Hurricane Fiona Situation Report #7
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. We are closely tracking impacts to healthcare supply chain and healthcare access. In addition to situation reporting, we are updating Rx Open daily to map open pharmacies in Puerto Rico and the US Virgin Islands (USVI). We are also sharing updates for responders and the public on social media: Twitter, Facebook, and Linkedin.
High-Level Situation Summary
Hurricane Fiona made landfall in southwestern Puerto Rico at 3:20 pm ET on September 18, 2022. Prior to landfall, Fiona produced heavy rains and high 90-mph winds across Puerto Rico and USVI. Hurricane Fiona made landfall on 9/19 in the southeastern region of the Dominican Republic causing catastrophic rainfall and flooding. As of 11am on 9/20, Hurricane Fiona is producing heavy rainfall with localized threats of flash-flooding in Turks and Caicos. Following this, the storm is expected to enter the open Atlantic and will not be a threat to land. A flood watch is in effect in Puerto Rico until Tuesday, September 20, 08.00 pm AST/EDT.
Puerto Rico has been heavily impacted by Hurricane Fiona. Parts of the island have experienced up to 27 inches of reported rainfall, which is projected to rise. Weather forecasts indicate that the western coast of the island will receive additional rainfall from 9/22 to 9/25. The most impacted areas of the island are the southern, southwestern, and central mountain regions of the island; these areas are currently most susceptible to flooding.
Flooding and wind have led to major impacts on Puerto Rico’s power grid, leaving most areas without electricity. Road conditions have also been impacted by the storm. Reports of direct impacts to healthcare operations have been minimal so far, but additional assessments are in progress. However, some indirect impacts to continuity of care are expected due to impacts to road conditions and power.
Highlights
- All hospitals are operation, with 45 running on generators.
- Health clinics are undergoing damage assessments; some are running on generator power while the national grid comes online.
- As of 2pm ET 9/20, 66% of pharmacies are reporting as Open in Puerto Rico. Most remain on generator power.
- As of 2pm ET 9/20, all dialysis clinics are operational. However, most remain on generator power.
- 80% of the island remains without power. Power restoration is concentrated in and around San Juan. Restoration timelines for the rest of the island are not yet clear.
- More than 750,000 residents remain without water. Restoration times are not yet clear.
Assessment of Healthcare and Logistics Impacts
Emergency Declarations and Measures
- Puerto Rico Governor Pedro Pierluisi declared a state of emergency on Saturday, 9/17.
- 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, 2022, 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.
- Pharmacies that provide services to beneficiaries of social health care plans can only charge the copay on the Vital insurance card.
- The order does not apply to controlled substances (Schedule 2 drugs).
Critical Infrastructure Impacts
- Power
- As of Tuesday 9/20, 80% of the island remains without power, with the majority of outages occurring in the northwest, southern coast, and northeaster coast.
- Power has been restored to about 286,000 customers mainly in San Juan and the regions to its south.
- There are 40,951 electricity dependent Medicare beneficiaries in Puerto Rico, with large proportions of them residing in San Juan (3,720 patients), Bayamon (2,555), Ponce (1,891), Caguas (1,763), Carolina (1,628), Arecibo (1,183), and Mayaguez (1,158). Most municipalities have hundreds of electricity dependent patients (see the emPOWER Map for municipality-specific data).
- As most power restoration has occurred in San Juan and the surrounding regions, including Bayamon, the majority of electricity dependent patients in Puerto Rico (including the thousands in highly populated southwestern municipalities like Ponce and Mayaquez) are reliant on generator power in their homes or in shelters to operate their medical devices. If power is not restored, the chances of generators failing or running out of fuel increases, as does the risk of patients suffering negative health impacts.
- LUMA Regional Operating Centers (ROCs) have been deployed to assess damage and give estimated timelines of restoration to other parts of the island. Updates on power restoration will be given periodically through the LUMA website and their Twitter feed. The exact timelines for restoration have not yet been published.
- FEMA generators are pre-staged in Puerto Rico.
- As of Tuesday 9/20, 80% of the island remains without power, with the majority of outages occurring in the northwest, southern coast, and northeaster coast.
- Fuel
- The availability of fuel seems to not have been impacted by Hurricane Fiona, but accessing fuel may pose a problem while roads and other major infrastructure are obstructed by debris or water.
- There have not been reports of generator fuel shortages for healthcare facilities as of this report. However, if power outages remain widespread and are in effect for an extended period, generator fuel availability may become an issue.
- Transportation
- Road closures
- 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
- San Juan’s international airport (SJU) resumed air operations on Monday, September 19. Fernando Luis Ribas Dominicci Airport in Isla Grande and Rafael Hernandez Airport (BQN) in Aguadilla also opened on September 19.
- Flights resumed on Tuesday, 9/20 at Eugenio María de Hostos airport in Mayagüez. The terminal and runway remain powered by generators.
- Mercedita International Airport
- As of Monday, September 19, port authorities began cleaning and removing obstacles at Mercedita International Airport in Ponce. Air operations have not yet resumed, and a timeline on when operations will resume has not been released. Clean up efforts continue into September 20, however rain has delayed reopening timeline.
