Hurricane Irene.Photo: NASA’s Marshall Space Flight Center

Like most people on the East Coast, I’m anxiously watching the approach of Hurricane Irene, a swirling knot of wind and rain taking dead aim at New York City, where I’m currently visiting my family. I had been hoping to fly home to California on Monday morning, but now I’m wondering if that will happen. I’m also wondering about what kind of damage and health threats this hurricane will bring.

Almost precisely six years ago today, I watched anxiously as Hurricane Katrina bore down on the Gulf Coast. After that disaster, I was part of a health response team mobilized to evaluate the environmental damage in New Orleans. I remember entering the flooded city horrified and awed at the destruction that happened there — cars flipped on their roofs and piled on top of each other, houses obliterated or moved from their foundations, and the chalk marks on homes showing the death toll inside. We created a photo journal and investigated the serious health threats from rampant mold, arsenic-laced sediment and soil, and contaminated drinking water.

One of the shocking things about the flooding of New Orleans was how predictable it was. The city was well-known to be vulnerable to hurricanes, and the levees were documented to be insufficient to withstand a powerful storm. Yet the failure to adequately prepare — both in the long term by building stronger levees, and in the short term by evacuating people from vulnerable areas — lead to nearly 2,000 deaths, the displacement of about 800,000 people, and an estimated cost of well over $120 billion dollars.

Today, New York City is staring down the barrel of a loaded gun named Irene.

Like New Orleans, New York and nearby areas are also known to be vulnerable to hurricanes, although the region has been lucky and hasn’t been hit with a major hurricane since 1821. Our luck may have just run out. High tide and storm surge could flood the New York subway system and roadways, large parts of lower Manhattan, and other coastal areas such as Long Island. High winds roaring through the urban canyons of New York propelling flying debris through windows is a really scary thought.

It’s hard to say what will happen when Hurricane Irene hits, and it will certainly look different from the Katrina disaster, but there’s a really high likelihood of over a billion dollars of damage to property, and — unfortunately — many lost lives. But it’s not only New York that’s at risk. A major portion of the Eastern seaboard is in the storm track. To find out if you live in an area vulnerable to flooding along the East Coast, check out these flood vulnerability maps that allow you to search for your local area. Or if you live in New York City, you can check this site to determine your risk. If you live in a flood zone, be prepared to evacuate if you need to. See my colleague Kim Knowlton’s blog for information about how to prepare for the storm.

Climate change is projected to significantly increase the intensity of hurricanes and other storms. We have already seen a record-breaking year in 2011, with major winter storms, tornadoes in the spring, record-breaking heatwaves this summer, and now, a potentially devastating hurricane. Things are so bad that the new “normal” weather is swinging into a pattern of extremes. The climate-related events of 2011 so far bear an estimated price tag of $265 billion, at a time when our nation can ill afford it.

Our climate is already changing right before our eyes, and it’s not a pretty sight. As a health professional, I am pleading with politicians in Washington, D.C. to take practical steps to deal with climate change … Before it deals with us.

Working to clean up the Gulf oil spill

Cross-posted from NRDC’s Simple Steps blog.

Venice, La. – “You shoulda been out here last evening” said Carey, the shrimp boat captain who took me out to South Pass today. He saw that I was taking air samples with a hand-held monitoring device, and recounted the strong smell and choking fumes he had suffered through yesterday when he went out to rescue a stranded boat in the Main Pass channel. “Those guys on that boat had it worse than me” he added. “They were pretty sick – headaches and sick to their stomachs – but they had been sitting out there stranded in that stuff for two hours.”

At noon on a sunny day with a light wind from the southeast, I only found traces of volatile organic compounds in the air and noticed only a hint of a petroleum smell. But I could imagine how it had been the night before.

Captain Carey is making a little money taking reporters and environmentalists out to look for oil along the Louisiana coastline near Venice. Many of his friends have taken a different job. They are out there cleaning up the oil.

