By Will Atwater
Tropical Storm Helene’s impact on western North Carolina was felt acutely in the days, weeks and months after the storm, including in the region’s hospitals and clinics. New research shows how pregnant patients and people with anxiety and other health issues turned to emergency departments for treatment when primary care practices were closed.
That influx created new pressures on hospitals and clinics that were already dealing with power, water and staffing disruptions.
As a primary care doctor and founder of Asheville’s Trillium Family Medicine, Mark McNeill saw firsthand what North Carolina-based researchers quantified in their data.
“Once the roads opened up, I left and went to Winston‑Salem just to get back online,” McNeill said. “My inbox was full of patients who still needed their medicines … needed primary care.”
The situation McNeill described is reflected in forthcoming results from studies led separately by researchers Jen Runkle from NC State University and Maggie Sugg from Appalachian State University, who, along with their respective colleagues, analyzed emergency department use in western North Carolina after Helene.
Who turned to the ER after Helene
Sugg and her partners focused on 19 hard‑hit western counties and compared three post‑storm windows — the first two weeks after landfall, weeks three through seven, and weeks eight through 14 — with the same dates in 2023, drawing on data from nearly 130 emergency departments statewide.
“We do see overall … a lot of emergency department use following Helene for 65 and older — there’s a big jump for that age demographic during this time period,” Sugg said.
One of the most surprising findings, she said, was a sharp rise in alcohol‑related emergency visits among people 65 and older. She suspects that, in some hard‑hit communities, people may have had less access to their usual medications, including opioids for pain, and instead turned to alcohol, a pattern she and colleagues plan to investigate further.
A companion analysis led by Sugg documented sustained post‑storm increases in alcohol‑ and anxiety‑related emergency visits across western North Carolina, with the sharpest effects in counties with more older residents. They also noted lower apparent ED use in counties with higher shares of uninsured and Medicaid patients, suggesting serious access barriers.
And residents in some of the hardest‑hit, poorest counties who did not have access to emergency department care may have gone without care altogether.
Emergency department visits post-Helene
Runkle and her colleagues used the same data set as Sugg to examine how disruptions in primary care showed up in emergency rooms.
In the three months after Helene, emergency visits climbed for conditions that are usually handled in primary care or outpatient mental health settings. Runkle found that preventable, primary‑care‑sensitive visits rose 7 percent for adults and 12 percent for youth — tallying up to about 3,000 extra emergency department trips and more than $20 million in added costs. Anxiety‑related visits alone increased 25 percent in adults and 14 percent in young people, with about $10 million in added costs.
She also led research on a maternal‑health brief that zoomed in on pregnancy and the first year after birth.
“It’s a really vulnerable time, and then thinking about catastrophe and how you’re going to access the care that you need — driving the mountain mile, which is different from the mile in the eastern portion of the state,” she said. “Anecdotally, I might have said, ‘Yep, sure,’ but when the numbers came through, that was surprising.”
That analysis found that the storm contributed to increased emergency department visits tied to mood and anxiety problems during pregnancy and in the first year post partum. Visits during pregnancy rose by about 15 percent, adding an estimated $3.2 million in costs, while visits in the period after childbirth increased by roughly 59 percent, with another $2.6 million in excess costs.
Runkle and colleagues concluded that complications during pregnancy and the first year after birth — including high blood pressure, mood and anxiety problems, gestational diabetes and postpartum hemorrhage — accounted for about 600 more emergency department visits, resulting in about $13 million in added costs in that same three‑month window.
A fragile safety net
Taken together, Runkle and Sugg’s research, along with McNeill’s experience, suggest that Helene did more than topple trees and power lines — it exposed how fragile western North Carolina’s health‑care safety net can be when primary care goes dark.
For McNeill, getting back online was just the start. He eventually reopened True Again Family Medicine with a small generator that powered a Starlink satellite internet dish on the roof. He rented a porta‑potty that he placed out back and supplied jugs of hauled‑in water so staff could wash their hands. He estimates he lost roughly $50,000 in productivity in the weeks after Helene.
“I was lucky — I had a very good support system,” McNeill said. “I did some of this myself, but I was able to rely on my business partners in the accountable care organization and some family members to help me get the generator and the water.”
McNeill said timing and his payment model made the difference.
“I have another income stream besides the fee‑for‑service,” he said. “I’m in contracts through my [accountable care organization] where I get value‑based payments in a big lump at the end of the year. When my fee‑for‑service dollars disappeared in November, my shared‑savings checks showed up, so I was able to make payroll and not lay anyone off.”
Preparing for the next storm
Now, as researchers track the long‑term fallout, doctors and public health experts are asking what needs to change before the next big storm.
In his latest Helene‑relief proposal, Gov. Josh Stein is asking lawmakers for $792 million more for western North Carolina, including money for microgrids and emergency communications that could help keep vital services online in the next disaster, but the plan does not explicitly dedicate funding to shoring up primary care and behavioral‑health access in the ways Sugg, Runkle and McNeill describe.
“I think we need more funding post‑Helene — particularly for mental and behavioral health for youth and for people 65 and older,” Sugg said.
“What we see in our paper is just the tip of the iceberg,” she continued. “These are the people who were able to get to an emergency department. In some of the hardest‑hit, rural counties, utilization is actually lower, which suggests people still had needs but couldn’t get care.”
For the people who couldn’t access care, McNeill said there is a direct way insurers can help address this issue. He said that for telehealth to remain a viable option during future disasters, insurers need to keep paying for virtual visits at the same rate as in‑person appointments. If not, he warned, many practices will simply stop offering telehealth because it isn’t financially sustainable.
Runkle’s analysis of millions of dollars worth of emergency department visits in the months after Helene shows how easily gaps in primary care and mental health spill over into overcrowded emergency rooms. She said that western North Carolina won’t be ready for the next big storm unless policymakers treat “social infrastructure”— clinics, mobile units, telehealth and long‑term mental health support — as just as essential as roads and bridges.
“We’re still in recovery, and recovery isn’t a few months — it’s 10, 15, even 20 years,” Runkle said. “The mental health burden, especially for pregnant people and kids, is only going to grow if we don’t build up services now.”
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