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 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. As of September 28, an excessive heat warning remains in effect along the North coast of Puerto Rico from Toa Bajo to Arecibo. With many residents remaining without consistent power and air conditioning, risk of heat illness is increased.
Highlights
- As of September 28, a ship carrying diesel fuel is waiting for a waiver of the Jones Act to dock in Puerto Rico.
- As of September 28, 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.
- Approximately 23% of the island remains without power. Power 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.
- 90.28% 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.
- All hospitals in Puerto Rico are operating, with 8 operating on generator power as of September 26, a number that has been decreasing as the national power grid comes online.
- As of 2 pm ET on September 28, roughly 76% of pharmacies are reporting as Open in Puerto Rico. Most remain on generator power.
- Penuelas, Culebra, and Santa Isabel Municipios are reporting that fewer than 50% of pharmacies are open.
- Since September 23, all dialysis clinics are operational.
- Health impacts due to lack of food and electricity in mostly affected areas are expected.
Assessment of Healthcare and Logistics Impacts
Emergency Declarations and Measures
- On September 21, the Biden Administration has 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.
- 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 Wednesday, September 28, roughly 23% 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 1.15 million customers mainly in San Juan and the regions to the east, while 321,000 residents on the island remain without power.
- As of Wednesday, September 28, roughly 23% of the island remains without power, with the majority of outages remaining in the northwest, southern coast, and the interior of the territory.
- Fuel
- As of September 28, the Biden administration is assessing if legal requirements can be met to waive the Jones Act to allow a ship carrying diesel fuel to one of Puerto Rico’s ports, which has been stuck since September 25. Governor Pedro Pierluisi has requested the Secretary of the Department of Homeland Security (DHS), Alejandro Mayorkas, to intervene and requested a seven to 10 day waiver of the Jones Act.
- DHS has stated they will examine individual requests for Jones Act waivers in consultation with the Maritime Administration, Department of Defense, and Department of Energy on a case-by-case basis.
- 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, September 24. They reiterated that there is not a fuel shortage on the island. It is unclear if this is ship is the same as the ship mentioned above that is waiting to dock.
- 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.
- As of September 28, the Biden administration is assessing if legal requirements can be met to waive the Jones Act to allow a ship carrying diesel fuel to one of Puerto Rico’s ports, which has been stuck since September 25. Governor Pedro Pierluisi has requested the Secretary of the Department of Homeland Security (DHS), Alejandro Mayorkas, to intervene and requested a seven to 10 day waiver of the Jones Act.
- Water
- As of September 28, 90.28% (1,198,721) of residents have had water restored, while 9.72% (129,019) of residents still remain without water. AAA recommends that residents boil their water before consuming it, and FEMA announced a boil water advisory throughout Puerto Rico on September 21.
- There are frequent reports of intermittent interruptions to water supply due to generator failure and pipes bursting.
- Communications
- As of September 27, the FCC reports that 14.1% (-3.6% from September 26) of cell sites in Puerto Rico are out of service. 333 (-100) sites are due to power outages, 22 (-18) are due to transport, and 2 (-2) are due to damage. 385 sites are running on back-up power, which is 170 less than reported on September 26.
- 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
- As of September 27, there are approximately 23 road closures and 236 critical incidents in Puerto Rico, with landslides being the leading cause for 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
- There are no new updates as of September 28.
- 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, September 20, at Eugenio María de Hostos airport in Mayagüez. The terminal and runway remain powered by generators.
- Mercedita International Airport
- As of September 22, PSE has opened its runway and is open for commercial flights.
- Port status
- Puerto Rico
- All ports in Puerto Rico have resumed normal operations and are now open 24 hours.
- 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.
- 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 September 26, all hospitals are operational with 8 (-32) hospitals relying on generators.
- Figures show that hospitals reliant on generator power are gradually decreasing as the national power grid is restored.
- As of September 26, all hospitals are operational with 8 (-32) hospitals relying on generators.
- 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 28. As of this update:
- 75.67% (+0% from September 26) of pharmacies are reporting as Open in Puerto Rico
- 4.53% (+3.29%) of participating pharmacies in Puerto Rico were reporting Closed or Unknown.
- The four closures are present in in Toa Alta, Aguadilla, Ponce and Gurabo.
- Only three Municipios are reporting less than 50% of pharmacies as Open in Puerto Rico
- These Municipios are Culebra, Penuelas, and Santa Isabel.
- Rx Open is activated for Puerto Rico. The map was last updated at 2 pm ET, September 28. As of this update:
- Dialysis
- All dialysis centers are operating as of September 23.
- Emergency Medical Services
COVID-19 and other Infectious Diseases
- COVID-19
- As of September 28, the CDC reports 20.57 COVID-19 related hospitalizations (seven-day average). Additionally, 4,018 new cases (+318 from September 21) 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 Lajas, Guayama, Cidra, and Jayuya Municipios.
- Monkeypox
- The CDC reports 172 cases in Puerto Rico on September 27. There is minor risk of more infections due to people entering shelters after the hurricane.
- Leptospirosis risk
- No cases reported as of September 28. 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
- As of September 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
- 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 10:00 am ET on September 26, 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.
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.
