response- INFECTIOUS DISEASE AND NATURAL DISASTER
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response-INFECTIOUSDISEASEANDNATURALDISASTER.docxDamien Oneal
May 5 9:44am
Reply from Damien Oneal
Epidemiology in Disaster Response: The 2023 Turkey-Syria Earthquake
Turkey-Syria Earthquake Overview
On February 6th, 2023, an earthquake with a magnitude of 7.8 struck the Kahramanmaraas province of southeastern Turkey on the East Anatolian Fault at 4:17 a. m. This was closely followed by a second magnitude of 7.5 along the East Anatolian Fault. This two seismic sequence impacted an estimated 13.5 million people in eleven Turkish provinces and at the same time devastated the northwestern region of Syria, a territory that has been impacted by a decade of civil war (Yildrim, 2024). The fact that the earthquake occurred at pre-dawn hours maximized fatalities since residents were sleeping in structurally deficient buildings, which rendered over 50,000 people confirmed dead in Turkey and up to 8,000 in Syria (Yildrim, 2024). This simultaneous transnational disaster caused one of the most complicated multi-state emergency healthcare responses, exposing the systemic preparedness gaps.
Health Consequences at the Population Level
The earthquake caused an acute influx of crush injuries, traumatic amputations, and respiratory distress due to the inhalation of dust. The implications of the disaster at the population level were not only limited to immediate trauma, but the mass displacement of about three million people in Turkey increased the risk of communicable diseases outbreaks such as cholera, hepatitis A, and respiratory infections (Mavrouli et al., 2023). Also, the pre-existing malnutrition and failed health systems in Syria increased the rate of fatality in cases by a great degree. The Mental health sequelae such as post-traumatic stress disorder, major depressive disorder were secondary epidemics that afflicted the survivors and first responders. The resulting disrupted access to medications to treat hypertension, diabetes, and epilepsy led to further breakdown of continuity of care across the populations.
Concepts of Epidemiology in Assessing Disaster Preparedness
Epidemiologic methods are necessary to determine disaster preparedness and health outcomes. Population-representative estimates of vulnerability could have been generated through rapid needs assessment with standardized instruments, such as the Standardized Monitoring and Assessment of Relief and Transitions methodology (Rhythy et al., 2026). Also, evidence-based pre-positioning of medical supplies and evacuation planning would have been possible through the mapping of seismic risk zones, hospital capacity, and the burden of chronic diseases using the geographic information system mapping. Moreover, syndromic surveillance systems that monitor crush-related acute kidney injury and clusters of respiratory illnesses would have provided a way of making real-time decisions on resource allocation. The basic intelligence required to turn reactive disaster response into anticipatory, equity-based preparedness action is epidemiologic profiling of pre-disaster conditions, such as malnutrition rates in Syria and the high elderly population in Turkey.
Concepts of Epidemiology in Mitigating Negative Health Effects
Population health models and epidemiologic concepts should be applied in the process of mitigation and recovery. Under-detection of communicable diseases within the displaced population is reduced by active case-finding strategies, such as deploying community health workers with rapid diagnostic tools (Schoch-Spana et al., 2022). Also, the analysis of social determinants highlights subgroups with compounded vulnerability, such as pregnant women, older adults, persons with disabilities, and undocumented Syrian refugees that faced systematic barriers to accessing help. Additionally, the longitudinal epidemiologic cohort follow-up can be used to track trauma-related chronic conditions, such as cardiovascular exacerbation and long-term mental health deterioration. Finally, integrating health equity indicators into post-disaster monitoring systems is essential so that resources could be allocated based on the need instead of being distributed based on geographic or political accessibility.
Nursing Leadership Roles in Mitigating Negative Health Outcomes
Nurses hold indispensable leadership role across the disaster management spectrum. In resource-constrained field hospitals and mobile health units, advanced practice registered nurses are the primary care providers. In this regard, nurse leaders organize interdisciplinary emergency response units, implement triage guidelines, and are incident command system liaisons, which makes systematic prioritization of care (Alotaibi et al., 2024). Also, nurses provide epidemiologic surveillance and psychological first aid, which is trauma-informed, and advocate biased populations in the context of humanitarian policies. Mentoring of novice nurses in times of crisis and developing institutional surge capacity are some of the key inputs towards enhancing community resilience and population recovery.
