autoimmune
Hurricane damage in Puerto Rico leads to fears of drug shortages nationwide.
Two weeks after Hurricane Maria hit Puerto Rico, manufacturers are rushing to get their plants on the island back on line to avoid production problems.
Hurricane Damage in Puerto Rico Leads to Fears of Drug Shortages Nationwide
By KATIE THOMAS and SHEILA KAPLANOCT. 4, 2017
A factory owned by the pharmaceutical company Mylan, which makes the childhood leukemia drug methotrexate, in Caguas, P.R., is one of 80 drug manufacturing plants struggling to stave off shortages of critical medicines in the aftermath of Hurricane Maria. Credit Erika P. Rodriguez for The New York Times
Federal officials and major drugmakers are scrambling to prevent national shortages of critical drugs for treating cancer, diabetes and heart disease, as well as medical devices and supplies, that are manufactured at 80 plants in hurricane-ravaged Puerto Rico.
Pharmaceuticals and medical devices are the island’s leading exports, and Puerto Rico has become one of the world’s biggest centers for pharmaceutical manufacturing. Its factories make 13 of the world’s top-selling brand-name drugs, from Humira, the rheumatoid arthritis treatment, to Xarelto, a blood thinner used to prevent stroke, according to a report released last year.
With business of nearly $15 billion a year at stake in Puerto Rico, drug companies and device makers are confronting a range of obstacles on the island: locating enough diesel fuel for generators to run their factories; helping their employees get to work from areas where roads are damaged and blocked, electricity is down and phones don’t work. Companies have taken out radio ads pleading with workers to check in. The pharmaceutical and device industries contribute to the employment of nearly 100,000 people on the island, according to trade groups.
“Some of these products are critical to Americans,” Scott Gottlieb, the commissioner of the Food and Drug Administration, told a congressional panel this week. “A loss of access could have significant public health consequences.”
Dr. Gottlieb, who visited F.D.A. staff in Puerto Rico last week, told the House Energy and Commerce Committee’s subcommittee on Health: “We have a list of about 40 drugs that we’re very concerned about. It reflects maybe about 10 firms.”
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Thirteen of the drugs, Dr. Gottlieb said, are “sole-source,” meaning the product is made only by one company. Those include H.I.V. medications, injectable drugs and sophisticated medical devices, although he did not name the products. The biggest problem, he said, was not damage to the factories, but the instability of the electric supply. Manufacturers are worried that a long-term lack of connection to a major power grid could jeopardize their products, and are also wary of relying on the more limited electrical grids that the territory is likely to activate as a first step to restoring power.
One of the drugs F.D.A. officials said they were concerned about was methotrexate, which treats childhood leukemia and other diseases. It has been scarce, off and on, for several years. Mylan makes the product in Puerto Rico, and all five manufacturers of the injectable form of the drug have reported shortages of the product, according to a list maintained by the American Society of Health-System Pharmacists.
In a statement, Mylan did not address the methotrexate shortage but said it was “working closely with F.D.A. to help address drug shortage concerns.” Its plant has sources of water, electricity and communication, and the company said it is “working on ways to make them sustainable for manufacturing purposes.” Like other companies, it said it was focusing on helping employees and other residents of the island with basic needs, including chartering a cargo plane carrying essential goods to deliver to them.
Several pharmaceutical and medical device companies said that their factories were coming back on line with the assistance of generators and that they did not anticipate supply shortfalls. But others said the situation was precarious. Drug companies depend on consistent refrigeration to avoid shortages. And device makers are wondering when the power grid would be back up, which some officials have predicted could take months.
“Everybody is struggling to get diesel fuel — that’s just widespread,” said Antonio Medina, an independent consultant who until last year was executive director of the Puerto Rico Industrial Development Company, a government-run group that promotes manufacturing.
Wilberto Maldonado, a pharmaceutical consultant in Puerto Rico, said drug and device makers were navigating a logistical “nightmare,” especially when trying to get access to fuel for their generators.
With phone lines down, “many employers have people still unaccounted for,” Mr. Maldonado said in a message through LinkedIn. “This may not improve, as telecom service providers are also depending on backup generators.”
Industry officials have sought to strike a delicate balance in making their case for help without appearing to divert precious resources from hospital and other emergency services. Returning the drug and device industry to its feet, however, is crucial for ensuring the island’s economic recovery as well as safeguarding the supply of medicines and devices to the rest of the United States.
If the manufacturing plants are slow to fully recover, some companies could shift their production elsewhere, said Deepak Lamba-Nieves, research director at the Center for a New Economy, a nonpartisan economic think tank in Puerto Rico. “That may have medium and long-term consequences for an island that is going to be hugely and severely impacted by this hurricane for many years to come,” he said.
Lobbyists and executives from health care companies met Tuesday with the Department of Health and Human Services and the Federal Emergency Management Agency to make their pitch for assistance.
Photo
Fallen wires hung just outside the Mylan facility on Wednesday. Challenges to getting the drug manufacturers up and running again include locating diesel fuel to power their generators and helping their employees get to work in areas where roads are blocked, electricity is down and phones don’t work. Credit Erika P. Rodriguez for The New York Times
AdvaMed, the trade group for the device makers, said its requests included priority access as the electricity grid is restored.
“Even if companies are fine now with diesel fuel, we want to make sure we’re in the queue in terms of priority,” said Greg Crist, a spokesman for AdvaMed. “Because if there is an electricity shortage well into November, for example, how can we as an industry make sure we are in line for those priorities, once you’ve taken care of hospitals and essential needs?”
While AdvaMed has outlined its members’ challenges, its pharmaceutical counterpart — the Pharmaceutical Research and Manufacturers of America — provided fewer specifics and referred questions to Healthcare Ready, an industry group that is coordinating the recovery operations in Puerto Rico.
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Several drug companies said that while their plants lost power and were forced to shut down, they were not anticipating a disruption in supply. “We have a strong local team working through incredible logistical challenges, and we’re seeing progress each day,” said Ernie Knewitz, a spokesman for Johnson & Johnson. Tylenol and Prezista, an H.I.V. drug, are among the products that the company manufactures in Puerto Rico. “We are also closely monitoring our product inventory levels and will work to ensure all critical needs are met.”
The industry’s rosy outlook, presumably offered in part to assure nervous shareholders, contrasted with the concern expressed by Dr. Gottlieb.
“We know that the grid is going to be unstable for a long period of time,” Dr. Gottlieb said. “The generators were never meant to operate for months and months on end.”
Erin Fox, a drug shortage expert at the University of Utah, said she and other hospital pharmacists were monitoring the situation, and were worried that the storm’s impact could exacerbate the United States’ already dire drug-shortage problem.
Ms. Fox said companies typically do not disclose where they manufacture their drugs because it is considered a trade secret. Several companies declined to list which products they made in Puerto Rico.
“Because we have no transparency around that,” she said, “it’s actually hard to know the true impact of this.”
Baxter, a medical-supply company, has said that it is limiting shipments of products made in Puerto Rico to conserve its supply, including small bags of dextrose and saline, which are used by hospitals to prepare medication. Hospitals will be limited to their typical monthly shipment to prevent some institutions from stockpiling the products.
Ms. Fox said hospitals rely on these small bags of saline solution to mix medicines for patients, and “an allocation doesn’t guarantee that you will get some.”
A few years ago, Baxter was at the center of a shortage of large saline bags that led to state and federal investigations into its business practices.
Baxter said that its three manufacturing sites in Puerto Rico sustained “some damage,” and that “limited production activities” had resumed at all of its plants.
Puerto Rico has been a hub of drug manufacturing for decades — companies were lured to the island because of tax breaks and its access to the United States market, along with skilled employees who worked for lower wages. About a decade ago, expiring tax incentives led to a wave of factory closings, stoking fears that the industry was in jeopardy.
