Hurricane Ian Situation Report #3
September 29, 2022
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 and Puerto Rico.
- 2.6 million in Florida are without power (about a quarter of the state).
- 10,000 residents are being housed in shelters.
- Damage assessments across affected areas in Florida are underway, though it may be some time before power in some areas are restored. Response/recovery crews are standing by and ready to deploy to impacted areas as soon as it is safe to do so (if they haven't deployed already).
- Several private insurance companies have lifted restrictions to make it easier for plan members to obtain prescriptions or care via telemedicine (specifics, below).
- Hundreds of healthcare facilities, including pharmacies, dialysis centers, and community health centers have closed or adjusted hours in anticipation of the storm.
- On 9/28, the Federal Motor Carrier Safety Administration (FMSCA) issued a regional emergency declaration for Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.
- Report business closures, roadblocks to reopening businesses, supply chain concerns, etc. to Florida SERT: 850-815-4925 or Esf18@em.myflorida.com
- According to Florida access and re-entry plans and policies, 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.
- Vendors requiring access to affected areas in North Carolina and South Carolina must be pre-registered which each state's respective agencies (links below).
High-Level Situation Summary
Since making landfall at 3:05pm on 9/28, Hurricane Ian has caused catastrophic damage across Florida. Several hundred healthcare facilities have been affected, with operating status of some facilities likely to remain uncertain until power and communication returns online in the most heavily affected areas. Additional impacts to healthcare and public health are expected to begin being reported on 9/29 as the storm moves away from the West Coast of Florida. However, full impacts will not be known until later in the week. There have been some transportation impacts, including an advisory from Florida DOT that members of the public not drive unless absolutely necessary, as well as damage to a bridge connected Sanibel Island to the mainland, cutting off access to 6,300 residents.
The storm is expected to cause further damage as it moves northeast, with severe impacts anticipated for Central Florida into Thursday. States of emergency have also been declared for Georgia (where some power outages are reported), South Carolina, North Carolina, and Virginia. Ian is expected to make a second landfall along the coast of South Carolina on Friday 9/30, at which point the storm is expected to be at hurricane strength.
Assessment on Healthcare and Logistics Impacts
Emergency Declarations and Measures
- On 9/29 Georgia declared a State of Emergency
- On 9/28 Virginia declared a State of Emergency
- On 9/28 North Carolina declared a State of Emergency
- On 9/28 South Carolina declared a State of Emergency
- No information is available for the state of Maryland or District of Columbia.
- 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 Emergency Declaration “provides regulatory relief for commercial motor vehicle operations while providing direct assistance supporting emergency relief efforts transporting supplies, goods, equipment, and fuel” and other assistance into affected states.
- On 9/24, Florida’s Department of Highway Safety and Motor Vehicles released Emergency Order 09422 to waive additional registration and hours-of-service requirements for vehicles providing emergency services or supplies in Florida. Georgia is expected to declare a state of emergency on 9/29 at 7am EDT.
- On 9/24, President Joseph Biden approved Florida’s emergency declaration and ordered Federal assistance to supplement state, tribal, and local response efforts as a result of increased response to Hurricane Ian. This authorizes the Department of Homeland Security Federal Emergency Management Agency (FEMA) to coordinate all relief efforts.
- On 9/26, HHS Secretary Xavier Becerra Declared a Public Health Emergency for Florida. This declaration includes a Waiver or Modification of Requirements under Section 1135 of the Social Security Act (SSA). An 1135 Waiver waives or modifies requirements under the SSA to increase access to care by ensuring:
- 1. Healthcare items and services are available to meet the needs of individuals enrolled in Social Security Act program (including Medicare, Medicaid, and Children’s Health Insurance Program) requirements
- 2. Providers who give services in good faith can be reimbursed and exempted from sanctions
- On 9/23, Florida Governor Ron DeSantis declared a state of emergency for 24 counties. On 9/24, the declaration was expanded to include the entire state of Florida.
- Florida Law, Section 252.358, outlines prescription refills under an Executive Order and allows for early prescription refills.
- Mayor Lenny Curry of the City of Jacksonville, declared a State of Emergency for Duval County effective 12PM Wednesday, 9/28.
Critical Infrastructure Impacts
- South Carolina
- 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 U.S. oil production) in the Gulf of Mexico as Ian headed to Tampa and Florida.
- As of 9/28/2022, Chevron Corp (CVX.N) 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.
- Florida officials are also identifying opportunities to safely store fuel and transport equipment as the storm passes. Port impacts pose significant risk to fuel supply for central Florida, and cascading impacts on the movement of goods.
- The Federal Communications Commission (FCC) has begun Hurricane Ian Communications Status Reports.
- As of FCC's last report on 9/29:
- 1,552 (10.9%) cell sites are down, 180 due to damage, 577 due to transportation issues, and 795 down due to power outages.
