The Perfect Storm Hurricane season in the North Atlantic begins on June 1st. Just last month, The Weather Company predicted a hurricane season this year that will be more active than 2019. The Company calls for eighteen named storms and nine hurricanes, of which four could be major hurricanes (Category 3 or higher). Florida and its various counties are also in Phase 1 of reopening. The result: A possible recurrence in COVID infections might occur during peak hurricane season. While we cannot predict how many of these hurricanes will be realized and of them how many will make landfall, there is a definitive possibility of the overlap between at least one hurricane and that of a COVID-19 surge. What happens when a natural disaster intersects with a pandemic? The modern world, fortunately, has never seen anything like it. Unfortunately, for the world, this also means that we cannot fall back on experience. We need to plan – plan for eventualities, for resources and logistics, and for the fact that things will sometimes not go according to plan. And when that happens, we cannot falter.
In the scenario of an overlap of a hurricane event
already extended because of COVID-19 might now
with COVID-19 resurgence, the challenges will be
have to overextend to treat hurricane and storm-related
exponential. Historic response to hurricane evacuees
injuries.
has been to shelter them in large spaces at close quarters. Stadiums, schools, and arenas have been
There are, of course, ways to mitigate the impact of this
facilities of choice. We now know how fast COVID-19
disastrous overlay. Multiple Florida counties are already
can spread from person to person. Crowding people
considering hotels as a possible evacuee space. The
together becomes a less than ideal solution. Even if
use of hotel rooms reduces the close contact resulting
evacuees could be screened, there is a high probability
from densely packed large indoor spaces. Repurposed
of undetected asymptomatic carriers encountering
spaces will need to be evaluated for risks of airborne
a susceptible population. There is also increasing
and surface microbial transmission by ensuring proper
evidence of possible transmission from fecal matter
pressures, air flows, specific humidity, temperature, air
(Northwestern Now, 2020). Storm surges and flooding
change rates, filtration, and surface cleanliness. Some
during hurricanes often overwhelm sanitary systems and
of these spaces might have been shuttered for weeks
can lead to secondary transmission challenges. Social
due to the shelter in place mandates. Effective cleaning
distancing recommendations of 6-feet are the minimum
will include ultraviolet radiation, HEPA filtration,
and stronger winds in the hours before and during the
electrostatic filtration, increased ventilation and outside
storm might require this criterion to be increased. And,
air supply with minimized recirculation and directional
most of all, some of our healthcare facilities that are
airflows from clean to less clean areas and controlled
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Going forward, healthcare systems will need to rely heavily on telemedicine and ensure facilities are prepared to utilize this technology in a meaningful and effective manner.
supply and exhaust (Wagner, J; Greene, C; Kaiser, R;
measures recommend, reports a new study from Chile.
Greeley, D; for OnSite, 2020). And while ultraviolet (UV)
(Guerrero, Brito, & Cornejo, 2020). These conversations
light has been touted as a means of killing the virus,
have already been broached in the context of outdoor
most studies to date have been conducted on bacteria
activities like biking and running, but need to be
and not viruses. For UV lighting to be effective, duration
continued and studied further in this context.
and intensity of exposure must be considered. It should also be noted that UV lighting can also cause damage to
Telemedicine has come to the forefront since the start
surface materials over time. The most proven solution
of the COVID-19 crisis. Going forward, healthcare
so far is routine cleaning with disinfectants (Page, K; for
systems will need to rely heavily on telemedicine and
BSA LifeStructures, 2020).
ensure facilities are prepared to utilize this technology in a meaningful and effective manner. The temporary (or
High winds prior to and during a storm or hurricane will
permanently) relaxed regulations around telemedicine
also require that social distancing guidelines be revisited,
(Zook, J; for BSA LifeStructures, 2020) means facilities
and the public must be provided with clear direction on
can adapt more spaces to support this function,
what to expect. The current 6-foot separation guideline
effectively allowing caregivers to diagnose and treat
is based on the absence of high winds or forceful
minor injuries and ailments remotely, hence reducing the
airstreams. Respiratory particles exhaled during a sneeze
strain on the physical system. This will also minimize the
can be transported by the forceful wind more than three
interaction between hurricane or storm-related injuries
times further than current social or physical distancing
and COVID-19 patients presenting at the facility.
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Manufacturers of PPE and independent volunteer
within the AII space, and through a contamination risk
organizations will need to prepare for yet another PPE
mapping algorithm (Gormley, T; Greely, D; Wagner,
deficit and increase production as much as possible.