Today, the drug and device industries remain a mainstay of the Puerto Rican economy. Pharmaceutical and medical manufacturing accounted for nearly three-quarters of Puerto Rico’s exports in 2016, of $14.5 billion, according to the federal Bureau of Labor Statistics.
“These are some of the best jobs,” Mr. Medina said.
Dr. Gottlieb hopes the companies stay there.
“A highly skilled, highly dedicated and highly productive Puerto Rican work force enables the success of the industry,” Dr. Gottlieb said. “If they decide to relocate after this disaster, it would jeopardize the island’s economic future.”
A version of this article appears in print on October 5, 2017, on Page A1 of the New York edition with the headline: Drug Shortages Are New Concern In Wake of Storm. Order Reprints| Today's Paper|Subscribe
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Steve 4 hours ago
Its plant (Mylan) has sources of water, electricity and communication, and the company said it is “working on ways to make them sustainable...
Kittredge White 4 hours ago
How generous, how sweet! It's really funny how no one gave a hoot about PR until corporate bottom lines were at risk...
Mountain Dragonfly 4 hours ago
Great time to put some money into getting these operations back up and running. Would be a political win as it would provide JOBS!!!! and...
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What we get wrong about Lyme disease.
The stories we tell about the epidemic get things backward.
BIOLOGY ENVIRONMENT
What We Get Wrong About Lyme Disease
The stories we tell about the epidemic get things backward.
BY KATHARINE WALTER
OCTOBER 5, 2017
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My sister Camilla and I stepped off the passenger ferry onto the dock at Vineyard Haven, Martha’s Vineyard’s main port, with a group that had already begun their party. They giggled, dragging coolers and beach chairs behind them. We competed to see how many items of Nantucket red we could spot.
Not that we were wearing any. Camilla wore shorts with white long underwear underneath, and I wore beige quick-dry hiking pants. Both of us had on sneakers with long white socks. It was late June, perfect beach weather. The water sparkled. But we weren’t headed toward the ocean. We were there to hunt for ticks.
On the island, we hopped in a cab. Camilla looked longingly out the window as we passed the turns for the town beach and Owens Park Beach. The driver pointed out the location of the famous shark attack beach from Jaws. We drove on south to Manuel Correllus State Forest, an unremarkable park in the center of the island and the farthest point from any beach.
THE GLAMOUR OF IT ALL: Camilla Walter harvesting deer ticks on Prudence Island, in Rhode Island’s Narraganset Bay. Tick collecting made Popular Science’s 2004 list of worst science jobs.Courtesy of the author
Deer ticks, or blacklegged ticks, are poppy-seed sized carriers of Lyme disease. We needed to collect 300 before the last ferry returned to Woods Hole, Massachusetts that night. We each unfurled a drag cloth—a one-meter square section of once-white corduroy attached to a rope—and began to walk, dragging the cloth slowly behind us as if we were taking it for a stroll. The corduroy patch would rise and fall over the leaves and logs in the landscape, moving like a mouse or a chipmunk scurrying through the leaf litter. Ticks, looking for blood, would attach to the cloth. Every 20 meters, we’d stoop to harvest them.
Tick collecting made it to Popular Science’s 2004 list of worst science jobs alongside landfill monitor and anal wart researcher. On cool days, though, sweeping the forest floor, kneeling to pluck ticks from corduroy ridges, the job became rhythmic. I felt strangely close to the forest. As I soon found out, the work got me closer to people, too.
The wilderness that we’ve feared, romanticized, and valorized is a fantasy.
Sometimes hikers would stop by, curious, then repulsed. They would want confirm the proper way to pull off ticks (with tweezers planted close to skin, perpendicularly), or to tell us about their diagnoses. Lyme disease isn’t like many of the diseases studied by my friends in the epidemiology department, where I was a doctoral student. No one talks about their grandmother’s syphilis infection, caused by Treponema pallidum, another spirochete bacterium.
But once people heard what Camilla and I were collecting, stories of brushes with ticks and family members’ diagnoses were shared freely. I quickly became the “tick girl.” When I started my dissertation I was preoccupied by the ecological question: How have humans altered the environment and triggered a disease emergence? By the time I finished, I realized that far more interesting were the rich and revealing tick stories shared with us along the way.
Illness makes us talk. “This is true of all forms of pain and suffering,” Arthur Kleinman, an anthropologist and physician at Harvard University, told me. We talk about illness “to seek assistance, care, and in part to convey feelings about fear, anxiety, or sadness.” In his book, The Illness Narratives, Kleinman writes that “patients order their experience of illness … as personal narratives.” These narratives become a part of the experience of being sick. “The personal narrative does not merely reflect illness experience, but rather it contributes to [it].”
The result is a peculiar togetherness. Once, a friend’s mom emailed that she’d just pulled off her first tick of the season, from her pubic hair: “I’m guessing it doesn’t it surprise you to hear, Katie, that you came to mind almost immediately when I discovered the little bugger? I’m afraid that ticks and you will be forever linked in my mind.” Naturally some took the motif too far. One creepy grad student thought that, because I was standing in front of a tick poster at an academic conference, I’d want to hear about the time he pulled a tick off his dick.
By dosing ourselves, we gain control.
The country singer Brad Paisley romances the tick: “I’d like to see you out in the moonlight / I’d like to kiss you way back in the sticks / I’d like to walk you through a field of wildflowers / And I’d like to check you for ticks.” I’m with Paisley here. Creeps aside, tick grooming is an act of love. My sister and I were diligent in the tick checks we gave ourselves and each other. Most nights, we’d pull off several at the campsite showers.
Tick stories mostly fell into a few categories. There were the boastful ones. On Washburn Island, a tiny island a few hundred yards off of Cape Cod, two hairy, fully-bearded park rangers, Steve and Steve, couldn’t be bothered to pull off their ticks. For most of the summer, they lived outside in tents and tarps and always had a few handfuls of ticks embedded in their skin. The Steves boasted that they’d each been infected with Lyme disease and babesiosis, a parasitic illness also carried by deer ticks, on and off for the last several years. Theirs was a backcountry machismo, as if their burliness made them immune to the intrusion of the forest twigs and ticks upon their bodies. Their symptoms, though, were presumably as real as anyone else’s.
The bulk of people’s reactions to the disease reflected a confused anxiety about boundaries. En route to a wedding in Easton, Connecticut, deep in Lyme country, someone found out that I was a tick girl and asked if they should be worried. The wedding was on a farm, an edge habitat where weedy species—mice, chipmunks, and robins—proliferate. Weedy animals include some of the best hosts for the Lyme disease bacterium. They can be infected with a tick bite and pass on the bacterium to the next tick that feeds on them, continuing unbroken chains of transmission. Deer, which are also hosts for ticks, thrive in these fragmented habitats, too.
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I recited my usual tick check endorsement: Shower and check yourselves at the end of the night and you’ll be fine. The Lyme bacterium is only transmitted after the tick has been attached for two or three days. Still, when guests filled the lawn for corn hole and cocktails, I couldn’t help but notice all the cocktail dresses and open heels, ankle-deep in grass. The next morning, one woman told me she’d plucked three ticks from her ankle.
Worry bled to fear. On Cuttyhunk Island, the most remote of the Elizabeth Islands, a necklace of islands spilling off of southern Cape Cod, my sister and I were generously hosted by a woman I’ll call Susan, a self-trained student of the Lyme epidemic. “Ticks have become the bane of island existence,” Susan gravely told me shortly after I arrived. By 2010, everyone Susan knew on the island was taking doxycycline, the antibiotic most commonly prescribed for Lyme disease. She and her husband arrive in Cuttyhunk at the start of the summer season armed with bottles of it and take it prophylactically. Every time they pull off a tick, they take three doses, spread over 24 hours. This is not recommended by the CDC (the Centers for Disease Control and Prevention). Doxycycline makes your skin sensitive to the sun, so their regimen makes it necessary to wear a hat and lots of sunscreen or stay inside.
