2005 Hurricane Season

Transcript of Press Briefing - HHS Response to Hurricane Katrina

Department of Health and Human Services
Press Briefing with
HHS Secretary Mike Leavitt, Dr. Julie Gerberding,
Director, Centers for Disease Control and
Prevention, and Dr. Richard Carmona, Surgeon General

Tuesday, September 6, 2005

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MS. PEARSON: This is Christina Pearson with the U.S. Department of Health and Human Services. Thank you for joining us today.

We have Secretary Mike Leavitt, Surgeon General Richard Carmona and Dr. Julie Gerberding. They're going to give some overviews of their--to the impacted areas of the Gulf region as well as talk about HHS's response to Katrina. Then we will open it up to some questions.

Secretary Leavitt is here and he's going to lead it off. He may have to depart, but Dr. Gerberding and Dr. Carmona will be able to also answer some additional questions. Secretary Leavitt?

SECRETARY LEAVITT: Thank you. As indicated, I'm just going to give a brief overview and then we'll respond to the questions. Because of the depth and the number of different ways in which this department is involved in our disaster response, we'll cover basically three areas. The first is health care. The second will be our public health care response. That is to say, preventing outbreaks of disease. Then third, we'll talk some about our efforts to position families and individuals for the long-term recovery that we'll need to be making.

We traveled, visited many of the major evacuation centers as well as New Orleans and Baton Rouge and Mississippi. We went through Texas, specifically Houston, Dallas and San Antonio. I'd make the following observations. With respect to health care, the response was massive led in large measure by local communities. I would judge it to have been strong and high quality, but predictably, imperfect. It has drained resources from local service providers. They have responded in a remarkable way.

We walked medical shelters that were staffed by the heads of departments of major hospitals working alongside medical students. The quality that they were receiving was amazingly high. I recount seeing--in Houston I walked past a curtain and the curtain was pulled and there were probably 50 computer terminals creating electronic medical records for patients that had just walked off the street that had been hooked into a major hospital authority in the Houston area.

I walked down the corridor a ways and there was a large building that had been rolled in by Siemens. It was a demonstration of lab capacity or laboratory equipment. They were doing lab tests on-site, electronically sending them to a hospital where they were being read and interpreted and electronically sent back. That's at the high end. We also saw rooms full of cots where people were responding at the most basic first aid level.

We inspected what was going on at the New Orleans airport. There were nine DMAT teams from all over the country who were processing people in the most difficult of conditions.

We had a chance to look at the facilities in Baton Rouge where they had assembled field hospitals that after 3 or 4 days were working with a remarkable rhythm, a rhythm that would be akin to an emergency room setting in a major city that had worked together for years. People have responded in remarkable and professional ways.

The natural evolution now will be for the shelters to see the pace of patient influx slow, and that is now happening. Those that are the most acute are being transferred to hospitals. We evacuated close to 2,000 people off to hospitals out of the New Orleans airport. They were taken to hospitals that were identified through the NDMS system, which we had identified 2,600 hospital rooms in a 12-state area and 40,000 nationally. We also had established a system for extremely acute care through the National Institutes of Health that was ready to receive patients if necessary.

As the shelters now begin to see less intense traffic, the next wave of this will be for back-filling within those shelters. We have identified 200 hospital organizations who have committed now to move in and begin to support the local hospital efforts so that the people who have left their stations at major hospitals to come run the shelters can return and catch their breath. And we're also beginning to identify local hospitals that need the same kind of back-filling because of the additional pressure.

One of the most significant areas affected in that way would be Baton Rouge. That city has gone from a city of a half a million to a city of 850,000, and while we have set up additional shelters there that are now operating and have some capacity, the hospitals are under significant pressure.

We have established a working plan in the city of New Orleans to restore capacity for citizens as they return. There are over 1,000 hospital beds that are functional and operating in the New Orleans area. We have a plan in place with the providers there, and FEMA, to begin bringing up a second thousand and to provide the support services and staffing necessary from the hospitals that I alluded to earlier.

I might also add that we have about 8,000 professional volunteers, professionally qualified volunteers, who have called our 1-800 line and have indicated a willingness to go. Both the 200 hospital organizations and the 8,000 individual volunteers have been told that we will need them now in the second, third and fourth waves which will happen over the next several months as we work our way through this dilemma.

