A week after Hurricane Sandy struck the East Coast, parts of the Northeast are still reeling from the wind, rain and flooding. Though the darkened Manhattan skyline may be the hurricane's most obvious consequence, the storm's health impacts may be the more significant and longest-lasting.

The hurricane's death toll in the United States climbed to 113 over the weekend, with 48 fatalities in New York and 24 in New Jersey, the Los Angeles Times reported. Thousands still lack power as temperatures drop further and a brewing nor'easter threatens to pour over the area later this week.

Relief workers now have to contend with a variety of health issues stemming from the late-season storm. "Typically, we usually are dealing with these types of disasters when it's warmer out," said Melanie Pipkin, a spokeswoman for the American Red Cross.

With the cold, people forced from their homes need to take extra care to find shelter and stay warm, Pipkin said, adding that people remaining in their homes and using alternative power sources like portable generators need to be cautious of carbon monoxide poisoning. Fires and shorts from damaged electrical wiring also pose health hazards.

At St. Jacobi Church in the Sunset Park area in Brooklyn, volunteers with Occupy Sandy coordinated relief efforts, including medical care. Outside, cars lined up for more than a dozen blocks, waiting for gasoline at a nearby station. Brett Goldberg, an organizer with Occupy Sandy, explained that the group emerged from Occupy Wall Street to fill the wide gaps in the disaster response, marshaling more than 2,000 volunteers at sites all over the city.

"We've set up a medical dispatch. We put out the word we're looking for medical professionals of all different sorts," he said, adding that New York City's towering high-rises make it difficult for people to get in and out when the elevators shut down during a power outage. "We will dispatch those professionals that go door-to-door, canvassing to find elderly and disabled folks."

Hypothermia, flu, contaminated water
Diabetes, and particularly getting regular insulin, is a big concern among people seeking help, according to Goldberg. The colder temperatures are raising concerns about hypothermia, and people huddling in close proximity could increase cold and flu transmission, he added.

Pipkin said it is still too early to tell if New York and New Jersey face any unique health risks compared to similar and more frequent storms along the Gulf Coast. She also said the Red Cross would not take a stand on whether climate change may be a factor, as well.

"We stay out of that debate. That's a little too political for us," Pipkin said. "I think this is definitely a large-scale disaster, which we've dealt with before. We're still working along the same procedure lines." However, she added, "We're still right in the thick of it."

Patrick Kinney, a professor at the Mailman School of Public Health at Columbia University and director of the school's climate and health program, agreed that health risks might yet emerge. "This particular storm, I think we're still learning what the health impacts specifically were," he said.

However, he said there are likely patterns based on previous storms. Many of the initial storm deaths resulted from flooding, especially in areas from which officials told people to evacuate. In the immediate aftermath, many injuries and fatalities came from removing debris, fire and electrical damage.

"From a longer-term perspective, you start looking at things like the effects of the power outage: What does that mean for the spoilage of food? For the contamination of the water supply? You also worry about access to routine medical care," Kinney said. People with chronic diseases like high blood pressure might not get their regular medication after storms, and might suffer as a result, he noted.

Traumatic disasters can also linger in the minds of the afflicted. "We shouldn't forget about mental health issues. Disruption or not having access to your local support system can have serious consequences for mental health," Kinney said. "That was documented fairly well after [Hurricane] Katrina."

However, New York is not New Orleans. Compared to the Louisiana bayou or the Florida wetlands, Gotham's concrete jungle reacts a bit differently to high water levels. "The impervious surfaces that are characteristic of urban areas prevent some of the natural buffeting that natural coastlines can provide when a storm hits," Kinney said. He observed that Staten Island faced some of the most severe flooding in Sandy's wake, largely because concrete now coats the borough's wetlands.

The standing water can then overwhelm the city's sanitation services, which end up dumping raw sewage into the Hudson and East Rivers. Pooled water also leaches and mobilizes toxic compounds in streets and soils, Kinney added.

New York City's size and scale also exacerbate problems less populated regions could shrug off. "You have a lot more people in harm's way," Kinney said.

Health care facilities also suffered from the storm. "New York City, as we learned from Sandy, has a lot of its critical infrastructure along the coast," said Radley Horton, an associate research scientist at Columbia's Earth Institute. Scenic views of the rivers put the hospitals at greater risk for flood damage, as the storm made abundantly clear last week.

Hospitals among the victims
New York University's Langone Medical Center near the East River saw both of its backup generators fail from flooding. The same thing happened at Palisades Medical Center in New Jersey. As of yesterday, officials evacuated Bellevue, Langone, Manhattan VA and Coney Island Hospitals due to systems failures. Beth Israel Hospital regained power recently after running on a generator following the storm.

Without power, hospitals cannot keep ventilators, drug pumps and dialysis machines running. Their computers also need to stay online to track patients, keep inventory and dispense medications.

Under a changing climate, these problems will only get worse. "New York City has experienced about a foot of sea-level rise over the last century. Under conservative estimates, we expect to see 2 feet [of sea-level rise] over the next century," said Horton. "We expect coastal flooding events happening three times as often."

But hurricanes have exacted heavy tolls before, and hospital backup generators failed in New Orleans after Katrina and in Connecticut after Hurricane Irene. Given New York City's vulnerability to flooding and lessons from past storms, should planners have seen these problems coming, and could they have made better choices?

"When you look back at an event, it's always easy to identify things you should have recognized," said Henry Willis, acting director of the RAND Homeland Security and Defense Center. "We do need, as we plan out infrastructure and risks, to consider what the risks to the infrastructure are going to be."

To handle rising sea levels and increasingly destructive disasters, officials need to consider all of the ways they can reduce risk, according to Willis. This includes big infrastructure projects to control floods, like levees and breakwaters; retrofitting individual homes or moving homeowners away from floodplains; and restoring wetlands to serve as natural water sinks.

"The choice you make in a plan like that requires setting priorities among what people value most," Willis said. Regional planners need to decide issues like whether they value coastal real estate above all else or the integrity of the environment, or whether they are willing to pay the costs up front or over time.

For medical facilities, Horton suggested elevating critical components, like backup generators, and placing them on higher floors. "There's more we can do in terms of having redundant power systems," he said. "I think another lesson is to highlight and focus on vulnerable individuals, those with pre-existing health conditions."

Still, Occupy Sandy's Goldberg said the city should have done more to prepare, like establishing relief stations in vulnerable areas before the storm rather than trying to get there after roads were underwater and the tunnels were flooded. "It's hard not to put the blame on the city, because there is no way they did not see it coming," he said. "From what I understand, there were warnings from the storm for the weeks leading up to it. It may not be an exact science, but it's a science."

Reprinted from Climatewire with permission from Environment & Energy Publishing, LLC. www.eenews.net, 202-628-6500