- Port status
- Puerto Rico
- The US Coast Guard authorized maritime operations in the San Juan Bay only during daylight hours. Furthermore, it authorized the entry and exit of vessels to the municipal islands (Vieques and Culebra).
- The following ports have been reopened as of Monday, September 19: Arecibo, Ceiba, Culebra, Fajardo, San Juan (with the restriction to conduct daylight operations only until further notice), Vieques, Yabucoa.
- As ports have been reopened and are operating on a restricted schedule, they are experiencing congestion from the backlog.
- Puerto Rico
- 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
- No impacts to emergency medical services have been reported as of this report. However, disruption to patient movement can be expected due to road conditions and closures.
- 4 hurricane related fatalities have been reported per the September 20, 2022.
- Healthcare Facilities
- All hospitals are operational with 45 relying on generators per the September 20, 2022 FEMA update.
- According to local outlets, care facilities for the elderly are still without power making it difficult for staff to care for their patients.
- Hospital General Castañer has suspended clinical and pharmaceutical operations of their Castañer, Adjuntas, and Jayuya campuses until Tuesday, September 20. As of today’s report there are no further updates.
- Hospitals in the Ponce, Mayaguez, Cabo Rojo, Yauco, y San Germán regions should take extra caution with the care of their patients and their power supply as they are still under heavy rainfall. Cancellations of surgeries and elective appointments are likely.
- Health Clinics
- 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 and the US Virgin Islands. The map was last updated at 2 pm ET, September 20. As of this update:
- 16.25% of participating pharmacies in Puerto Rico were reporting Closed or Unknown.
- 65.72% of pharmacies are reporting as Open in Puerto Rico.
- 4.76% of participating pharmacies in USVI were reporting Closed or Unknown.
- 71.43% of pharmacies are reporting as Open in the USVI.
- 16.25% of participating pharmacies in Puerto Rico were reporting Closed or Unknown.
- Rx Open is activated for Puerto Rico and the US Virgin Islands. The map was last updated at 2 pm ET, September 20. As of this update:
- Dialysis
- All dialysis centers are operating as of 9/20. Most sites are on generator power, and some are running on water tankers. If power is not restored in the next three days, fuel supply will be needed at some sites.
- Emergency Medical Services
COVID-19 and other Infectious Diseases
- COVID-19
- As of September 18, CDC reports medium community spread throughout most of Puerto Rico, with low community spread in in six municipalities including Vieques. Also on 9/18, CDC reported 304.9 new cases in Puerto Rico and 9,728 cases total.
- With people entering shelters due to the hurricane, there is a higher potential for COVID to spread and possibly increase throughout the island.
- Monkeypox
- CDC reports 163 cases in Puerto Rico as of September 19. There is minor risk of more infections due to people entering shelters after the hurricane.
- Leptospirosis risk
- No risks reported today. Due to contaminated water from flooding, there is increased risk of this illness spreading throughout the island. We are monitoring for reports of spread of leptospirosis.
Supply Chain
- There are 132 shelters in Puerto Rico open to receiving those that have been affected by the hurricane. Currently, there are over 2,000 residents at the various shelters. We expect to see shelter residents to increase over the coming days.
- The shelters with the highest populations are in the areas with catastrophic damage, including Arecibo, Canovanas, and Guayanilla.
- Per the PR VOAD call all shelters have the capacity to accommodate people with medical needs.
- There are 1077 residents in shelters, the number is expected to go down tomorrow.
Resource Staging
- FEMA’s Sunday, September 18, announcement states that federal emergency aid is available to the Government of Puerto Rico, due to the approved Federal Emergency Declaration. The declaration ensures coverage of 75% of protective measures and relief by federal funds. Funding may be used a variety of resources, including for flood fighting, EOC costs, emergency access, supplies and commodities, medical care and transport, evacuation and sheltering, search and rescue, use of temporary generators, childcare, and safety assessments.
- FEMA Region II’s Incident Management Assistance Team (IMAT) is deployed to USVI. The National IMAT Blue is deploying to Puerto Rico. On 9/20, FEMA reported that Regions I and V IMATs are also deploying to Puerto Rico.
- The HHS Secretary’s Operation Center (SOC) is activated at Level II.
- 600 Members of the National Guard are involved in the search and rescue operations in Puerto Rico. The members of the National Guard were prepositioned Friday, September 16, to nine points throughout the island to tend to emergencies as they arise.
- New York will send 100 members of Spanish-speaking members of the state police, and 50 troopers and is organizing community partners to drive donations to assist the government of Puerto Rico. Full statement by Governor Kochul is available on the New York State website.
- Pennsylvania’s Governor Wolf announced that two members of Pennsylvania Task Force 1 (PATF-1) Urban Search and Rescue (US&R) are deployed to Puerto Rico to support response operations.
Emergency Prescription Refills
- 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.
- As of 9/20 3pm ET ASPR’s Emergency Prescription Assistance Program (EPAP) has not been activated.
Evacuations and Curfews
- There are no reported curfews at this time.
- No major evacuations at this time, however, many water rescues have been reported.
Sheltering
- Per the September 27 PR VOAD call, there are 14 shelters with 163 residents ranging in age from 25-65, with 22 being people with access and functional needs. All shelters have the capacity to accommodate people with medical needs.