It's become clear that the demand of several hundred thousand evacuees leaving the state of Louisiana and Mississippi for other states will put significant stress on the public medical capacity within major cities, and we are actively pursuing strategies to bolster the community health clinics in those areas.

That will give you a basic report on health care. I will now comment on the public health situation, that is to say, our efforts to prevent outbreak of disease in not just New Orleans, but the entire Gulf Coast, and also the federal medical shelters and other shelters that are involved in the recovery.

We have developed a joint task force that includes the Centers for Disease Control, the Environmental Protection Agency, the Defense Department and the Department of Energy, also the state of Louisiana and New Orleans city public health officials. We have secured a command center at Kindred Hospital in New Orleans. They are on site and they are working, and their task is to monitor the public health in the New Orleans area and to begin to make judgments on when New Orleans is safe to reinhabit.

The process they will follow is not known to me, but we have the best people in the country who are there occupying and at some future time we can have more conversation, or it may be that Dr. Gerberding at the right moment can give you more details on what they will be doing. Our purpose, of course, is to make certain that we do not have outbreaks of disease, or if there are circumstances where disease is reported, to respond in a robust and quick way.

I might add that we're co-locating at that location at Kindred a number of different functions. In addition to the joint task force that I have just enumerated, the city of New Orleans will be locating their Public Health Department there on a temporary basis. HHS will also have its field command there. I also want to indicate to you that we have embedded uniformed public health officers from the commissioned corps in each of the major evacuation shelters throughout Texas, throughout Louisiana, and throughout Mississippi.

Their purpose is to assure that the medical needs are ascertained and communicated in a way that we can be supportive with federal resources. A good example, in Mississippi now there are three hospitals that are not functioning; the rest appear to be. However, they have had difficulty with their supply chain and we have resupplied them from national resources once, and we're in the process of resupplying a second wave.

We've also put in Meridian, Mississippi, and perhaps we're looking at another one in Jackson, 500 bed facilities that are serving as overflow. Those are being staffed primarily by HHS and commissioned corps personnel. We'll have to back-fill them in the future from the 200 hospital organizations I alluded to earlier.

That covers both health care and public health. I would just touch on the next objective which we're feverishly working on, and that is the need to help the evacuees who have arrived in cities and towns all over the country with an immediate and massive effort to assure that they have food or help buying food, health care, family support, mental health, education, unemployment, housing, job training, all of the things that it takes to get one's life back on track. I'm not going to give you a lot of details on that because we're in the process of formulating our approach, but I will tell you that you'll hear much more about that soon.

I will now respond to questions. I will call on Dr. Gerberding and the surgeon general who are with me to supplement my answers or to give you answers in areas that they're well-qualified to provide.

OPERATOR: Thank you. At this time, if you'd like to ask--

MS. PEARSON: --is to give their name as well as their outlet when they ask the question.

OPERATOR: Again, to ask a question please press star one. You'll be announced prior to asking a question. To withdraw your request, you may press star two.

Tod Zwilich of WebMDnews, you may ask your question.

QUESTION: Hi. Tod Zwilich with MDnews and UPI.

Can we get an idea--as we're ongoing with shelters, people in close quarters, you know, in dozens of different shelters throughout the region, what are the primary public health concerns in those places right now. Also in the disaster areas. And could Dr. Carmona or Dr. Gerberding comment on vaccine-preventable diseases that are either of concern or have been seen in any of those areas, and any vaccination efforts that are underway?

SECRETARY LEAVITT: I'll ask Dr. Gerberding to respond first. I hope she's there.

MS. PEARSON: She was on a cell phone; it may have cut out. So she will be getting back on the call.

DR. GERBERDING: This is Julie Gerberding. Can you hear me?

SECRETARY LEAVITT: Go ahead; thank you.

DR. GERBERDING: Okay. Thank you.

We are preparing for the possibility of infectious diseases that could be spread under conditions of crowding in the shelters. There are several steps to that preparation. One is to anticipate it because it's not going to be surprising. We see this any time people are crowded together. The second is to do an assessment of people when they arrive, to screen out anyone who's got an obvious infection, and that's very difficult to do, and people are arriving unexpectedly in such large numbers, so we recognize that will be imperfect.

