Katrina Refugees Faced Injury, Chronic Disease

ATLANTA, July 7 - In the wake of the mass Gulf Coast evacuation from Hurricane Katrina, the most common health condition treated in evacuation centers was chronic disease while injury was the most common problem reported in health-care facilities, the CDC reported.

Many of the public health consequences officials feared did not come to pass, including outbreaks of infectious disease, and worsening of chronic conditions among those displaced to evacuation centers, private homes, and hotels.

But little was clear at the time, according to a report in the agency's Morbidity and Mortality Weekly Report, because local surveillance was often disrupted by the need for emergency responses and a coordinated system of morbidity surveillance tailored for widespread disasters did not yet exist.

Nearly a year after the Aug. 29, 2005, landfall of Katrina, the CDC reported surveillance data from the four states that took the brunt of the exodus - Arkansas, Louisiana, Mississippi, and Texas. But the report was subject to limitations, the agency said:

• Morbidity rates couldn't be calculated, because population data for evacuation centers and health-care facilities wasn't complete.
• Because the number of facilities and their populations varied, temporal trends are hard to discern.
• Forms used to report data differed and so some data were not included.
• The picture of the impact of the hurricane itself and subsequent evacuation is incomplete, because morbidity surveillance was neither complete nor representative.

Nevertheless, the CDC says, it's clear that the biggest problem in evacuation centers was chronic disease (e.g., diabetes, asthma, emphysema, and cardiovascular disease), peaking Sept. 9 at 651 clinical visits in all four states combined. Overall, chronic illness accounted for 33% of the 14,531 reported clinical visits (defined as care for one person and one condition).

Gastrointestinal illness was the second greatest issue, accounting for 27% of the total visits and peaking between Sept. 5 and 22, followed by respiratory illness at 20%. Rashes, injuries, and mental illness accounted for smaller proportions.

In health-care facilities, the major category was injury, accounting for 58% of total visits. Between Sept. 5 and 22, there were about 135 visits daily because of injury, with a peak of 532 on Sept. 8, the agency said. Respiratory illness was the second most common condition, accounting for 16% of total visits.

"This pattern is similar to that identified after floods and other hurricanes," the agency reported. It is likely that evacuation centers treated people with milder conditions, while those with more severe or acute problems sought the aid of health-care facilities.

Since the hurricane, the CDC, other federal agencies, and state and local health authorities have been developing a system for disaster-related surveillance, possibly using such tools as hand-held devices and Internet-based reporting of data, the agency said.

"The challenges associated with the Hurricane Katrina response underscore the importance of standardized surveillance that supports a collaborative and integrated approach to monitoring and reporting the health status of affected populations," the agency said.