Susan fenced in her lawn to keep out rabbits, which can host adult ticks, then raised the fence to defend against deer. “Our house is ringed with Damminix tubes, the yard fenced, grass mowed short, and still they turn up in the bed with us,” she told me. (Damminix tubes hold cotton infused with an insecticide that kills ticks.) We slept in her son’s room, crisp and nautically themed and lined with file cabinets full of scientific articles about Lyme disease epidemiology and ecology, local and national reporting on the epidemic, and printed email exchanges with epidemiologists and local politicians. Susan is now spearheading the island’s Tick Eradication Campaign. Her plan for eradication was ambitious, she admitted. But, she asks: “Wouldn’t it be nice to be able to say that you are stepping onto a tick-free island where a sunburn is the most dangerous health risk?”
The idea that the natural and human exist in separate realms is the very “trouble with wilderness,” the environmental historian William Cronon wrote in his 1995 book Uncommon Ground. The wilderness that we’ve feared, romanticized, and valorized over the last few hundred years, he says, is a fantasy:
[Wilderness] is quite profoundly a human creation—indeed, the creation of very particular human cultures at very particular moments in human history … Wilderness hides its unnaturalness behind a mask that is all the more beguiling because it seems so natural. As we gaze into the mirror it holds up for us, we too easily imagine that what we behold is Nature when in fact we see the reflection of our own unexamined longings and desires.
In the stories told by our doctors, our parks, and the CDC, ticks are invaders. To defend ourselves, we use insect repellent, clothing, and prophylactic antibiotics; fences, signs, and pesticides. “When it comes to pesticides, the environmental toxin par excellence, Lyme patients are often its greatest proponents,” writes Abigail Dumes, an anthropologist at Michigan State University. We prefer the risk posed by pesticides to the fear of Lyme, Dumes explained to me. They let us become actors instead of victims. By dosing ourselves with pesticides (or antibiotics), we gain control of our risks. Ticks, on the other hand are uncontrollable. “It’s difficult to live with the idea that there are enormous threats and many can’t be controlled,” Kleinman tells me.
The problem is our defensive barriers aren’t working particularly well. Deer ticks are now established across 45 percent of United States counties. Their range has more than doubled in the last 20 years. Reported cases of Lyme disease have more than tripled since 1995 and the CDC estimates that more than 300,000 Americans fall ill each year. The story of tick-as-invader isn’t particularly helpful—or complete.
LYME EMERGES: Allen Steere and Stephen Malawista published these maps of Lyme disease in 1979, just two years after it had been named. They noted a correspondence between disease clusters and areas where two species of black-legged ticks were known to exist.Courtesy of the author
In November 1975, Polly Murray, an artist living in Lyme, Connecticut, contacted the Connecticut State Department of Public Health. Two of her children were sick with what doctors called juvenile rheumatoid arthritis, a disease of joint pain. Their knees were so swollen that they were forced to walk with crutches. Several other neighborhood children had similar symptoms. Arthritis is rare in children. And it is not normally found in clusters. So Murray kept careful notes of her children’s symptoms and compiled a list of other sick children.
At first, doctors were dismissive. But Allen Steere, a young rheumatologist at Yale-New Haven Medical Center, was curious. He began to investigate cases in Lyme, Old Lyme, and East Haddam, quiet, wooded communities just east of the mouth of the Connecticut River. Through a surveillance “grapevine,” he found 51 residents—39 children and 12 adults—in a community of 12,000 suffering from unexplained arthritis. A quarter of patients also had erythema migrans, an expanding circular rash with a pale center, also called a bullseye. In some neighborhoods, 10 percent of children suffered from this unexplained arthritis. In 1977, in the journal Arthritis and Rheumatism, Steere and his team named the set of symptoms Lyme arthritis. They called it “a previously unrecognized clinical entity.”
If anyone is an invader here, it’s us.
At that point, what caused the symptoms remained a mystery. The clustering of cases suggested the new disease was infectious, and the summertime peak of cases suggested it was spread by something in the water—picked up by swimmers—or by insects. Steere’s team tested his patients’ blood for dozens of viruses and bacteria. Nothing fit. In 1979, Steere and a colleague mapped out the first 512 cases of Lyme arthritis. The distribution of cases overlapped neatly with what was then the range of deer ticks. Many of Steere’s patients lived in wooded areas and had mentioned insect bites. But hundreds of ticks were tested and no pathogen was found.
A few years later, William Burgdorfer, an entomologist at the Rocky Mountain National Laboratories, identified a new spirochete—a corkscrew shaped bacterium, capable of spiraling through the tissues of its hosts—in ticks collected from Shelter Island, a tiny island nestled between the two pointer fingers of Long Island. Sixty percent of ticks collected on the island carried the bacterium. Soon after, spirochetes were found in the blood of people suffering from Lyme arthritis. The Lyme disease bacterium, Borrelia burgdorferi, was named in his honor. It cycles silently in forests between ticks and a group of hosts, mostly small rodents and birds. From the perspective of the bacterium, humans are dead-end hosts and play no role in the spread of disease to new areas.
The modern history of the disease is relatively short: Just 40 years have passed since it was named. This can contribute to the sense that it is a new invader into our pristine neighborhoods and parks. But where did the bacterium come from? Was it truly new? And why did it first appear in a bucolic Connecticut suburb?
Spreading ticks and migrating bacteria leave no trace on the environment. Unlike pathogens that spread strictly from human to human (like measles), we cannot trace the history of the Lyme disease bacterium from the history of human epidemics. So, in 1990, biologists turned from medical records to museums. They sifted through old ticks in entomology collections at Harvard University and the Rocky Mountain National Laboratories, testing for bacteria. They found ticks infected with B. burgdorferi collected in the 1940s in Montauk Point and Hither Hills, parks near the Hamptons on the eastern tip of Long Island. Museum collections held no ticks before the 1940s.
That effectively doubled the known history of the disease. Then, researchers turned to the hosts themselves. They snipped ear punches from mouse specimens at the Smithsonian Museum, the Natural History Museum in New York, and the Harvard Museum of Comparative Zoology. Mice from Cape Cod in the 1890s turned out to be infected. Now the disease had a century-long history. Scientists studying Ötzi, the Tyrolean Iceman, stumbled upon in 1991 by hikers in the Italian Alps, have found that he was lactose intolerant, had intestinal parasites, severe atherosclerosis—and probably had Lyme disease. This meant the bacterium likely existed in western Europe 5,000 years ago.
PIERCING: The hypostome of a deer tick is a piercing organ with recurved teeth.Ed Reschke / Getty Images
To extend the history of the bacterium further back still, my advisors, Maria Diuk-Wasser and Gisella Caccone, and I turned to the 1 million letters of the bacterium’s genome. Pathogens evolve as they spread, and their genome carries a historical record of this development. By comparing pathogen genomes collected from different areas, we can build an evolutionary tree and a history of the pathogen’s spread. We can also tell how big the population of pathogens is now, and whether it is growing. This is the crux of phylogeography: Use evolutionary relatedness to answer questions about biogeography, the historic and spatial distribution of genetic diversity. A classic finding in the field, for example, is that the HIV epidemic originated in the French or Belgian Congo around the 1920s.
I began to chase bacteria from as wide an area and from as far back in time as possible. Biologists mailed me ticks in tiny tubes of ethanol from Michigan, Wisconsin, and Virginia. A Styrofoam container filled with dry ice and DNA samples of infected ticks collected across Canada was Fed-Exed to me. Old ticks were harder to come by. At the Yale Peabody Museum of Natural History, I pulled out drawer after drawer of taxidermied Peromyscus leucopus, white-footed mice, elegantly arranged in rows, with handwritten labels tied around their right ankles. Many were collected in the 1800s, when natural history museums were filled with hunting trophies. But the taxidermist had been tidy. The mouse skins had been cleaned of ticks. The oldest ticks I could find that were infected and had well-preserved DNA were from the early 1980s. Camilla and I added them to the 7,000 ticks from our summer harvest.