And then the next step is to make sure that we have the personnel available to detect a problem and the laboratory support to diagnose it when it does emerge, and then the infection control methods in place to help organize people in such a way to minimize spread.

These activities are already ongoing in all the shelters that we have visited in the last several weeks.

The key specific diseases that we would be concerned about are of course the diseases transmitted by the respiratory route, things like common colds or things like influenza when it's flu season, or even potentially things that would be unusual but not completely unexpected like tuberculosis.

The other category of infectious diseases are those that are transmitted by close contact, and any of the diarrheal diseases could certainly emerge in this environment and then spread from person to person.

It's amazing, what the shelters are doing about supplying hand hygiene products and really helping people understand the importance of hand hygiene under the circumstance. But there's a lot more that can be done and CDC has deployed already more than a 140 people to help with these activities and we have at least eight more teams available at CDC to augment the shelter staff, to help with this infectious disease containment.

In terms of vaccines right now for people in shelters, we're focusing on making sure that the immunization of children is up to date. It would be unusual for measles or Rubella or the other childhood vaccine preventable diseases to emerge, but many of the people in these shelters are among the people in our country who already experience health disparities, and we're erring on the side of immunizing anyone for whom we have any reason to suspect their vaccination status is not up to date.

For the adults, we're of course also concentrating on tetanus immunization, because many of these people have been injured and could be at risk for that infection, and when flu vaccine is available we will also be encouraging flu immunization simply because, again, it's a crowded environment, a vulnerable population, and the last thing they need to be dealing with right now, in the context of all the other difficulties, is a flu outbreak.

QUESTION: Have there been any reports of any of the diseases that you're mentioning in shelters, that have caused concern so far, that have had to be dealt with?

DR. GERBERDING: Well, every possible case is a reason for concern and there are reports of diarrheal illness which are under active investigation in Texas right now, so there are teams of individuals documenting whether there is in fact a true outbreak, or whether this is just the distribution of diarrhea that you would normally see in a population.

As I said, we won't be surprised if this proves to be a situation where intestinal illnesses can spread. We just have to identify them early and be prepared to take the appropriate steps to contain them.

There's also been some investigation of potential cases of tuberculosis. Some of the people in these shelters were already known to have TB and were on TB medication. Getting their medication restarted and making sure that they're not in an infectious state is obviously a priority, and if new cases of tuberculosis emerge, they've being investigated. The appropriate containment steps are being taken.

Fortunately, TB obviously is an issue because it's transmitted person to person, but it does take fairly prolonged contact with a highly-infectious patient for that to be a major threat and I think we're much more concerned about the common illnesses that any crowded condition can promote.

MR. : Next question.

OPERATOR: Maggie Fox of Reuters, you may ask your question.

QUESTION: Hi. Thanks very much. I've been talking by phone to a lot of the medical crew that are out there and they're telling me that they were up and running, sometimes a day before the hurricane actually hit. They were there fast. Yet we have to compare this and contrast it with the situation, for instance, in the SuperDome, where people were without medical care for days.

Can you guys help explain that disparity?

SECRETARY LEAVITT: This is Mike Leavitt. It's very difficult to know what went on in the SuperDome because the reports are so widespread and varied. I have had lengthy conversations with Dr. Kevin Stevens, who are in the SuperDome. He's the head of the public health department for New Orleans. I don't think we have a lot to add on the fact, on that, other than the fact that the health community was moving rapidly and successfully and being able to establish centers for health care, and people received remarkable care under the circumstances.

As I indicated, within hours we had nine DMAT [ph] teams at the airport as evacuees were being moved through there.

It was more difficult to establish a foothold at the convention center and the SuperDome because of the security issues that have been widely reported but, ultimately, health care was provided in those areas.

QUESTION: And as a follow-up, can you guys explain a little bit about some of the people who may have been the most vulnerable. It's my understanding that, you know, that we have a lot of frail people in our population who are just kept alive by dint of good medical care, and once that's gone they may have expired quickly.

Have you seen that situation happening?

SECRETARY LEAVITT: Well, any time you're dealing with a population this large, there are special needs populations, particularly the elderly and those who are disabled, those who have known diseases, those who are diabetics, and so forth.

I'll ask Dr. Carmona, the surgeon general, to respond.

