Hurricane Fiona Situation Report #1

Assessment on Healthcare and Logistics Impacts

• Puerto Rico Governor Pedro Pierluisi declared a state of emergency on Saturday, 9/17.  on Saturday, 9/17.
• Governor Pierluisi issued an Executive Order OE-2022-048 granting immunity to physicians, osteopaths, nurses, physician’s assistants, and health professionals assisting the government during the duration of the declaration of emergency for Hurricane Fiona.
• On Sunday, September 18, 2022, President Biden approved an emergency declaration to provide federal assistance and resources in response to Hurricane Fiona.

• Power
  • On Sunday 9/18, Puerto Rico’s entire energy grid went offline. On Monday 9/19, the entire island remains without consistent power.
    • Power has been restored to about 100,000 customers, with most restoration centered around San Juan and surrounding municipalities.
    • Puerto Rico Electric Power Authority (PREPA) technical staff carried out a joint operation with LUMA Energy, the private consortium responsible for transmission and distribution of electricity in Puerto Rico, to enable operations energize el Super Acueducto del Norte (the Northern Super Aqueduct) and other connected nearby areas at 1:03 pm AST/EDT.
    • LUMA Regional Operating Centers (ROCs) have been deployed to assess damage and give estimated timelines of restoration to other parts of the island. Updates on power restoration will be given periodically through the LUMA website and their Twitter feed. The exact timelines for restoration have not yet been published.
  • According to the US Power Outage Map, the USVI power grid has been completely restored with no customers experiencing outages. The Virgin Islands Water and Power Authority is providing updates on debris clean up on their Twitter feed.
  • FEMA generators are pre-staged in Puerto Rico and USVI.
• Fuel
  • The availability of fuel seems to not have been impacted by Hurricane Fiona, but accessing fuel may pose a problem while roads and other major infrastructure are obstructed by debris or water.
  • There have not been reports of generator fuel shortages for healthcare facilities as of this report. However, if power outages remain widespread and are in effect for an extended period, generator fuel availability may become an issue.
• Transportation
  • Road closures
    • The Department of Transportation and Public Works (DTOP) of Puerto Rico calls for all citizens to stay home while they work to clear debris from roads. Additionally, weather conditions, flooding, and landslides have caused dangerous road conditions which DTOP workers continue to clear.
  • Airports
    • San Juan International Airport
      • As of Monday, September 19, San Juan’s international airport resumed air operations following cancellation of all flights on Sunday, September 18. Updated as of 12pm ET, please find a list of flights that have confirmed their departure for September 19.
    • Fernando Luis Ribas Dominicci Airport
      • As of Monday, September 19, air operations have resumed at the Fernando Luis Ribas Dominicci airport in Isla Grande.
    • Rafael Hernandez Airport
      • As of Monday, September 19, airport operations remain operational in Aguadilla.
    • Mercedita International Airport
      • As of Monday, September 19, port authorities began cleaning and removing obstacles at Mercedita International Airport in Ponce. Air operations have not yet resumed, and a timeline on when operations will resume has not been released.
  • Port status
    • Puerto Rico
      • The US Coast Guard authorized maritime operations in the San Juan Bay only during daylight hours. Furthermore, it authorized the entry and exit of vessels to the municipal islands (Vieques and Culebra).
      • The following ports have been reopened as of Monday, September 19: Arecibo, Ceiba, Culebra, Fajardo, San Juan (with the restriction to conduct daylight operations only until further notice), Vieques, Yabucoa
    • USVI
      • Hurricane Fiona has passed the US Virgin Islands. The seaports are open and the St. John and St. Thomas ferry service has resumed.

• Emergency Medical Services
  • No impacts to emergency medical services have been reported as of this report. However, disruption to patient movement can be expected due to road conditions and closures.
• Healthcare Facilities
  • According to local outlets, all but one hospital are relying on generator power, while one is still connected to the national power grid.
  • The Hospital Association of Puerto Rico is periodically posting updates on operating status on their Facebook page.
    • Hospital General Castañer has suspended clinical and pharmaceutical operations of their Castañer, Adjuntas, and Jayuya campuses until Tuesday, September 20.
  • Hospitals in the Ponce, Mayaguez, Cabo Rojo, Yauco, y San Germán regions should take extra caution with the care of their patients and their power supply as they are still under heavy rainfall. Cancellations of surgeries and elective appointments are likely to be cancelled.
• Health Clinics
  • The status of free and charitable clinics and federally qualified health clinics are unknown at this time as damage assessments are underway. Healthcare Ready is working on mapping the operating status of these facilities once information is received.
  • As these clinics support the medical needs of the uninsured, the status and operations are critical to serving those impacted by Hurricane Fiona.
• Pharmacy
  • Rx Open is activated for Puerto Rico and the US Virgin Islands. The map was last updated at 2 pm ET, September 19. As of this update:  
    • 53.46% of participating pharmacies in Puerto Rico were reporting Closed or Unknown.
      • Only 27.98% of pharmacies are reporting as Open in Puerto Rico.
    • 9.52% of participating pharmacies in USVI were reporting Closed or Unknown.   
      • 66.67% of pharmacies are reporting as Open in the USVI.
• Dialysis
  • Dialysis facility operations are stable, with no unmet needs reported.