- All 911 calls are being answered but some Public Safety Answering Point (PSAP) are being rerouted due to power outages.
- 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.
- Road closures
- On 9/29, the Florida Department of Transportation (FL DOT) advised individuals to not drive unless absolutely necessary.
- Road closures have been reported in the St. Petersburg, Tampa, Orlando, and Daytona Beach areas. All lanes remain closed on I-275 North at Skyway Bridge, which connects St. Petersburg to Rubonia across the Tampa Bay.
- 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 where roughly 6,300 residents reside. With the bridge compromised, Sanibel-Captiva rescues can only be conducted by water or air. We will be monitoring efforts on responses to the situation.
- Florida 511 will be providing real-time traffic conditions and incident information.
- As of 9/29, most airports are closed with flights cancelled until further notice.
- As of 9/29 North Perry Airport (HWO) in Hollywood Broward County is closed due to tornado damage.
- Although most reopening plans have not been announced, the Federal Aviation Administration’s airport status map expects Sarasota-Bradenton International to resume operations Thursday, Tampa International, Orlando International, St. Pete-Clearwater International, and Southwest Florida International to open Friday, and Daytona Beach International to reopen on Wednesday, 10/5.
- Key West International Airport reopened on 9/29 at 7:00am EDT.
- As of 9/29, Fort Lauderdale International Airport is operating with significant flight delays and cancellations.
- Port status
- As of 9/29, several ports, such as Port Everglades and Port Miami, have reopened.
- As of 9/28, the following ports are under Port Condition Zulu, meaning the facility is shut down but fueling operations can continue: Port Canaveral, Port of Jacksonville, Port Tampa Bay, SeaPort Manatee, Port St. Pete, Port of Palm Beach, and Port of Key West. Port of Miami is also closed.
- The Port of Jacksonville is involved in shipping supplies to Puerto Rico. If the Port remains closed for a long period of time, it could impact Hurricane Fiona relief. However, there are plans to offload operations to other ports if needed.
- Closures of Port Canaveral, Port Tampa Bay and Jacksonville Port Authority (JAXPort) have left 5 cruise ships stranded at sea.
- Freight activities have slowed (increasing delays) or temporarily stop operations. On 9/29, FEMA reports that eight railways have closed with numerous Amtrak and Northern schedule cancellations and changes.
- As of 9/29, Brightline has resumed commercial trains.
- As of 9/27, SunRail service has been suspended.
Healthcare Response Updates and Needs
- Healthcare and Adjacent Facilities
- Emergency Medical Services
- Rx Open is activated for Georgia, Florida, and South Carolina and is showing 821 (7.32%) pharmacy closures across the impacted states.
- Please see the table outlining pharmacy statuses per state:
- County Statuses:
- Florida – the following counties are reporting less than 50% pharmacies as operational: Alachua, Baker, Brevard, Charlotte, Citrus, Clay, Collier, DeSoto, Duval, Flagler, Gilchrist, Glades, Hardee, Hendry, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Levy, Manatee, Marion, Martin, Miami-Dade, Nassau, Okeechobee, Orange, Osceola, Pasco, Pinellas, Polk, Putnam, St. Johns, St. Lucie, Seminole, Sumter and Volusia
- Georgia – the following counties are reporting less than 50% pharmacies as operational: Baker, Camden, Chattahoochee, Clay, Clayton, Decatur, Echols, Fayette, Glascock, Irwin, Putnam, Quitman, Talbot and Taliaferro
- South Carolina: No counties in South Carolina are reporting less than 50% pharmacies as operational.
- Pharmacy deliveries via Express Scripts may arrive late.
- 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:
- As of 9/29, retailers, such as Amazon.com Inc., have about 10 fulfillment centers in Florida and have paused operations at these sites. Walmart Inc. (WMT.N) and Sam Club have closed at least 100 stores and Target Corp (TGT.N) temporarily closed stores. Costco Wholesale Corp closed 9 stores in Florida.
- As of 9/29, various agriculture, food, and fertilizers are being impacted by Hurricane Ian. Mosaic Co, Agribusiness Cargill, Perdue Farms, Tyson Foods Inc, etc., may need to delay food/grain/supplies distribution during the effects of the hurricane.
- Many of the medical product distributors as well as third party logistics providers have operations and/or distribution centers in Florida. We will be closely tracking any impacts to facilities or centers to determine any downstream supply chain impacts.
COVID-19 and other Infectious Diseases
With people entering shelters due to the hurricane, there is a higher potential for COVID-19 and other infectious diseases to spread without the appropriate precautions and protective measures.
Information for: Florida, Georgia, South Carolina, Alabama, North Carolina
- As of 9/29, Florida Emergency Operation Center (EOC) and Georgia EOC have fully activated. Alabama EOC is monitoring and South Carolina EOC is expected to activate on 9/30.