References
Alotaibi, T. M. M., Alqahtani, F. W., Majrashi, E. B., Alqahtani, F. A. F., Alshammari, A. O. H., Al-Mutairi, N. M. A., Alanazi, N. H., Alrukhaimi, A. R., Almutairi, S. S., Almushtah, F. S. A., Alqhtani, E. S. A., Khalid, B. A. S., Almutairi, A. M., Alenazi, B. G., & Almotiri, S. M. M. (2024). Nursing practice in emergency care settings: Evidence-based approaches. The Review of Diabetic Studies, 253-268. https://doi.org/10.70082/1q6pfy61Links to an external site.
Mavrouli, M., Mavroulis, S., Lekkas, E., & Tsakris, A. (2023). The impact of earthquakes on public health: A narrative review of infectious diseases in the post-disaster period aiming to disaster risk reduction. Microorganisms, 11(2), 419. https://doi.org/10.3390/microorganisms11020419Links to an external site.
Rhythy, T. R., Xu, Y., & Hu, D. (2026). Understanding socioeconomic and psychological vulnerabilities in post-disaster recovery: Insights from the displaced New Orleans residents survey. International Journal of Environmental Research and Public Health, 23(3), 368. https://doi.org/10.3390/ijerph23030368Links to an external site.
Schoch-Spana, M., Ravi, S. J., & Martin, E. K. (2022). Modeling epidemic recovery: An expert elicitation on issues and approaches. Social Science & Medicine, 292, 114554. https://doi.org/10.1016/j.socscimed.2021.114554Links to an external site.
Yildrim, A.K. (2024, October 10). Lessons from the 2023 Kahramanmaraş earthquake. Baker Institute. https://www.bakerinstitute.org/research/lessons-2023-kahramanmaras-earthquake
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MG
May 5 3:47am
Reply from Mobolanle O Greene
Main Post
Infectious Disease and Natural Disaster
Selected Natural Disaster: 2023 Maui Wildfires, Hawaii
In August 2023, catastrophic wildfires driven by Hurricane Dora’s winds and prolonged drought conditions swept through
Maui, Hawaii. The historic town of Lahaina was almost completely destroyed, with 100 confirmed deaths, more than 2,200 structures damaged or lost, and roughly 7,000 residents displaced (Hawaii Emergency Management Agency, 2023). Power failures, contaminated municipal water systems, and limited evacuation routes intensified the crisis, making it one of the deadliest U.S. wildfires in over a century.
Health Consequences at the Population Level
The health impacts of the Maui wildfires extended well beyond the initial burn injuries and fatalities. Acute mortality was primarily related to smoke inhalation, thermal injury, and inability to evacuate in time (Centers for Disease Control and Prevention [CDC], 2024). In the days and weeks that followed, emergency departments reported sharp increases in visits for asthma, chronic obstructive pulmonary disease exacerbations, and cardiovascular events due to prolonged exposure to fine particulate matter in wildfire smoke (Holm et al., 2023). The mental health burden was also substantial, with survivors, first responders, and children showing elevated rates of post-traumatic stress disorder, depression, and anxiety. Native Hawaiian communities were disproportionately affected due to cultural ties to land and greater housing loss (Yoshikawa et al., 2024). Environmental damage created additional risks. The municipal water system in Lahaina was contaminated with benzene and other volatile organic compounds, leading to “unsafe water” advisories and concerns about both acute gastrointestinal illness and long-term cancer risk (Hawaii Department of Health, 2023). The destruction of the community’s only health clinic and local pharmacies disrupted chronic disease management for conditions such as diabetes, hypertension, and end-stage renal disease, increasing the likelihood of secondary complications and preventable hospitalizations.
Using Population Health and Epidemiology to Assess Preparation and Outcomes
A population health framework emphasizes the social determinants that shape vulnerability before, during, and after disasters (Kindig & Stoddart, 2023). Epidemiologic tools could have improved assessment of both preparedness and outcomes in Maui. Geographic information systems combined with census data would have identified Lahaina’s high concentration of older adults, residents with limited English proficiency, and tourists as groups at elevated risk for evacuation failure. Real-time syndromic surveillance of emergency department visits for respiratory complaints would have provided faster estimates of smoke-related morbidity and helped direct N95 distribution and clean-air shelter resources (CDC, 2024). After the fire, rapid needs assessments such as the CDC’s Community Assessment for Public Health Emergency Response (CASPER) could be used to systematically estimate household displacement, medication access, and mental health needs, ensuring that relief efforts match actual community-level demand rather than assumptions (Schnall et al., 2022).