Finally, with 150 complete genomes in hand, my colleagues and I were able to extend the North American history of Lyme disease from a hundred years to many thousands. We drew a new evolutionary tree which showed that the bacterium likely originated in the northeast of the U.S., spreading south and west across North America to California. Birds likely transported it long distances to new regions, where small mammals continued its spread. Imprinted on the bacterial genomes was also a signature of dramatic population growth. As it evolved, it seemed to have proliferated.
Most interestingly, the tree was far older than we’d expected—at least 60,000 years old. Lyme was likely here in North America much longer than that, long before it was first named in the 1970s, long before humans first arrived in North America from across the Bering Strait (about 24,000 years ago), and long before the last glacial maximum, when much of North America was covered by an ice sheet (also about 24,000 years ago). If anyone is an invader here, it’s us. Our analysis also showed that the modern epidemic was not sparked by some new mutation that made the bacterium more readily transmissible. It was sparked by changes in ecology, most of which were man-made.
When colonists first arrived in New England, much of the area was forested. White-tailed deer were abundant. Deer ticks, whose distribution is closely tied to that of deer, most likely existed throughout much of the continent, too. Colonists pressed and pleated the complex fabric of New England’s forests, grasslands, and swamps into a starched blanket of fenced farmlands. Hunting and deforestation decimated deer populations. By the mid 18th-century, deer had almost entirely vanished. They never disappeared, though. Deer—and likely, deer ticks and B. burgdorferi—persisted in refugia, isolated pockets of southern Cape Cod and the far eastern tip of Long Island. Some deer populations were carefully cultivated. In 1698, hunters stocked the Naushon Island, one of the Elizabeth Islands (a few islands north of Susan’s Cuttyhunk) with deer. The island soon became a glamourous hunting destination and was purchased by the Forbes family in 1856, whose annual hunting party was attended by Ralph Waldo Emerson and Herman Melville, among others. The earliest record of a deer tick in the northern U.S. was on Naushon Island in 1926.
Beginning in the mid 1800s, farming gradually shifted westward and New England slowly reforested. But only shreds and slivers of forest were allowed to regrow. Deer populations rebounded and the animal spread across a transformed, suburban New England, one in which wolf predators had been exterminated, and where deer hunting was strictly limited. Ticks followed the deer, and B. burgdorferi followed the ticks. The sprawling grassy suburban lawn adjacent to a forest patch is the ideal Lyme disease habitat. The majority of tick-borne infections occur here because excellent hosts for B. burgdorferi also thrive in these manufactured edge habitats. More recently, climate change has been warming our winters, accelerating ticks’ life cycles and extending their range eight miles farther north each year.
The genetic and ecological history of the Lyme disease bacterium make it clear: Neither ticks nor the bacterium are invaders onto our pristine landscapes. They are the beneficiaries of an artificial and fragmented ecology created by the real invaders, us. Having sectioned and sliced the continent into a patchwork, we are confronted with the consequences. “Many of the individuals I spoke with during the course of my fieldwork moved to or remained in forested suburbs to be ‘close to nature,’ ” writes Dumes. “But ‘after Lyme,’ many described an experience of becoming ‘prisoners of their own paradise.’ ”
We’ve built structured domestic spaces on the periphery of the natural world to help us keep alive our fantasy of a wilderness that is pristine but kept at a safe distance. Ticks put the lie to that fantasy. They make us pay attention. They force us to notice and explore the freckles and spots of dirt on our ankles and our partners’ ankles. They force us to observe the spaces around us. They are rude reminders that there is no such thing as wilderness untouched by humans or humans detached from nature.
That’s a better story than tick-as-invader. This history doesn’t offer a tidy answer for how to stem the epidemic. But it shows us that our modern response to Lyme disease—to build more boundaries—echoes the impulse that created the epidemic in the first place. It’s not a just problem with Lyme. I defended my doctoral work earlier this year and am now studying another artificial boundary—the one between prisons and the free world—that is creating another epidemic: tuberculosis. My study sites have moved from Martha’s Vineyard to Brazilian prisons, but in a few ways, the new disease stories I’m encountering are alarmingly familiar.
Katharine Walter is a postdoctoral fellow at Stanford University.
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Puerto Rico’s slow-motion medical disaster.
Hurricane Maria left a ruined island and 16 Puerto Rico residents dead. But public health experts worry that figure could climb higher in the coming weeks, as many on the island fail to get medicines or treatment they need for chronic diseases.
Hurricane Maria left a ruined island and 16 Puerto Rico residents dead. But public health experts worry that figure could climb higher in the coming weeks, as many on the island fail to get medicines or treatment they need for chronic diseases. Roads are blocked, supplies are stuck at the ports, and only 11 of Puerto Rico’s 69 hospitals are open. Doctors at one children’s hospital were forced to discharge 40 patients this week when their generator ran out of diesel fuel.
But the immediate need for treatment is only the beginning of the island's public health challenges. With the island’s entire power grid knocked out, Puerto Rico’s massive pharmaceutical manufacturing industry—which provides 30 percent of the island’s gross domestic product and 90,000 jobs—has been shut down. FDA administrator Scott Gottlieb announced this week that his agency is trying to shift production to the mainland US to prevent shortages of cancer drugs, immunosuppressants for transplant patients, and medical devices for diabetes patients. Bringing Puerto Rico back online will make a big difference for people living both on—and off—the island.
In the short term, energy is essential to keeping patients alive. Medicines like insulin to treat diabetes or tetanus vaccines need to be kept cool. That means either in a refrigerator at 45 degrees Fahrenheit (for seasonal flu or tetanus vaccines) or at room temperature, which is about 72 degrees (for insulin). But without air conditioning, Puerto Rico’s tropical climate is hitting the upper 80s this week. “Refrigeration and cold storage are really big issues, and will be for the forseeable future,” says one former federal emergency response official who asked not to be identified.
The patients most affected by the failing cold chain will be those with chronic conditions. One-fifth of Puerto Rico's population has some kind of disability, including half of those above age 65. Its 3.5 million residents have the highest prevalence of diabetes in the United States—nearly 13 percent compared to 8.7 percent on the US mainland. That helps make Puerto Rico the most vulnerable US territory to a natural disaster like Hurricane Maria, according to a recent study by the Association of State and Territorial Health Officers .
Federal health officials say they are already seeing patients come into emergency clinics with chronic disease related problems. “People with the most dire need are dialysis patients,” says Lt. Cmdr. Garrett Martin-Yeboah of the US Public Health Service and the national clinical pharmacist to the Department of Health and Human Service’s assistant secretary for emergency preparedness and response. “They are on a good number of prescription medications. Because of the volume of medications and tenuousness of their condition, those are some of the patients we are concerned about.”
The immediate refrigeration problem is solvable. Martin-Yeboah said a squad of federal emergency care doctors who were stationed on the island before Maria struck brought battery-powered mini-fridges that can run four days without power. They also brought their own diesel generators—though a week after the storm left, there is still not enough fuel to run them. “There are some challenges in Puerto Rico with fuel and things like that,” says Martin-Yeboah, who coordinates medicines and supplies for HHS doctors. “We’ve had to go to the airport to retrieve medical supplies,” she says. “Our suppliers can get them to Puerto Rico, but can’t get it to the site.”
