Hurricane Helene unleashed record rainfall in parts of Florida, Georgia, North and South Carolina, and Tennessee, becoming one of the deadliest hurricanes in modern times and setting up the affected regions to face years of health challenges.
Some of the effects, like the flooded manufacturing plant that produces 60% of the nation’s IV supply, will reverberate throughout the entire country.
In western North Carolina, the mountains molted. The rains fell on the already-sodden clay soil and sloughed off mud and rocks and houses, sending it all – buildings, cars, roads, water pipes – into churning rivers swollen beyond residents’ imaginations.
Jerry McNeely’s house in Swannanoa, North Carolina, stood, miraculously, as five nearby homes were swept away in a 75-yard (70-meter) mudslide.
“I had to do something,” he said. He rushed out to help. After 45 minutes of digging through mud and debris in one neighbor’s collapsed home, McNeely spotted a toe, painted purple, shining like a beacon. Other neighbors arrived, and they staged a heroic rescue of the woman, who’d been pinned under a beam.
It took 18 hours to evacuate his neighbor for leg injuries and head trauma, but she’s now in stable condition, McNeely said. Another neighbor, a man who was thrown from his mobile home in the slide, suffered a broken back and died of his injuries before medical help arrived; his wife had been killed instantly.
The immediate health concerns in the wake of the disaster have included complications from injuries, a lack of clean water and safe food, and challenges accessing medical supplies and treatments like insulin, oxygen and dialysis, especially given power outages and closed roads.
In a crisis like this, “you can’t separate yourself from people”, which raises risks for infectious disease, said Melody Gardner, a former nurse who lives in Black Mountain, North Carolina, with her mother and manages rental homes in Swannanoa.
“I’m very, very concerned about flu and Covid,” she said. Covid continues circulating at high levels throughout the country, with another winter surge expected, while flu season is nigh – yet few people usually get vaccinated against either this early in the respiratory season, she said.
Asthma flare-ups and breathing issues will also likely increase with mold and standing water. And in Conyers, Georgia, residents were told to shelter in place after a fire at the BioLab chemical company.
Rescuers have delivered truckloads of drinking water, but in areas like western North Carolina, where water lines were washed away, McNeely believes it may be months before the region has running water again.
That raises concerns for sanitation, including the spread of viruses like hepatitis A and stomach bugs, particularly if people don’t have enough water to wash their hands regularly and don’t have access to functioning toilets.
“We’re used in the mountains to losing our power, but losing your water service is uncommon. It’s unprecedented, really,” McNeely said.
In places that were spared some of the worst of Helene’s fury, there’s a different threat: online rumors. Officials in Columbia, South Carolina, have repeatedly debunked rumors about the safety of drinking water after rumors circulated that the water service would soon shut down due to contamination.
The pharmaceutical company Baxter has closed its plant in Marion, North Carolina – the largest manufacturer of IV and dialysis solutions in the nation – following floods and damaged infrastructure, leading to nationwide shortages of IV fluids.
In the longer term, the region will probably suffer from worst access to medical care and the lingering effects of stress and trauma, according to new research published in Nature on Wednesday.
“The mortality impacts of hurricanes extend way beyond the immediate aftermath of the storm, and we find that it actually persists for up to 15 years,” said Rachel Young, an environmental economist at University of California, Berkeley, and one of the authors of the study.
The researchers studied 500 hurricanes and tropical storms in the US over the past 60 years, and they estimated that 7,000 to 11,000 excess deaths happen after storms like these – about 300 times more mortality than official counts.
“Hurricanes and tropical storms are a far greater public health concern than anyone previously thought,” Young said. These effects even extend to the health of babies born after the crisis, pointing to the need for greater prenatal and postpartum support.
And the fallout from these tragedies is often unequal.
“Black populations are much more likely to die – about three times greater than white populations,” Young said.
Rebuilding lives and homes will draw down people’s savings, if they had any to begin with – so if they have a medical issue years down the line, they may not be able to afford care, she said. State and local governments may also be strapped for cash after rebuilding, which means they’re not able to invest as much in public health and health infrastructure. Pollution can also have long-term health effects.
Everyone responding to the crisis has been doing “heroic work”, said Young. “We don’t want those efforts to be in vain, and we can’t forget about these communities. There’s going to be longer-term repair and recovery that needs to occur – far longer than anyone had previously thought before.”
There’s also the immense stress of surviving events like this and rebuilding in their wake. Stress can lead to heart attacks and other long-term health issues.
“During the recovery time period, there is an increase in things like stress and depression, and we often see an increase in suicide,” said Samantha Montano, author of Disasterology and assistant professor of emergency management at the Massachusetts Maritime Academy. Yet mental health providers may be displaced themselves, making it harder for them to offer services, she said.
McNeely noted there will be a need for long-term wellness counseling as there was “already an existing need for expanded mental health services in western North Carolina, and this is just going to put more burden on an already struggling system”.
It’s also difficult for people to access medical care – and that’s compounded in rural areas, where it was already a challenge.
“It looks like there were hospitals and other medical facilities that were significantly damaged,” said Montano. Fifty patients and staff were rescued from a flooded hospital in Tennessee. Although all hospitals in western North Carolina managed to stay open, staff have struggled to get to work on washed-out roads.
Few people in the area had flood insurance.
“One of the main drivers of an increase in stress during recovery is the inability to find resources to rebuild your life, and based on just flood insurance numbers alone, it would not be surprising to see particularly high rates of stress in many of these communities,” said Montano. “We’re looking at a 10-, 15-, 20-year recovery here, easily, for the communities that were most significantly impacted.”
Making sure attention stays on these communities – and resources continue flowing in – will be critical to the recovery of the region and the people who call it home, Montano said.
As soon as it was safe to do so, McNeely’s wife and son left Swannanoa to stay with family, but he was compelled to stay. He formed a band of “door knockers” to go all over the mountain and check on neighbors. He brought a generator to an elderly neighbor who uses an oxygen machine, and he carried cases of water, food, and supplies to anyone he could.
Now that first responders have taken over that work, McNeely is left to contemplate the future. “I don’t really know what’s next,” he said.
He’s a professional fly fishing guide, but “our rivers, our ecosystems, are utter disasters.” They’re polluted with chemicals and wreckage, and recovery could take years. Tourism is the biggest industry in this area, and many people will be out of work until it’s rebuilt.
“I think we’re going to transition from a time when people are needing food because the grocery stores aren’t open to a time when people need food because they don’t have income,” McNeely said.
“It’s a difficult situation, looking forward. You don’t know – what’s your path now? And a lot of people are feeling that way,” McNeely said.
“If I had to send a message out to everybody, it would be: please don’t have a short, passionate outpouring of love for our community. Know that these needs are going to exist well into the future.”
A few days ago, he found himself gazing at the mud flow and “all these broken homes and broken lives,” McNeely said. The woman who was standing next to him, who is from out of state, said: “They’ll never rebuild this.”
He looked at her and smiled.
“The people of western North Carolina are resilient, and we’ve been hanging on these mountains like fleas on a dog’s back for over 200 years,” McNeely said. “If you think a little flood is going to keep us from rebuilding this community, then you don’t know much about the community.”
• This article was amended on 7 October 2024. Due to a change made during editing, an earlier version referred to a fire at a “bio-lab facility” in Conyers, Georgia. The fire was at a pool and spa chemical company called BioLab.