I talked with some of them this weekend, the night before they headed out to start dragging boom. They described the safety training they got from BP, and showed off the containment boom, absorbant boom, and large absorbant pads they were supposed to drag behind their boats.

“It’ll be like sweeping the State of Texas with a broom” one said.

“It’s just to make people feel better and to make it look like BP is doing something,” another added.

“But at least they’re paying us well.”

Then they showed me the protective equipment they had received: hard hats, safety glasses, coveralls, and gloves. “These are just for the guys who are pulling in the boom. Not for the boat captains” one captain explained.

“Where are the respirators?” I asked.

“Respirators? They didn’t give us any”

“Did they explain why not?”

“They said all the chemicals in the air dissipate within a few hours, and we’ll be in areas where the oil has been there for a while, so all the vapors will have gone away. Nothing to worry about.”

I checked the BP website, Coast Guard website, NOAA website, and EPA website. No data on air levels of volatile organic compounds (VOCs) offshore. I guess we’re supposed to take it on faith that it’s safe out there.

That’s why I’m out here today with an air monitor.

I don’t expect to find anything; I hope I won’t find anything. But it’s always best to check.

The problem is that we can’t get all the way out to the areas where the fishermen are working — a lot of those areas are closed off, plus we’re in a small boat and the sea is rough in the Gulf today. In addition, I realize that we’re still far from the spill, and in the heat of mid-day, the vapors are probably going straight up, not hugging the ocean like they might do in the cool of the evening.

But I still found VOC vapors out there.

Maybe I’ll need to go back soon.

Cleanup crews get the highest exposures to both the oil spill itself and chemical dispersants.

Oil spill clean-up brings workers and volunteers into close contact with chemicals that are known to be hazardous to human health.  As we deal with the oil spill in the Gulf, it helps to brush up on history. 

After the Exxon Valdez disaster, the National Institute for Occupational Safety and Health (NIOSH) reported an increase in respiratory symptoms, headaches, throat and eye irritation, rashes and other skin problems among the clean-up workers.  More recently, a study of beach clean-up workers and volunteers in Spain after a 2002 oil spill found an increase in DNA damage. The long-term significance of this finding is not yet known. In Alaska, a mental health study of residents one year after the spill found that exposed individuals were more likely to suffer from anxiety, post traumatic stress disorder (PTSD) and depression.

Here’s a summary of some of the scientific studies of the health effects to workers, volunteers, and local residents associated with five previous oil spills:

Exxon Valdez (1989)

• According to NIOSH there were 1,811 compenstation claims filed by people involved with the spill. Claims were related to cuts, sprains, contusions, respiratory problems, and dermatitis.
• 599 local residents were surveyed one year after the spill. They found that exposed individuals were 3.6 more likely to have anxiety disorder, 2.9 times more likely to have post-traumatic stress disorder, and 2.1 times more likely to be depressed.

The Braer oil spill (1993)

• People living in a 5 kilometer radius 1 to 2 weeks after the oil spill had a high prevalence of headache, throat irritation, dermatitis, and itchy eyes. One week after the accident, 97% of symptoms were resolved. No differences were found in the lung function, blood, or urine tests.
• Another study quantified DNA adducts and other genetic abnormalities in local residents after the accident. There was found to be no difference in the control and exposed group.

The Sea Empress oil spill (1996)

• There was an association between exposure to the spill and headaches, sore eyes, and sore throats.
• Environmental levels of hydrocarbons, suspended particles, and sulfur were below accepted occupational limits. Twenty days after the spill, 282 residents were interviewed about their work with the spill, exposure to fuel oil, and health; urine samples were also taken. Symptoms that were reported included back and leg pain, headache, itchy eyes, and irritated throat. There was a positive correlation between the number and duration of symptoms and the number of days worked on the accident.

The Erika oil spill (1999)

• Information was collected from 1465 people who participated in the cleanup activities. The most common symptoms that were reported were back pain, headache, and dermatitis.

