Hurricane Sandy, one of the most destructive natural disasters in New Jersey history, made landfall on October 29, 2012. Prolonged loss of electrical power and extensive infrastructure damage restricted access for many to food and water. We examined the rate of dehydration in New Jersey residents after Hurricane Sandy.

We obtained data from 2008 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records from nonfederal New Jersey hospitals (N=517,355). Patients with dehydration had ICD-9-CM discharge diagnosis codes for dehydration, volume depletion, and/or hypovolemia. We used log-linear modeling to estimate the change in in-patient hospitalizations for dehydration comparing 2 weeks after Sandy with the same period in the previous 4 years (2008–2011).

In-patient hospitalizations for dehydration were 66% higher after Sandy than in 2008–2011 (rate ratio [RR]: 1.66; 95% confidence interval [CI]: 1.50, 1.84). Hospitalizations for dehydration in patients over 65 years of age increased by nearly 80% after Sandy compared with 2008–2011 (RR: 1.79; 95% CI: 1.58, 2.02).

Sandy was associated with a marked increase in hospitalizations for dehydration. Reducing the rate of dehydration following extreme weather events is an important public health concern that needs to be addressed, especially in those over 65 years of age. (Disaster Med Public Health Preparedness. 2016;10:188–192)

To summarize existing literature on the mental health impact of the Flint Water Crisis.

In March 2020, we searched 5 databases for literature exploring the psychological consequences of the crisis. Main findings were extracted.

132 citations were screened and 11 included in the review. Results suggest a negative psychological effect caused by the water crisis, including anxiety and health worries, exacerbated by lowered trust in public health officials, uncertainty about the long-term impacts of the crisis, financial hardships, stigma, and difficulties seeking help. There was evidence that concerns about tap water continued even after the state of emergency was lifted.

With a possible compound effect to residents of Flint with the recent COVID-19 pandemic, the results highlight the need for more resources for psychological health interventions in Flint as well as a need for local governments and health authorities to regain the trust of those affected by the Flint Water Crisis.

This review systematically explores the current available evidence on the effectiveness of interventions provided to first responders to prevent and/or treat the mental health effects of responding to a disaster.

A systematic review of Medline, Scopus, PsycINFO, and gray literature was conducted. Studies describing the effectiveness of interventions provided to first responders to prevent and/or treat the mental health effects of responding to a disaster were included. Quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and the Critical Appraisal Skills Programme (CASP) checklist.

Manuscripts totaling 3869 met the initial search criteria; 25 studies met the criteria for in-depth analysis, including 22 quantitative and 3 qualitative studies; 6 were performed in low- and middle-income countries (LMICs); 18 studies evaluated a psychological intervention; of these, 13 found positive impact, 4 found no impact, and 1 demonstrated worsened symptoms after the intervention. Pre-event trainings decreased psychiatric symptoms in each of the 3 studies evaluating its effectiveness.

This review demonstrates that there are likely effective interventions to both prevent and treat psychiatric symptoms in first responders in high-, medium-, and low-income countries.

In South Korea, many individuals were self-quarantined for the coronavirus disease 2019 (COVID-19) after the quarantine criteria were extended to all overseas travelers. This study was conducted to identify the noncompliance rate of self-quarantine for COVID-19 cases and assess the impact of a 1-strike out policy and an increased amount of penalty for the violating self-quarantine in South Korea.

The self-quarantine noncompliance rate for COVID-19 was examined using publicly available data. We collected the daily number of quarantine and quarantine violation cases from March 22 to June 10, 2020. A Poisson regression analysis was conducted to identify the impact of additional sanctions for the quarantine violation.

The median number of individuals quarantined per day was 36,561 (interquartile range, 34,408-41,961). The median number of daily self-quarantine violations was 6 (range, 0-13). The median rate of self-quarantine violations was 1.6 per 10,000 self-quarantined individuals (range, 0.0-8.0 per 10,000 self-quarantined individuals). The additional sanction has no significant impact on the number of violations among quarantine individuals (P = 0.99).

The additional sanction for the violation of quarantined individuals did not reduce the self-quarantine violations. Further studies are warranted to strengthen the compliance of self-quarantine for future pandemics.

Studies quantifying relationships between floods and diarrheal diseases have mainly been conducted in low-latitude regions. It’s therefore increasingly important to examine these relationships in midlatitude regions, where they may have significant public health implications. This study aimed to examine the association between floods and bacillary dysentery in the city of Dalian, China.

A generalized additive mixed model was applied to examine the association between floods and bacillary dysentery. The relative risk (RR) of flood impact on bacillary dysentery was estimated.

A total of 18,976 cases of bacillary dysentery were reported in Dalian during the study period. Two weeks’ lagged effect was detected from the impact of floods on bacillary dysentery. The RR of flood impact on bacillary dysentery was 1.17 (95% CI: 1.03-1.33).

