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Hurricane Katrina: An American tragedy

Article in Occupational Medicine · July 2006

DOI: 10.1093/occmed/kqj043 · Source: PubMed

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222 OCCUPATIONAL MEDICINE

doi:10.1093/occmed/kqj043

Hurricane Katrina: an American tragedy

The true extent of the American tragedy that is Hurricane
Katrina is still unfolding almost 12 months after the event
and its implications may be far more reaching. Hurricane
Katrina, which briefly became a Category 5 hurricane in
the Gulf of Mexico, began as a storm in the western
Atlantic. Katrina made landfall on Monday, 29 August
2005 at 6.30 p.m. in Florida as a Category 1 hurricane,

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turned north, gained strength and made landfall again at
7.10 a.m. in southeast Louisiana as a Category 4 hurri-
cane and rapidly attenuated over land to a Category 3
hurricane. New Orleans is below sea level as a conse-
quence of subsidence and because of elevation of the
Mississippi river due to altered flow. The storm brought
a nearly 4 m storm surge east of the eye, where the winds
blew south to the south shore of Lake Pontchartrain, and
gusts of 344 km/h at the storm’s peak at 1.00 p.m.
Levees protecting the city from adjacent Lake Pontchar-
train failed, inundating 80% of the city to a depth of up
to 8 m. Further east in the Gulf Coast, a storm surge of
10.4 m was recorded at Bay St Louis, Mississippi [1,2].
What followed was horrifying and discouraging. Poor
residents and the immobilized were left stranded in
squalor. Essential services failed. Heroic rescues were
undertaken with wholly inadequate follow-up and reset-
tlement [3]. Emergency response was feeble. It was only
after the military intervened that the situation began,
slowly, to improve. New Orleans and much of the Gulf
Coast to the east is still a depleted, devitalized, largely
uninhabitable wreck. Less than a month later, on 24
September, Hurricane Rita followed. A much stronger
storm in magnitude, Rita caused further displacement
and disruption in Texas, where evacuation measures,
undertaken in near-ideal conditions, were shown to be
completely inadequate.
Floods usually conceal more than they reveal. Hurri-
cane Katrina was an exception. It revealed truths about
disaster response in the United States that had been con-
cealed. Now, months later, one may assess the response
and recovery to the disaster, evaluate how the country
handled the challenge and determine what lessons were,
or could have been, learned.
Katrina revealed that natural disasters and public
health crises are as much threats to national security as
intentional assaults. An entire region that played a vital
role in the American economy and a unique role in the
country’s culture ground to a halt. During Katrina and