J; Markel, T; Jones, H; Clarke, J; Ostojic, J; for OnSite,
This includes masks, face shields, gowns, gloves, and ear
2017), produces a ‘risk map.’ The numerical risk
protectors.
readings are color-coded green (ok), yellow (below target), and red (critical) on the map for easy reference
Healthcare organizations have and will continue to
by the team member collecting the data. The risk
confirm and ramp up resiliency measures that allow
readings are uploaded to an interactive floor plan of
critical infrastructure to stay functional and re-mobilize
the AII room, indicating location of patient bed, toilet
as soon as possible during and after a hurricane event.
room and anteroom in relation to the team member collecting the readings. Each location (2-10 per room)
What happens when hospitals need to accommodate more patients than anticipated?
takes approximately 5 seconds (average 5 one-second readings), minimizing disruptions to patient care processes or procedures. Data from each reading is
Like in the past few months, some facilities will be
stored to enable analytics and trending of historical
forced to adapt existing spaces for different uses, and
conditions.
separate COVID positive from the uninfected (Wagner, JA; Greeley, DG; for OnSite, 2020). Companies like
Another field that will need to be effectively utilized
OnSite offer a hand-held technology that allows the
is Teleanalytics. In order to minimize in-person
user to input space identification information, room
interactions, consultants, designers, and engineers can
temperature, and specific humidity. It measures the
remotely assist hospital staff in measuring critical data in
velocity and direction of the air at various points
JUPE's emergency deployable flat packs can be transported 24 units at a time on a 40-foot flatbed to remote areas.
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the spaces to analyze, without putting themselves and others at risk.
While this scenario may or may not happen, the only way we can be prepared for it, is if we are.
We also need to be prepared to supplement the resources of healthcare organizations, especially in
Florida has immense resources. Each healthcare facility
hard to reach areas with expedited critical response
and the local government in coordination with the
infrastructure. An example of this is the flat pack
federal government and FEMA will need to plan out
prototype that JUPE Health has created. With three
worst-case and best-case outcomes, decide on the
options ranging from a respite area, to an off-grid
chains of command, logistics, supplies, and actions to
recovery unit designed for non-critical COVID patients,
be followed and execute based on what has been set
and an ICU level unit that is currently in development,
in place. The loss of life, just like the loss of property
these units can be transported 24 pieces at a time on
is not only preventable, it is imperative and it falls on
a 40-foot flatbed to areas in need. These care units are
all of us – a multidisciplinary team to come up with
designed by a multidisciplinary group of physicians,
innovative solutions to as many imaginable challenges,
public health experts, architects, interior designers,
all while attempting to navigate a novel threat with
automobile engineers, information technology experts
unconventional solutions. A combination of the
and others. JUPE is an example of cross-pollination at its
approaches presented above with others might just be
best in times of need. A similar approach will be required
the difference between a thoughtful and determined
to come up with innovative solutions for the challenges
response to a disaster and a great loss.
at hand. No longer can ideation, design and creation happen in silos, because those silos won’t hold long.
The loss of life, just like the loss of property is not only preventable, it is imperative and it falls on all of us – a multidisciplinary team to come up with innovative solutions to as many imaginable challenges, all while attempting to navigate a novel threat with unconventional solutions.
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References: Gormley, T; Greely, D; Wagner, J; Markel, T; Jones, H; Clarke, J; Ostojic, J; for OnSite. (2017). Methodology for Analyzing Environmental Quality Indicators (EQIs) in a Dynamic Operating Room Environment. Guerrero, N., Brito, J., & Cornejo, P. (2020, April 17). COVID-19. Transport of Respiratory Droplets in a Microclimatologic Urban Scenario. Retrieved from MedRxiv. Northwestern Now. (2020, May 8). Northwestern.edu. Retrieved from Northwestern Now for Journalists: https://news.northwestern.edu/stories/2020/05/risk-of-covid19-transmission-through-wastewater/&fj=1 Page, K; for BSA LifeStructures. (2020). UV Light for Decontamination. Zook, J; for BSA LifeStructures. (2020). Telemedicine. Background and benchmarks for planning. Wagner, J; Greene, C; Kaiser, R; Greeley, D; for OnSite. (2020, May). Safely Reopening Healthcare and Public Spaces - Prepare your Environment to Instill Public Confidence. Wagner, JA; Greeley, DG; for OnSite. (2020, May). Airborne Infectious Isolation Rooms A Protective Airflow Verification Solution.
Author: Melanie Harris Regional Director, Florida
Email: mharris@bsalifestructures.com bsalifestructures.com 800.565.4855