Floods have significantly increased the risk of bacillary dysentery in Dalian. More studies should focus on the association between floods and infectious diseases in different regions. Our findings have significant implications for managing the negative health impact of floods in the midlatitude region of China. (Disaster Med Public Health Preparedness. 2017;11:190–195)

This brief report examines the shift from in-person care to US Department of Veterans Affairs (VA) telehealth services during 3 devastating hurricanes in 2017 (Harvey, Irma, and Maria).

VA administrative data were used to analyze the number and percentage of telehealth services 30 d pre- and 30 d post- the 2017 hurricanes for 3 hurricane-impacted VA medical centers (VAMCs): Houston (Texas), Orlando (Florida), and San Juan (Puerto Rico).

All 3 VAMCs remained open during the hurricanes. For the Houston VAMC, during the first week post-Harvey, in-person patient visits decreased while telehealth visits increased substantially. Similarly, for the Orlando VAMC, during the 1-wk post-Irma, telehealth use increased substantially. For the San Juan VAMC, there were many interruptions in the use of telehealth due to many power outages, resulting in a modest increase in the use of telehealth post-Irma/Maria. The most commonly used telehealth services at Houston and Orlando VAMCs during the hurricanes were: primary care, triage, mental health, and home health.

Telehealth has the potential to improve post-disaster access to and coordination of care. However, more information is needed to better understand how telehealth services can be used as a post-disaster health-care delivery tool, particularly for patients receiving care outside of systems such as VA.

The purpose of the study is to describe changes in mental health among women following an oil spill and to examine their association with the Deepwater Horizon oil spill (DHOS).

The Women and Their Children’s Health study followed 2038 women in Louisiana after the DHOS. Subjects were interviewed in 2012-2014 and 2014-2016. Oil spill exposure was characterized using survey items about economic and physical exposures. Outcomes were depressive symptoms and mental distress.

After adjustment for relevant demographics, depressive symptoms increased over 2 time points following the DHOS, whereas symptoms of mental distress decreased. For every year increase in time since the DHOS, the rate ratio for depressive symptoms increased by a factor of 1.08. In contrast, the rate ratio for mental distress decreased by a factor of 0.97. In addition, initial associations between economic and physical exposure to the DHOS persisted up to 6 years after the spill; women who were more highly exposed experienced higher levels of depressive symptoms (rate ratios ranged from 1.08 to 1.11) and mental distress (rate ratios from 1.05 to 1.11) at each time point than women who were less exposed.

A better understanding of recovery patterns following an oil spill can help direct critical mental health response efforts. (Disaster Med Public Health Preparedness. 2019;13:183–190)

In this investigation, we reported the increase in emergency department and inpatient admission cases during the month of November 2012 post Hurricane Sandy as compared with baseline (November 2010, 2011, and 2013) for elderly patients aged 65 and up.

Medical claims data for patients aged 65 and over treated at emergency department and inpatient health care facilities in New Jersey were analyzed to examine the surge in frequencies of diagnoses treated immediately following Hurricane Sandy. The differences were quantified using gap analysis for 2 years before and 1 year after the event.

There was an average increase of 1700 cases for the month of November 2012 relative to baseline for the top 15 most frequently diagnosed emergency department medical conditions. On a daily basis, a volume increase by an average 57 cases could be expected, including significant numbers of limb fractures and other trauma cases for these most frequently encountered medical conditions.

Understanding the surge level in medical services needed in emergency departments and inpatient facilities during a natural disaster aftermath is critical for effective emergency preparation and response for the elderly population. (Disaster Med Public Health Preparedness. 2018;12:730-738)

The objective of this study was to draft a new Japanese Disaster Medical Assistance Team (DMAT) training program based on the responses to the Great East Japan Earthquake.

Working group members of the Japan DMAT Investigative Commission, Ministry of Health, Labour and Welfare, reviewed reports and academic papers on DMAT activities after the disaster and identified items in the current Japanese DMAT training program that should be changed. A new program was proposed that incorporates these changes.

New topics that were identified to be added to the DMAT training program were hospital evacuation, preparations to receive DMATs at damaged hospitals, coordination when DMAT activities are prolonged, and safety management and communication when on board small helicopters. The use of wide-area transport was reviewed and changes were made to cover selection of various transport means including helicopter ambulances. Content related to confined space medicine was removed. The time spent on emergency medical information system (EMIS) practical training was increased. Redundant or similar content was combined and reorganized, and a revised DMAT training program that did not increase the overall training time was designed.

