Hurricane Fiona Situation Report #10
This report provides an assessment of the impacts to healthcare and public health due to Hurricane Fiona.
Note: Green text indicates new or updated content in this report compared to the previous report.
Healthcare Ready's Posture
Healthcare Ready is ENGAGED for the response to Hurricane Fiona and Hurricane Ian (situation reports for Hurricane Ian are sent separately). We are closely tracking impacts to healthcare supply chain and healthcare access for both events. In addition to situation reporting, we are updating Rx Open daily to map open pharmacies in Puerto Rico and Florida. We are also sharing updates for responders and the public on social media: Twitter, Facebook, and LinkedIn.
High-Level Situation Summary
Puerto Rico has been heavily impacted by Hurricane Fiona. President Biden visited Ponce, one of the areas hardest hit by Fiona, on October 3 to survey damage and discuss aid to be made available to Puerto Rico:
- $60 million through the Bipartisan Infrastructure Law will be directed to Puerto Rico to help with response and recovery
- $14 million to help clean contaminated waterways and the ecosystem, as well as help mitigate for the next disaster
- $4 million to repair the power grids and install mini power grids so that the island is less dependent on long distance transformers, therefore decreasing the amount of time the island would be without power during the next disaster
Highlights
- While overall the situation continues to improve, as of 10/5, there is a remaining need for electricity and food in impacted areas. Prolonged lack of these resources is resulting in negative health outcomes for residents.
- As of 10/5,approximately 5% of the island remains without power.
- 98% of residents have had potable water restored as generators have been installed at water treatment plants and wells have been cleared of obstructions. Intermittent disruptions have been reported due to generator failures and pipes bursting.
- As of 1:30 pm ET on 10/5 , Puerto Rico has no reported pharmacy closures. Hormigueros and Santa Isabel municipios are reporting less than 50% pharmacies as open (while no pharmacies are reporting as closed, some still have unknown status).
Assessment of Healthcare and Logistics Impacts
Emergency Declarations and Measures
- On September 21, the Biden Administration approved a major disaster declaration for Puerto Rico, authorizing for individual and government assistance to affected individuals and municipalities.
- Puerto Rico Governor Pedro Pierluisi declared a state of emergency on Saturday, September 17.
- Governor Pierluisi issued an Executive Order OE-2022-048 granting immunity to physicians, osteopaths, nurses, physician’s assistants, and health professionals assisting the government during the duration of the declaration of emergency for Hurricane Fiona.
- On Sunday, September 18, President Biden approved an emergency declaration to provide federal assistance and resources in response to Hurricane Fiona.
- Executive Order 22-0915 signed on September 20, guarantees access to medications of beneficiaries of Plan Vital, the government health plan of Puerto Rico. The plan provides physical and mental health services to 1.3 million Puerto Ricans. The Executive Order authorizes Pharmacy Benefit Manager/Management (PBM) to fill 50% of a prescription without a primary care provider’s signature.
Critical Infrastructure Impacts
- Power
- As of Wednesday, 10/5, roughly 5% of the island remains without power, with the majority of outages remaining in the southern and western regions of Puerto Rico.
- However, the west and the south are 30% and 10% without power respectively.
- As of Wednesday 10/5, roughly 1.4 million customers have had power restored.
- As of Wednesday, 10/5, roughly 5% of the island remains without power, with the majority of outages remaining in the southern and western regions of Puerto Rico.
- Fuel
- On 9/30, a BP-chartered diesel tanker docked in Guayanilla Port, Puerto Rico, to begin resupplying the island with diesel fuel. The tanker was carrying about 308,000 barrels of diesel.
- The Marshal Islands-flagged tanker was able to dock following Department of Homeland Security Secretary Mayorkas’s approval of a Jones Act waiver for Puerto Rico.
- Another diesel-carrying tanker chartered by BP and carrying 185,000 barrels of diesel arrived on 9/30.
- Water
- As of 10/4 98% (1,301,185), have had water restored, while 2% (26,555) of residents remain without water. AAA recommends that all residents boil water as they work to restore water.
- As of 9/30, the Añasco filter plant and the Morovis filter plant are out of operations. No new updates as of 10/5.
- Communications
- As of 9/30, the FCC reports that 8.7% (-.8% from 9/29) of cell towers are out. The FCC has deactivated reporting as of 9/30.
- Transportation
- Road closures
- As of 10/4, there are approximately 18 road closures (-2) and 250 (+1) critical incidents.
- Landslides and sinkholes have closed local roads in Humacao, Guyama, and Toa Baja, among others. DTOP is calling on drivers to take precautions when driving and to report landslides and other obstructions on the roads.
- Airports
- There are no remaining airport closures due to Fiona as of 10/3.
- Port status
- All ports in Puerto Rico have resumed normal operations and are now open 24 hours.
