Superstorm Sandy: Public Health Practice and Response, NJ

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

2. 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

4. 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

5. 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

6. 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

7. 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)

8. 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

9. 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

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

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

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

14. 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

15. Demographics of Health Service Visits

16. Categories of Health Needs Addressed (n=6825)

17. Most Common Health Needs (n=6825)

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

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

20. Fatal Work-Related Injuries

21. 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)

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

23. 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/clean-up workers • Two deaths from tree-cutting accidents • Two deaths from being struck by motor vehicles

24. Syndromic Surveillance and Emergency Department Uniform Billing Data

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

26. 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

27. 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"

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

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

30. Data from EpiCenter Syndromic Surveillance System

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

32. 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

33. 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

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

35. 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

36. Acknowledgments American Red Cross Mary Casey-Lockyer Nancy Meininger Teresa Schreffler Esther Tan Jo West NJDOH Andria Apostolou Miranda Chan Joe Eldridge Jerry Fagliano Denise Garon Teresa Hamby Gary Ludwig Fernando McLean, 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

37. 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