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Healthcare Ready Hurricane Ian Situation Report #7

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 #7

This report provides an assessment of the impacts to healthcare and public health due to Hurricane Ian.

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 closely tracking potential impacts to healthcare infrastructure and supply chain, and will share information frequently via situation reports and Twitter, Facebook, and LinkedIn. Our pharmacy operating status map Rx Open will be updated daily for pharmacies in Florida, Georgia, South Carolina, North Carolina, and Puerto Rico. Healthcare Ready’s Team is on the ground in Florida to support public-private coordination requests.

High-Level Situation Summary

Prolonged power and water outages in certain areas remain the main risk and current impact to healthcare operations following Ian’s initial landfall in Florida on 9/28. In Florida’s Lee County, which sustained significant impacts that forced evacuations, healthcare operations are slowly resuming. Field hospitals and response teams situated nearby have been responding with resources (water and fuel tankers, etc.), and returning power to facilities via generators. There have been reports of potential long-term implications to electrical infrastructure in the area, but details are yet to be determined. While damage assessments continue, pharmacies, clinics, hospitals, and dialysis centers in most areas have started to resume operations. Individuals with medical needs who typically rely on access to water and power at home (to reconstitute medicines, or to operate medical equipment, etc.) are at greatest risk for experiencing impacts from lack of access to water and power. Transportation impacts, including damage to roadways, and delays to resuming public transportation, may continue to threaten the health of communities with medical conditions who rely on regular access to health professionals, medications, water, or power. Healthcare operations in states affected by Ian’s second landfall in South Carolina on 9/30 appear to be stable, overall. 

Highlights

  • There are 35 pharmacy closures reported on rxopen.org as of 2pm EDT on 10/3.
  • Healthcare facilities, including hospitals, urgent care, pharmacies, and dialysis centers are largely resuming operations as of 10/3. However, many facilities are still operating on generators and fuel being tanked in.
  • Boil water advisories are still in effect for parts of 24 counties. Residents are advised to conserve water.
  • Nearly 600,000 Florida customers are still without power, with Lee County and surrounding areas experiencing the greatest outages. Nearly 10% of Volusia County also remains without power.
  • Information on Points of distribution (POD) for food, water, ice, etc. have been posted.
  • Southwest Florida International Airport (RSW) is the only major airport that is still closed due to issues with water and power. RSW is expected to reopen on 10/5 at 8:00am EDT according to the FAA. The airport continues to serve emergency personnel and humanitarian flights.
  • Healthcare operations are believed to be relatively stable in other states affected by Ian, though power issues remain. More 4,000 customers are without power in North Carolina, 1,900 in Virginia, and 800 in South Carolina.

