Hurricane Fiona Situation Report #9

• While overall the situation continues to improve, as of 10/3, there is a remaining need for electricity and food in impacted areas. Prolonged lack of these resources is resulting in negative health outcomes for residents.
• President Joe Biden visited Ponce, Puerto Rico on 10/3 to survey the damage and announced more than $60 million in aid to Puerto Rico to recover from the storm and prepare for future emergencies.
• As of 10/3, approximately 8% of the island remains without power.
• Most (96%) residents have had potable water restored as generators have been installed at water treatment plants and wells have been cleared of obstructions. Intermittent disruptions have been reported due to generator failures and pipes bursting.
• As of 2 pm ET on 10/3, RxOpen.org shows 76% of pharmacies as Open. Some remain on generator power.  

The southwest of Puerto Rico has been heavily impacted by Hurricane Fiona. Power and water infrastructure have been damaged in the most impacted areas, resulting in many residents remaining without power and/or water even weeks after the storm. While overall the situation continues to improve, as of 10/3, there is a remaining need for electricity and food in impacted areas. Prolonged lack of these resources is resulting in negative health outcomes for residents.

Assessment on Healthcare and Logistics Impacts

• Today, 10/3, President Biden visited Ponce, one of the areas hardest hit by Fiona, to survey damage and announce the following federal aid be made available to Puerto Rico:
  • $60 million through the Bipartisan Infrastructure Law will be directed to Puerto Rico to help with response and recovery
  • ​$14 million to help clean contaminated waterways and the ecosystem, as well as help mitigate for the next disaster 
  • $4 million to repair the power grids and install mini power grids so that the island is less dependent on long distance transformers, therefore decreasing the amount of time the island would be without power during the next disaster
• On September 21, the Biden Administration has approved a major disaster declaration for Puerto Rico, authorizing for individual and government assistance to affected individuals and municipalities.
• Puerto Rico Governor Pedro Pierluisi declared a state of emergency on Saturday, September 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, President Biden approved an emergency declaration to provide federal assistance and resources in response to Hurricane Fiona.
• Executive Order 22-0915 signed on September 20, guarantees access to medications of beneficiaries of Plan Vital, the government health plan of Puerto Rico. The plan provides physical and mental health services to 1.3 million Puerto Ricans. The Executive Order authorizes Pharmacy Benefit Manager/Management (PBM) to fill 50% of a prescription without a primary care provider’s signature.

• Power
  • As of Monday 10/3, roughly 8% of the island remains without power with the majority of outages remaining in the southern and western regions of Puerto Rico. Power has been restored to roughly 1.3 million customers.
  • Today, 10/3, President Biden announced the creation of a "Puerto Rican grid recovery modernization team" to be led by US Department of Energy Secretary Jennifer Granholm. He said the team will help "repair the grid quickly & drive decisive progress on the game plan for Puerto Rico’s clean energy transformation."
• Fuel
  • On 9/30, a BP-chartered diesel tanker docked in Guayanilla Port, Puerto Rico, to begin resupplying the island with diesel fuel. The tanker was carrying about 308,000 barrels of diesel.
  • The Marshal Islands-flagged tanker was able to dock following Department of Homeland Security Secretary Mayorkas’s approval of a Jones Act waiver for Puerto Rico.  
  • Another diesel-carrying tanker chartered by BP and carrying 185,000 barrels of diesel was reported to be expected to arrive on 10/1.
  • Though there have not been reports of generator fuel shortages for healthcare facilities as of this report, due to the significant number of facilities still relying on generator power, the delivery helps ensure that an adequate supply of fuel will be on-hand when generators inevitably run out of fuel.
    • The Jones Act requires the transportation of goods between two US ports to be carried out by vessels that are built in the US and operated primarily by Americans. The century-year old Act is intended to increase national security and support the US maritime industry. The waiver comes just as Hurricane Ian’s devastating impacts on ports in Florida comes to light. The waiver is for a limited time and only applies to shipments of fuel.
    • There is some discontent among entities such as the American Maritime Partnership (AMP), who claim that the maritime supply chain was steady and the introduction to Jones Act waivers could cause a disruption in that supply chain. Others have noted that the Jones Act has delayed emergency aid to Puerto Rico in the past, including during Hurricane Maria. A Jones Act waiver was issued for the Maria response approximately one week after the storm made landfall.
• Water
  • As of 10/2, 96% (1,274,631) of residents have had water restored, while 4% (53,109) of residents still remain without water. AAA recommends that all residents boil water as they work to restore water.
  • As of 9/30, the Añasco filter plant and the Morovis filter plant are out of operations.
• Communications
  • As of 9/30, the FCC reports that 8.7% (-.8% from 9/29). The FCC has deactivated reporting as of 9/30.
• Transportation
  • Road closures
    • As of 10/2, there are approximately 20 road closures (-1) and 249 (+1) critical incidents.
    • Landslides and sinkholes have closed local roads in Humacao, Guyama, and Toa Baja, among others. DTOP is calling on drivers to take precautions when driving and to report landslides and other obstructions on the roads.
  • Airports
    • There are no remaining airport closures due to Fiona as of 10/3.
  • Port status
    • All ports in Puerto Rico have resumed normal operations and are now open 24 hours.