- Road closures
Access and Re-entry
- There is no formal access and reentry program in Puerto Rico. All 78 municipalities of the Commonwealth of Puerto Rico are tasked with coordinating specific access and re-entry requirements for vehicles transporting staff, supplies, and other essentials in close coordination with the Government of Puerto Rico and federal agencies.
Healthcare Response Updates and Needs
- Emergency Medical Services
- Throughout the storm and response efforts, EMS services did not suffer any impacts and were able to safely transport patients to the emergency room.
- Puerto Rico Voluntary Organizations Active in Disasters (PR VOAD) reported one fatality on September 27, raising the hurricane related death toll to 17. Health impacts due to lack of food and electricity in mostly affected areas are expected.
- Healthcare Facilities
- As of 10/3, all healthcare facilities are operational with eight running on generators, two in Mayagüez and 6 in Ponce. No new updates as of 10/5.
- Per President Biden’s announcement on 10/3 survivors and first responders needing mental health assistance can call 800-981-0023 to speak to a counselor in English/Spanish.
- Some clinics are still in need of assistance.
- The status of free and charitable clinics and federally qualified health clinics is largely unknown at this time as damage assessments are underway. Healthcare Ready is working on mapping the operating status of these facilities once information is received.
- As these clinics support the medical needs of the uninsured, the status and operations are critical to serving those impacted by Hurricane Fiona.
- Pharmacy
- Rx Open is activated for Puerto Rico. The map was last updated at 2 pm ET, 10/5. As of this update:
- There are no reported pharmacy closures in Puerto Rico. The following Municipios are reporting less than 50% pharmacies as open: Hormigueros and Santa Isabel municipios
- Rx Open is activated for Puerto Rico. The map was last updated at 2 pm ET, 10/5. As of this update:
- Dialysis
- As of Monday, 10/3, all dialysis centers are operating with two in Ponce relying on generators.
- Supply Chain
- As of 10/5, no significant disruptions to healthcare product manufacturing or distribution have been reported.
- Emergency Medical Services
COVID-19 and other Infectious Diseases
- COVID-19
- As of 10/3, the CDC reports 14.86 COVID-19 related hospitalizations (seven-day average). Additionally, 7,161 cases have been reported in the last seven days.
- The CDC reports that the community level of COVID-19 is low in most areas, but medium in southeast regions of Puerto Rico and some western regions: Moca, San Sebastian, Lares, and Adjuntas.
- As of 10/3, the CDC reports 14.86 COVID-19 related hospitalizations (seven-day average). Additionally, 7,161 cases have been reported in the last seven days.
- Monkeypox
- The CDC reports 183 cases in Puerto Rico as of 10/5. There is minor risk of more infections due to people entering shelters after the hurricane.
- Leptospirosis risk
- As of 9/30 there are 72 suspected cases of Leptospirosis according to Puerto Rican officials. No new cases of 10/5.
- Puerto Rico experienced an outbreak of leptospirosis in 2017 after Hurricane Maria due to the inability to clear stagnant water and diminished capacity of public health laboratories to test water samples. As the power grid is coming online and facilities are becoming less reliant on generator power, testing may be more robust during this response and is needed to prevent a widespread outbreak across the island.
Supply Chain
- As of 10/7, no significant disruptions to healthcare product manufacturing or distribution have been reported.
Resource Staging
- No updates since 9/27.
- As of 9/24, FEMA and other federal agencies have deployed over 1,000 employees to Puerto Rico and the FEMA Region II Regional Response Coordination Center in addition to 700 staff who live and work on the island.
- Five FEMA Incident Management Assistance Teams are present to bolster response efforts. Moreover, Mobile Emergency Response Support, Incident Support Base, Staging Management Teams, and Mobile Communication Office Vehicle operators are in Puerto Rico.
- To coordinate water delivery to isolated communities, a Water Distribution Task Force, comprised of federal and commonwealth government partners and private sector partners is present.
- The US Army Corps of Engineers (USACE) is installing generators at critical facilities and preparing and staging additional generators to support requests. In addition, USACE issued $30,000 in funding to support a team of engineers to assess federal projects and infrastructure and coastal areas for post-storm damages.
Emergency Prescription Refills
- As of 12:00 pm ET on October 5, ASPR’s Emergency Prescription Assistance Program (EPAP) has not been activated.
- In an emergency situation, Puerto Rico law dictates that prescribing professionals may provide a prescription verbally or digitally, provided that the physical prescription be provided to the pharmacy less than 120 hours later. The pharmacist may dispense an emergency medication to cover at most a 120-hour period.
- Executive Order 22-0915 signed on September 20, guarantees access to medications of beneficiaries of Plan Vital, the government health plan of Puerto Rico. The Executive Order authorizes Pharmacy Benefit Manager/Management (PBM) to fill 50% of a prescription without a primary care provider’s signature.
Evacuations and Curfews
- There are no reported curfews at this time.
Sheltering
- According to the American Red Cross Shelter map, only one shelter in Santa Isabel is housing residents, with a population of 10.