Assessment of Healthcare and Logistics Impacts

Emergency Declarations and Measures

Critical Infrastructure Impacts

  • Power  
    • Florida
      • As of 12:00pm EDT on 10/3, nearly 600,000 Florida customers have power outages. This is a decrease of about 217,000 outages since 10/2. Outages are concentrated from the West to the East of central Florida, with the greatest outage rates in Lee County and surrounding counties, where between 30-60% of customers are out. Additionally, nearly 10% of Volusia County remains without power.
      • Florida Power and Light Company (FPL), Duke Energy, and Tampa Electric Company are three of the largest providers in the Tampa area. These companies, and other energy companies, are reporting major outages and are working to repair damage.
    • South Carolina
    • North Carolina
      • As of 12:00pm EDT 10/3, more than 4,000 customers are without power in North Carolina. Outages are concentrated in the center of the state.
    • Virginia
      • As of 12:00pm EDT 10/3, nearly 2,000 customers are without power in Virginia – an improvement from the day prior (7k).
  • Fuel 
    • As of 10/3, fuel sites in Port Charlotte, Punta Gorda, North Fort Myers, Cape Coral and Bonita Springs, Florida have severely limited operations. Wait times for gas has been reported to be longer than six hours in some areas.
    • Those looking for fuel and gas are encouraged to use Gas Buddy, to search for open stations and providers using crowdsourced information.
    • As of 10/1, 49.9% of gas stations in the Fort Myers region, one third of gas stations in Tampa, and 20% of gas stations in Orlando are without fuel due to impact of the hurricane.
    • The Interior Department’s Bureau of Safety and Environmental Enforcement has suspended around 190,000 barrels of oil production (equal to around 2% of total US oil production) in the Gulf of Mexico as Ian headed to Tampa and Florida.
    • As of 9/28, Chevron Corp removed staff from two offshore Gulf of Mexico platforms, however Occidental Petroleum Corp (OXY.N) and Hess Corp (HES.N) have taken precautions ahead of the storm’s arrival and are implementing storm procedures. This may impact fuel resources getting sent to other areas of the country and could impact medical and other types of manufacturing.
  • Water
    • As of 10/3, parts of 24 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. 
    • As of 10/1, 42 drinking water treatment plants are non-operational; 45 plants partially operational; 700 fully operational; 98 (+51) boiled water notices are in effect. As of 10/3, the FDEM has identified Points of Distribution for water and other supplies across 7 counties.
    • As of 10/1, the state of Florida is providing additional resources (water and diesel) to Lee County in order to power water supply to nearby hospitals.
    • Governor DeSantis and state officials said restoring water service to the area was a top priority for responders. The outage is impacting a population of about 760,000 residents, who are now reliant on bottled water distribution sites. 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
      • As of 12pm EDT 10/3, FCC reports: 3.8% of cell sites are down. 10 (-1) cell sites are down due to damage, 128 (-45) are due to transport, and 167 (-93) are due to power outages. 375 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 10/3, 1 TV station is reported as being out of service, 6 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.
        • International Bureau grants verbal special Temporary Authority (STA)  for two weeks to repair of antennas and other facilities. The purpose of this STA is to allow the provider to operate with facilities that are not covered by their current authorization while they are fixing facilities caused by Hurricane Ian.
        • Public Safety and Homeland Security Bureau issue a verbal waiver for Florida public safety officials to use 700 – 800 MHz interoperability channels.
        • Wireless Telecommunications Bureau grants the American Radio Relay League (ARRL) an emergency request for a temporary waiver of Section 97.307(f) of the Commission’s Rules.
        • Wireless Telecommunications Bureau and the Public Safety and Homeland Security Bureau extend licensing and regulatory deadlines for 30 days following President Biden’s declaration of emergency for the State of Florida.
        • Wireless Telecommunications Bureau grants an emergency waiver of sections 96.67(c)(2) and (3) of the Commission’s rules governing the Citizen’s Broadband Radio Service to Federated Wireless, CommScope, Inc., and Google LLC.
        • Wireless Telecommunications Bureau and Public Safety and Homeland Security Bureau Extend Filing and Regulatory Deadlines in Additional Areas (SC and GA) Affected by Hurricane Ian.
      • Comcast has opened Xfinity WiFi hotspots in Central, North, Southwest, and Panhandle of Florida for Xfinity customers, and non-customers, to remain in contact during and after the storm.
      • 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
    • Road Closures and Travel Updates 
      • Florida
        • The US Coast Guard, paramedics, and other volunteers spearheaded evacuation efforts to residents on Pine Island on 10/2. Because the only bridge to Pine Island is still damaged, the only way to reach the barrier island is by boat or air. Residents were asked to go to the fire department on the island where they were boated across the Matlacha Pass.
        • Ride-hailing app Uber is offering discounted or free rides to or from state-approved evacuation shelters. Use code IANRELIEF.  
        • Florida 511 has real-time traffic conditions and incident information.
          • There are dozens of road closures across central and southwest Florida from coastal Fort Myers/Cape Coral area northeast to Daytona Beach. Closures are concentrated in Fort Myers, Port Charlotte, Tampa Bay, Lakeland, and Daytona Beach.
          • The SR-78 / Pine Island at Matlacha Draw Bridge, which connects Pine Island to Ft. Myers, remains closed as of 10/3.
          • Hurricane Ian destroyed a section of the Sanibel Causeway connecting Sanibel Island and Captiva to mainland Florida, cutting off the only access to the barrier island. The Sanibel Causeway bridge remains closed as of 10/3.
          • Sanibel officials estimated it would take months to fix the damages from Hurricane Ian.
      • South Carolina and North Carolina
        • The South Carolina Department of Transportation provides live updates on South Carolina 511. Users can view alerts from the National Weather Service as well as evacuation resources.
        • Based on South Carolina 511, all the previous road closures due to Ian impacts or flooding are now open.
        • Current road conditions and road closures in North Carolina are mapped on DriveNC.gov.
        • As of 10/3, there are 7 active incidents on secondary roads due to impacts from Hurricane Ian.
        • North Carolina’s 511 Information Line is available to motorists throughout the state.
    • Airports
    • Port status
      • Ports in Florida, North Carolina, and South Carolina have all resumed operations.
    • Rail
      • As of 10/3, FEMA reports that most Amtrak and railroad services resumed normal operations.
      • As of 10/3, SunRail has resumed service. Due to track damages sustained during Hurricane Ian, they will be running a slightly modified schedule.