- Incident Management Teams are in Tallahassee, Miami, and Atlanta. Mobile Emergency Response Support teams are present in Tallahassee and Orlando, with support teams located in Alabama and Georgia.
- More than 2,000 personnel are supporting the response throughout the Southeast with more than 3,200 reservist personnel and more than 7,500 Surge Capacity Force members standing by for deployment. FEMA is establishing a personnel mobilization center to expedite deployments when critical.
- As of 9/29, FEMA reports that more than 32,000 mutual assistance power crew personnel will begin assessing damages and making repairs. Crews are on standby for Hurricane Ian’s landfall in Georgia and South Carolina.
- As of 9/28, a US Army Corp of Engineers team will deploy to Craig Field in Alabama ahead of the storm to provide power restoration services.
- As of 9/29, FEMA teams have delivered over 1million meals and liters of water to impacted areas. More supplies are expected to follow once conditions are deemed safe for transport. FEMA is currently procuring additional water and meals.
- As of 9/28, FEMA has been preparing and staging supplies in strategic locations in Alabama and Florida. One location is Maxwell Airforce Base in Alabama. Supplies being staged at Maxwell Airforce Base include 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) personnel to Miami and two other teams to Robins Air Force Base in Georgia. Additionally, health and medical task forces and pharmacists were deployed to Atlanta. Additional DMAT teams are on standby if needed.
Emergency Prescription Refills
- Centers for Medicare & Medicaid Services (CMS) implemented 1812 Waiver and 1135 Waiver in response to the Public Health Emergency (PHE) declaration. These waivers and modifications are intended to ensure individual pharmaceutical and medical needs are met during emergency and disaster situations.
- As of 9/29, individuals that live in one of the 67 impacted counties who have Blue Cross Blue Shield of Florida (Florida Blue and Truli) memberships can access early prescription refills for maintenance medications through 10/24/2022.
- People impacted can receive a 30-day supply.
- Teledoc, the virtual healthcare system is available for $0 cost to those impacted by Hurricane Ian.
- This hotline number, 855-225-5032, will help to reach doctors 24/7 through this network for basic care and prescriptions and prescription refills that are not controlled substances.
- As of 9/29, Humana Healthy Horizons™ in Florida will provide special accommodations for prescription access until the PHE declaration has ended, and or, 30 days has passed since the initial event.
- As of 9/28, Cigna has lifted certain medical and benefit pharmacy restrictions.
- As of 9/28, Molina Healthcare of Florida is suspending all prior authorization requirements for prescription refills until the state of emergency is lifted.
- As of 9/24/2022, early prescription refills are permitted under State of Emergency. All health insurers, managed care organizations, and other entities licensed by the Office of Insurance Regulation and provide prescription medication coverage as part of a policy or contract will waive time restrictions on prescription medication refills.
- Opioids are considered a controlled substance, and therefore excluded from emergency prescription refill laws. According to the CDC, there was a rate of 43.4 retail opioid prescriptions dispensed per 100 persons in Florida in 2020.
- About 13% of Florida’s population is uninsured. Emergency Prescription Assistance Program (EPAP) is the federal program that provides medication coverage for uninsured patients, but the program has not yet been activated.
- Healthcare Ready will be closely tracking the activation status of the Emergency Prescription Assistance Program (EPAP) to understand what resources may be available to uninsured individuals in disaster areas.
Evacuations and Curfews
Access and Reentry
- Strikethrough indicates removal from evacuation category or warning.
- As of 9/29, the following Florida counties have issued mandatory evacuation orders: Charlotte County, Citrus County, Clay County, Collier County, Flagler County,
Hillsborough County Lee County, Levy County, Pasco County, Sarasota County, and St. Johns County, Pinellas County, and Sarasota County.
Mandatory evacuations are in effect for most of the West coast of Florida and portions of northeast Florida.
- As of 9/29, the following Florida Counties have issued voluntary evacuation orders:
Clay County, Franklin County, Gilchrist County, Glades County, Highlands County, Manatee County, Nassau County, Orange County, Osceola County, Polk County, Putnam County, Orange County, Seminole County, Sumter County, Taylor County, and Volusia County.
- Information about evacuations, resources, and explanations of warnings can be found here.
- As of 12:30pm EDT 9/29, there are no curfews in 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:
- Note, DHS CISA’s Access Coordination Letter is not an acceptable document to enter any disaster areas in Florida.
- Demonstrated need to enter the area (work order, inventory list, employer authorization)
- Proof of employment (employer credentials, document on company letterhead)
- Valid government issued ID (driver’s license, passport)
- 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.
- FEMA reports open with 10k residents and 27 special needs shelters open in Florida. Medical services are available at each shelter.
- Full list and map of shelters, including special needs 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.