THE PROGNOSIS

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Today's Prognosis is by Sandhya Somashekhar. Paige will be back later this week.

Long after the waters have receded, Americans will be grappling with the effects of Hurricanes Harvey and Irma, which broke records and ruined lives as they wreaked havoc on the United States and the Caribbean.

Many of those effects will be health-related. State and federal health authorities have warned residents to be on the lookout for mold in their homes, strange rashes on their bodies, stray jagged items in standing water that can lead to infected wounds, and depression and post-traumatic stress disorder as those affected try to stitch their lives back together.

Some of the dangers are obvious. For example, drowning is a top cause of hurricane-related fatalities. But there are some lesser-known health threats that Americans face.

Here are five of them:

  1. Carbon monoxide poisoning. After hurricanes, people often struggle without power for days or even weeks. Many people set up generators to provide much-needed electricity while they clean up their homes. But these generators emit odorless, colorless carbon monoxide, which is toxic to breathe, and experts say the gas poses a poisoning risk when the devices are used improperly.

Carbon monoxide poisoning accounted for 13 percent of all hurricane-related deaths in Florida in 2005, the Florida Health Department said in a report two years ago about the health dangers associated with hurricanes. Nine deaths after Hurricane Sandy in 2012 were blamed on the gas, and five nonfatal carbon monoxide poisonings were detected after Hurricane Katrina.

The Florida agency found that a noticeable spike in reports of carbon monoxide exposure in 2004 and 2005 among Florida residents probably was related to the intense hurricane activity during those years.

The Florida Department of Public Health took to Twitter to warn people about the location of generators:

  1. Chemicals. The winds and storm surge that sweep onto the land during and after a hurricane can unleash dangerous chemicals, as floodwaters inundate industrial sites, overflow sewage and wastewater treatment facilities, and drench agricultural sites.

Dangerous substances can also spew into the air as a result of fires and other malfunctions. In Texas, for example, Hurricane Harvey damaged oil refineries and sparked a fire at a chemical plant in Crosby. Such incidents led to the release of more than 1 million pounds of dangerous air pollutants into the atmosphere in the week after the storm, according to public regulatory filings aggregated by the Center for Biological Diversity.

My colleague Steve Mufson warned of the dangers facing the Turkey Point and St. Lucie nuclear plants in southern Florida — both of them opted to shut down before the storm hit.

But you don't have to live near a chemical plant to be in danger — some of the most dangerous chemicals can come from a person’s garage. Damaged cars can leak battery acid and crude oil. Fertilizer and pesticides can spill from their containers, according to the Centers for Disease Control and Prevention.

  1. Mosquitoes. A lot of attention has fallen on the alligators, snakes and fire ants that were forced from their swampy abodes and into flooded back yards and living rooms during Hurricane Harvey. But the most fearsome creature to emerge from the storm may be the humble mosquito.

The annoying little critters are expected to proliferate as they breed in the waterlogged debris left over from the storm. There’s good news, at least at first, according to entomologists at Texas A&M: This first wave of “floodwater mosquitoes” will not carry any of the nasty diseases we associate with the bloodsuckers, including Zika and West Nile virus.

“Then as conditions dry up, we will cycle out of those weeks of floodwater mosquitoes, and then begin cycling into a period of time where the disease-transmitting mosquitoes will emerge and build up,” Sonja Swiger, a veterinary entomologist at Texas A&M AgriLife Extension Service, said a statement. “So, the initial run of mosquitoes is not too much of a disease threat  -- although a huge nuisance to people. But it’s the next run we really need to be concerned about.”

Brazoria County, Texas, warned residents not to be alarmed by spray planes targeting mosquitos:

  1. Chronic illnesses. The aftermath of a hurricane can spark a variety of health problems, from respiratory illnesses caused by mold outbreaks to infected wounds. But a potentially larger problem for some people is the lack of access to medications and treatment for chronic conditions such as diabetes, asthma and kidney disease.

During Hurricane Katrina, 94 dialysis facilities were shuttered because of flooding or power loss, affecting nearly 6,000 patients, according to a November 2015 study in the American Journal of Kidney Disease. Patients on dialysis need the treatment three or four times a week to keep their bodies functioning.

Dialysis clinics reported long lines for care in Houston after Hurricane Harvey. Among the first to be evacuated from U.S. territories battered by Hurricane Irma last week were those needing the life-sustaining treatment.

  1. Mental health. It’s no surprise that natural disasters can traumatize people, so it perhaps follows that hurricanes can exacerbate mental illness.

