As Hurricane Ian pummels Florida with punishing winds and record storm surges, researchers released a new study finding Boston’s hospitals among the nation’s most vulnerable to hurricane flooding severe enough to restrict access to care.
Of 78 urban areas along the Atlantic and Gulf coasts assessed by the study, published Thursday in the journal GeoHealth, Boston ranked third most vulnerable — behind Miami and New York. The authors found that even a relatively weak Category 2 hurricane could render major medical centers unreachable due to flooded roads, effectively paralyzing their ability to respond to storm injuries and threatening critical ongoing care. The findings are based on factors including hurricane strength, sea level rise, predicted storm surges, and hospital locations.
A Category 2 hurricane, which has maximum sustained wind speeds between 96 and 110 mph, could flood eight Boston-area hospitals, according to the study. It would also likely flood more than 14 percent of roads within a mile of Boston-area hospitals, including Boston Children’s Hospital, Beth Israel Deaconess Medical Center in Boston, and Massachusetts General Hospital.
Though New England is less known for hurricanes than the Gulf Coast, which has left it less prepared than places like Texas, climate change is increasing the risk of hurricanes in the region. Climate models predict hurricanes will become stronger, carry greater volumes of water, and be more likely to strike further north.
“With climate change and sea level rise, we expect that regions like Boston are probably going to see more hurricanes and more severe hurricanes,” said Alexandra Tarabochia-Gast, a family physician and coauthor of the study who most recently practiced at Boston Medical Center. “Our study found that Boston hospitals are at risk of flooding, even under current sea level conditions, from hurricanes, and even relatively weak ones and that the risk increases with sea level rise.”
The implications for care, particularly in densely populated cities such as Boston, are far-reaching, the study’s authors said.
“The hospitals that appear to be flooded in our model from a Category 2 storm knock out a higher percentage of beds in proportion to the number of people in the community,” said Aaron Bernstein, interim director of The Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health, and a coauthor of the study. “Meaning that a Category 2 storm is a bigger problem for us than it is for other places.”
The authors noted that patients turned away from stricken hospitals would have to be taken to facilities farther away, potentially overwhelming them.
“You’re left with this effect that kind of ripples through the entire health care system,” said Drew Michanowicz, an environmental health scientist with P.S.E. Healthy Energy, and an author on the study.
Nationally, the study found that at least half the hospitals in 25 of the 78 areas assessed were at risk of flooding from a Category 2 hurricane, and that at least half the roads within a mile of hospitals in 18 different metropolitan areas could flood.
“A lot of people, including often health care system leaders themselves, don’t understand how vulnerable their facilities are right now to flooding, to increased heat stress, to increased wind speeds,” said Paul Biddinger, the chief of the division of emergency preparedness at Massachusetts General Hospital, who was not involved in the study.
When hospitals flood, the stakes are high. After the New Orleans levees broke following Hurricane Katrina in 2005, Memorial Hospital was incapacitated, with no power or water as temperatures rose and hospital staff struggled to find ways to evacuate patients. After the storm passed, dozens of bodies were recovered.
After Hurricane Harvey struck Houston in 2017, dumping an unprecedented amount of rain, researchers looked at how patients who were receiving radiation therapy for cancer were affected. Leticia Nogueira, a senior principal scientist with the American Cancer Society, wrote in a 2019 study that those patients were less likely to survive, and that even a delay in treatment of two days could have life or death implications.
“I thought first about radiation therapy, but if you think about people who need dialysis, who have chronic kidney conditions, they’re going to be impacted by more frequent flooding events, too,” said Nogueira, who did not participate in the new study.
Based in Tampa, Nogueira had recently evacuated her home due to Hurricane Ian. “I think it’s time that we all need to wake up that climate change may impact all of us,” she said. “Nobody’s safe, and we all need to be working together to address this issue.”
The study’s authors are hoping that their work will help prompt awareness and lead emergency planners and hospitals to consider the risks they face and how to coordinate care ahead of time.
“It’s really kind of striking to think that this is the new status quo, of these hugely catastrophic hurricanes,” said Michanowicz. “When I think about the contribution of climate change, these moments are very salient in terms of the climate and health nexus.”