The Navy hospital ship Comfort, which was finally dispatched this week, may also help in the short-term, especially for trauma patients. The converted supertanker will bring 1,000 beds, 12 operating rooms, a CAT-scan, and radiology capabilities to Puerto Rico. Meanwhie, emergency responders are using ham radios to reach some communities and even considering air-dropping medicines into villages, according to Nicolette Louissaint, executive director of Healthcare Ready, a group that coordinates post-disaster medical supply chain between public agencies and private suppliers such as pharmacies and drug manufacturers.
“The most important part is how we support the patients,” Louissant says. “These disaster responses are massive logistical operations. We have to do unusual things. Folks are looking at how you can get up to the mountains, and what solutions to move medicines to people but also people to medicines.”
Louissant noted that less than 10 percent of the island’s pharmacies were open as of Wednesday. Overall, there is no panic over medicines, according to health officials working in Puerto Rico. But they are prepared for the situation to worsen if conditions don’t improve quickly. Chronic diseases like cardiovascular disease and diabetes are often not counted in the final toll of natural disasters like Hurricane Maria. “These people end up dying from things that are preventable under ordinary circumstances,” said the former federal emergency official. “That’s what is going to start happening.”
But long-term, the effects of Puerto Rico's collapse may ripple far beyond the island. Twelve of the top 20 global pharmaceutical and biotechnology companies have manufacturing facilities on the island, according to the Puerto Rico Industrial Development Company. As a result, Puerto Rico manufactures seven of the top 10 drugs sold globally including AstraZeneca's cholesterol treatment Crestor, Abbvie arthritis drug Humira, and Johnson & Johnson-owned HIV drug Prezista, USA Today reported. Those three companies have said supplies of their drugs are in good shape and drugmakers are working to get production up and running. Still, Puerto Rico officials say it may be months before the island's power grid is fixed.
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Farmer wants a revolution: 'How is this not genocide?'
Health comes from the ground up, Charles Massy says – yet chemicals used in agriculture are ‘causing millions of deaths’. Susan Chenery meets the writer intent on changing everything about the way we grow, eat and think about food.
The kurrajong tree has scars in its wrinkled trunk, the healed wounds run long and vertical under its ancient bark. Standing in front of the homestead, it nestles in a dip on high tableland from which there is a clear view across miles and miles of rolling plains to the coastal range of south-east Australia.
Charles Massy grew up here, on the sweeping Monaro plateau that runs off the eastern flank of Mount Kosciuszko, an only child enveloped by the natural world, running barefoot, accompanied by dogs and orphaned lambs. Fifth generation, he has spent his adult life farming this tough, lean, tussock country; he is of this place and it of him. But when his friend and Aboriginal Ngarigo elder Rod Mason came to visit he discovered that a lifetime of intimately knowing the birds, trees and animals of this land wasn’t significant at all.
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The tree is probably a lot older than 400 years. Rod told him that when the old women walked their favourite songline tracks they carried seeds of their favourite food and resource plants, and sowed them at spirituality significant camping places. His front garden was one such ceremony place – there would have been a grove planted, and the women had stripped the bark from the tree to make bags and material. This old tree represented a connection to country “deeper than we can imagine, and linking us indivisibly with the natural world”, he writes in his book Call of the Reed Warbler: A New Agriculture – A New Earth.
Part lyrical nature writing, part storytelling, part solid scientific evidence, part scholarly research, part memoir, the book is an elegant manifesto, an urgent call to stop trashing the Earth and start healing it. More than that, it underlines a direct link between soil health and human health, and that the chemicals used in industrial agriculture are among the causes of modern illness.
It makes a world war look like a little storm in a teacup. And we are in denial
“Most of our cereal crops, the soybeans, the corn, are all predicated now on the world’s most widely used chemical which is glyphosate [Roundup],” Massy says. “There is mounting evidence that it is one of the most destructive chemicals ever to get into the system. Its main effect is on the human gut and our entire immune system.
“When you look at the As – autism, ADHD, all the other auto-immune diseases – their take off is a 95% correlation to these chemicals being introduced. The evidence is that it affects the gut and the immune system, though it is not the sole factor, and it is a complex thing. But it is that gut that drives our whole immune system, it is our second brain.”
Roundup in a supermarket
‘There is mounting evidence that it is one of the most destructive chemicals ever to get into the system,’ Charles Massy says of Roundup. Photograph: Rene van den Berg/Alamy
He says that when you spray insects with insecticides you kill off the predators so you have got to have more powerful chemicals next time because the pests come back stronger. “Roundup is now on its sixth or seventh phase.”
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Massy is among scientists who believe we have entered a new geological epoch, the life-threatening Anthropocene, where human impact has permanently altered the Earth’s geology and sustaining systems, causing ecological destruction and extinction of species. “It is the greatest crisis the planet and humanity has ever faced,” he says, sitting at his kitchen table in country New South Wales. “It makes a world war look like a little storm in a teacup. And we are in denial.”
Tall, lean, fit, with white hair crowning a face that has spent a life outdoors, Massy looks more like the establishment grazier he is rather than a powerful advocate for revolutionising everything about the way we farm, eat and think about food. We are at a tipping point, he says, and if we it ignore we are “history”.
Massy spent eight years going to his office in an outbuilding behind the house in the early hours of morning to write before a day of working on the farm; the 569-page book is his life’s work; the big picture, the long view both historical and into the future that pulls together the latest international scientific research and thinking on climate change, regenerative farming, industrial agriculture and the corporations driving it.
He writes: “While consuming more resources than the Earth’s systems can replenish, we are hurtling towards multiple calamities. We are degrading the air we breathe, denaturing the food we eat and water we drink and lacing them with a witch’s brew of deadly poisons.”
We have lost touch with the land, we manipulate the Earth to our own ends, we dominate it and are ultimately destroying it. Aboriginal people, he says, saw it differently, as something to be nurtured and nourished, a living entity. He calls their custodianship “one of the greatest ever sustainable partnerships between humankind and the ecosystems they occupied”.
Farmer and author Charles Massy
The farmer, scientist and author at home on his property, Severn Park. Photograph: Mike Bowers for the Guardian
Then white Australians brought what he calls the mechanical mind and the European mind. “It is a totally different continent to anywhere else in the world. It works totally differently to that young landscape of Europe with humidity and rich soils. Until we throw off the European mechanical mind we are going to continue to stuff the joint. It is not something inanimate that you can belt. It is almost like being with a lover, you have got to nurture it and care for it.”
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Now 65 and “a fossil” Massy is, by his own admission, a “biophilia”, filled with the wonder and delight of nature. “I believe one cannot gain true ecological literacy without a great empathy with, and understanding of, nature and how it functions. Thus one’s heart also needs to be involved.”
But his own journey and awakening was slow and stumbling. He was at university when, at the age of 22, his father had a heart attack and he came home to manage the merino and cattle property. Well-intentioned and diligent he read the books, he sought advice, he learned. “I thought I was running a pretty good show.” His wool was being bought for fabric by “the top guys in Italy. We were the first group to breed animal welfare-friendly sheep.” But he now realises he was “blind” and “oblivious”, he saw the landscape “as if through a glass darkly”.
He writes: “I completely overlooked the most important of all factors, the keystone of the whole operation: that our farm was a complex and dynamic series of ecological systems, and that our landscape actually functioned in specific but sensitive ways.” He made mistakes; he assiduously ploughed a paddock just before a huge storm came and washed the topsoil away, “I had cost the landscape perhaps a thousand years of topsoil.” Like many other regenerative farmers he reached the conclusion he had to make a big shift when something “cracked” his mind open.
If people ate truly nutrient-rich food out of healthy soil, you would slash the national health bill straight away
For Massy it was the years of drought, 1979 to 1983, that plunged him into depression and major debt. He finally understood that he needed a completely different mindset and management approach if he was going to come to terms with the reality of drought. “The land, soils, micro-organisms and other creatures and vegetation are adapted to this,” he writes. And so he began his journey towards enlightenment. After 35 years he went back to university and completed a PhD in human ecology, consulting everyone from scientists to Aboriginal elders.
