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Healthcare Ready Hurricane Ian Situation Report #11

High Level Situation Summary Highlights Emergency Declarations and Measures Critical Infrastructure Impacts Access and Reentry Healthcare Response Updates and Needs Public Health Impacts Supply Chain Resource Staging Emergency Prescription Refills Evacuations and Curfews Sheltering
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Hurricane Ian Situation Report #11

This report provides an assessment of the impacts to healthcare and public health due to Hurricane Ian. After today’s situation report, the cadence for releasing the reports will be every other day.

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 Ian. We are tracking potential impacts to healthcare infrastructure and supply chain, sharing information via situation reports, Twitter, Facebook, and LinkedIn. Our pharmacy operating status map Rx Open is updated daily (moving to every other day as of 10/7) for pharmacies and dialysis centers in Florida, Georgia, South Carolina, North Carolina, and Puerto Rico

High-Level Situation Summary

As of 10/7, the risk of critical infrastructure impacts on healthcare operations has largely stabilized across areas affected by Hurricane Ian. While search and rescue activities are still ongoing (with 101 deaths reported to date), many areas are shifting to a long-term recovery response posture. There are reports of certain communities – hardest-hit by Ian and enduring longer waits for power and water restoration – that signal a greater need for equity considerations. In parts of Naples and Ft. Meyers, residents of historically African American neighborhoods such as Dunbar and River Park remain without access to necessary resources (water, power, and transportation) to treat medical conditions. Further, delays to restoring public transportation and long distances to shelters (the nearest shelter to River Park is 11 miles away) compound the impacts of Ian, placing the lives and health of individuals at greater risk.

These areas are a part of southwest Florida counties that were among the hardest hit by Ian (including Lee, Charlotte, and Sarasota Counties) where restoration efforts have prioritized bringing essential infrastructure and large-scale healthcare operations back online.  Restoring healthcare access for historically underserved communities will require additional support and the assurance of resources for FQHCs, clinics, and other essential institutions that are necessary for long-term recovery.

Highlights

  • In Florida, there are 18 pharmacy closures reported on rxopen.org as of 2:00pm EDT on 10/7.
  • As of 10/7 there are three dialysis centers closed all in Florida.
    • Cape Coral (2), Fort Myers (1)
  • Since 10/6, parts of 21 counties remain under boil water advisories.
  • Power restoration continues to improve across Ian-affected states, but areas of Lee, Collier, Ft. Meyers, Sarasota counties are still experiencing wide-spread outages.
  • Public transportation in certain areas are still taking loner to return to normal operations, which may impact residents’ abilities to access to food, or regular medications.
    • Collier Area Transit (CAT) servicing the River Park Neighborhood in Naples is operational.
    • LeeTran servicing Dunbar in Fort Myers is reintroducing limited bus services beginning 10/7.
  • UPS, FedEx, and USPS are still experiencing service impacts, particularly for communities on Pine and Sanibel Island which were cut off to road access (a temporary bridge to Pine Island should relieve these issues for residents there).
  • Location of POD sites distributing food, water, and ice are updated daily at FLGOV.COM.
  • Disaster Recovery Centers, staffed by state, federal, and volunteer organizations are open and accessible for individuals seeking recovery information.
  • Federal, state, and local agencies are urging citizens to be aware of the possibility of fraud, scams, and cybersecurity threats following Hurricane Ian.
  • As of 10/5, Governor DeSantis and the Florida Department of Transportation announced the early completion of the emergency road and temporary bridge repairs for Pine Island, making it accessible for emergency vehicles.

Assessment of Healthcare and Logistics Impacts

Emergency Declarations and Measures

  • General
    • No changes or updates since 10/7.
    • On 9/28, the Federal Motor Carrier Safety Administration (FMSCA) issued a Regional Emergency Declaration for Alabama, Florida, Georgie, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. The order will remain in effect until the end of the emergency, or 10/28.
  • Florida
  • South Carolina
  • North Carolina
    • On 9/30, President Biden approved a federal Emergency Declaration for all 100 North Carolina counties and the Eastern Band of Cherokee Indians.
    • On 9/28 North Carolina declared a State of Emergency, which will expire on 10/28.
  • Georgia
  • Virginia

Critical Infrastructure Impacts

  • Power
    • Please note, power outages are improving across impacted states by the hour. For the latest updates, please visit https://poweroutage.us/.
      • Florida
        • As of 1:30pm EDT on 10/7, nearly 117,700 Florida customers are without power. This is a decrease of about 68,700 outages since 10/6. Outages are concentrated in southwestern Florida, between Lee County and DeSoto County.
        • The greatest outage rates are in Lee, Charlotte, and DeSoto, Counties where between 5-15% of customers are without power. Additionally, Sarasota County is now only reporting less than 3% of customers are without power.
        • Florida Power and Light Company (FPL) and Duke Energy continue to report the highest number of outages.
        •  Long-term outages may be reported across the state for customers who will not be able to receive power due to damage or flooding. In these cases, electrical systems will need to be inspected by licensed electricians to determine if repairs are needed before power can be restored.
      • As of 10/7, power has largely been restored to affected areas of South Carolina, North Carolina, and Virginia.
  • Fuel 
    • Those looking for fuel and gas are encouraged to use Gas Buddy, to search for open stations and providers using crowdsourced information.
    • As of 10/6, the FDEM has nine active fuel depots throughout Central and Southwest Florida to ensure first responders have fuel to continue conducting search and rescue operations.
    • Two residential fueling agencies are open; one in Dunbar, Fort Myers and one in Arcadia. Cars can get up to 10 gallons per day, and trucks can get up to 50 gallons per day.
    • As of 10/4, all ports and terminals are open for fuel and many gas stations have begun receiving shipments.
  • Water
    • As of 10/7, parts of 21 counties are still under boil water advisories. Residents are encouraged to reach out to local utility or county emergency contacts for the most up-to-date information.
    • On 10/5, the City of Naples and the City of Arcadia lifted their boil water notices.
    • As of 10/7, the FEMA Daily Ops Brief is no longer reporting on water infrastructure impacts.
    • As of 10/6, the FDEM has identified 22 Points of Distribution (PODs) sites for water and other supplies across 7 counties.
    • State officials continue to provide resources (water and diesel) to impacted counties to restore water supply to critical infrastructure, including hospitals.
    • The U.S. Army Corps of Engineers (USACE) are meeting with county officials, noting that work crews are using water trucks to pressurize critical facilities to locate and repair leaks.
  • Communications 
    • Florida
      • According to the Federal Communications Commission (FCC):
        • As of 12pm EDT 10/6, FCC reports: 1.5% of cell sites are down. 15 (+3) cell sites are down due to damage, 29 (-23) are due to transport, and 78 (-11) are due to power outages. 132 cell sites are running on back-up power.
        • All 911 calls are being answered but some Public Safety Answering Point (PSAP) are being rerouted due to power outages.
      • As of 10/6, no TV stations are reported as being out of service, 4 FM stations are reported as being out of service, and 2 AM stations are reported as being out of service.
      • The (FCC) may grant Special Temporary Authority (STA) to permit immediate or temporary operation of certain radio facilities during emergencies or other urgent conditions, as well as waivers to support emergency communications and service restoration.
        • Wireless Telecommunications Bureau issues multiple STAs to Verizon and T-Mobile in Florida to restore communications in the aftermath of Hurricane Ian.
      • Verizon’s crisis response team is providing free communications support to public safety agencies responding to the hurricane by setting up portable cell sites, Wi-Fi hotspots, free charging stations and other services. Additionally, they have extended their unlimited talk, text, and data for customers in affected areas through 10/11.
      • T-Mobile’s community support teams have set up Wi-fi and device charging stations in various locations in Fort Myers, Englewood, Port Charlotte, Venice, Arcadia, Nocatee, Lake Placid, Avon Park, Wauchula and Sarasota. As of 10/6, they are also focusing on the hardest hit parts of Lee County, including Sanibel Island and Bonita Beach.
      • As of 10/4, Comcast has opened four Xfinity WiFi hotspot vans, two in Lee County, one in Collier County, and one in Charlotte County. Additionally, as of 10/4, Comcast suspended billing for all Sanibel, Pine Island, and Captiva residents.
      • AT&T has waived talk, text, and data overage charges for Postpaid and Prepaid customers with billing addresses in the Florida zip codes (828) through October 28, 2022, to facilitate customer access to communications before, during, and after major events.
  • Transportation