The Prestige oil spill (2002)

• A study of paid and volunteer workers in a highly polluted area five days after the accident reported headache, back pain, dizziness, dermatitis, respiratory problems, irritated eyes and throat. This study also investigated genetic toxicity in volunteers, paid beach cleaners, and paid hose operators. There was an increase in DNA damage in all three groups; however, more was observed in the volunteers working on the beaches. The type of DNA damage that was observed can be repaired by the body.

• Toxic effects were observed more frequently among workers working more than 20 days in highly polluted areas, performing 3 or more tasks, having skin contact with oil, or eating while in contact with oil.
• Throat and respiratory problems were most frequent in seaman and workers who had worked more than 20 days in highly polluted areas.

These studies show that workers and local residents can suffer from health effects after oil spills. The main symptoms are acute headaches, dizziness, skin rashes, irritation of the eyes and throat, and breathing problems. Genetic abnormalities (which are potentially repairable) were also found in some studies but not others. One study reported mental health effects in local residents. These are the health issues we should be watching out for – and protecting against – in the Gulf Coast during the current oil disaster.

How do you think the health of local communities around the gulf will be impacted from the oil?

The petroleum vapors and mists can cause a variety of immediate health effects. There are also long-term health concerns because some of the contaminants from the oil will remain for a long time in the sediments and will accumulate in the food chain. Contamination in fish and shellfish—for many years into the future—may pose a significant risk of cancer and other health effects.

What’s actually in oil that could be hazardous to health?

Oil contains a mixture of chemicals. The main ingredients are various hydrocarbons, some of which can cause cancer (such as the PAHs or polycyclic aromatic hydrocarbons); other hydrocarbons can cause skin and airway irritation. There are also certain volatile hydrocarbons called VOCs (volatile organic compounds) which can cause cancer, and neurologic and reproductive harm. Oil also contains traces of heavy metals such as mercury, arsenic and lead.

How can these chemicals get into our bodies?

VOCs and some of the other hydrocarbons can be inhaled, causing lung problems and other health effects. Skin contact causes irritation and rashes. The oil will contaminate fish and shellfish, causing health risks from eating these foods that could persist for years.

What are the acute health effects from exposure to the oil?

Inhalation of oil vapors or aerosolized particles (from wind-blown waves) can cause headaches, dizziness, nausea, vomiting, irritation of the eyes and throat and difficulty breathing. People with asthma or other lung diseases could have serious exacerbations. High-dose inhalation (if people are very close to the vapors) may cause a chemical pneumonia known as “hydrocarbon pneumonia,” which can require hospital care. Direct skin contact can cause various kinds of rashes, including generalized skin irritation, or something known as “folliculitis” from oil-clogged skin pores.

Have you had any reports that the oil is making people sick?

We have been hearing some reports from people along the coast who are noticing the smell of oil. Some people have been complaining of headaches, nausea, coughing and throat irritation. We are collecting reports of health problems.

The Louisiana Department of Health is setting up shelters for those impacted by the air emissions. What do you know about the quality of the air and how it would possibly affect people?

People with underlying respiratory disease—such as emphysema, chronic bronchitis or even moderate or severe asthma—are at especially high risk of exacerbation from the vapors and aerosols. Petroleum is very irritating to the airways. As mentioned previously, at high doses such as might be experienced by workers it can cause hydrocarbon pneumonia. 

Are there risks to pregnant women?

Some of the volatile chemicals in oil have been linked to miscarriage, preterm birth, and low birth weight, so it is a good idea for pregnant women to avoid the areas where there are elevated levels of VOCs in the air. These are areas that include noticeable smells of oil or visible oil and also any areas where the EPA monitoring system detects elevated levels. The EPA air monitoring results are being updated regularly at www.epa.gov/bpspill. To be cautious, pregnant women may choose to avoid any areas directly along the waterfront and beachfront, even when oil is not visible.