A year after Hurricane Katrina, for example, residents reported an increase in suicidal thoughts and a worsening of post-traumatic stress disorder and depression, according to a 2015 paper published in the journal Nature.

 

AHH, OOF and OUCH

-- AHH: An unlikely voice has chimed in on the single-payer debate. Former Montana Democratic Sen. Max Baucus, who played a key role in the passage of the Affordable Care Act in 2010, now says he supports the idea of a single-payer system. 

“My personal view is we’ve got to start looking at single-payer,” he said in during an address at Montana State University, according to the Bozeman Daily Chronicle. “I think we should have hearings... We’re getting there. It’s going to happen.”

Baucus’s comments come just days before Sen. Bernie Sanders (I-Vt.) plans to introduce his “Medicare-for-All” bill on Wednesday, and as a handful of Democrats have brought the idea back into the headlines.

Our colleague Dave Weigel writes that "As the chairman of the Senate Finance Committee, Baucus was focused on passing a reform bill that moderate Republicans could support." The former senator’s endorsement marks a turning point in the Democratic Party on this issue.

Dave writes: “All of that has demonstrated a shift in Democratic Party politics that began in 2016 and accelerated during the Republicans’ eight-month fumble of the repeal effort. No Democrat, nor Sanders, expects all 48 members of the party’s caucus to endorse one of the universal health-care bills this year. But even Democrats in competitive races have begun talking about single-payer as an eventual end point. At a Homeland Security committee meeting this week, Sen. Jon Tester (D-Mont.), who faces re-election next year, went out of his way to call single-payer “something we should, quite frankly, take a solid look at.”

OOF: Former White House chief strategist Stephen K. Bannon suggested the tension within the Republican Party may have contributed to lawmakers failure to repeal Obamacare.

“Paul Ryan and these guys come in and said, 'We've done this for seven years. We've voted on this 50 times. We understand this issue better than anybody. We know how to repeal and we know how to replace, and this is ours. That's what we're going to start with day one, and we will have something on your desk by Easter,' " Bannon told "60 Minutes" in his first post-White House televised interview.

Bannon outlined what he said was the administration and GOP leadership's ideal initial timeline for repeal-and-replace: Obamacare overhaul by Easter Break, a tax rewrite by the August recess and infrastructure this fall.

When asked by CBS’s Charlie Rose if he was “blaming” Republicans for their failure to get rid of the ACA, he continued:

“I’m not blaming … what I’m saying is that when left to even repeal it in June, in the Senate they put it up for a vote -- they only had 41 votes. There's a wide discrepancy in the Republican Party as we know it today now that we’re in it, but leadership didn’t know it at the time. They didn’t know it until the very end.”

And any current Republican health care plan? Bannon said it was much more likely to be a “fix,” a pretty remarkable admission from the former chief strategist bent on dismantling the government:

"It does not repeal Obamacare… I think the choice is going to be, you’re not going to be able to totally repeal it," he said.

Here are four takeaways from the interview (full interview above):

OUCH: The Joint Commission, a nonprofit agency that accredits nearly all hospitals, rarely revokes approval from facilities even in the face of safety violations, the Wall Street Journal reported in a new investigation, citing a federal inspection.

In 2013 and 2014, two babies died at a hospital in Northampton, Mass., months after a death of a pregnant woman who was not properly treated for pre-eclampsia.

“The failure to provide quality medical care resulted in the death of all three patients,” reads the report from the Centers for Medicare and Medicaid Services, per the Journal.

“Yet the Joint Commission, a nonprofit organization that provides hospital accreditation, made no change in Cooley Dickinson’s status, allowing it to continue promoting itself as fully accredited despite being out of compliance with safety requirements to participate in Medicare. The organization named the hospital a 2013 top performer on several measures, such as surgical care and treating heart failure," The Journal reports. "This certifier of hospital quality, however, typically takes no action to revoke or modify accreditation when state inspectors find serious safety violations, according to a Wall Street Journal database analysis of hundreds of inspection reports from 2014 through 2016."

TRUMP TEMPERATURE

--Is it really an emergency? It’s been a month since President Trump declared the opioid crisis a “national emergency.” But he has yet to take any public action to follow up with his early August announcement. The New York Times’s Maggie Haberman writes that Trump is “discovering the realities of limited government resources, slow-moving agencies and the competing agendas of cabinet members, even as they try to push in the same general direction.”

“The opioid crisis is an emergency, and I’m saying officially right now it is an emergency,” Trump said in Bedminster, New Jersey during his announcement. “It’s a national emergency. We’re going to spend a lot of time, a lot of effort, and a lot of money on the opioid crisis.”

