By Sarah Ovaska-Few

As people start to trickle back to the areas devastated by Hurricane Florence, they will face a whole other set of health risks now that the rain has stopped and floodwaters have begun to recede.

Houses inundated with water are lurking with dangers, from the mold that quickly starts to grow, to exposed asbestos and lead paint in older homes, to unknown contaminants mixed in with floodwaters. Generators improperly left running indoors can release lethal carbon monoxide gas.

Don’t forget that tetanus shot

By Rose Hoban

I knew it would be a problem as soon as it happened.

On Tuesday, I became yet another North Carolinian cleaning up in the aftermath of Hurricane Florence.

We had stored many of our gardening supplies in the crawlspace under our Chapel Hill house in anticipation of wind and flooding. If things were going to wash around, at least they’d be contained under the house and not be swept into the stream that runs behind our property.

On Monday morning, the thing we’d been waiting for happened: That stream became a torrent and a flash flood filled our neighborhood with feet of water, including about 16” of water in our crawl space.

By Tuesday, most of the water had receded and my husband and I spent several hours cleaning up. As I carried a chicken wire-covered vegetable cage out of the muck, one of the rusted wires scratched my neck.

My first thought was unprintable. My second thought was, “I have no idea of the last time I got a tetanus shot.”

Tetanus is nasty stuff. It’s a bacteria that’s nearly ubiquitous in the soil and thrives in an oxygen-free environment. That’s why the standard advice is to make sure you have a booster if you step on a rusty nail. It’s not about the rust, it’s about the deep penetrating wound that would provide tetanus’ preferred environment.

So, strictly speaking my scratch doesn’t really qualify for tetanus risk, but with all the junk that floated into our yard, the chances of getting stuck with something contaminated are pretty high. And I was due anyway, it turns out. So, it was off to my doctor I went, where it was a simple (and relatively cheap) nursing visit to get the vaccination.

“Get it,” said Becky Tobin, my physician, when I expressed some hesitation. “You don’t know what’s been floating in that water.”

In North Carolina, a pharmacist can also administer a tetanus booster, I got quotes of between $55-$65 to get it done. It’s also covered by Medicaid and by insurance.

shows a woman grimacing as she gets a shot in the left arm
Editor Rose Hoban gets a jab from nurse Lu Pittman on Tuesday afternoon. Photo credit: Rebecca Tobin, MD

“We see more illnesses and injuries in the days and weeks post-hurricane,” said Tom Skinner, a spokesman for the Centers for Disease Control and Prevention.

There will also be risks of infectious diseases in the coming days and weeks, as there was after Hurricane Matthew and its deluge of rainwaters pummeled the area in 2016, said Dr. Obiefuna Okoye, the infectious diseases medical director for Lumberton’s Southeastern Health.

“We had rising cases of wound infections, diarrhea-related illnesses,” he said. “We are expecting that again, especially at this time of the year as we are going into the colder months.”

Here’s some of what Kirby and Okoye said people should be doing to stay safe during the recovery:

Protect yourself.  If cleaning up around a damaged home, wear steel-toed boots and work safety goggles that cover your eyes and preferably the sides of your face, said Sarah Kirby, an N.C. State University professor and extension specialist for housing issues. Wear rubber boots if going through floodwaters to avoid contact with contaminated water.

Get a tetanus shot if it’s been 10 years since your last booster or you can’t recall when your last one was. (See sidebar)

shows a white face mask
An N100 mask can prevent you from inhaling small fibers, mold and dust as you clean up.

Respiratory masks should be worn if you’ll be repairing, cleaning or tearing down houses damaged by wind, rain or floodwaters.

In older homes, there could be exposure to lead paint in houses built before 1978 or to asbestos if the house was built before the 1980s. Use respiratory masks designated as N100, Kirby said, which can be bought at hardware stores and are often also provided by groups such as the Red Cross and others working in recovery zones.

“It’s really making sure you don’t inhale those fibers,” she said. “Hopefully that’s not going to be that big of a deal but you never know.”

Also, don’t share masks, she said. Each mask should be fitted individually to be effective.

Food safety. Throw out any food that was in refrigerators and freezers that lost power for significant periods of time, Skinner said. That also goes for boxed foods exposed to water. Canned foods are okay to eat. Read this guide from N.C. State University’s Extension Agents for specific advice about what to keep and what to toss.

Avoid pooled water. Keep out of floodwaters if possible, Okoye said. It’s likely teeming with contaminants, including ones that could spread disease or infect old or new wounds.

Wash any parts of your body that have been in contact with the waters, and be especially diligent with children who may be playing in dangerous waters unbeknownst to adults.

If you don’t have access to running water to bathe or wash hands, use alcohol swabs to disinfect and clean parts of your body that came in contact with flood waters or storm debris, Okoye said.

Assume that all areas that have been flooded may be contaminated with sewage or chemicals, Kirby said, not just those near industrial sites or agricultural areas with known contaminants.

Seek medical attention. At the first signs of any fever, nausea or vomiting, seek out medical attention, Okoye said. Viruses and infection can escalate quickly, and it’s important to get treated as soon as possible. Look for wounds that aren’t healing, are red, have changed in color, and are warm or hot to the touch. That could mean infection, he said.

“We don’t advise delay,” he said. “This might be dangerous.”

Those staying in emergency shelters also need to be vigilant, with the potential for gastrointestinal viruses to spread quickly in close quarters.

Know your limits. Exhaustion can lead to injuries, and Kirby cautioned that people need to both be aware of their skill levels as well as their physical abilities. Volunteer groups often come in after disasters like Hurricane Florence and can saw up fallen trees and more for those not physically able to.

“This kind of work is exhausting, both physically and mentally,” she said. “People do need to take breaks.”

For resources, Kirby suggests those who are going to be doing recovery work in the southeast North Carolina counties affected by the storm educate themselves on the best safety practices. N.C. State University extension agents created several YouTube videos in the wake of Matthew’s damage about staying safe after a disaster and properly cleaning damaged goods. There are other resources compiled here.

She also suggests downloading the Rebuilding Healthy Homes application put out by the U.S. Department of Housing and Urban Development, which includes step-by-step directions on how to properly clean, disinfect or dispose of damaged household items.

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Sarah Ovaska is a freelance writer based in Orange County, who has called North Carolina home for well over a decade. She’s reported on criminal justice, education, health and government issues at publications...