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
    • As of 10/3, FEMA reports 128 (-10) healthcare facilities impacted by Ian.
    • On 10/3, Lee Health offices reopened across the county, including primary care, pediatrics, specialty care, hospitalist and continuum of care, community and women’s health, rehabilitation services, and outpatient services.
      • Lee Convenient Care on Page Road reopened on 10/1 and Lee Convenient Care on Pine Island Road reopened on 10/2.
      • As of 10/2, in Lee County,  only one facility is reporting below normal water pressure, and Cape Coral Hospital has a water-tanker truck supplementing waterline.
    • On 10/2, DMAT was deployed to Gulf Coast Medical Center to set up supplemental emergency care.
    • As of 10/2 NCH Downtown Baker Hospital’s emergency department and all other NCH emergency departments are now open; the NCH Physician Group Practices and Outpatient Facilities are scheduled to reopen 10/4.
    • As of 10/3, all Tampa General Hospital locations are open and caring for patients.
    • Other closures and evacuations (no new updates as of 10/2):
      • HCA Florida Pasadena in Pinellas County reopened on 9/30 after evacuating patients on Monday 9/26.
      • HCA Florida South Tampa Hospital and HCA Florida West Tampa Hospital also reported evacuations, however they resumed services on 9/29.
      • On 9/29, Sarasota Memorial Hospital in North Point closed its emergency room and has not reopened as of 10/3. However, as of 9/30, Sarasota Memorial Healthcare System has reopened their urgent care centers.
      • On 9/28, Kindred Hospital Bay Area – Tampa and Kindred Hospital Bay Area – St. Petersburg announced they safely evacuated all patients to other facilities.
      • On 9/28, Windmoor Healthcare of Clearwater reported it safely evacuated patients and staff. On 10/3, they reopened and are resuming normal operations.
      • As of 9/27, Encompass Health Rehabilitation Hospital of Cape Coral has evacuated all patients and staff to another Encompass Health area hospital.
      • HCA Florida Fawcett Hospital in Port Charlotte was severely damaged during the hurricane, patients in the ICU were affected by flood waters entering their rooms. As of 10/3, they remain closed.
      • Advent Health locations in Central Florida remain closed and hospice care facilities have paused home visits and admissions. Elective surgeries are postponed. AdventHealth North Pinellas also evacuated patients. No new updates since 9/28.
    • As of 10/2, all hospitals operated by BayCare remain open. In Polk County, outpatient wound care at Bartow Medical Center and Winter Haven Hospital are closed.
    • 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 10/2, Walmart Health Centers in Tampa and Orlando are offering complimentary sick or injury exams. Make appointments at walmarthealth.com or walk-in. Health and Wellness Service Locations:
    • Kissimmee, FL Store 2881, 904 B Cypress Pkwy, Kissimmee, FL
      Walmart Health is open Mon. – Fri. from 7:30am – 7:30pm; Sat. from 9am – 5pm; Sun. telehealth only*
    • Sanford, FL Store 857, 3647 S Orlando Dr, Sanford, FL
      Walmart Health is open Mon. – Fri. from 7:30am – 7:30pm; Sat. from 9am – 5pm; Sun. telehealth only*
    • Wesley Chapel, FL, Store 3418, 28516 State Road 54, Wesley Chapel, FL
      Walmart Health is open Mon. – Fri. from 7:30am – 7:30pm; Sat. from 9am – 5pm; Sun. telehealth only*
    • Brandon, FL, Store 2387, 11108 Causeway Blvd, Brandon, FL
      Walmart Health is open Mon. – Fri. from 7:30am – 7:30pm; Sat. from 9am – 5pm; Sun. telehealth only*
  • Emergency Medical Services
  • Pharmacy
    • Rx Open is activated for Georgia, Florida, South Carolina, and North Carolina. It was last updated on 10/3 at 2:00pm EDT and is showing 39 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 – Baker, Glades, Hardee and Miami-Dade counties.
        • For the first time since the storm made landfall, Lee County is reporting greater than 50% pharmacies as operational.
      • Georgia – Baker, Butts, Charrahoochee, Clay, Clayton, Decatur, Echols, Fayette, Glascock, Quitman, Schley and Teliaferro counties.
      • North Carolina – Camden county.
      • South Carolina – Abbeville county.
    • As of 10/2, OptumRx provided guidance to customers for rerouting existing prescription deliveries to new addresses. 
    • Pharmacy deliveries via Express Scripts may arrive late.
  • Dialysis
    • No changes since 10/1.
    • As of 10/1, many dialysis facilities impacted by Ian have reopened, though closures remain in Florida. Most closed facilities plan to reopen by Monday, 10/3.
    • 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. The page includes patient helpline numbers and contacts for End Stage Renal Disease Networks supporting Florida:

