Applying Lessons Learned from Caribbean Disasters to Improving Healthcare Resilience to Climate Risk in Miami, Florida

Summary: Hurricane Maria, a category 4 storm, arrived in Puerto Rico in 2017, knocking out power to the entire island of 3.2 million people. Power remained out in areas for months, taking scores of primary care operations offline, interrupting the pharmacy supply chain, and diverting outpatient care to hospital systems. Initial death tolls were reported as low as 64. Multiple subsequent studies demonstrated deaths downstream of the disaster due to power interruptions in the thousands. Similarly, Hurricane Dorian, which hit the Bahamas in 2019, stayed over a populated island for more than 24 hours as a category 5 hurricane, causing widespread infrastructure destruction of its primary healthcare system and prolonged power loss. Primary care delivery was further interrupted shortly thereafter by the COVID-19 epidemic, resulting in compounding disaster and increased mortality from chronic conditions, as well as population migration seeking primary health services. Both hurricanes resulted in large-scale international relief efforts, much of which focused on implementing resilient power infrastructure. Miami-Dade County sits on the southern tip of the peninsula of subtropical Florida. With a rapidly growing population of 2.7 million people, it is uniquely susceptible to flooding, heat, and hurricanes. Much of the county’s population is served by governmentally subsidized health care. An interruption in care in primary healthcare centers due to closures, particularly for vulnerable populations, including patients reliant on power-supplied durable medical equipment, will be deadly. The University of Miami, who launched long term responses to both hurricanes, is proposing to add solar energy microgrids and batteries to reduce the post-disaster burden on inpatient healthcare systems, and reduce morbidity from chronic illness, as well as reducing carbon emissions for a cost savings overall to the healthcare system, developing the concept of the “medical resilience hub,” to offset reliance in disaster on tertiary care centers and relief agencies.