Access and Reentry

  • No updates since 9/30.
  • Florida
    • Florida’s access and re-entry plans and policies are managed by local officials, working closely with Florida’s Division of Emergency Management. During a disaster, private sector companies should coordinate with the Division of Emergency Management, in addition to local health departments and local emergency managers to assess whether they are authorized to enter an impacted area, only after it has been deemed safe enough to do so.
    • Individuals who wish to enter the disaster area must have the following on hand:
      • Valid government-issued ID (driver’s license, passport)Proof of employment (employer credentials, document on company letterhead)
      • Demonstrated need to enter the area (work order, inventory list, employer authorization)
      • Note, DHS CISA’s Access Coordination Letter is not an acceptable document to enter any disaster areas in Florida.
  • North Carolina
    • North Carolina requires pre-registration of vendors who provide critical services and goods before they attempt to enter disaster areas. These vendors must apply for a Certificate of Post Disaster Re-entry to be able to enter areas impacted by disasters. Information on applying for this certificate can be found at this North Carolina Business Emergency Operations Center site. Final decisions about entry/re-entry are still under the authority of local governments.
  • South Carolina
    • South Carolina requires business to register for post-disaster reentry certification before they attempt to enter impacted areas. Business can register for the program with the SC Emergency Management Division and SC Department of Commerce. Final decisions about entry/re-entry are still under the authority of local governments.

