How Tech Aided Tuberculosis Control After Hurricane Harvey

Tuberculosis culture. Image has been resized. Courtesy of CDC/Dr. George Kubica, Wikimedia Commons.

In the run-up to a hurricane, public health agencies and healthcare organizations prepare for and aim to prevent another sort of disaster: a tuberculosis (TB) outbreak. Regional and local health department, officials use established protocols to monitor patients, medication adherence, and more.

After a number of devastating hurricanes over the past decade, the CDC appears to have pinned down best practices for such events, a set of guidelines that was tested this year in Texas. Hurricane Harvey hammered the Lone Star State for roughly a week in late August, killing at least 82 people and causing $180 billion in property damage. But the TB results were promising, showcasing the potential of cemented procedures and high-tech video solutions, according to officials.

“During Hurricane Harvey, the high proportion of patients successfully managed through video-enabled [directly observed therapy] (DOT) demonstrates that video-enabled DOT can help ensure TB treatment completion when regular treatment options have been disrupted by a major storm or other disasters,” CDC officials and their local partners wrote in the agency’s Morbidity and Mortality Weekly Report.

The Texas Department of State Health Services uses state and federal dollars on TB surveillance, prevention, and control programs in 8 regions, 31 local health agencies, and 4 “binational” projects, according to the authors. Prior to Hurricane Harvey, these programs enacted anti-TB protocols, ensuring that patients have their drugs and health departments have those individuals’ contact information. Officials monitored and accounted for patients, whose treatment durations often go longer than expected after storms, to make up for missed doses. Information sharing among various agencies, according to the CDC, is also key.

But this time around, the agency made further use of video-enabled DOT, meaning that workers kept an eye on more TB patients than is typical after hurricanes, according to the CDC. Patients and officials used electronic devices, like smartphones, in a telehealth-driven move built on lessons learned during Hurricane Katrina, in 2005.

After Harvey, 17 local and regional health departments reported 282 high-priority TB cases, 75% of which were in 1 county, according to the CDC. Within a week after the start of the storm, public health officials had accounted for 280 of those patients, finding the remaining 2 the next week. What’s more, health agencies put 61 patients on video DOT, and 97% of them did not miss a single medication dose, according to the CDC.

The protocols seem to have worked. “Although respiratory illnesses among shelter residents were reported, no suspected cases of undiagnosed TB disease were identified,” the authors wrote, referencing people who were removed from their homes because of the storm.

Perhaps other circumstances contributed to the positive results in Texas. After Katrina struck New Orleans, for instance, half of Louisiana’s TB patients left the state, according to the CDC. But in Texas, most TB patients “typically remained close to their usual residence.”

So, what’s next for tech-centric disaster responses, particularly surrounding TB? Next year may offer new insights, as each hurricane season serves as a new proving ground, according to the CDC.