Hurricane Ian Situation Report #2
September 28, 2022
This report provides an assessment of the anticipated 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.
- 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) has issued a regional emergency declaration for Alabama, Florida, Georgie, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.
- Florida SERT has opened a hotline number and email address to report business closures, roadblocks to reopening businesses, supply chain concerns, etc.:
- Healthcare facilities, including hospitals and nursing homes in hurricane warning areas have evacuated ahead of impacts.
- Florida’s access and re-entry plans and policies are managed by local officials, working closely with Florida’s Division of Emergency Management. Companies with operations in affected areas should coordinate with appropriate entities to assess whether they are authorized to enter an impacted area, only after it has been deemed safe enough to do so.
High-Level Situation Summary
Hurricane Ian made landfall at 3:05pm EDT 9/28 as a Category 4 hurricane near Cayo Costa, Florida. At landfall, maximum sustained winds were recorded at 150 mph. Ian will travel across Florida through Thursday (9/29). Catastrophic storm surge, wind damage, and flash flooding have been observed in the counties where Ian made landfall. Impacts are expected to continue, especially over central Florida, into Thursday. The coast of Georgia and South Carolina are expected to experience Ian’s second landfall on Friday, 9/30, at which point the storm is expected to be at tropical storm strength.
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.
Assessment on Healthcare and Logistics Impacts
Emergency Declarations and Measures
- 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
- Federal and state officials are coordinating to ensure fuel needs will be met during response and recovery. 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.
Access and Reentry
- The Federal Communications Commission (FCC) has begun Hurricane Ian Communications Status Reports. We expect cell site and possibly 911 service outages to increase in the coming days as the storm moves through Florida and damage assessments are completed.
- As of 12pm EDT 9/28, FCC reports:
- 188 (1.4%) cell sites are down, 8 are due to damage, and 18 are down due to power outages.
- Sanibel Police Department Headquarters has been rerouted to another Public Safety Answering Point (PSAP) with location information.
- 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.
- Road closures
- Road closures have been reported in the St. Petersburg and Tampa area. All lanes are closed on I-275 North at Skyway Bridge, which connects St. Petersburg to Rubonia across the Tampa Bay.
- Florida 511 will be providing real-time traffic conditions and incident information.
- Port status
- 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.
Healthcare Response Updates and Needs
- Healthcare Facilities
- As of 9/28 most listed VA hospitals are closed through at least Thursday (9/29), with many closed through 9/30 or later.
- As of 9/28 Tampa General Hospital and Advent Health are postponing elective surgeries.
- As of 9/28 North Plant Bay Hospital operated by BayCare is closed. All urgent cares operated by the company are also closed.
- Sarasota Memorial Healthcare System closed their urgent care on Tuesday and their physicians offices as of 9/28.
- As of 9/27, at least 40 patients have been evacuated from Florida hospitals ahead of Hurricane Ian. The following hospitals evacuated patients along with several other adjustments.
- South Tampa and West Tampa
- Central Tampa emergency facility
- HCA Florida Pasadena Hospital also canceled elective procedures
- Tampa Bay Nursing Homes are working on evacuating residents
- Tampa General Hospital also announced ambulatory location closures and canceled elective surgeries
- Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., announced it is open, but has likewise postponed elective surgeries and closed outpatient care facilities.
- Emergency Medical Services
- Express Scripts (pharmaceutical delivery service) may arrive late due to Hurricane Ian.
- Rx Open is activated for Florida. As of 9/28 2pm EDT, there are 253 (3.68%) reported pharmacy closures across the state.
- 20 counties in FL are reporting less than 50% pharmacies as open: Baker, Charlotte, Citrus, Collier, DeSoto, Glades, Hardee, Hendry, Hernando, Highlands, Hillsborough, Lake, Lee, Manatee, Miami-Dade, Osceola, Pasco, Pinellas, Polk and Sarasota.
- The Kidney Community Emergency Response (KCER) program has created a Hurricane Ian webpage to share information with the dialysis community. The page includes patient helpline numbers as well as contact information for the End Stage Renal Disease Networks supporting Florida:
- No updates since 9/27.
- Florida has a relatively large pharmaceutical and medical devices manufacturing footprint, with most companies concentrated in northeast Florida (near Jacksonville). Though not anticipated to have direct impacts from the, the region is still expected to experience heavy rainfall with the possibility of flash flooding.
- Florida has a moderate plastics manufacturing presence. Should the state be unable to supply power to these manufacturers, due to impacts to critical infrastructure caused by Ian, it is possible upstream medical supply could be impacted in the coming months. This analysis of potential impacts is based on the observed impacts to plastics following the severe winter weather that affected Texas in 2021.
- No major disruptions to PPE manufacturing, or downstream impacts across the US are anticipated from this event.
- No updates since 9/27.
- 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.
- As of 9/26 CDC reports 14,856 total COVID-19 cases and 35 deaths in the past 7 days.
- There are 2,508 monkeypox cases in Florida.
- No updates since 9/27.
- FEMA is 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 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.
- A US Army Corp of Engineers team will deploy to Craig Field in Alabama ahead of the storm to provide power restoration services.
- FEMA activated a National Medical Transport Support contract for 52 ambulances and 100 paratransit seats. These resources will stage at Orange County Convention Center in Orlando Florida.
- U.S. Department of Health and Human Services has pre-positioned two 15-person Health and Medical Task Force teams from its National Disaster Medical System (NDMS), a 13-person incident management team, and two pharmacists to assist with the response in Florida.
Emergency Prescription Refills
- No updates since 9/27.
- 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
- As of 9/28, the following Florida counties have issued mandatory evacuation orders: Charlotte County, Citrus County, Clay County, Collier County, Flagler County, Hernando County, Hillsborough County, Lee County, Levy County, Pasco 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 9/28, the following Florida Counties have issued voluntary evacuation orders: Clay County, Franklin County, Gilchrist County, Glades County, Highlands County, Manatee County, Nassau County, Polk County, Putnam County, Orange County, Seminole, St. Johns County, Taylor County.
- As of 3pm EDT 9/28, there are no curfews in Florida.
- As of 7:47am EDT 9/28, there were 196 shelters open with 10.6k occupants in Florida.
- The full list and map of shelters, including special needs shelters, open in Florida can be found on the Florida SERT site.
- The 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.