Healthcare Response Updates and Needs

  • Healthcare Facilities
    • On 10/4, the Governor’s office confirmed that only 9 of the 26 healthcare facilities who initially evacuated remain evacuated, with the other 17 having reopened. No new updates as of 10/7.
    • FACHC asks Florida’s Health Centers to report their status and resources needed using the Live Response Tool or by contacting 850-591-1832 or gianna@fachc.org.
    • The Agency for Health Care Administration for the State of Florida is collecting health facility status. All licensees providing residential or inpatient services are asked to update status via the Health Facility Reporting System.
    • As of 10/7, Sarasota Memorial’s freestanding Emergency Department in North Port remains closed due to damages, and the North Port Family Practice and Venice Medical Office Building also remain closed due to power outages.
    • As of 10/7, while the HCA Florida Fawcett Hospital in Port Charlotte remains temporarily closed, the HCA Florida Care Coral Emergency Room, a part of the HCA Florida Fawcett Hospital, has re-opened, and emergency services at the Emergency Room are available 24/7.
    • As of 10/5, AdventHealth’s home care, hospice, home infusion, and respiratory equipment services returned to normal operations. However, AdventHealth reports the following closures:
      • Hospitals:
        • AdventHealth Sebring is open, but as of 10/7, outpatient services are currently unavailable.
        • AdventHealth North Pinellas has reopened, but some services may still be unavailable.
      • AdventHealth Medical Group: As of 10/7, all AdventHealth Medical Group Practices in Flagler and Volusia Counties are closed for both in-person and virtual care.
      • Urgent Care: Centra Care Locations with no reported opening hours: Titusville, Lake Mary, Daytona, Port Orange, and Brandon, Centra Care Kids Lake Mary.
      • Sports Med and Rehab: As of 10/7, locations with no reported opening hours: Daytona, DeLand Stetson, Fish Memorial/Orange Park, Horizon West, Innovation Tower, Kissimmee, Wekiva, New Smyrna Beach Campus, Orange Ave (SoDo), Palm Coast Parkway, Pediatrics Winter Park, Port Orange Health Park, West Lakes Early Learning Center, and Winter Park.
      • Primary Care: As of 10/7, locations with no reported opening hours: Lakeland and Orlando – Training Center.
      • Orthopedics: no locations reporting opening hours as of 10/5.
    • As of 10/5, NCH status updates on services and open locations are posted online.
      • NCH Virtual Care is accessible to anyone in the community at no cost, 24-hours per day, 7 days a week for two weeks following Ian. Use the coupon code “NCH”.
      • For patients who do not have internet access, the NHC Employee Medical Center in the Greentree Plaza is open from 7:00am-7:00pm for patients to use Wi-Fi.
    • CentraCare will remain open for free video visits for non-emergency patients. Use promo code “Ian” to access free visits on the AdventHealth app.
    • As of 10/5, the following Lee Health locations reopened, and are servicing patients from 8:00am-5:00pm (a full list of reopenings can be found here).
    • As of 10/4, all hospitals and non-hospitals operated by BayCare are open.
      • Assistance is available for patients who are in need of durable medical equipment, including oxygen, walkers, wheelchairs, or CPAP. Patients should call 1-800-940-5151, option 3.
      • BayCare is offering 1 free telehealth visit for all registered users of BayCareAnywhere though 10/12. Initiate a telehealth visit in the BayCareAnywhere app and use the code “IAN”.
    • GoodRx is offering free telehealth appointments to Florida residents affected by Hurricane Ian through 10/17.
    • According to the Governor’s Office, as of 10/4, the Lee County Healthcare Center, VA Outpatient Clinic in Daytona Beach, and the Naples and Port Charlotte VA Clinics are closed until further notice.
    • As of 10/4, Walmart Health Centers in Tampa and Orlando continue to offer complimentary sick or injury exams. Make appointments at walmarthealth.com or walk-in. Health and Wellness Service Locations can be found at this link.
  • Emergency Medical Services
    • No updates as of 10/7.
    • As of 10/5, Disaster Medical Assistance Team’s (DMATs) are currently in place at Cape Coral Hospital and Lee Memorial Hospital.
    • Florida Department of Health’s Division of Emergency Preparedness and Community Support continues to support patient movement requests and special need shelter requests.
    • Several emergency response organizations, including fire departments, mass care specialists, and other volunteers or task forces, deployed to Florida (and remain on the ground) to assist with emergency medical services in response to Ian.
  • Pharmacy
    • Rx Open is activated for Georgia, Florida, South Carolina, and North Carolina. It was last updated on 10/7 at 2:00pm EDT and is showing 19 pharmacy closures across the impacted states, with closures primarily in Florida.
    • Please see the table outlining pharmacy statuses per state below:
    • The following counties are reporting less than 50% pharmacies as operational:
      • Florida – Glades, Miami-Dade, and Baker Counties
      • Georgia – Baker, Butts, Chattahoochee, Clay, Clayton, Decatur, Echols, Fayette, Glascock, Quitman, Talbot, and Taliaferro Counties
        • These counties have less than 50% pharmacies as open primarily due to Unknown Statuses, and not confirmed closures.
      • North Carolina – Camden county.
        • This county has less than 50% pharmacies as open primarily due to Unknown Statuses, and not confirmed closures.
    • OptumRx provided guidance to customers for rerouting existing prescription deliveries to new addresses.
    • Pharmacy deliveries via Express Scripts may arrive late as recovery operations continue.
  • Dialysis
    • As of 10/7, three dialysis centers remain closed in Florida.
    • In Florida, several facilities are on generator power and/or connected to water tankers. Damage has been reported at some facilities, but overall damage is minimal.
    • See Kidney Community Emergency Response (KCER’s) Hurricane Ian webpage to share information with the dialysis community.