DR. CARMONA: What the Secretary said is absolutely true. These populations have special needs because of mobility, because of their condition. But what's been remarkable, that we have seen in all of the shelters in the communities that we had the opportunity to visit with Secretary Leavitt, is that the communities themselves came together and realized they needed special provisions for this, and they joined together with wheelchair brigades, stretcher brigades, and did everything they could to mobilize individuals to help those who needed additional resources to get out of harm's way and into shelters where they could be cared for.

So this was very much on the mind of all of the communities that we saw, and I know early on, Secretary Leavitt directed all of us to ensure that we supplemented, where necessary, in all of those communities, to make sure that those persons who had special needs were cared for, from the very young child to the very senior citizen.

DR. GERBERDING: I would just to add that some of the stories that we heard from people who were so tragically affected by this really speak to great personal courage, and how one neighbor would reach out and help another neighbor with special needs, and then link that neighbor to the rescue and relief resources that were available.

So this is an example of a vast network of individuals who were caring for each other, eventually were able to connect up with the services that were available in the shelters.

It's not perfect but it's a remarkable story of individual courage and I think an enormous amount of public heroism.

MS. PEARSON: Great. Secretary Leavitt had to step away for a moment but why don't we take some questions. Dr. Gerberding and Dr. Carmona are still here. If you have some more public health questions, or public health response questions.

OPERATOR: Lorin Neargard [ph] of Associated Press, you may ask your question.

QUESTION: Hi. This is for Dr. Gerberding. First of all, if you could tell us what are some of the suspects in the diarrheal cases that are being investigated now, if it's Vibrio, or e. coli, or some of the other bigees.

And also what is sort of the timetable for the infectious diseases that might have been contracted before people arrived to shelters, manifesting themselves now, as opposed to something like flu that could come in later?

And what you're anticipating dealing with right now is to, you know, what they might have been exposed to, suddenly surfacing versus dealing with chronic diseases, sort of at the same time, the people who are now trying to get up to speed on their diseases that they deal with on a daily basis.

DR. GERBERDING: Yeah. I think you're making a very important point, is that we have to be prepared to deal with the emerging problems that are a consequence of anyone in a shelter situation where crowding and challenges in maintaining personal hygiene are evident, versus those conditions that preexisted the problem or that occurred as a consequence of the trauma of the problem, that are going to require ongoing medical care as this timeframe unfolds.

The infectious diseases, particularly diarrheal illnesses, any number of the common bacterial infections could emerge, but I think a category of viruses that cause diarrhea, that are the most easily spread among the population like this are the Noroviruses. These are the same viruses that have caused the widespread outbreaks on cruise ships. They're so easily transmitted.

It really requires almost perfection of personal hygiene to be completely safe, and once these viruses get established in a population, you can expect some vomiting and diarrhea to occur.

Usually this is not a serious disease or a life-threatening disease, but when you do have a vulnerable population, or small children or the elderly, who come in contact with any ordinary infectious virus, it can certainly lead to dehydration or more complications that would require acute care intervention, and that's what we're working hard to avoid.

I just can't tell you how impressive these shelters are with respect to the attention being paid to this issue. I have some remarkable photographs in the Astrodome of a line of sinks, stretching out as far as I, you know, can see down the aisle, of portable sinks that have been brought in, and the emphasis on hand hygiene is everywhere.

People are being given these alcohol-based hand rubs and instructions are being widely distributed to help people protect themselves, and yet we know, when you're got 24,000 people in a facility for a long period of time, we just have to expect this and be prepared for it, and then take the steps necessary to respond.

The chronic disease situation--I think that's what Secretary Leavitt was really emphasizing, that yes, there are the problems that emerge because of the hurricane and the flooding, the injuries and the trauma, the problems that emerge as people go in and try to recover and have injuries and difficulties during the recovery phase. But the biggest challenge of all of this is going to be maintaining the chronic care services to the people who had them before the hurricane ever hit.

These people are dislocated. We have to expect enormous pressure on the health delivery system because of the surge in local communities that are taking on the responsibility or sharing in the responsibility for providing care, and certainly the services and support for that are something that aren't going to go away overnight.

They're going to require some major investments from a federal perspective, and that's exactly why the Secretary was on this trip, and exactly what all of us are gearing up to support.

