Hurricane Andrew devastated South Florida with winds in excess of 160 miles per hour after it entered the peninsula on August 24, 1992. Following the hurricane and the initial recovery efforts, we noticed a change in the pattern of certain disease states. The following study was conducted to define the changing disease patterns in the immediate aftermath of Hurricane Andrew.

A retrospective epidemiologic survey was conducted to assess objectively the frequency of respiratory and other illnesses in a NW area of Dade. All the diagnoses of discharged patients who were treated at the Emergency Department of Palmetto General Hospital were codified for the months of September and October, 1990, 1991, and 1992. The data from previous years during the months of interest with regards to the post Hurricane Andrew epidemiology, was used as a baseline for the frequency of the illnesses studied.

The increase in the number of cases seen was due in part to the greater number of patients who sought emergency services. There was, however, a disease specific increase in the rate of URA's from 22.2 per 1000 ER patients in 190-91 to 35.5 per 1000 in 1992 in the two months studied. This higher than expected rate suggests  that persons who usually are not ill with these illnesses became sick during the study interval and sought medical attention in the emergency department. Since some private medical offices were closed in the interval because of lack of electricity and/or running water, some of the increase may have been related to the fact that the emergency department was the only place available for care. On the other hand, most areas in NW Miami-Dade County had running water and electricity by the middle of September 1992. The number of patients with asthma increased from 44 in 1990 to 84 in 1992.

The results are indicative of an increase of 160% in the number of patients treated for respiratory ailments during the study interval (September and October 1992). The number of patients treated monthly increased from 197 to 311 for the two months in question in 1990-91 and 1992 respectively (P <0.01). The two groups of illnesses found to be most responsible for the epidemic where upper respiratory afflictions (URA) (nasopharyngitis, sinusitis, pharyngitis, tracheitis, bronchitis and bronchiolitis) and asthma. The number of cases of URA increased from 95.5 to 193. The rate for the prevalence of asthma in this population also increased from 11 per 1000 ER  patients in 1990 to 16 per 1000 in the previous 2 months (P<0.05).

The prevalence of various other diseases studied in the same time interval and location did not vary appreciably. Since the features of the population and location studied have not changed appreciably over the past 3 years. Therefore, an environmental factor is blamed for of the epidemic. Environmental changes in the wake of Hurricane Andrew may be due to changes in the pollen, molds and other natural air contaminants. Since open burning fires in urban populated areas were prevalent in Dade during the two months of 1992 studied, it is certain that the population was exposed to the byproducts of open burning. This is felt to have resulted in an undue risk of respiratory illnesses for the community. Since the emergency phase of such practice is now past, aside from the important cost containing measures publicly discussed recently, the health effects of open burning should be high in the priorities of all regarding debris disposal practices.

Although the county's DERM  Lab has monitored several sites for pollution, the present epidemic suggests that the locations of sampling may not be representative to the population at risk or that unknown, unmeasured pollutants have been generated. In view of these findings, it is suggested that: open burning be banned, that further data be obtained in other areas of the county particular in the South Dade neighborhoods, that a search be made for other health hazards to which our community may be at risk at this time, and that it is reasonable to ask for federal funds to preserve the health of our community.

An unequivocal increase in the number of patients afflicted with respiratory illnesses during the months of September and October. 1992 can be attributed to changes in the environment after Hurricane Andrew, in particular to the open burning of debris. These data were made available to the local press including The Miami Herald but were deemed not publishable. At that time, these data were the first made public in this epidemic which with serious implications for the entire community. It is felt that these observations may be useful in the future management of community emergencies in which large quantities of debris may be subjected to burning and thusly increasing the level of chemical and particulate pollutants in the atmosphere resulting in an increase in the rate of respiratory illnesses.