Public Health Impacts

  • Infectious illnesses
    • With people entering and/or remaining in shelters due to the hurricane, there is an increased risk of transmission of COVID-19 and other infectious diseases.
      • As of 10/7, CDC reports 9,855 total COVID-19 cases, an average of 226 new hospital admissions, and 38 deaths over the past seven days in Florida.
      • As of 10/6, there are 2,565 confirmed Monkeypox cases in Florida.
  • Chemicals/Flood Water
    • Gas and diesel can generate carbon monoxide when generators are not properly used. This can cause dizziness, headaches, and other negative health effects. Breathing can also be impacted by mold and pollutants in the air. Practice safe generator usage to decrease risk of health implications.
  • Mosquito-borne illnesses
  • Waterborne hazards
    • Waterborne hazards are common after a hurricane because of the high amounts of water that buildup post storm and flood. Experts recommend avoiding drinking tap water, using water filters when possible, and to refrain from walking through flood waters when possible.
      • Leptospirosis – Leptospirosis is a bacterial disease caused by animal urine contaminating water sources. Avoiding exposure to contaminated is the best way to prevent the bacterial disease.
      • Waterborne diseases, like Cholera, are not expected to threaten impacted areas due to low prevalence prior to Ian.
  • Mental health
    • The Crisis Center of Tampa Bay offers a free mental health helpline for first responders and their loved ones. The program focuses on Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough, Lee, Manatee, Pasco, Pinellas and Sarasota counties. Firefighters, police officers, emergency care providers and other first responders can reach the program by filling out a web form at lasttoask.com and can receive confidential support by calling 1-866-435-4376 (1-866-4FL-HERO).
    • Florida Blue is offering free virtual doctors’ visits and a bilingual emotional support helpline for Floridians impacted by Ian at 855-225-5032 for visits, and the helpline at 833-848-1764 for emotional support. Both lines are available 24/7.
    • The Florida Behavioral Health Association provides a list of helplines offered to Floridians in various counties, including an Aspire Health Partners helpline that residents of Orange, Osceola, Lake and Seminole counties can call at 407-875-3700, ext. 2.
    • The Veterans Crisis Line is a free, confidential resource that is available to veterans 24/7. The service is available to all veterans, even if you are not registered with the VA or enrolled in VA healthcare. You can call 800-273-8255 ext. 1, text 838255, contact the veterans crisis chat, or dial 988 ext.1
    • The Hurricane Ian disaster recovery hotline is available for mental health needs, disability services, military and veteran assistance, and other needs.
    • Individuals may call or text 211 to be connected with help for physical and mental health needs and assistance in the aftermath of Hurricane Ian.
    • The SAMSHA Disaster Distress Helpline 1-800-985-5990 is open 24/7 to provide immediate crisis counseling for people who are experiencing emotional distress. The Helpline is toll-free, multilingual, and confidential and is available to all residents in US and its territories via phone or text. Deaf or hard of hearing callers can utilize a videophone or ASL Now.
  • Other
    • This website is for reporting missing persons related to Hurricane Ian.
    • US government agencies have shared that routine non-criminal immigration enforcement operations will not be conducted at evacuation sites or assistance centers.
    • Disaster Unemployment Assistance (DUA) is available to Florida businesses and residents in FEMA disaster-declared counties whose employment or self-employment was lost or interrupted as a direct result of Hurricane Ian.

Supply Chain

  • Manufacturing
    • No updates as of 10/7.
    • Manufacturers in Florida have not reported any major impacts. There are no expected impacts to Georgia, South Carolina, and North Carolina supply chain.
  • Distribution
    • As of 10/7, UPS is continuing to report that most UPS facilities are operational as conditions permit. There will still be no pickups or deliveries today in zip codes listed below – all located on Pine or Sanibel islands. Disruptions in service to Pine Island (Bokeelia and St. James) may decrease soon as a temporary bridge restoring road access to the island has been established as of 10/6.
      • 33924 – Captiva
      • 33957 – Sanibel
      • 33931 – Fort Myers
      • 33956 – St. James
      • 33922 – Bokeelia
    • As of 10/7, FedEx is reporting delays and disruptions for inbound and outbound shipments across impacted areas. FedEx Express, Ground, and Freight have temporarily suspended service in a number of cities in Florida which can be found here.  
      • Service is temporarily suspended in Bokeelia, Captiva, Fort Myers Beach, Saint James City, Sanibel, and Cape Coral.
    • As of 10/7, US Postal Service reports that 12 facilities remain temporarily closed until further notice. Each of the 12 facilities have an alternate location provided.