Vice News’s Keegan Hamilton wrote about Trump’s inaction in late August, highlighting that the “announcement was conspicuously short on details.”

Haberman reports that Trump advisers are “scrambling to fulfill his pledge,” and added: “A White House official, speaking on the condition of anonymity to discuss private deliberations, said the administration was reviewing options and putting the report through an expedited legal process."

HEALTH ON THE HILL

--Notable: House Freedom Caucus Chairman Mark Meadows (R-N.C.) expressed openness to the Obamacare replacement plan in the works by Sens. Lindsey O. Graham (R-S.C.) and Bill Cassidy (R-La.).

"The most promising thing right now ... is Senator Lindsey Graham and Senator Cassidy working on a block-grant issue," Meadows said Friday on MSNBC's "Morning Joe."

Meadows said on MSNBC he has met with 12 different senators on the health-care quandary and said he was “optimistic” that Republicans would be able to find a “sweet spot” but warned that “time is running out.” 

By that he means that budget instructions allowing Republicans to avoid securing Democratic support for a health-care measure expire at the end of September, according to the Senate parliamentarian -- meaning it will be next to impossible for the GOP to pass a wide-ranging repeal bill after that.

--Trouble? A government watchdog agency is set to launch a probe into whether Interior Secretary Ryan Zinke threatened Sen. Lisa Murkowski (R-Alaska) in order to try and influence her vote on the Republican plan to overhaul Obamacare, the Washington Examiner reported.

Murkowski was one of the key players who took down the plan to repeal Obamacare, along with Sen. Susan Collins (R-Maine) and Sen. John McCain (R-Ariz.).

The Government Accountability Office’s investigation follows a request from Reps. Frank Pallone Jr. (R-N.J.) and Raul Grijalva (D-Ariz.) to look into the alleged conversations between Zinke and Murkowski and Sen. Dan Sullivan (R-Alaska). The Alaska Dispatch News reported in July that the senators “received a phone call from [Zinke] letting them know the vote had put Alaska's future with the administration in jeopardy.”

Following the report, Zinke shared a photo with Murkowski on Twitter, appearing to mend fences:

Here are a few more good reads from The Post and beyond: 

In an interview with CNN, the Arizona Republican noted, “Every life has to end, one way or another.”
Ashley Parker
MEDICAL MISSIVES

Here’s a deep dive you should read from 60 Cincinnati Enquirer journalists detailing a week of heroin use in their city. The report describes 18 deaths, at least 180 overdoses, 200 heroin users in jail and 15 babies born with heroin-related medical problems. 

"We believe that God gave us this baby,” Nick DeKlyen said.
Kristine Phillips
Two AstraZeneca drugs tackling lung cancer in different ways delivered impressive clinical results on Saturday, helping the British group offset July's big clinical trial setback in the disease.
Reuters
INDUSTRY RX
Outside groups are scrambling to figure out how to fill the $90 million in ad funding for Obamacare that was cut by the Trump administration...
Washington Examiner
Groups that for years have helped people sign up for ObamaCare say the White House's cuts to their funding will almost certainly lower enrollment in the health care exchanges this year.
The Hill
REPRODUCTIVE WARS
The Ohio Supreme Court will hear two high-profile abortion cases this month. The first will decide whether to shutter Toledo's last abortion clinic,
Columbus Dispatch
DAYBOOK

Coming Up

  • The Senate Finance Committee holds a hearing on health care cost and coverage on Tuesday.
  • HealthAffairs holds a briefing on “Understanding the Value of Innovations in Medicine” on Wednesday.
  • The Senate Committee on Health, Education, Labor and Pensions holds hearings on how to stabilize the insurance marketplaces on Tuesday and Thursday.
  • The Hill hosts an event on “Turning Genes into Medicine” on Tuesday.
  • The Hill hosts an event on the opioid epidemic on Wednesday featuring Sen. Rob Portman (R-Ohio) and Rep. Paul Tonko (D-N.Y.)
  • The House Energy and Commerce Subcommittee on Health will hold a hearing on FDA’s regulation of over-the-counter drugs on Thursday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on “Examining Workforce Programs Under the Public Health Service Act” on Thursday.
SUGAR RUSH

See floodwaters bear down on Miami during Irma:

See this timelapse video of Irma's effects on Miami:

Fact Check: Will a border wall stop drugs from 'pouring in?':

Stephen Colbert's take on Steve Bannon's "60 Minutes" interview: 

Washington Post Satire: Meet Sarah, the New Siri: