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Public Health in Puerto Rico after Hurricane Maria

Issue Brief
  1. Signifying that catastrophic damage will occur which, among other things, means that power outages will last weeks to possibly months and most of the area will be uninhabitable for weeks or months. See, http://www.nhc.noaa.gov/aboutsshws.php.

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  2. Robles F. Puerto Rico Deaths Spike, but Few Are Attributed to Hurricane. New York Times. November 8, 2017.  https://www.nytimes.com/2017/11/08/us/puerto-rico-deaths-fema.html?_r=0.

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  3. Information summarized from: See: Institute of Medicine (2015). Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. The National Academies Press. https://doi.org/10.17226/18996; Chandra A, et al (2011). Building Community Resilience to Disasters: A Way Forward to Enhance National Health Security. RAND Technical Report. https://www.rand.org/content/dam/rand/pubs/technical_reports/2011/RAND_TR915.pdf; Institute of Medicine (2007). Environmental Public Health Impacts of Disasters: Hurricane Katrina Workshop Summary. National Academies Press. https://doi.org/10.17226/11840; Morbidity and Mortality Weekly Report (2006). January 20, 2006 / 55(02);29-30; Malilay J (1997). Tropical cyclones. In: Noji EK, ed. The public health consequences of disasters. Oxford University Press, 1997:207–27; Kleinpeter MA, Norman LD, Krane NK (2006). Dialysis services in the hurricane-affected areas in 2005: lessons learned. American Journal of Medical Science 332(5):259-63.

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  4. US Census Bureau. Quick Facts. https://www.census.gov/quickfacts/PR.

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  5. Williams Walsh M. Puerto Rico Declares a Form of Bankruptcy. May 3, 2017. https://www.nytimes.com/2017/05/03/business/dealbook/puerto-rico-debt.html?_r=1.

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  6. US Census Bureau. Quick Facts. https://www.census.gov/quickfacts/PR.

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  7. US Census Bureau. Household Income 2016. https://www.census.gov/content/dam/Census/library/publications/2017/acs/acsbr16-02.pdf.

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  8. Department of Labor. Puerto Rico Economy at a Glance. https://www.bls.gov/eag/eag.pr.htm.

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  9. Kaiser Family Foundation. Puerto Rico: Medicaid, Fiscal Issues and the Zika Challenge. September 27, 2016. https://www.kff.org/medicaid/fact-sheet/puerto-rico-medicaid-fiscal-issues-and-the-zika-challenge/.

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  10. Shin P, et al. Puerto Rico’s Community Health Centers: Struggling to Recover in the Wake of Hurricane Maria.  Geiger Gibson / RCHN Community Health Foundation Research Collaborative, October 2017. https://publichealth.gwu.edu/sites/default/files/downloads/GGRCHN/GG%3ARCHN%20Policy%20Issue%20Brief%20%2350%20FV.pdf.

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  11. Health Resources and Services Administration. Designated Health Professional Shortage Areas Statistics, November 17, 2016. https://ersrs.hrsa.gov/ReportServer/Pages/ReportViewer.aspx?/HGDW_Reports/BCD_HPSA/BCD_HPSA_SCR50_Smry&rs:Format=PDF.

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  12. US Census Bureau. Quick Facts. https://www.census.gov/quickfacts/PR.

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  13. National Center for Health Statistics. Health, US, 2016. https://www.cdc.gov/nchs/data/hus/hus16.pdf.

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  14. CDC. Zika Case Counts.  https://www.cdc.gov/zika/reporting/case-counts.html.

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  15. Reinberg S. 'Herd immunity' may be curbing U.S. Zika numbers. Chicago Tribune, August 7, 2017. http://www.chicagotribune.com/lifestyles/health/sc-hlth-herd-immunity-zika-0830-story.html.

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  16. Chapell B. Trump Hints At A Limit On Federal Aid To Puerto Rico; San Juan Mayor Responds. NPR, October 12, 2017.  http://www.npr.org/sections/thetwo-way/2017/10/12/557353205/trump-hints-at-a-limit-on-federal-aid-to-puerto-rico-san-juan-mayor-responds

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  17. Houser T, Marsters P. America’s Biggest Blackout. Rhodium Group. October 26, 2017. http://rhg.com/notes/americas-biggest-blackout

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  18. Prakash N. Millions Of Puerto Ricans Just Lost Power Again After A Line Repaired By Whitefish Energy Failed. Buzzfeed News November 9, 2017. https://www.buzzfeed.com/nidhiprakash/most-of-puerto-rico-just-lost-power-again-after-a-line?utm_term=.npXRvRyDO#.emQ2K27X6 .

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  19. Levin J. Puerto Rico Hit by New Blackout Just as Governor Touts Recovery. Bloomberg. November 15, 2017. https://www.bloomberg.com/news/articles/2017-11-15/puerto-rico-hit-by-new-blackout-just-as-governor-touts-recovery.

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  20. Golden A. San Juan mayor: Hurricane death toll could be 10 times higher than reported. CNN November 4, 2017. http://www.cnn.com/2017/11/03/politics/san-juan-mayor-puerto-rico-the-lead-cnntv/index.html

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  21. Sutter JD. Puerto Rico's uncounted hurricane deaths. CNN. October 27, 2017. http://www.cnn.com/2017/10/27/us/puerto-rico-uncounted-deaths-isabel-rivera-invs/index.html

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  22. https://www.vox.com/science-and-health/2017/10/11/16424356/puerto-rico-official-hurricane-maria-death-toll

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  23. Robles F. Puerto Rico Deaths Spike, but New Are Attributed to Hurricane. New York Times, November 8, 2017. https://www.nytimes.com/2017/11/08/us/puerto-rico-deaths-fema.html?_r=0.  

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  24. Kroft S. Puerto Rico’s Storm of Misery. CBS News 60 Minutes. November 5, 2017. https://www.cbsnews.com/news/puerto-ricos-storm-of-misery/.

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  25. Heredia Rodriguez C, Bluth R. The Storm Has Passed, But Puerto Rico’s Health Faces Prolonged Recovery. Kaiser Health News. October 16, 2017. https://khn.org/news/the-storm-has-passed-but-puerto-ricos-health-faces-prolonged-recovery/

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  26. CDC. Advice for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and US Virgin Islands. October 24, 2017.  https://emergency.cdc.gov/han/han00408.asp.

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  27. Arroyo MP. Confirman más casos de leptospirosis. El Nuevo Dia, November 2, 2017.  http://www.elnuevodia.com/noticias/locales/nota/confirmanmascasosdeleptospirosis-2370965//

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  28. Dorell O, Nunez A. Puerto Rico's water woes raise fears of health crisis six weeks after Hurricane Maria. USA Today November 2, 2017. https://www.usatoday.com/story/news/world/2017/11/02/puerto-rico-water-woes-raise-fears-health-crisis-six-weeks-after-hurricane-maria/808672001/

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  29. Reardon S. Puerto Rico struggles to assess hurricane’s health effects. Nature. November 15, 2017. http://www.nature.com/news/puerto-rico-struggles-to-assess-hurricane-s-health-effects-1.22973.

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  30. Melia M. Raw sewage contaminating waters in Puerto Rico after Maria. Associated Press. October 16, 2017. https://apnews.com/fc9e9238f77e4053a02832040ba0ea97.

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  31. Hand M. EPA steps in as Puerto Ricans grow desperate for clean drinking water. ThinkProgress. October 16, 2017. https://thinkprogress.org/epa-focuses-on-puerto-rico-32c0a8862cdf/.

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  32. Government of Puerto Rico. http://status.pr.

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  33. Cummins E. In Puerto Rico, Surgery by Flashlight Is Just the Beginning. Slate. October 23, 2017.  http://www.slate.com/articles/health_and_science/medical_examiner/2017/10/puerto_rico_is_still_in_crisis.html

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  34. Newkirk V. Puerto Rico's Dire Health-Care Crisis. The Atlantic. October 29, 2017. https://www.theatlantic.com/politics/archive/2017/10/puerto-ricos-health-care-crisis-is-just-beginning/544210/

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  35. Shin P, et al. Puerto Rico’s Community Health Centers: Struggling to Recover in the Wake of Hurricane Maria.  Geiger Gibson / RCHN Community Health Foundation Research Collaborative, October 2017. https://publichealth.gwu.edu/sites/default/files/downloads/GGRCHN/GG%3ARCHN%20Policy%20Issue%20Brief%20%2350%20FV.pdf

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  36. Testimony of Robert Kadlec. Assistant Secretary For Preparedness and Response U.S. Department of Health and Human Services, before the Senate Homeland Security and Governmental Affairs Committee. October 31, 2017.  http://www.hsgac.senate.gov/download/10/30/2017/testimony-kadlec-2017-10-31

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  37. Health Resources and Services Administration. Designated Health Professional Shortage Areas Statistics, As of November 17, 2016. https://ersrs.hrsa.gov/ReportServer/Pages/ReportViewer.aspx?/HGDW_Reports/BCD_HPSA/BCD_HPSA_SCR50_Smry&rs:Format=PDF.

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  38. Personal Communication with HRSA staff, November 17, 2017.

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  39. Dickerson C. After Hurricane, Signs of a Mental Health Crisis Haunt Puerto Rico. New York Times. November 13, 2017. https://www.nytimes.com/2017/11/13/us/puerto-rico-hurricane-maria-mental-health.html?_r=0.

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  40. Rhodes J, et al (2010). The Impact of Hurricane Katrina on the Mental and Physical Health of Low-Income Parents in New Orleans. American Journal of Orthopsychiatry. 80(2): 237–247.

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  41. Reardon S. Hurricane Katrina’s psychological scars revealed. Nature. August 24, 2015. http://www.nature.com/news/hurricane-katrina-s-psychological-scars-revealed-1.18234.

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