Resource Staging

  • On 10/6, Gov. DeSantis announced that two additional Disaster Recovery Centers would be opening in Sarasota and Lee counties. These centers are operated by the Department of Economic Opportunity, in conjunction with more than 10 agencies, to provide a one-stop shop for individuals or businesses that need help recovering from Ian.
    • Sarasota County
      • Shannon Staub Library: 4675 Career Lane; North Port, FL 34289
    • Lee County
      • Joseph P.D Alessandro Office Complex: 2295 Victoria Ave.; Ft. Myers, FL 33901
      • Lakes Regional Library: 15290 Bass Road; Fort Myers, FL 33919
  • The USACE has activated Operation Blue Roof to provide temporary tarp-like covering to help reduce further damage to property until permanent repairs can be made. This service is free to homeowners, and the initial sign-up period is set for 21 days, ending on October 23. Five counties are currently eligible: Lee, Charlotte, Sarasota, Collier, DeSoto.
  • As of 10/6, more than 829,000 MREs and 3.8 million bottles of water have been distributed so far.
  • Florida Department of Emergency Management (FDEM) is identifying locations and resource needs for Points of Distribution (POD).
  • As of 10/6, President Biden granted an additional 30 days of federal funding for debris removal and emergency protective actions, ensuring the first 60 days of response and recovery are all federally funded.
  • A mobile, public fueling station opened on 10/4 in Lee County at the Stars Complex to provide fuel for vehicles and gas cans for generators to impacted residents.

Emergency Prescription Refills

Evacuations and Curfews

  • Evacuations:
    • As of 10/7, the following Florida counties remain under mandatory evacuation orders: Lee County and Osceola County.
    • As of 10/7, Seminole County remains under a voluntary evacuation order.
    • As of 10/7, Sarasota County lifted its mandatory evacuation order, which may increase assistance needs as individuals return to heavily impacted areas.
  • Curfews:
    • As of 10/7, Lee County’s curfew from 9:00pm-6:00am remains in effect.  
      • Pine Island, Fort Myers Beach, and Bonita Beach are reported to be under a 24/7 curfew as of 10/7. As of 10/7, Charlotte County remains under a curfew from 10:00pm-6:00am.
      • Beginning the evening of 10/6, the City of Sanibel transitions to a 7:00pm-7:00am mandatory curfew. During curfew hours, residents should not be on the island, even in their homes.
      • As of 10/4, the City of Sanibel began issuing Hurricane Re-Entry Passes for residents and business owners to grant temporary re-entry to the island.
    • As of 10/5, Collier County has a mandatory curfew from 12:00am-6:00am and the City of Naples residential areas have a curfew from 10:00pm to 6:00am until further notice.

Sheltering

  • As of 10/7, Florida Disaster Maps shows there are 4 open shelters and 1 Special Needs Shelters in the state.
  • Full list and map of shelters open in Florida can be found on the Florida SERT site.
  • A list of open American Red Cross shelters can be found here.
  • On 10/2, Airbnb rolled out urgent hurricane accommodations, info at airbnb.com/hurricaneianflorida. For displaced residents of Lee and Charlotte counties, Airbnb is also working with nonprofit partners to offer vouchers for temporary housing at Airbnb properties.
  • Florida SERT and Florida Tourism Department have partnered with Expedia to launch an emergency accommodations page. Expedia has reached out to accommodation partners and encouraged them to waive cancellation fees and pet restrictions for evacuees.

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