Using Population Health and Epidemiology to Mitigate Negative Health Effects
Epidemiologic concepts also guide mitigation. Risk stratification allows public health officials to prioritize interventions for people with preexisting respiratory disease, limited mobility, or dependence on electrically powered medical devices before wildfire season begins (Holm et al., 2023). Biomonitoring of populations exposed to contaminated water helps establish long-term cancer surveillance registries and informs remediation priorities. At the population level, brief validated screening tools such as the PC-PTSD-5 can be deployed in shelters to identify individuals at high risk for chronic psychiatric sequelae and connect them to early treatment (Yoshikawa et al., 2024). Applying a health equity lens is essential, because Native Hawaiians experienced disproportionate housing loss and displacement. Mitigation therefore requires culturally tailored outreach, rebuilding policies that prevent permanent displacement, and investment in community-based primary care to reduce future vulnerability.
Nursing Leadership Roles in Mitigating Negative Health Outcomes
Nurses hold unique leadership positions in disaster mitigation because they bridge clinical care, community trust, and health systems knowledge. Nurse leaders should be included in local emergency planning committees to ensure that evacuation and shelter protocols account for medically fragile populations, medication storage, and access to dialysis (Veenema et al., 2022). During response, public health nurses often lead rapid assessment teams and shelter health screenings, collecting epidemiologic data that directly inform state and federal resource requests (American Nurses Association, 2023). In the recovery phase, nurse case managers play a critical role in tracking displaced patients with chronic conditions, reconciling medications, and re-establishing continuity of care to prevent avoidable complications. Nurses also function as trusted risk communicators, translating complex information about air quality, water safety, and mental health resources into clear, culturally appropriate guidance for affected communities. Finally, nurse leaders advocate for policies that address social determinants such as affordable housing and access to care, recognizing that reducing everyday inequities is one of the most effective ways to decrease morbidity and mortality in future disasters (Langan et al., 2023).
References
American Nurses Association. (2023). Disaster preparedness and response for nurses. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/
Centers for Disease Control and Prevention. (2024). Wildfire smoke and public health.
https://www.cdc.gov/air/wildfire-smoke
Hawaii Department of Health. (2023). _Lahaina water system unsafe water advisory. https://health.hawaii.gov/mauiwildfires/
Hawaii Emergency Management Agency. (2023). 2023 Maui wildfire after-action report. https://dod.hawaii.gov/hiema/
Holm, S. M., Miller, M. D., & Balmes, J. R. (2023). Health effects of wildfire smoke in children and public health tools: A narrative review. Journal of Exposure Science & Environmental Epidemiology, 33_(1), 1–20. https://doi.org/10.1038/s41370-021-00358-3
Kindig, D., & Stoddart, G. (2023). What is population health? _American Journal of Public Health, 113_(4), 380–383. https://doi.org/10.2105/AJPH.2022.307169
Langan, J. C., Lavin, R., Wolgast, K. A., & Veenema, T. G. (2023). Nursing’s role in securing population health equity in disaster preparedness and response. _Health Emergency and Disaster Nursing, 10_(1), 12–20. https://doi.org/10.24298/hedn.2022-0011
Schnall, A. H., Wolkin, A. F., Roth, J. J., & Ellis, E. M. (2022). Community assessments for public health emergency response (CASPERs): Current practice and future directions. _Disaster Medicine and Public Health Preparedness, 16_(5), 2132–2139. https://doi.org/10.1017/dmp.2021.123
Veenema, T. G., Lavin, R. P., Griffin, A., Gable, A. R., Couig, M. P., & Dobalian, A. (2022). Call to action: The case for advancing disaster nursing education in the United States. _Journal of Nursing Scholarship, 54_(5), 604–613. https://doi.org/10.1111/jnu.12749
Yoshikawa, H., Chaudry, A., & Rendall, M. (2024). Mental health impacts of the Maui wildfires: Implications for disaster response. _JAMA Network Open, 7_(2), e2356211. https://doi.org/10.1001/jamanetworkopen.2023.56211.
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