• Emergency Medical Services
  • Throughout the storm and response efforts, EMS services did not suffer any impacts and were able to safely transport patients to the emergency room.
  • Puerto Rico Voluntary Organizations Active in Disasters (PR VOAD) reported one fatality on September 27, raising the hurricane related death toll to 17. Health impacts due to lack of food and electricity in mostly affected areas are expected.
• Healthcare Facilities
  • As of 10/3, all healthcare facilities are operational with eight running on generators, two in Mayagüez and 6 in Ponce.
  Health Clinics
  • Some clinics in the hardest hit areas still require assistance to return to operations. 
  • 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. The map was last updated at 2 pm ET, 10/3. As of this update:    
    • 76.25% (-0.07% from September 26) of pharmacies are reporting as Open in Puerto Rico
    • Less than 1% of participating pharmacies in Puerto Rico were reporting Closed or Unknown.
      • The three confirmed closures are in Toa Alta, Bayamon, and Isabela.
• Dialysis
  • As of Monday, 10/3, all dialysis centers are operating with two in Ponce relying on generators.

• As of 10/3, no significant disruptions to healthcare product manufacturing or distribution have been reported.

• COVID-19
  • No updates since 9/30.
  • As of September 30, the CDC reports 19.43 COVID-19 related hospitalizations (seven-day average). Additionally, 4,706 cases have been reported in the last seven days.
    • The CDC reports that the community level of COVID-19 is low in most areas, but medium in southeast regions of Puerto Rico and some western regions: Moca, San Sebastian, Lares, and Adjuntas.
• Monkeypox
  • The CDC reports 179 cases in Puerto Rico as of 10/3. There is minor risk of more infections due to people entering shelters after the hurricane.
• Leptospirosis risk
  • As of 9/30 there are 72 suspected cases of Leptospirosis according to Puerto Rican officials.
  • 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.

• No updates since 9/27.
• As of 9/24, FEMA and other federal agencies have deployed over 1,000 employees to Puerto Rico and the FEMA Region II Regional Response Coordination Center in addition to 700 staff who live and work on the island.
  • Five FEMA Incident Management Assistance Teams are present to bolster response efforts. Moreover, Mobile Emergency Response Support, Incident Support Base, Staging Management Teams, and Mobile Communication Office Vehicle operators are in Puerto Rico.
• To coordinate water delivery to isolated communities, a Water Distribution Task Force, comprised of federal and commonwealth government partners and private sector partners is present.
• The US Army Corps of Engineers (USACE) is installing generators at critical facilities and preparing and staging additional generators to support requests. In addition, USACE issued $30,000 in funding to support a team of engineers to assess federal projects and infrastructure and coastal areas for post-storm damages.

• As of 12:00 pm ET on October 3, ASPR’s Emergency Prescription Assistance Program (EPAP) has not been activated.
• 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.
• Executive Order 22-0915 signed on September 20, guarantees access to medications of beneficiaries of Plan Vital, the government health plan of Puerto Rico. The Executive Order authorizes Pharmacy Benefit Manager/Management (PBM) to fill 50% of a prescription without a primary care provider’s signature.

• There are no reported curfews at this time.  

• 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.

• Per the 9/30 PR VOAD call, there are 4 shelters open with 32 people, ages 25-65.