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We are driving in his ute across the plateau, cloud shadows dancing across the big-sky landscape, kangaroos and wallabies bouncing along, kelpies on the back to muster the healthy sheep. The paddocks are strewn with great monolithic rocks, 400m years old. There are birds and wildlife that have returned since he became a holistic farmer. Deep in the soil the bugs, microbes and fungi are sourcing nitrogen and nutrients. Change has to literally be grassroots, food health comes from the ground up, the health of people is entwined with the health of landscapes and soil. “The minute you fertilise and spray all that biology is gone. The vital thing about regenerative or organic farming is this healthy living dynamic soil. Landscapes with diverse arrays of plants are nutrition centres and pharmacies with vast arrays of primary and secondary compounds.”
As the dogs bound away to herd the sheep, he says, “One of the big ideas I discovered going back to uni was this concept which I came to, that our natural complex systems will self-organise themselves back to health. I think it is one of the biggest ideas. I think it is as big as evolution. It has only just emerged with physics and chemistry and computers and stuff. The Earth itself it is a self-organising regulating system.”
The human element is the problem, the learning how to live tuned to its rhythms, to get out of its way, to listen to the land. “I say confidently that not many farmers can read the landscape. For them to change they have got to admit they have been wrong for most of their lives. The thing that is challenging about it is that you have got to be totally flexible to adjustment and really get your mind into how nature works and be able to change tactics.”
He tells the story of the grasshoppers. Before he began holistic grazing the property was regularly hit by plagues of wingless grasshoppers. “They turned an OK season into instant drought. They thrive under degrading management, bare ground provides them with egg beds. But once we began our biodiverse plantings plus holistic grazing we have not had a grasshopper attack since.
The entrance to Charles Massy’s property
The entrance to Severn Park: ‘Now we have got 10 invaluable native grass species I never thought I would see on our property,’ Massy says. Photograph: Mike Bowers for the Guardian
“Ecological grazing yields total ground cover, higher cover, deeper roots, more moisture absorption plus more biologically alive soils; it means nematodes and other creatures eat the grasshopper eggs. You get excited when you see a new plant species suddenly emerge again. Now we have got 10 invaluable native grass species I never thought I would see on our property.”
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The winter nights are cold on the plateau and, with a glass of red wine and before an open fire, Massy is unrepentant about criticising the big-end-of-town companies that promote chemicals in industrial farming, and the governments that don’t act. In the book he says unhealthy food “is not just poisoning us but is also, confoundingly, making us obese as well”. Now he says “when you are eating that McDonald’s crap even though you are bloated your body is still hungry because your organs are not getting nutrients.
“If people ate truly nutrient-rich food out of healthy soil, you would slash the national health bill straight away. The big chemical companies and big food companies know exactly what they are doing. It is now causing millions of deaths – tell me why that is not genocide?”
But just as nature find its own solutions, culling, reorganising, so too is Massy offering answers, a “toolkit” of how to change.
“This combines the best of Old Organic – namely its respect, empathy and reverence for Mother Nature – with the best of modern, ecologically simpatico science and Earth-empathic thought.” The kind of people who make the change, he found, were those with strong belief in community and healthy food that does not come from contaminated soil.
Call of the Reed Warbler cover
What lies beneath “is a burgeoning mass of life and activity that is 10-fold that above the ground; fungi bacteria, and other organisms have begun to create and sustain an entirely different, living absorbent soil structure; the very heart and essence of healthy farming and landscape function. The secret is to simply restore healthy landscape function and allow nature to do the rest.”
Massy agrees that he is “not naive enough to think it would be a nice seamless shift. I think we are going to see some pretty frightening stuff.”
But for him, a defining moment came when, while sitting against an old snow gum, he heard the “beautiful, piercing song of a reed warbler” returning after a long absence from this area. It was, he says, a “metaphor for us humans to once more become the enablers, the nurturers, the lovers of Earth”.
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Facing months in the dark, ordinary life in Puerto Rico is "beyond reach."
Everyone from the governor of Puerto Rico to the mayor of San Juan is predicting that it could take four to six months to resume electrical service. For Puerto Ricans, that means empty refrigerators, campfire cooking, bathing in their own sweat and perhaps wrangling for fresh water.
SAN JUAN, P.R. — Two days after Hurricane Maria flattened this island of 3.5 million people, knocking out all its power and much of its water, the rebuilding of the services and structures needed for people to resume some semblance of ordinary life was looking more complicated by the day.
All or part of three towns in the northwestern part of the island — Isabela, San Sebastián and Quebradillas — were being evacuated Friday because of fears about structural damage to the nearby Guajataca Dam. Close to 70,000 people could be affected if the 90-year-old dam, which is 120-feet high and can hold about 11 billion gallons of water, collapsed, said Puerto Rico’s governor, Ricardo Rosselló.
And with everyone from the governor of Puerto Rico to the mayor of San Juan predicting that it could take four to six months to resume electrical service, people were contemplating empty refrigerators, campfire cooking, bathing in their own sweat and perhaps wrangling for fresh water on an island accustomed to hard times but nothing like what the future may bring.
“It’s been hard to see infrastructure deteriorate in Puerto Rico, but it has been harder to meet citizens who have lost it all,” Governor Rosselló said.
The most immediate danger was from the dam, which suffered structural damage. And finding gasoline was already a big problem. Lines for ice and gas stretched for blocks. Generators needed diesel or regular gas to work, and supplies at gas stations were quickly dwindling.
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“People will start going nuts pretty soon,” said Miguel A. Soto-Class, president of the Center for a New Economy, a nonpartisan research organization. “I don’t think it will be 'Mad Max,’ but people will be looking for diesel and gasoline, more than water even.”
The water supply was also becoming a problem. Even in San Juan, people need electricity to access water, and water is also critical to running some air-conditioning systems. At Centro Medico, a major hospital outside San Juan in Río Piedras, the emergency unit was treating patients but had no air-conditioning, said Dr. Johnny Rullán, a physician.
But the biggest long-term obstacle was the prospect of months without power.
Puerto Ricans are the first to say they can improvise — resolver — when a drought dries them up or a terrible storm knocks them down. But the idea of grappling long term without power hung like a pall over the island.
“This is really affecting me,” said Nina Rodriguez, a human resources manager in San Juan. “I have four children and the youngest is 6 months old. We are preparing for six months, maybe even a year without power.”
She added: “All the infrastructure has collapsed. Everything we had before the hurricane is beyond reach.”
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An aerial view of a flooded neighborhood in Catano, P.R., in the aftermath of Hurricane Maria. Credit Ricardo Arduengo/Agence France-Presse — Getty Images
While few places could withstand a Category 4 hurricane without extensive damage to power grids, Puerto Rico’s government-owned power company was particularly vulnerable because of a history of neglect, mismanagement, out-of-control debt and decrepit infrastructure, experts said. A monopoly by the Puerto Rico Electric Power Authority, or Prepa, was reviled by island residents long before Hurricane Maria shut it down.
“Our plants look like the cars in Cuba,” said Eduardo Bhatia, a Puerto Rican senator. They could produce power before the hurricane, but not efficiently and not cheaply.
Even though Hurricane Irma spared Puerto Rico, brushing it lightly as it whirled west two weeks ago, almost 70 percent of the island lost power. Some residents were still waiting for electricity when Hurricane Maria hit the island.
Eugenio Toro and his wife Cristina Bernal lost power Sept. 6. As a result, they felt ill prepared for Hurricane Maria. “We couldn’t freeze things,” Mr. Toro said. “We never got the light back. We did go buy a generator but there is little gas and we can only use it a few hours a day.”
