On Monday morning, in Maxton, N.C., Dan Lowry, 48, and his wife, Jewel, 51, trudged through the waist-high water around Dan’s father’s house, aware of the dangers around them.
“Yeah, there could be bacteria,” Dan said. “Or snakes.”
Both were wearing shorts. Their feet were bare. The sun had finally broken through the clouds, and they were going to check on their trailer, in the backyard.
Beside him, his wife shrugged in resignation. “What are you going to do?” she said.
Disaster experts categorize health hazards in the wake of disasters as short-term, midterm and long-term dangers.
The majority of people who die during or immediately after a storm die by drowning.
Missing manhole covers and storm drains can become sudden hazards.
“When the water on the street is three or four feet deep, those drains can be active, sucking hundreds of gallons of water a second, and you won’t see anything on the surface,” said David Persse, Houston’s public health officer and head of emergency services. Years ago, he said, a teenager was pulled into a drain and died.
“People see their neighbors floating in kayaks and small boats and think, ‘How can the water be dangerous? It looks just like a lake.’ ” Persse said. But that water is often a toxic chemical stew of all the organic matter people have flushed down their toilets and sinks, along with the contents of cleaning supplies under their sink, paint cans and chemicals from their garages. Hurricane Katrina in 2005 sent exhumed corpses floating through neighborhoods.
EPA officials on Monday described a near miss after a train hauling chemicals derailed near the border of North and South Carolina. The chemical inside, butanol, did not spill, but diesel fuel from the train did, gathering in a low-lying area. Manure and other agricultural runoff from animal farms are a concern, as well as coal ash storage pits.
Another immediate concern: getting medication and treatment to people with chronic illnesses.
Speaking by phone from the parking lot of a dialysis center in North Carolina on Sunday night, Tom Cotter, state team leader for the relief group Americares, said he was waiting for more than 100 dialysis patients being transported by bus who had been rescued from flooded homes in Jacksonville, 90 miles to the south. Some hadn’t gotten treatment for their kidneys for as long as five days because of the storm.
“This is very much an ongoing disaster,” Cotter said.
In the medium term, disease is a major concern.
At a shelter in Lumberton, N.C., Makoma Patahalla recalled the last time he lived through a big storm, Hurricane Matthew in 2016. After wading through waist-high murky water and getting picked up by a rescue crew, he had painful, inexplicable sores on his arms and legs.
“I got contaminated by something,” he said. A doctor gave him an ointment to treat the sores, but they were never diagnosed. That’s why he decided to take refuge at a high school this time around before the rain even started. He didn’t want to have to wade through the dark, soupy floodwater again.
After Hurricane Harvey in Houston last year, residents saw an increase in upper respiratory infections and skin rashes.
After Hurricane Maria in Puerto Rico, the number of cases of a rare bacterial disease known as leptospirosis increased from dozens of cases a year to the low hundreds.
The bacteria is carried by animals such as rodents, raccoons, cattle and pigs. People get infected through cuts in the skin, or the bacteria getting in their eyes or mouth, said Ilana Schafer, a Centers for Disease Control and Prevention veterinary epidemiologist.
Most patients have a mild flulike illness, but some become severely ill, developing kidney and liver failure and, in rare cases, dying.
After extensive flooding in Louisiana in 2016, state health officials discovered two patients hospitalized with severe leptospirosis. In the previous 28 years, there had been only three reports of the illness.
As waters recede, two of the biggest long-term concerns are mold and mental health.
For residents who have had water in their homes for more than 48 hours, “you are already growing mold,” said Donna Knutson, who is overseeing the CDC’s emergency response.
Mold can trigger allergies or asthma, and post-Katrina mold was implicated in the deaths of four people who worked in the same storm-damaged building.
For more than a decade, clinical psychologist Jean Rhodes has studied the mental toll on survivors of Hurricane Katrina. Many were traumatized multiple times — by the violence of the storm itself, loss of family, loss of home, having to rebuild their lives in a new city, loss of relationships they built up in their neighborhood over years.
She saw spikes in anxiety, depression and post-traumatic stress disorder among survivors.
One of the surprising findings from her research was that the loss of a pet was one of the strongest predictors of depression. Another major concern that has emerged from her work and others’ is the effect of additional traumas as survivors struggle to heal — traumas like having the community to which you evacuate turn hostile toward new arrivals or having to live through yet another hurricane.
Many of the communities now contending with Florence were hit two years earlier by Matthew, noted Andrew Short, chair of the disaster response task force for the North Carolina Psychological Foundation.
“That’s got to be really tough on them because you tend to think of these things as once-in-a-lifetime events, and it’s not turning out that way,” he said.
One hopeful finding from post-disaster research is how resilient most people are. In her study, now entering its 13th year tracking Katrina survivors, Rhodes said, many appear to have recovered. “They may not think of themselves as resilient, but most people are,” she said.
Many survivors she has interviewed in the course of her surveys even experienced something she called “post-traumatic growth.”
“It’s sort of the flip side to PTSD. The disaster for many people becomes an inflection point, causing them to take stock of their life and relationships and the meaning of their life. It’s an existential moment,” she said. “Now that doesn’t mean they don’t experience depression or trauma. There’s a high price many are paying for it. But when your whole life is shattered, it obviously gives you a new perspective as well.”
Sarah Kaplan and Ben Guarino contributed to this report.