Spring 2018​

​According to a study by the National Center for Atmospheric Research, the volume of rainfall from storms will rise by as much as 80% in North America by the end of the century. Not only do storms and floods threaten public health laboratory facilities, but receding floodwaters pose serious public health risks. So what's the best weapon in a public health laboratory’s arsenal? Preparation for inundation…from any source.

Photo: Former SHL limnologist Matt Waters collects a water sample from the Iowa River that overflowed its banks near the confluence with the Mississippi River in 2008

by Nancy Maddox, MPH, writer

On June 23, 2016, the skies opened over West Virginia. As much as 10 inches of rain inundated parts of the state in less than 24 hours—a once-in-1,000 years rainfall.

“We did get a little bit of a notice that there would be flooding, but nobody realized it would be as bad as it was,” said Greg Young, the environmental chemistry supervisor for the West Virginia Office of Laboratory Services. A local news crew happened to set up a reporting station about five miles north of the laboratory. And, “by accident,” because they were watching the news, Young and colleagues learned that a wall of water was heading their way.

By 11 am, the water arrived. A low spot about half a mile from the facility quickly filled and overflowed, blocking access to the interstate and bringing muddy floodwaters within a foot of the laboratory parking lot. “We had no issues with flooding,” said Young. “But that was the closest I’ve seen it.”

Other areas were not so lucky. The Elk River crested at an all-time high of 33.4 feet above flood stage. Twenty-six people were killed in flash floods. And the tiny city of Clendenin was literally “wiped out.”

In an odd turn of fate, the devastating deluge had little impact on laboratory operations. Floodwater stranded  one microbiologist at her home, and requests for well water testing rose only 4% over the next couple months. Because the damage in hard-hit areas was so complete, Young said, “there was no house, no well, with water to test. Everything was just gone.”

Even though the facility survived unscathed, Young said, “We’re now looking at the cost of replacing all our equipment and seeing if we have enough insurance to cover that.”

2016, as it turns out, was a record year for flooding. In addition to the West Virginia calamity, the US had 18 other severe flood events, more than any year since recordkeeping began in 1980. In Louisiana, for example, a no-name storm dropped more than 20 inches of water across several parishes—7.1 trillion gallons in all (three times as much as Hurricane Katrina), constituting another 1,000-year downpour.

Yet Mother Nature has not let up. The hyperactive 2017 Atlantic hurricane season spawned 17 named storms, including ten back-to-back hurricanes— yet another record. Two hurricanes— Irma and Maria—reached Category 5 status, with winds in excess of 157 miles per hour.

According to a study by the National Center for Atmospheric Research (funded by the National Science Foundation and US Army Corps of Engineers), the volume of rainfall from mesoscale convective systems (MCSs)—storm clusters characterized by lift, heavy rain and strong winds—will rise by as much as 80% in North America by the end of the century, “substantially” raising flood risk. Moreover, the frequency of intense summertime MCSs will more than triple.

Already, 100-year storms have become so common, the National Oceanic and Atmospheric Administration is considering revising the standards used to define such an event; Boston has experienced two 100-year “monster storms” so far this year.

Responding to a Rising Risk

Even as more precipitation falls, rising seas are increasing flood risk for many US coastal areas. The Union of Concerned Scientists (UCS) reports that more than 90 US communities now suffer “chronic inundation,” defined as ≥10% of usable land flooded at least 26 times per year. By 2100, UCS predicts nearly 500 communities will experience chronic inundation, including 40% of all oceanfront communities on the East Coast and Gulf Coast.

For state and local governmental laboratories, these forecasts are a wake-up call. Not only do storms and floods threaten the laboratories themselves, but receding floodwaters pose serious public health risks. Among other things, floodwaters may contain raw sewage, metals, agricultural chemicals, volatiles, fuels, parasites, enteric viruses and pathogenic bacteria. Of additional concern, a New York Times analysis found that flood-prone areas of the US are home to more than 2,500 entities known to manufacture or handle toxic chemicals.

After Iowa’s massive flooding in 2008, the State Hygienic Laboratory at the University of Iowa (SHL) detected over two dozen inorganic contaminants in floodwaters and sediments (most at low levels): acetone, 2-butanone, ethylbenzene, toluene, 11 pesticides, two phthalates, chloride sulfate, motor oil, diesel fuel, gasoline, nitrates, ammonia, arsenic, chromium, copper, lead, nickel and zinc. In addition, E. coli concentrations reached up to 15,000 MPN/100mL in beach water, compared with typical levels of <10-1,000 MPN/100mL.