The revised DMAT training program will provide practical training better suited to the present circumstances in Japan. (Disaster Med Public Health Preparedness. 2014;8:477-484)

The Great East Japan Earthquake and tsunami affected approximately 53 000 people in the city of Ishinomaki, Miyagi Prefecture. Approximately 30 000 people were relocated to temporary/rental housing. The remainder re-inhabited tsunami-affected houses, and their conditions were not known. As social isolation could affect physical and psychological health, we investigated the risk of social isolation among the survivors who returned to their homes.

The surveyors went door-to-door to the tsunami-affected houses and interviewed each household between October 2011 and March 2012. The participants’ risk of social isolation was assessed using 3 factors: whether they have (1) friends to talk with about their problems, (2) close neighbors, and (3) social/family interactions. We analyzed the groups at risk of social isolation and identified the related factors.

The elderly (older than age 65 years) were more likely to have close neighbors and social/family interactions, as compared with younger persons. Persons living alone were less likely to have social/family interactions. Non-elderly men who were living alone were the highest proportion of people without social/family interactions.

Our findings suggested that men, particularly those younger than age 65 years and living alone, were at high risk of social isolation and may need attention. (Disaster Med Public Health Preparedness. 2014;0:1-8)

We launched a health promotion program called the Hamarassen (“let’s get together”) Farm, which provided farming opportunities for the victims of the Great East Japan Earthquake who resided in temporary housing. The aim of this study was to evaluate the effects of this program on physical and mental health in terms of bone mineral density (BMD) and a sense of purpose in life.

Among 39 female participants in whom BMD was evaluated, there were 12 Hamarassen participants, 8 self-farming control subjects, and 19 non-farming control subjects. BMD was measured by calcaneal quantitative ultrasound immediately after the project launch and 5 months later. A sense of purpose in life prior to and 2 months after the project’s commencement was measured in 21 additional Hamarassen participants by use of the K-I Scale. Interviews were also conducted to qualitatively evaluate the effects of the Hamarassen program.

The mean BMD T-score improved by 0.43 in the Hamarassen group, by 0.33 in the self-farming group, and by 0.06 in the controls (p=0.02). Among the 21 Hamarassen participants in whom mental health was evaluated, the average score for a sense of purpose in life improved from 20.5 to 24.9 (p=0.001).

The Hamarassen Farm provided disaster victims with opportunities for social participation, interpersonal interaction, and physical exercise; such opportunities may improve physical and psychosocial well-being. (Disaster Med Public Health Preparedness. 2015;9:103-110)

The study provides a comprehensive insight into how an initial receiving hospital without adequate capacity adapted to coping with a mass casualty incident after the Formosa Fun Coast Dust Explosion (FFCDE).

Data collection was via in-depth interviews with 11 key participants. This was combined with information from medical records of FFCDE patients and admission logs from the emergency department (ED) to build a detailed timeline of patients flow and ED workload changes. Process tracing analysis focused on how the ED and other units adapted to coping with the difficulties created by the patient surge.

The hospital treated 30 victims with 36.3% average total body surface area burn for over 5 hours alongside 35 non-FFCDE patients. Overwhelming demand resulted in the saturation of ED space and intensive care unit beds, exhaustion of critical materials, and near-saturation of clinicians. The hospital reconfigured human and physical resources differently from conventional drills. Graphical timelines illustrate anticipatory or reactive adaptations. The hospital’s ability to adapt was based on anticipation during uncertainty and coordination across roles and units to keep pace with varying demands.

Adapting to beyond-surge capacity incident is essential to effective disaster response. Building organizational support for effective adaptation is critical for disaster planning.

The novel coronavirus disease 2019 (COVID-19) pandemic has spread to over 213 countries and territories. We sought to describe the clinical features of fatalities in patients with severe COVID-19.

We conducted an Internet-based retrospective cohort study through retrieving the clinical information of 100 COVID-19 deaths from nonduplicating incidental reports in Chinese provincial and other governmental websites between January 23 and March 10, 2020.

Approximately 6 of 10 COVID-19 deaths were males (64.0%). The average age was 70.7 ± 13.5 y, and 84% of patients were elderly (over age 60 y). The mean duration from admission to diagnosis was 2.2 ± 3.8 d (median: 1 d). The mean duration from diagnosis to death was 9.9 ± 7.0 d (median: 9 d). Approximately 3 of 4 cases (76.0%) were complicated by 1 or more chronic diseases, including hypertension (41.0%), diabetes (29.0%) and coronary heart disease (27.0%), respiratory disorders (23.0%), and cerebrovascular disease (12.0%). Fever (46.0%), cough (33.0%), and shortness of breath (9.0%) were the most common first symptoms. Multiple organ failure (67.9%), circulatory failure (20.2%), and respiratory failure (11.9%) are the top 3 direct causes of death.

COVID-19 deaths are mainly elderly and patients with chronic diseases especially cardiovascular disorders and diabetes. Multiple organ failure is the most common direct cause of death.