Public Health Impacts

  • Infectious illnesses
    • With people entering shelters due to the hurricane, there is a higher potential for COVID-19 and other infectious and vector borne diseases to spread without the appropriate precautions and protective measures.
      • As of 10/3, CDC is still reporting 11,825 total COVID cases, 256 new hospital admissions, and 53 deaths in the past seven days in Florida.
      • As of 10/3, there are still 2,529 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.
  • 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 residents 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 hours a day, seven days a week with a trained counselor. 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, etc.
    • 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 the United States and its territories. Individuals may call or text 1-800-985-5990 to connect with a trained crisis counselor.
      • Royal Park Hospital Patients experiencing behavioral health crisis are encouraged to call the National Suicide and Crisis hotline at 988.
  • Other
    • Website 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.

Supply Chain

  • Manufacturing
    • No updates as of 10/3.
    • 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 10/3, UPS is reporting that most UPS facilities are providing pickup and delivery services as conditions permit. There will be no pickups or deliveries today in the following zip codes: 33924, 33957, 33931, 33908, 33901.  
    • As of 10/3, 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.  
    • As of 10/3, US Postal Service reports that 14 facilities remain temporarily suspended until further notice. Each of the 14 facilities have an alternate location provided.
    • Localized healthcare supply chain disruptions are likely, however damage to distribution centers has been minor.