Nuclear power plants pose a special risk. Because they rely on a nearby water source to cool the steam used  to generate electricity (and thus indirectly cool the nuclear core), they can be vulnerable to flooding. When the Missouri River overflowed its banks in 2011, response crews hastily erected sandbag walls to protect Omaha’s Fort Calhoun Nuclear Generating Station. Nonetheless, floodwaters forced the plant to shut down its off-site power supply, which runs through a few big electrical switch buildings, and resort to back-up generators. In the process, it lost cooling to its spent fuel pools for about 90 minutes.

Dustin May, radiochemistry laboratory supervisor at the SHL, said there was “no real risk to the public” at any time during the shutdown. Yet, had authorities suspected a release of radioactive material—just across the river from Iowa—he and his staff were prepared to test air, soil, foliage and water samples for risk assessment.

Fighting the Crisis with Connections

One of the worst catastrophes last year was due to an especially large MCS that hung over the Houston area for days in the wake of Hurricane Harvey. Even before the storm ended, the National Weather Service issued a dire appraisal, warning: “This event is unprecedented and all impacts are unknown and beyond anything experienced.”

Ultimately, the weather system dropped 30 to 60 inches of water in parts of the Houston and Beaumont metropolitan areas. Over 100 people died in storm-related incidents, more than 10,000 were rescued from flooded areas and tens of thousands were displaced. Storm damage topped $100 billion, with some estimates close to $200 billion.

Although the City of Houston Health Department Laboratory sits close to some of the area’s bayous, Kim Phillips, the lab’s water microbiology team lead, said, “Water did not come in. We just got very, very lucky.”

The laboratory, having survived past floods, knew what to expect—water testing would be a high priority. “What we’ve done,” Phillips explained, “is establish very strong contacts with the county health departments and extension agencies to help with bottle distribution and sample drop-off points,” with courier service between those sites and the laboratory. She said, “We’re way in the middle of Houston. Some of [our customers] are 60 miles away. A lot of them are knee-deep in mud or can barely get away from their houses. We’re very spread out. This is Texas, you know.”

Even so, some of the laboratory’s partners were themselves flooded, underscoring the need, as Phillips said, “to be very  well connected so you can serve the community.”

In the immediate aftermath of the storm, the laboratory was closed for three days. Then, beginning Labor Day weekend, the facility operated seven days a week with whatever staff could make it in. Over the next two months, scientists conducted almost 3,000 private well water tests, compared with about 700 during the same period in 2016. Almost 40% of those tests were positive for coliform bacteria.

“But [testing] didn’t stop,” Phillips said. “Recontamination is a very real issue after floods, because the water table is not just connected to your well, and the floodwater keeps trickling down and trickling down. And we had feet of standing water.”

She said, “If we get a positive sample for coliforms or E. coli, we call the next day. So we’re speaking to these people constantly. They’re treating their wells and re-testing, re-testing, re-testing. Once we find bacteria in the water, it’s not safe to drink, not safe to bathe, not safe to wash your hands or brush your teeth or wash any food you’re gonna eat raw. ... So these people are just paralyzed.”

As late as March 2018, Phillips and  her team were still doing follow-up water testing.

About 200 miles down the coast from Houston, Corpus Christi was spared Harvey’s unending rainfall, but took the brunt of its Category 4 winds before the storm weakened and stalled.

Valerie Requenez, BS, MLS(ASCP)CM, BT coordinator at the Corpus Christi-Nueces County Public Health Laboratory, said she and colleagues “did a lot of in-house preparation” before Harvey made landfall on Friday night, August 25. All of the laboratory’s select agents were autoclaved. Equipment was moved to higher areas within the facility. Reagents and supplies were consolidated within a few refrigerators and freezers. “Everything that wasn’t vital” was disconnected from its power supply to reduce potential demand on back-up generators. Loose objects were secured. Analyzers and computer equipment were covered  with tarps.

On the personnel side, the laboratory director opted to weather the storm on-site at the facility. Most other staff members evacuated the area. Requenez said, “We had a good timeline of where people were going to be, so we knew how long it would take them to get back, once we got the all-clear.”

That came on Monday morning, when the health district called for a collective “huddle” to assess damages.

Fortunately, laboratory impacts were minimal. A back door was blown open, admitting water and debris. The entire facility—all on the ground floor—was flooded with water, but “not more than an inch deep.” And, of greater consequence, while city power was out, a back-up generator was flooded and out of commission for 3-4 hours.

