Healthcare Ready Hurricane Fiona Situation Report #5

Hurricane Fiona Situation Report #5

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: TwitterFacebook, and LinkedIn.

High-Level Situation Summary

Puerto Rico has been heavily impacted by Hurricane Fiona. Parts of the island have experienced up to 27 inches of reported rainfall. As of 9/23, Tropical Depression 9 may produce additional rainfall in southern Puerto Rico. However, no more than two inches of rain are expected. 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. As of 9/23, an excessive heat warning remains in effect along the North coast of Puerto Rico from Toa Bajo to Arecibo. With many residents remaining without power and air conditioning, risk of heat illness is increased.


  • 58% of the island remains without powerPower restoration is concentrated in and around San Juan, while the most affected parts of the island remain without power. Restoration timelines for the rest of the island are not yet clear.
  • Around 72% of residents have had potable water restored as generators have been installed at water treatment plants and wells have been cleared of obstructionsIntermittent disruptions have been reported due to generator failures and pipes bursting.
  • President Biden approved a major disaster declaration on 9/21, authorizing the mobilization of additional resources and federal funds for recovery.
  • All hospitals in Puerto Rico are operating, with 40 operating on generator power, a number that has been decreasing as the national power grid comes online.
  • As of 2pm ET 9/23, 73% of pharmacies are reporting as Open in Puerto Rico. Most remain on generator power.
  • As of 2pm ET 9/23, all dialysis clinics are operational, with some remaining on generator power.

Assessment of Healthcare and Logistics Impacts

Emergency Declarations and Measures

  • On 9/21, the Biden Administration has approved a major disaster declaration for Puerto Rico, authorizing for individual and government assistance to affected individuals and municipalities.
  • Governor Pierluisi has requested a major disaster declaration from the White House on September 20 to bolster federal resources supporting the island’s recovery. As of 11am 9/20, the Biden Administration has not approved the request.
  • 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 Thursday 9/23, 58% of the island remains without power, with the majority of outages remaining in the northwest, southern coast, and the interior of the territory.
      • Power has been restored to about 540,000 clients mainly in San Juan and the regions to the east, while the interior counties of the island such as Arecibo are around 99% without power.
  • Fuel
    • The Departamento de Asuntos del Consumidor (DAC) issued a statement that a fuel carrier ship with 300,000 barrels of fuel will begin to distribute to the island beginning on Saturday, 9/23. They reiterated that there is not a fuel shortage on the island.  
    • 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.
  • Water
    • As of 9/2372.09% (968,793) of residents have had water restored, while 27.03% (358,947) still remain without water. AAA recommends that clients still boil their water before consuming it, and FEMA reports that a boil water advisory is in place throughout Puerto Rico.
    • There are frequent reports of intermittent interruptions to water supply due to generator failure and pipes bursting.
  • Communications
    • As of 9/23 at 1P2M, the FCC reports that 22.4% (-2% from 9/23) of cell sites in Puerto Rico are out of service. Out of 614 (-52) sites with outages: 532 (-66) are due to power outages, 77 (+12) are due to transport, and 5 (+2) are due to damage. 371 sites are running on back-up power, which is 134 fewer than yesterday.
    • As cell phone towers come back online with the support of generator power, the CEO of Liberty Communications cautions that cell towers may go offline as diesel supply decreases.  
  • Transportation
    • Road closures
    • 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
    • Port status

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.
        • 5 (+1) hurricane related fatalities have been reported as of 9/22.
      • Healthcare Facilities
        • All hospitals are operational with 40 (-1) hospitals relying on generatorsas of 9/23.
          • Figures show that hospitals reliant on generator power are gradually decreasing as the national power grid is restored.
        • The increased temperatures may negatively impact patients that are without power and are not able to access air conditioning.
        • 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. The map was last updated at 2 pm ET, September 23. As of this update:  
          • 73.46% (+0.28% from 9/22) of pharmacies are reporting as Open in Puerto Rico.
          • 8.34% (+0.36%)of participating pharmacies in Puerto Rico were reporting Closed or Unknown.
            • Only 4 municipios are reporting less than 50% of pharmacies as Open in Puerto Rico
              • Aibonito, Culebra, Santa Isabel and Yauco Municipios.
      • Dialysis
        • All dialysis centers are operating as of 9/23. A number of the sites remain on generator power, and some are running on water tankers.

COVID-19 and other Infectious Diseases

  • COVID-19
    • As of September 21, CDC reports low community spread throughout most of Puerto Rico, with medium community spread in in five municipalities, all of which are in areas with high rates of power outages. CDC reported 3,700 cases, 115.9 of which are new, in the last 7 days in Puerto Rico. There has been 1 COVID related death reported in the last 7 days.
    • 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 170 cases in Puerto Rico as of September 23. There is minor risk of more infections due to people entering shelters after the hurricane.
    • Leptospirosis risk
      • No cases reported as of September 23. 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

  • Manufacturing: Pharmaceutical and medical device manufacturing companies have operations in Puerto Rico. Though assessments of manufacturing facilities are on-going, experts do not expect any large-scale disruptions to the medical supply chain.
  • Distribution: The distribution of medical supplies should be closely monitored as roadways, bridges, and other transportation infrastructure could be impacted by heavy rainfall, debris, flooding, and landslides.

Resource Staging

  • Approximately 400 (-168) FEMA and 500 (+67) other federal agency responders are deployed to Puerto Rico and FEMA Region II Regional Response Coordination Center, as of 9/22.

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.
  • 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.  
  • No major evacuations at this time, however, many water rescues have been reported.


  • There are 38 (-55) shelters currently open as of 9/22, with 469 (-608) occupants in shelters in Puerto Rico.
  • Shelters with the highest populations are in Ponce, Hormigueros, and Salinas.
    • More than 60% of residents in these areas are still without power.
  • Per the Puerto Rico Voluntary Organization Active in Disasters (VOAD) group, all shelters have the capacity to accommodate people with medical needs.



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