Resource Staging

  • General resource staging
    • As of 10/3, FEMA and state search and rescue operations continue in Florida with a priority on hospitals, healthcare facilities, and barrier island communities. More than 100 FEMA Disaster Survivor Assistance Team staff are working in the hardest hit communities to help survivors apply for assistance and identify immediate and emerging threats.
    • In Florida, approximately 5,200 Florida National Guard members and 2,000 National Guard members from other states are activated to help with the response.
    • As of 10/3, FEMA had nearly 10,000 staff deployed to support open and active presidentially declared disasters. This includes more than 2,400 supporting Ian response efforts. More than 1,800 emergency management personnel from 26 states were deployed to Florida through an Emergency Management Assistance Compact.
    • As of 9/29, FEMA teams have delivered 1.1 million meals and 1.5 million liters of water to impacted areas and procuring more. More supplies are expected to follow once conditions are deemed safe for transport.
    • As of 9/28, FEMA has been preparing and staging supplies in strategic locations in Alabama and Florida, including Maxwell Airforce Base in Alabama (four Mobile Communications Operation Vehicles, 3.5 million liters of water and 3.6 million meals. Supplies in Alabama include more than a million liters of water, more than 480,000 meals and more than 7,200 cots.)
    • As of 9/29, US Department of Health and Human Services deployed a National Disaster Medical System (DMAT) of 38 personnel to Miami and two other teams to Robins Air Force Base in Georgia. Additionally, two health and medical task forces and four pharmacists were deployed to Atlanta. Additional DMAT teams are on standby if needed.
  • Florida
    • Florida Department of Emergency Management (FDEM) is identifying locations and resource needs for Points of Distribution (POD) in Charlotte, Collier, DeSoto, Hardee, Highlands, Lee, and Sarasota counties.
      • More than 829,000 MREs and 3.8 million bottles of water have been distributed so far.
      • POD locations are open today in the following counties: Charlotte, Collier, DeSoto, Hardee, Highlands, Lee, and Sarasota. The exact locations can be found here.
    • FDEM has activated the State Assistance Information Line (SAIL) to provide an additional resource for Floridians to receive up-to-date information regarding Hurricane Ian. Residents and visitors can call this toll-free hotline at 1-800-342-3557.
    • FDEM is working with feeding partners to open kitchens for impacted and displaced residents. On 10/1, more than 69,700 hot meals were served on-scene at food banks in Alachua, Brevard, Charlotte, Collier, DeSoto, Flagler, Hardee, Hillsborough, Lee, Manatee, Miami-Dade, Orange, Pinellas, Polk, Sarasota, Seminole and Union counties.
    • As of 10/3, FDEM has eight active fuel depots and is staging an additional four fuel depots today throughout Central and Southwest Florida to ensure first responders have the fuel they need to conduct search and rescue operations. More than 1.4 million gallons of fuels have been mobilized.
    • FDEM has received more than 3,400 resource requests for Hurricane Ian and fulfilled. Over 2,900 of these requests are currently being processed and are either en route or being mobilized. This includes the coordination of resources such as: trucks of food and water, generators and water pumps.

Emergency Prescription Refills

Evacuations and Curfews

  • As of 10/3, the following Florida counties have issued mandatory evacuation orders: Lee County, Osceola County, and Sarasota County.
  • As of 10/3, the following Florida Counties have issued voluntary evacuation orders: Seminole County.
  • As of 10/3, Lee County’s evacuation and curfew have not been lifted.
  • As of 10/3, the City of Kissimmee has a mandatory curfew from 9pm to 6am until further notice.
  • As of 10/3, Collier County and the city of Naples have a curfew from 12am to 6am until 10/4.
  • As of 9/30, multiple areas in Florida had issued stay at home orders or curfews. It is unclear if these curfews remain in effect.
  • As of 10/2, North Carolina does not have any evacuation orders or curfews.
  • As of 10/2, South Carolina has not issued any evacuation orders or curfews.

Sheltering

  • The FEMA Daily Ops Brief from 10/3 reports 39 open shelters with 3,418 residents. A slight decrease in sheltered residence from 10/2 (3,607).
  • As of 10/3, Florida Disaster Maps shows there are 15 open shelters and 6 Special Needs Shelters in the state.
  • Full list and map of shelters open in Florida can be found on the Florida SERT site.
  • List of open American Red Cross shelters can be found here.
  • 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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