuees returning to homes that have been submerged for more than 48 hours will get detailed instructions in how to clean to prevent mold, which can cause and exacerbate respiratory and allergic reactions.

The CDC is also readying environmental health officers to assess mold, drinking water threats and the escape of hazardous materials. Epidemiologists will be ready to detect exploding populations of rodents and mosquitoes, as well as outbreaks of the diseases they carry.

Knutson said the CDC will be vigilant for outbreaks of plague, transmitted when rat populations surge and people get bitten by rodent fleas carrying the Yersinia pestis bacterium.

“Plague we still get from squirrels in downtown Denver,” said Knutson. The likelihood that this now-treatable ancient scourge could reemerge from rat infestations of sodden debris is hardly inconceivable, she said. Infected patients experience a sudden onset of fever, headache, chills and weakness and one or more swollen, tender and painful lymph nodes.

The Asian tiger mosquitoes (Aedes albopictus) that spread West Nile virus are likely to thrive in the wet conditions that linger after a storm, facilitating the spread of a disease that can cause potentially fatal brain inflammation in 1 in 150 of people stricken.

North Carolina has also had outbreaks in recent years of the chikungunya virus, spread by the Aedes egyptii mosquito species that is considered “very likely” to live and reproduce in the Carolinas. Fever and joint pain, as well as headache, rash and joint swelling, develop three to seven days after a person is bitten by an infected mosquito.

Knutson said the CDC’s task force on “flying and walking disease vectors” expects more “nuisance mosquitoes” than virus-carrying ones. The Carolinas’ salt-marsh mosquitoes are vicious biters and could cause no end of misery for those engaged in cleanup efforts. But Knutson said the CDC will be watchful for evidence that disease-carrying mosquito populations are proliferating.

Finally, the CDC has made plans to recruit community members to conduct “behavioral health checks” in their neighborhoods as the rebuilding begins. In doorstep conversations, survey takers would ask residents about their anxieties, fears and levels of hope as they confront the significant task of rebuilding their homes and neighborhoods.

“It’s a really good way to get a handle on what an entire community feels,” Knutson said. The CDC would then analyze the information it collects, and share it with state and local community managers.

Hiring local residents to make door-to-door visits is the best way to gauge the mental health of a community, she added: “People want to open their door and talk to someone they’ve seen in the supermarket.”