QUESTION: What's your actual biggest need now for the folks in those shelters?

DR. GERBERDING: I think the biggest need for people in the shelters is to have a sense of hope. They've gone from a horrible situation to a situation that is settling down and there is some order in the chaos now. I think people really, at least all of the places we visited were able to see that their situation was certain improved, and that there was an enormous outpouring across the country to really try and help.

But to convert that to a true hope for the future, we've got to bring people to a home. We've got to help transition out of this environment and if we can somehow communicate what everyone is doing across this country, and beyond, I think that does help people develop a sense of hope and will really help them feel the dignity and empowerment that they need to take the steps that will lead them home.

QUESTION: Thank you.

MS. PEARSON: Next question.

MS. : Thank you. I was just wondering if somebody could comment on hospital preparedness. I was curious about what sort of things were done before this particular disaster to plan for a possibility of such a thing happening, and also any kind of lessons learned because of the hurricane. I was particularly struck by all the problems that some of the hospitals were having getting patients out and particularly the stark differences between public and private hospitals.

DR. GERBERDING: I'm going to ask Richard to take the question as it pertains to the forward deployment and the preparedness for accommodating damage to households. I just think it's really important to remember that when this hurricane was coming, we didn't actually know where it was going to go and the area of engagement was enormous. So I think hospitals did what they could to prepare, but it's very difficult to be prepared for something of this scope and magnitude and particularly in New Orleans, the flooding.

So the approach that we utilized was to anticipate that hospitals would be potentially affected and to forward deploy the medical personnel and resources within the zone of safety that we could realistically expect based on past hurricane performance. The fact is, just this morning I was in Meridian, Mississippi, and observed 1,000 beds that had been set up to provide the relief to the shelters in that region. It's not a hospital, but it certainly does represent preparedness for patient care.

SECRETARY LEAVITT: I was just going to say this is Mike Leavitt, and I have returned. Go ahead, sir.

DR. CARMONA: This is Surgeon General Rich Carmona.

Julie, thanks for the audience. Julie and I have worked together about a quarter of a century and trained in a very large metropolitan University of California system with the county hospital and have been involved in small and very large disasters both with public health consequences and just acute.

I think one of the stories that's been missing here in front of the public's eye is the extraordinary response that has occurred. A lot of it is because of preexisting hospital preparedness. In the last several years after 9/11, what we've seen is hospitals coming together and reaching a new state of readiness a lot of it driven by the 9/11 events and the events after that. The Joint Commission now requires hospitals to have bona fide disaster plans and call-down lists. In fact, if you want to be certified as a hospital nationally, this has to be part of your strategic plan. So I think that the hospitals were prepared. They have these plans in place.

You asked what have we learned so far. One of the things is the modeling of our responsiveness and preparedness. In order to be prepared and lean forward to be prepared for that next event, we look at what are possible worst-case scenarios. Those are modeled in various communities in FEMA activities, HHS activities, when we work with the communities to try and determine how do we best position ourselves to accept the future challenges.

This was a challenge that was unprecedented in the history of this United States for many, many reasons that you've already heard. The hurricane taking a path that went in a different direction, a sense that New Orleans looked like it was going to be okay for a little while, then the levees breaking. So when you look at the sequences of events that rolled out, truly, truly historic proportions.

Yet what we see happening is that each of the individual communities came together with what little or great resources they had, put together a new system. When the Secretary and I and Julie and others went through the Astrodome for instance or the other convention centers that we visited, 4 or 5 days ago these were empty, hollow shells with nothing.

As we walked through, we saw large metropolitan hospitals that had been resourced collectively through all of the resources available in those communities, and what we came and saw were functioning, multidisciplinary, tertiary care facilities in convention centers where there had been nothing several days later. Patients moving through were not only receiving care, but receiving social services that they need. And as Julie said earlier, a sense of hope, a sense of stability returned to their lives; mental-health professionals helping to rescue them from the trials and tribulations, the mental-health consequences of these.