• In an emergency situation, Puerto Rico law dictates that prescribing professionals may provide a prescription verbally or digitally, provided that the physical prescription be provided to the pharmacy less than 120 hours later. The pharmacist may dispense an emergency medication to cover at most a 120-hour period.
• As of 9/19 3pm ET, ASPR’s Emergency Prescription Assistance Program (EPAP) has not been activated.

• COVID-19
  • As of September 18, CDC reports medium community spread throughout most of Puerto Rico, with low community spread in in six municipalities including Vieques. Also on 9/18, CDC reported 304.9 new cases in Puerto Rico and 9,728 cases total.
  • With people entering shelters due to the hurricane, there is a higher potential for COVID to spread and possibly increase throughout the island.
• Monkeypox
  • CDC reports 163 cases in Puerto Rico as of September 19.  There is minor risk of more infections due to people entering shelters after the hurricane.
• Leptospirosis risk
  • No risks reported today. Due to contaminated water from flooding, there is increased risk of this illness spreading throughout the island. We are monitoring for reports of spread of leptospirosis.

• FEMA’s Sunday, September 18, announcement states that federal emergency aid is available to the Government of Puerto Rico, due to the approved Federal Emergency Declaration. The declaration ensures coverage of 75% of protective measures and relief by federal funds. Funding may be used a variety of resources, including for flood fighting, EOC costs, emergency access, supplies and commodities, medical care and transport, evacuation and sheltering, search and rescue, use of temporary generators, childcare, and safety assessments.
• FEMA Region II’s Incident Management Assistance Team (IMAT) is deployed to USVI. The National IMAT Blue is deploying to Puerto Rico. Additional FEMA assets are also being deployed to Puerto Rico.
• The HHS Secretary’s Operation Center (SOC) is activated at Level II.
• 600 Members of the National Guard are involved in the search and rescue operations in Puerto Rico. The members of the National Guard were prepositioned Friday, September 16, to nine points throughout the island to tend to emergencies as they arise.
• New York will send 100 members of Spanish-speaking members of the state police, and 50 troopers and is organizing community partners to drive donations to assist the government of Puerto Rico. Full statement by Governor Kochul is available on the New York State website.
• Pennsylvania’s Governor Wolf announced that two members of Pennsylvania Task Force 1 (PATF-1) Urban Search and Rescue (US&R) are deployed to Puerto Rico to support response operations.

• There are no reported curfews at this time.  
• No major evacuations at this time, however, many water rescues have been reported.

• There is no formal access and reentry program in Puerto Rico. All 78 municipalities of the Commonwealth of Puerto Rico are tasked with coordinating specific access and re-entry requirements for vehicles transporting staff, supplies, and other essentials in close coordination with the Government of Puerto Rico and federal agencies.

• There are 132 shelters in Puerto Rico open to receiving those that have been affected by the hurricane. Currently, there are over 2,000 residents at the various shelters. We expect to see shelter residents to increase over the coming days.
• The shelters with the highest populations are in the areas with catastrophic damage, including Arecibo, Canovanas, and Guayanilla.
• No information available on special needs/medical shelters at this time.

• The Autoridad de Acueductos y Alcantarillados (AAA) operates 113 water treatment plants and supplies 97% of Puerto Rico’s 3.3 million inhabitants.
• More than 750,000 customers are without potable water supply.
• Water treatment plants are out of service in municipalities of: Ponce, Trujillo Alto, San Sebastián, San Lorenzo, Gurabo, Arecibo, Manatí, Barceloneta, Vega Baja, Vega Alta, Dorado, San Juan, Toa Baja, Aibonito, Villalba, Comerío, Cabo Rojo, Juncos, and Carolina.
• Water treatment operations are dependent on electricity, so restoration time depends on when treatment plants are able to reconnect to grid power or connect to generator power.

• According to the Federal Communications Commission (FCC), 911 services are operational (none have been reported as being affected) in Puerto Rico and USVI.
• As of 9/19 at 12pm ET, the FCC reports that 23.5% of cell sites in Puerto Rico are out of service. Out of 617 sites with outages: 549 are site outages due to power outage, 62 are due to direct damage, and the remaining 6 are out due to transport issues. An additional 784 sites are online but on backup power.
• There are no cell site outages in the USVI. 16 cell sites are online but on backup power.