So much of the damage still needs to be assessed that it is possible the power situation may turn out to be less dire than feared. On Friday, Prepa’s chief executive, Ricardo Ramos, said on CNBC that he was hopeful that the power plants — as opposed to the power lines, pylons, substations and transformers — may be intact.
“We’ve lost probably 80 percent of the transmission and distribution infrastructure,” he said, adding that crews had completed only about a third of an island-wide survey of the damage and would have more information in two days.
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He also said that important buildings on the island, including Centro Medico and a convention center now being used by emergency workers, would have their power back in two or three days.
Mr. Ramos said he shortened estimates for how long power would be out after Gov. Andrew M. Cuomo of New York arrived Friday with teams to help restore electricity. “We expect three to four months at most,” for the whole island, he said.
Getting power back to Puerto Rico will be daunting and expensive. Transformers, poles and power lines snake from coastal areas across hard-to-access mountains. In some cases, the poles have to be maneuvered in place with helicopters.
And yet it gets worse. Puerto Rico is an island, which means the tons of much-needed supplies — trucks, poles, cables, tools, spare parts, helicopters — must be shipped into Caribbean ports, making the process infinitely more cumbersome. Trained electrical workers by the hundreds will also have to be flown into Puerto Rico, where they will have to find places to stay, not an uncomplicated task.
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Fallen trees and debris in Old San Juan. Credit Erika P. Rodriguez for The New York Times
So every relief delivery can be a major event.
Mr. Cuomo and a delegation from New York arrived Friday morning with supplies that included more than 34,000 bottles of water, 500 flashlights, 1,400 cots and blankets and, perhaps most important, 10 generators.
Mr. Soto-Class said Prepa has been plagued by bungling and more recently a debt it cannot pay, a shortage of cash, and layoffs. Some of its infrastructure dates back to the 1970s, or earlier.
“When the electric power authority had the money, they mismanaged it and didn’t invest,” he said. “Now there is less money to run the authority with. This compounds it all, one on top of the other.”
By some measures, the authority, formed during the Great Depression, is the largest public electric utility in the United States, with more than 1.5 million customers. Most of the electricity it produces is generated by burning fuel oil — a dirty, outmoded source. It is virtually the last power company producing electricity that way. Hearings in the Puerto Rican Senate revealed that the authority bought sludge and then billed Puerto Rico’s unsuspecting ratepayers as if they had bought high-grade oil.
The lack of electricity also affects the water supply in certain areas. Some towns need electricity to get their water pumped in.
For now, generators are the saving grace for the lucky few who have them to crank up their refrigerator and a few fans. Some restaurants, hotels and many hospitals have operating generators. But the vast majority of Puerto Ricans on the impoverished island cannot afford them.
For older residents, the lack of power could be dangerous.
Ermerita Rosa Perez, 83, sat on her porch in San Juan praying the rosary and worrying not just about comfort but about survival.
“Four to six months without electricity?! Oh no, no, no, no, we will die,” Ms. Rosa said. “Us old people can’t make it that long. Just today, I was looking at this flooded mess and I was thinking of mopping. I said, ‘No, I can’t. I need to rest.’ I will take a cold water bath — which I’m not supposed to do, because I have arthritis — and rest.”
She worried about her health. “I am diabetic. I have high blood pressure. It’s so hot I can’t take it,” she said. “I’m an old lady, hauling pots to my carport to cook on a gas stove? It’s too much. So I sit here on my porch, trying to catch a breeze, praying to God to bring things back to normal.”
Her son, Hilberto Caban, was less panicked. He said the authorities were probably exaggerating how long the lights would be out.
“That way if it takes three weeks or a month, we’ll all say, ‘Great! Look how hard they worked!” he said.
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Hurricane Maria passed, but for two women in Puerto Rico, the terror was only just beginning.
Neighborhoods have become disaster zones, the 100-mile island covered in detritus, destruction and despair.
By Samantha Schmidt, Sandhya Somashekhar and Katie Zezima September 21 at 7:29 PM Follow @schmidtsam7 Follow @sandhyawp Follow @katiezez
LEVITTOWN, PUERTO RICO — The winds had eased, the debris was no longer soaring through the air, the chaos had subsided. Elizabeth Serrano Roldan decided to lie in her bed and rest. In her gated, middle-class community in the San Juan suburbs, it appeared Hurricane Maria had finally passed.
Then came the water.
It was murky, and sudden, and it flowed into Serrano Roldan’s home with ferocity. Needing a wheelchair to get around, she was marooned on her mattress — her 82-year-old mother was similarly trapped nearby — as the water rose a foot, then two, then more. Her bed had become an island. There was no way out and no one heeding her pleas for help.
“We called and called and called,” Serrano Roldan said. “They promised to come, and nothing happened. It kept rising and rising and rising.”
She looked to the three crosses hanging over her bed, the painting of the Virgin María on the wall. And she prayed. No storm had ever done this here, not in this neighborhood. Hurricane Maria, it seemed, was coming to get her even after it was already gone.
Neighborhoods like this one across Puerto Rico have become disaster zones, the 100-mile island covered in detritus, destruction and despair. As of Thursday afternoon, more than 24 hours after the strong hurricane’s eye had cleared out, the scope of Maria’s damage was still unknown. Much of the U.S. territory remained without power — and could lack electricity for months. Communications were in many places nonexistent.
The information that did trickle out Thursday included images of downed power lines, caved-in buildings and streets blanketed in choppy brown water. Roofs in the capital of San Juan were torn apart, leaving the interiors open to the elements. Enormous trees were pulled from the ground by their roots, and forests were stripped of their leaves.
Stark images and grave news also emerged out of other islands battered by Maria. In the island nation of Dominica, the prime minister said Thursday that at least 15 were confirmed dead and 20 more were missing in the wake of the storm, according to the Associated Press.
A car sits in the middle of a flooded street in Levittown, Puerto Rico. (Dennis M. Rivera Pichardo/For The Washington Post)
‘Oh my God’
Here in Levittown, one of the largest planned communities in Puerto Rico, the flooding was triggered after authorities opened the gates to the Rio de la Plata, in the center of the island, to bring water levels down. The action caused an artificial lake to overflow about 8 or 9 p.m. Wednesday, flooding the community of thousands and trapping residents in their homes.
Early Thursday, emergency management teams and the National Guard rescued dozens of residents, taking them to nearby shelters. But many more remained stuck in their homes with almost no cellphone reception, some of them waiting on their rooftops.
More than 30 neighbors rushed to the two-story house where Serrano Roldan lives with her mother. The neighbors, many of them elderly, needed to find higher ground, and the Roldan family’s home was the only one on the block with a second floor. The women welcomed them.
As the neighbors sought refuge in the three small rooms upstairs, along with their five dogs, Serrano Roldan stayed downstairs, in her bed. Serrano Roldan has spinal muscular atrophy and uses a wheelchair; she must be lowered into her accessible bed with a crane.
With the waters swiftly rising around her on the first floor, she prayed: “Thy will be done.”
In front of her, sleeping on a lower bed, even closer to the rising water, was her mother, Anna Roldan, weeping.
“I couldn’t leave her,” the mother said.
Elizabeth Serrano Roldan, left, and Vicente Sanabria survived the flood together at a house in Levittown with other neighbors. (Dennis M. Rivera Pichardo/For The Washington Post)
As the sun rose, the water began to slowly pull away, allowing the neighbors to start filtering back to their homes. Residents assessed the damage. Many found all of their belongings — their furniture, their cars — destroyed from the floodwater.
The flooding was a shock to Levittown residents, not only because it was unexpected but because it was unlike anything the neighborhood had experienced. It is the largest housing development in the Toa Baja municipality, and historically, it had been considered safe from hurricanes. Residents across Levittown said their homes had never before flooded.