As Secretary Leavitt said, what we recognize now is we have to help these folks through their acute challenges, but we realize we're going to be there in the long haul, that as we move forward, these hospitals need to be sustained, but the care is changing from acute to chronic. Behind it all are the public-health needs that will be ongoing, some of the infectious disease, some of them sanitation, some of them clean water, but there are a multitude of challenges before us, and we have a very strong plan to be able to work with our sister cities and states to be able to help, advise, provide technical assistance, and where necessary, fill the gaps where they may need resources.

MS. : I was wondering in case Secretary Leavitt didn't hear, I was just curious what he thought the HHS role might have been or if there was a plan in place for how to get patients out of hospitals, particularly in the New Orleans area where they were stranded for several days and running out of food and no power and that kind of thing and it sounds like had to rely on private hospitals for resources and help getting out rather than any government resources.

SECRETARY LEAVITT: I think there was a lot of both, and that's the way it will always be in a disease of that proportion. There will be after-action opportunities for us to learn from what happened here, but there were private resources and there were public resources, and ultimately both had to be there.

MS. PEARSON: We have time for one last brief question before we have to go, unfortunately.

MS. MANNING: Can you hear me all right?

SECRETARY LEAVITT: Yes.

MS. MANNING: Thank you very much. I have questions about we're hearing about cholera threats in New Orleans, E coli, and what is the danger of the dead bodies? Are there any dangers posed to the people who are there in New Orleans doing rescue work?

SECRETARY PEARSON: Julie?

DR. GERBERDING: Thank you. We really need to take a look at what is the environmental threat in New Orleans, and the Secretary announced today that the best experts in the world are on-site now to really assess the health issues and the safety issues pertaining to the flood and other conditions there.

What we know about previous environments that have had this problem of raw sewage floating in the community setting is that the diseases that evolve are those that were present in the population and in the sewage prior to the event. In a city like New Orleans, cholera has not been present for many years. This would probably not be the first thing to emerge, it's certainly on the list of diarrheal diseases, but what we are concerned about are the things that could more likely persist in water in this society. That would include E coli, diarrhea, and potentially some other infectious diseases.

What I'm really concerned about from the standpoint of the water is the fact that we don't know if it's containing any toxic chemicals. We don't understand the status yet of whether the integrity of the many potential chemical and petroleum industries in that region have survived without damage that could lead to water contamination, and that's really why we have this comprehensive environmental health team there.

From the overall picture of the people affected by this and their infectious disease status, we're just putting together the picture now. I mentioned diarrheal illness in shelters being one focus, respiratory diseases being another focus, and as these emerge we're going to be able to provide ongoing updates.

But right now, so far so good. When you think about the tsunami situation that we experienced in December where likewise we anticipated the emergence of any number of infectious diseases, the fact was that people got in early, they set up the systems to try to prevent these infectious diseases and ultimately were remarkably successful in mitigating what could have been a second wave of infectious diseases in that context.

That's exactly what we're working to do here in this country in the context of the shelters and certainly in the city of New Orleans. I think if we get our experts engaged at the state and local level as well as what we feds can contribute to the solution, we'll be able to take these public-health issues in stride and act quickly to prevent them from becoming problems for larger sets of the population.

SECRETARY LEAVITT: It should be pointed out that we are a week out and so far so good.

MS. MANNING: But what about the danger of anything from the--there are a number of dead bodies that are either in the water or elsewhere in the environment? Is there--

DR. GERBERDING: Let me just say this. Dead bodies are horrifying and I think the risks they pose to people in this environment is just that humanitarian perspective of how awful to have anybody experience something like the site of a body floating in water or multiple dead bodies in the water, and I'm sorry that anyone, whether they're a rescue worker, a citizen or a child ever has to see something like that in this country or anywhere.

But from a health standpoint, bodies in the water do not pose an infectious disease threat. The only conceivable concern would be if someone had direct contact with the blood of one of these victims and that person happened to be carrying a blood-borne infection in which case it's like any body fluid exposure in a health or mortuary situation, it's something that we require personal protection to prevent.

So we really need to help people move beyond the threat of the infectious disease and really think about the sadness and the difficulty that the people who are searching for their relatives are really experiencing in this context.

MS. PEARSON: Unfortunately I think we're going to have to end it there. We just wanted to give you an opportunity to ask some questions.

Thank you everyone for joining us today, Dr. Gerberding, Dr. Carmona, Mr. Secretary, thank you. Thanks a lot. Thank you. Good-bye.

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