What about risks to children?

Young children should not be allowed near the beach where they could come into direct contact with the oil. Other than this, recommendations for children are the same as for adults.

What about risks to pets?

Pets should not be allowed on the beach in any areas where they could come into direct contact with the oil.

How does this situation affect the shrimping/fishing industry in terms of the quality of our food?

Apart from the economic disaster to the industry, this spill poses a long-term health concern for the safety of the fish and shellfish. Contaminants in oil can persist for years and accumulate in the food chain, causing elevated cancer risks or neurological risks from exposure to heavy metals such as mercury. It will be important for FDA and others to establish a rigorous monitoring program for the seafood that we eat from the Gulf subsequent to this spill.

Are there any health concerns associated with dispersants?

The dispersant that is primarily being used contains petroleum products, sulfonic acid salts and propylene glycol. It is somewhat volatile and will enter the air. Chemicals in dispersants share some of the same toxic properties as chemicals in the oil itself. Therefore it is critical for clean-up workers and volunteers to wear personal protective equipment at all times when either applying the dispersant or working where it has been applied. By the time the dispersants reach shore, they will probably be highly diluted and won’t pose a threat for communities, but this is something we’ll keep an eye on if they start using dispersants close to populations.

What about the fishermen and volunteers who are working to clean up the oil and rescue wildlife?

These are the people I’m most worried about. They are getting the highest exposures and they need adequate protection, both from the oil spill itself and chemical dispersants that are being applied to break up the oil. BP should provide these workers with proper protective equipment. In the meanwhile, volunteers at the Louisiana Environmental Action Network are providing workers with respirators, impermeable gloves and arm protectors. We’re still dealing with illnesses in the first responders and cleanup workers from the World Trade Center attack in 2001. It is a big mistake to put our first responders and clean up workers at risk again.

If I want to help with the clean-up, what kind of protective equipment do I need?

A half-face vapor cartridge respirator, rubber boots, and butyl rubber gloves are the minimum equipment needed if you will be in the oil-contaminated zone. Skin protection could also include Tyvek arm protectors, or a full Tyvek suit. For proper protection, it is recommended that you be fit-tested for the respirator to make sure it is adequately protecting you. We are looking for information about places where people can go to be fit-tested. A paper respirator mask and thin latex gloves will not protect you from the oil or dispersant fumes.

People are renting out rooms in their homes to the responders. Could this be a risk of possible exposure?

Yes. To limit exposure, people should not wear work shoes or boots into the house, and should have facilities where they can shower and change their clothes before going into homes. If showering and changing is not possible, then all contaminated clothing should be removed before entering the house. Oil-soaked clothing should be discarded in sealed plastic bags. Slightly soiled clothing should be laundered separately from clean clothes.

What about if they’re burning the oil offshore?

Burning will release particulate matter, which is harmful to the lungs. To check on particulate matter levels in your area, visit the EPA AirNow website. If the air is noticeably smoky or if the levels of particulate matter are high on the EPA website, avoid any strenuous activities outdoors. People with heart or lung disease, children or the elderly should consider staying indoors in an air-conditioned room and change the air-conditioner filter to make sure it is maximally effective.

What are your recommendations for how people should protect themselves?

• Avoid areas where oil can be seen or smelled. If you see or smell oil, leave the area right away.
• Avoid any direct skin contact with oil, oil-contaminated water and sediments.
• If any oil makes contact with your skin, wash it off immediately with soap and water.
• Do not fish, swim, or engage in water sports in the oil spill-affected waters.
• Young children, pregnant women, people with compromised immune systems and individuals with underlying respiratory conditions should avoid the areas near the contaminated water.
• If you experience symptoms such as headache, nausea, dizziness or throat irritation, leave the area immediately; if the symptoms do not resolve within a few minutes, seek medical attention.
• Anyone who experiences difficulty breathing, shortness of breath or other serious symptoms should seek immediate medical attention.