The Perfect Storm

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