Said Requenez, “Some of our refrigerators and freezers are on monitoring systems, so we could tell if they were ever out of the correct temperature range.” All reagents and supplies of questionable integrity—plus the destroyed select agents—had to be replaced. And, because the local FedEx route goes through Houston, the lab’s bulk reorders were delayed until that city “dried out.” (Select agents arrived sooner, coming via the state public health laboratory in Austin and a person-to-person handoff at a midway point between Austin and  Corpus Christi.)

On Tuesday morning, the laboratory reopened for business, with an immediate focus on water testing. The one post-hurricane change to the lab’s continuity of operations (COOP) plan: double-bolt all laboratory exterior doors.

Recovery from Square One

As bad as Harvey was, Maria may have been worse.

Described as “apocalyptic,” the storm made a direct hit on Puerto Rico September 20, 2017, as a nearly Category 5 hurricane. Over the next 30+ hours, it ravaged the island without mercy. Four months later, a third of this US territory still had no power, and so many residents had quit the island that academics described it as an “exodus.” As reported by the Los Angeles Times, one San Juan area resident predicted, “Puerto Rico isn’t going to be the same. It’s going to be before Maria and after Maria.”

The indiscriminate destruction did not spare the main island’s 11 discrete PHLs. In early October, CDC and APHL  (at the request of CDC) sent teams of  laboratorians to appraise the damage.

Christine Bean, PhD, MT(ASCP), head of the New Hampshire Public Health Laboratory and a member of the APHL team, said, “There was significant water damage [to the Laboratorio de Salud in San Juan]. Instruments were still covered in plastic. It was a complete mess. They couldn’t operate anything. There was evidence of mold in many of the labs; you could see it and you could smell it. It wasn’t a place you wanted to be.”

Eddie O’Neill La Luz, PhD, MS, MPH, a CDC deputy senior advisor for laboratory science and a member of the CDC assessment team, cited three immediate problems: “The island power grid was severely disrupted. Infrastructure damage created water leaks that compromised equipment, reagents, supplies. Because there’s no power, you cannot control the temperature, so things just cook inside.”

In addition to all these problems, some of the laboratories had been broken into and robbed of basic provisions, such as cleaning supplies.

Although CDC defers to other federal entities on facility repairs, the agency did contribute several uninterruptible power supplies to island laboratories. Working with the Puerto Rico Department of Health, CDC also arranged for high-priority specimens needing testing for tuberculosis, influenza, rabies, salmonellosis or leptospirosis to be shipped to the continental US for analysis at CDC and state PHLs in Georgia, Virginia and Florida.

“In the long term,” said La Luz, “our involvement has been to help reestablish their testing at the Puerto Rico Department of Health.” As of mid-March, Puerto Rico’s PHLs had restored about 50% of their testing menus, comprising about 80% of total test volume. The rabies laboratory is fully operational, and the HIV-STD-hepatitis laboratory is back to full capacity for HIV and STD testing.

A Different Kind of Flood

Yet, even while mega-storms are a grave and growing threat, Bean points out that they are not the only source of laboratory flooding. In 2012, over the Martin Luther King, Jr., holiday weekend, an improbable series of events left the New Hampshire PHL inoperable for about two weeks.

With temperatures well below freezing, the boiler in the laboratory HVAC system failed, as did not one, but two notification systems to alert authorities to the failure. By the time the incident was discovered, the laboratory interior was colder than the outdoors. “I had to find pencils to write with, because pens were frozen solid,” said Bean.

Even worse, once the building was slowly reheated, emergency personnel warned that overhead sprinkler heads would explode. “And boy did they blow,” Bean said. Although all equipment and desktops were covered in advance, the water turned to ice on the cold laboratory floors, leaving the building uninhabitable. After a specific incident, Bean said, it is easy to spot the gaps in COOP plans written for a generic emergency.

“Staff communication plans needed to be improved. We did not have an inventory list or map of all the nitrogen and CO2 canisters in our laboratory. The fire department wanted to know where they were. Another example:  We’ve known there are areas in the laboratory where cell phone coverage is not good. We decided we needed portable radio phones on each floor.”

Finally, staff discovered that many equipment service contracts had no coverage for natural disasters, necessitating extra insurance “just for floods,” even though the laboratory is not in a flood zone.

Reflecting on her experiences since Hurricane Harvey, Phillips said, “What you have to understand is that this will happen. Floods will happen. ... It’s hard for me to convey how hard everyone was—and still is—working to get back to some kind of normalcy; it was such a daunting task. We just did our part. Every single time we learn how to do it a little bit better [for] next time.” Phillips’ biggest piece of advice for fellow laboratorians? “Be prepared."