Rita, 19% of the nation’s oil refining capacity and 25%
of its oil producing capacity became unavailable [4]. The
country temporarily lost 13% of its natural gas capacity.
Together, the storms destroyed 113 offshore oil and gas
platforms. The Port of New Orleans, the major cargo
transportation hub of the southeast, was closed to oper-
ations. Commodities were not shipped or accessible, in-
cluding, in one of those statistics that are revealing
beyond their triviality, 27% of the nation’s coffee beans
[5]. Consequences of this magnitude are beyond the
reach of conventional terrorist acts.
Katrina revealed the close interconnection between
the natural environment and human health risk. The
capacity of wetlands in the Gulf Region to absorb
precipitation and to buffer the effects of such storms
has been massively degraded in recent years by local de-
velopment. This has been known for a very long time [6],
but development yielded short-term economic gain while
mitigation was expensive. Katrina also revealed that un-
derstanding the threat and the circumstances that enable
it means nothing if no concrete preparations are taken.
The disaster that struck New Orleans, specifically, was
not only foreseeable but also understood to be inevitable.
Emergency managers had participated in a tabletop ex-
ercise that followed essentially an identical scenario just
13 months before, called ‘Hurricane Pam’ [7]. Had their
conclusions and recommendations been acted upon, the
actual event may have turned out differently. Although
the levees would still have failed, perhaps those respons-
ible for safeguarding the people would not have done so.
Katrina revealed that the federal agency designed to
protect all Americans was incompetent. The Federal
Emergency Management Agency (FEMA) reached its
peak under President Clinton, when it enjoyed Cabinet-
level rank. Post 9-11 FEMA was subordinated within the
Department of Homeland Security (DHS), a department
highly focused on terrorism and intentional homeland
threats. The wisdom of combining the two was always
in doubt. The logical solution is to move FEMA out of
DHS but so far there has been no political will to do so
and FEMA is so reduced and depleted as an agency that it
probably could not now operate at a Cabinet level even
were it to have the authority [5,8].
Katrina revealed how large and resilient the American
economy has become overall. The evidence for this is
how quickly the country has returned to economic
growth and business as usual, despite the destruction of
a region once economically important [9]. Katrina dev-
astated $223 000 km [2] of the United States, an area
almost as large as Britain. Yet, with one exception, the
economy of the country barely registered an effect, even
on psychologically volatile indicators such as stock mar-
ket indices. It is projected that Katrina, as such, will only
reduce growth in GDP for the United States by about one
half of 1%. Although the southeast region served by New
Orleans is very large geographically, it constitutes only
EDITORIALS 223
1% of the total American economy [10]. The lower Mis-
sissippi region adds little of its own economic value to
GDP, other than tourism and as a source of energy.
The exception noted above, of course, was the price of
oil, as reflected in the prices of gasoline and refined
petroleum products.
Katrina revealed how marginal the Gulf Region had
become to the American economy, despite the wealth that
passes through it. New Orleans itself was a poor city—it
probably still is, although the returning citizens obviously
have sufficient resources to allow them to return—and its
neighbours in Mississippi and Alabama are not rich,
either. The region is economically significant mainly for
tourism, transshipment of cargo, oil and gas and for re-
distribution of wealth (in the form of legalized gambling).
Reconstruction efforts may even fuel an economic expan-
sion in the rest of the economy, although precious little
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prosperity resulting from it is likely to be seen in the dev-
astated Gulf itself anytime soon. Astonishingly, the com-
pounded effect of the war in Iraq, the high price of crude
oil and the direct effects of Hurricane Katrina did not set
back growth in the American economy, although it may
have kept stock market prices level to the end of 2005.
Katrina revealed the great divide that remains between
people living next to one another but differing in the clus-
tered characteristics of race, poverty, immobility and ill-
health [11,12]. Those who lacked the resources, who could
not fend for themselves, who were left behind, who hap-
pened to be sick were almost all African–American, and
therefore so were the ones who died. Relatively, well off
residents near the shore of Lake Pontchartrain also sus-
tained many deaths [2]. However, the brunt of the storm
was clearly borne by the poor and dispossessed. That this
was not intentional does not make it any more acceptable.
Honour in this dishonourable story came from the role
of rescue, medical, public health and occupational health
professionals. Rescuers took personal risks to save the
stranded citizens of New Orleans. Public health agencies
quickly identified and documented the risks of water con-
tamination [13], warned of risks from carbon monoxide
from portable generators [14], identified dermatitis and
wound infections as major health risks [15] and identified
outbreaks of norovirus-induced gastroenteritis [16]. Occu-
pational health clinics and occupational health physicians
and nurses treated the injured, from wherever they came
[17]. Occupational health professionals returned critical
personnel to work as soon as it was possible, to hasten
economic recovery and rebuilding. Occupational Safety
and Health Administration professionals warned against
hazards in the floodwaters and the destroyed, abandoned
houses but supplies for personal protection were nowhere
to be found. The American College of Occupational and
Environmental Health served as a clearing-house for in-
formation and provided almost 200 participants with web-
supported telephone training on Katrina-related hazards
and measures to get workers back on the job safely.
224 OCCUPATIONAL MEDICINE