By midday Thursday, some of the neighborhood’s most vulnerable residents still hadn’t found a way out of their wet, damaged homes.
Serrano Roldan sat in her doorway in her waterlogged, inoperable wheelchair. She was stuck, sweating in the humid, wet home, with a bandage wrapped around an open vein on her right wrist.
The gray-haired woman, a college professor at the University of Puerto Rico, was recently diagnosed with bronchitis and sepsis. Before the storm made landfall, she had been receiving IV treatment from a home nurse. She desperately needed to be taken to a hospital but could no longer make calls on her landline.
Her mother reached over to her, trying to feed her a bologna sandwich.
“I don’t have an appetite right now,” she said. “Nothing.”
Her mother, who has severe arthritis, walked slowly through the first level of the home, assessing the damage. In the bedroom, where Serrano Roldan’s butterfly collection lines the walls, nearly everything was lost. All of their clothes, dressers, bedding, all of the machines Serrano Roldan uses to get around on a daily basis, soaked in the floodwater.
“Oh my God,” the mother said.
Thursday happened to be her 82nd birthday.
‘Very perilous shape’
Puerto Rico, home to 3.5 million U.S. citizens, was still getting pelted by Maria’s outer bands Thursday as search-and-rescue operations began. The heavy rains sparked dangerous flash floods, particularly in more remote mountainous areas, which the National Hurricane Center called “catastrophic” and “life-threatening.”
The poor conditions complicated efforts to assess the full scope of damage, though authorities in Puerto Rico are already estimating that the cost could reach into the billions.
President Trump acknowledged the likelihood of severe damage. The island is in “very, very, very perilous shape,” Trump told reporters in New York during a meeting with Ukraine President Petro Poroshenko.
Across the continental United States, people pleaded for information about their loved ones on the island, sending panicked messages on social media and dialing and dialing and dialing, getting nothing but silence or busy signals.
About 5 million Puerto Ricans live on the U.S. mainland, including 700,000 in New York City and more than a million in Florida.
“People are begging for information,” Vanessa Pahucki, a teacher in New York, wrote in an email. She has not yet heard from her uncle, who is in Naguabo, on the eastern side of the island. Pahucki started a Facebook group called Loved Ones in Puerto Rico — Check In, where people are asking for updates about areas where loved ones live, and where people on the island are sharing videos.
Rep. Nydia M. Velázquez (D-N.Y.) hasn’t heard from her five siblings in Yabucoa. She did speak to a sister near San Juan who lost her home when a nearby river flooded.
“It’s terrible, but it’s the story,” she said. “We’re just getting so many phone calls. People are desperate because they don’t know. They don’t know the whereabouts, they don’t know if they are fine, and it’s terrible. This is unprecedented. This is beyond the imagination of everyone.”
Hurricane Maria passed through Puerto Rico leaving behind a path of destruction across the national territory. (Dennis M. Rivera Pichardo/For The Washington Post)
‘We’ll find someone’
Waiting with Serrano Roldan and her mother were a married couple, Barbara Terreforte and Vicente Sanabria, the last of the Levittown neighbors that had sought refuge in the home. They are both in their mid-70s, and Sanabria has diabetes.
They sat by the front door, wondering how they might get out of there. The roads were still flooded, and the only means of escape would be in a large SUV.
Terreforte’s daughter had managed to walk more than an hour to check on her parents. Around the neighborhood, scores of other Puerto Ricans trudged through knee-deep waters to check on their relatives.
With no cellphone reception, it was nearly impossible for families to communicate. Some of the Levittown residents were in shelters, but many others were still in their homes. Families drove around with their windows open, asking locals if they had seen their aunts, parents or friends. Others, on the mainland and around the world, posted messages on Facebook and Twitter. They posted coordinates, house numbers and names of their relatives in Levittown, asking authorities to please help rescue them.
Terreforte’s daughter went to fetch an SUV to try to bring her parents to safety. But Terreforte didn’t want to leave Roldan and her daughter behind.
“How do you know someone will come get you?” Terreforte asked.
“Go, don’t stay here. You’ll be safer there,” Roldan said. “We’ll find someone.”
Then, minutes later, a white SUV pulled into the driveway. It was a family friend, who had heard from Serrano Roldan’s daughter in Florida that her mother and grandmother were stranded in Levittown. The family friend offered to drive the mother and daughter to a hospital for Serrano Roldan to receive the treatment she needed.
She was “like a little angel,” Serrano Roldan said, tears forming in her eyes.
Roldan quickly grabbed what she could — clothes, essential medicines, identification — and stuffed it in one of her daughter’s butterfly-print suitcases. The family friends helped lift Serrano Roldan out of her wheelchair and into the car.
“I’ll sit with you and hold onto you,” her mother said. Then, waving to neighbors, they drove off through the flooded streets. A way out.
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Contary to what Rush Limbaugh said, hurricanes are not a liberal plot.
Everything is just fine. Is that dangerous, delusional, and irresponsible? You bet your life.
Katia and Jose? Seriously?
As if it were not bad enough that Houston is still drying out from Hurricane Harvey and South Florida is hunkered down in the face of Hurricane Irma, last week found the newly formed hurricanes Katia and Jose, respectively spinning in the Gulf of Mexico and whirling west across the Atlantic. We face multiple, simultaneous, catastrophes.
But it’s not just their timing that has some of us watching weather maps with fearful speculation. It’s also the record-shredding ferocity of the two storms that have so far impacted the United States. They’ve produced superlatives like a Donald Trump press conference.
Harvey dropped more rain on the continental United States than any storm ever has. At about the size of Texas, Irma is a behemoth, not to mention one of the strongest Atlantic storms ever recorded.
And the timing of them, combined with the historic awfulness of them, feels more sinister than simple coincidence, does it not? You find yourself wondering if this might not be a consequence of that inconvenient truth Al Gore has been warning about — if, thanks to global warming, this is just a preview of our ghastly new normal — record-breaking storms lining up like cars at a toll booth to take turns smashing the American coast.
Unfortunately for those of us craving clear cause and effect, the answer from scientists is a bit more nuanced. Asking if global warming caused all this is, it turns out, like asking if old age causes arthritis and bad eyesight. It doesn’t, but it does make those things more likely — and exacerbates them when they occur.
Not that everyone sees the same thing when they look at the weather map. Last year, right-wing radio host Rush Limbaugh said that hurricanes are actually part of a vast liberal plot. “It is in the interest of the left to have destructive hurricanes,” he said, “because then they can blame it on climate change …”
He expanded on that as Irma bore down on South Florida, opining that media and marketers were in on the conspiracy, using hurricanes to drive viewership and sales of bottled water. “So the media benefits with the panic with increased eyeballs,” he said, “and the retailers benefit from the panic with increased sales.”
Limbaugh’s lunacy reflects right-wing orthodoxy, which favors doing nothing in response to climate change on the theory it’s all an expensive boondoggle designed to victimize innocent oil and gas companies. So you get Trump pulling the country out of the Paris climate accord and Florida Gov. Rick Scott forbidding his team to even use the term “climate change.” Where the health of our planet is concerned, Republicans essentially ask us to make a wager that science is wrong.
Mind you, no one had trouble accepting science as authoritative last month when it predicted to the very minute a solar eclipse that darkened a great swath of America. But the eclipse threatened no one’s money pot. Global warming does. So conservatives pretend science is somehow suspect when it says the planet is warming because of fossil fuels. And we should accept it as just — What? Coincidence? — that the fossil fuels industry donated $55.1 million to the Republicans in 2016 alone?
That money is a wager against our one and only planet. And that feels especially obscene on a day when much of Houston is navigable by boat and a monster storm is bearing down on Florida. Nothing to see here, say the climate deniers. Everything is just fine.
Is that dangerous, delusional, and irresponsible? You bet your life.
No, actually, they do.
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