It was not enough. No human effort could have been
by then. But what can we, as a medical speciality, do
better next time? The occupational health physician is
not, as such, a specialist in emergency medicine, an ex-
pert in emergency management and incident command
or a safety engineer, although many do have special ex-
pertise in these areas because of personal interest, prior
training or military experience. The occupational health
physician is, however, uniquely prepared to work with
management and technical personnel at the plant, enter-
prise or corporate level. We can assist in preparing for
plausible incidents, planning for an effective response,
identifying resources that will be required, and advising
on their deployment.
The occupational physician has critical roles to play in
disaster preparedness and emergency management. Our
role in disaster preparedness is distinct from those of
8. FEMA. Hurricane Pam exercise concludes. Region 4 Press
Release R6-04-93. 24 July 2004. http://www.fema.gov/
news/newsrelease.fema?id=13051 (3 January 2005, date
last accessed).
9. Samuelson RJ. Waiting for a soft landing. Washington Post
2006;167:A17.
10. Fonda D. Billion-dollar blowout. Time 2005;166:82–83.
11. Atkins D, Moy EM. Left behind: the legacy of hurricane
Katrina. Br Med J 2005;331:916–918.
12. Greenough PG, Kirsch TD. Hurricane Katrina: Public
health response—assessing needs. N Engl J Med 2005;
353:1544–1546.
13. Joint Taskforce. Environmental Health Needs and Habitability
Assessment: Hurricane Katrina Response. Initial Assessment.
Washington, DC and Atlanta, GA: US Environmental
Protection Agency and Centers for Disease Control and
Prevention, 2005.
14. MMWR. Surveillance for Illness and Injury After Hurricane
Katrina—New Orleans, Louisiana, 2005.

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safety engineering and risk managers. Our role in emer-
gency management is distinct from those of emergency
medicine and emergency management personnel. Our
roles in both are complementary, sometimes overlapping
and predicated on the value that we bring to the table as
physicians familiar with facilities. We have the means to
protect workers in harm’s way and from the many hazards
already so familiar from our daily work. Katrina demon-
strates that occupational health professionals can trans-
late experience of the ordinary to play an integral role in
dealing with the extraordinary.
15. MMWR. Infectious Disease and Dermatologic Conditions in
Evacuees and Rescue Workers after Hurricane Katrina—
Multiple States, August–September, 2005, 2005;54:1–4.
16. MMWR. Norovirus among Evacuees from Hurricane
Katrina—Houston, Texas, 2005.
17. McIntosh E. Occupational medicine response to Hurri-
cane Katrina crisis. WOEMA Quarterly Newsletter (Western
Occupational and Environmental Medical Association) 2005,
pp. 2, 7.

Tee L. Guidotti
The George Washington University Medical Center,
Washington DC, USA
e-mail: eohtlg@gwumc.edu

References
1. US National Interagency Coordinating Center. SITREP
[Situation Report]: Combined Hurricanes Katrina & Rita.
Access restricted but unclassified (3 January 2006, date
last accessed).
2. Wikipedia. Hurricane Katrina. http://en.wikipedia.org/wiki/
Hurricane_Katrina (5 January 2006, date last accessed).
3. Economist. When government fails, 2005.
4. Bamberger RL, Kumins L. Oil and Gas: Supply Issues after
Katrina. CRS Report for Congress RS222233. Washington,
DC: Congressional Research Service, Library of Congress,
2005.
5. Time 2005;166:34–41.
6. Louisiana Wetlands Protection Panel. Towards a Strategic
Plan: A Proposed Study. Chapter 5. Report of the Louisiana
Wetlands Protection Panel. Washington, DC: US Environ-
mental Protection Agency, EPA Report No. 230-02-87-
026, April 1987. http://yosemite.epa.gov/oar/globalwar-
ming.nsf/UniqueKeyLookup/SHSU5BURRY/$File/louisia-
na_5.pdf (6 January 2006, date last accessed).
7. Grunwald M, Glasser SB. Brown’s turf wars sapped FE-
MA’s strength. Washington Post 2005;129:A1,A8.

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