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As a result of the 7.2 magnitude earthquake on August 14, 2021, according to Haiti's Civil Protection agency (DGPC), 2,207 people have died, 12,268 people were injured, and 320 are missing. In the most affected departments ­ Sud, Grand'Anse and Nippes ­ around 53,000 houses were destroyed and more than 77,000 damaged. Rapid assessments reported 59 health facilities affected in Grand'Anse, Nippes and Sud Departments: 27 severely damaged and 32 slightly damaged. In the affected departments, health sector evaluators are carrying out assessments to gather data on injured patients (hospitalizations, types of injuries and demographics) and the degree of damage to health facilities and needs. Logistics and security challenges continue limiting the delivery of supplies, deployment of personnel to affected areas and the transfer of patients to hospitals that are not overwhelmed. Health sector needs include: medical personnel, medicines, supplies and stock management, mental health and psychosocial support initiatives, implementation of preventive and control measures for communicable diseases, WASH operations in health facilities and shelters, rehabilitation of injured patients, among others

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A la fecha Colombia reporta 1.334.089 casos (9.297 casos nuevos en las últimas 24h) con un incremento nacional del 0,7% en las últimas 24h y 37.117 defunciones (183 las últimas 24 Horas) con un aumento nacional del 0,5% en las últimas 24h. Los departamentos y distritos que presentaron los aumentos relativos más altos de COVID-19 en los últimos 7 días fueron: Caldas 11,9% (2.070), Quindío 11,5% (1.397), Tolima 11,5% (2.445), Norte Santander 10,3% (2.075), Boyacá 9,3% (1.302), Casanare 9,0% (504), Cartagena 8,7% (2.044), Risaralda 7,8% (1.297), Santa Marta 7,3% (765), Santander 7,1% (2.658). La tasa de incidencia nacional es de 2.648,5 casos por cada 100.000 habitantes; los departamentos y/o distritos que superan la tasa nacional son en su orden: Bogotá (4.905,8), Amazonas (3.992,7), Barranquilla (3.590,0), San Andrés (3.433,7), Caquetá (3.275,8), Antioquia (3.247,0), Quindío (3.157,9), Cartagena (3.107,4), Huila (2.713,3), Meta (2.686,8). La tasa de mortalidad nacional es de 736,9 muertes por cada millón de habitantes; se observa una tasa de mortalidad mayor a la nacional en: Amazonas (1.556,6), Barranquilla (1.375,7), Caquetá (1.169,2), Bogotá (1.110,5), Santa Marta (943,2), Córdoba (904,3), Santander (893,5), Huila (870,3), Norte Santander (865,9), Quindío (831,8), Valle del Cauca (778,9).

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PURPOSE: Although the wind, rain, and flooding of Hurricane Maria in Puerto Rico abated shortly after its landfall on September 20, 2017, the disruption of the electrical, communications, transportation, and medical infrastructure of the island was unprecedented in scope and caused lasting harm for many months afterward. A compilation of recommendations from radiation oncologists who were in Puerto Rico during the disaster, and from a panel of American Society for Radiation Oncology (ASTRO) cancer experts was created. METHODS AND MATERIALS: Radiation oncologists throughout Puerto Rico collaborated and improvised to continue treating patients in the immediate aftermath of the storm and as routine clinical operations were restored gradually. Empirical lessons from the experience of radiation therapy administration in this profoundly altered context of limited resources, impaired communication, and inadequate transportation were organized into a recommended template, applicable to any radiation oncology practice. ASTRO disease-site experts provided evidence-guidelines for mitigating the impact of a 2- to 3-week interruption in radiation therapy. RESULTS: Practical measures to mitigate the medical impact of a disaster are summarized within the framework of "Prepare, Communicate, Operate, Compensate." Specific measures include the development of an emergency operations plan tailored to specific circumstances, prospective coordination with other radiation oncology clinics before a disaster, ongoing communications with emergency management organizations, and routine practice of alternate methods to disseminate information among providers and patients. CONCLUSIONS: These recommendations serve as a starting point to assist any radiation oncology practice in becoming more resiliently prepared for a local or regional disruption from any cause. Disease-site experts provide evidence-based guidelines on how to mitigate the impact of a 2- to 3-week interruption in radiation therapy for lung, head and neck, uterine cervix, breast, and prostate cancers through altered fractionation or dose escalation.

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Objectives. To determine the number and causes of excess deaths in Puerto Rico after Hurricane Maria made landfall on September 20, 2017. Methods. We obtained monthly vital statistics data on all deaths from January 2008 through October 2017. We conducted a time-series analysis to estimate excess mortality in September and October 2017 overall and by age, sex, and cause of death. Results. We estimated a total of 1205 excess deaths (95% confidence interval [CI] = 707, 1702). Excess deaths were slightly higher among men than women (632 and 579 deaths, respectively) and found only among people aged 60 years or older (1038 deaths). Most excess deaths occurred from heart disease (253 deaths), "other" causes (204 deaths), diabetes (195 deaths), Alzheimer's disease (122 deaths), and septicemia (81 deaths). Conclusions. The number of excess deaths was similar to recent government estimates. However, this study is the first to identify the causes of death that were exacerbated by the disaster. Public Health Implications. An accurate estimation of the top causes of excess mortality can help authorities plan resource allocation for the island's recovery and for the prevention of deaths in future disasters.

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BACKGROUND: Hurricane Maria struck Puerto Rico on Sept 20, 2017, devastating the island. Controversy surrounded the official death toll, fuelled by estimates of excess mortality from academics and investigative journalists. We analysed all-cause excess mortality following the storm. METHODS: We did a time-series analysis in Puerto Rico from September, 2017, to February, 2018. Mortality data were from the Puerto Rico Vital Statistics System. We developed two counterfactual scenarios to establish the population at risk. In the first scenario, the island's population was assumed to track the most recent census estimates. In the second scenario, we accounted for the large-scale population displacement. Expected mortality was projected for each scenario through over-dispersed log-linear regression from July, 2010, to August, 2017, taking into account changing distributions of age, sex, and municipal socioeconomic development, as well as both long-term and seasonal trends in mortality. Excess mortality was calculated as the difference between observed and expected deaths. FINDINGS: Between September, 2017, and February, 2018, we estimated that 1191 excess deaths (95% CI 836-1544) occurred under the census scenario. Under the preferred displacement scenario, we estimated that 2975 excess deaths (95% CI 2658-3290) occurred during the same observation period. The ratio of observed to expected mortality was highest for individuals living in municipalities with the lowest socioeconomic development (1·43, 95% CI 1·39-1·46), and for men aged 65 years or older (1·33, 95% CI 1·30-1·37). Excess risk persisted in these groups throughout the observation period. INTERPRETATION: Analysis of all-cause mortality with vital registration data allows for unbiased estimation of the impact of disasters associated with natural hazards and is useful for public health surveillance. It does not depend on certified cause of death, the basis for the official death toll in Puerto Rico. Although all sectors of Puerto Rican society were affected, recovery varied by municipal socioeconomic development and age groups. This finding calls for equitable disaster preparedness and response to protect vulnerable populations in disasters. FUNDING: Forensic Science Bureau, Department of Public Safety, and Milken Institute School of Public Health of The George Washington University (Washington, DC, USA).

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A crescente ocorrência de desastres naturais na contemporaneidade e o aumento de sua intensidade e gravidade colocam o desafio, para gestores, profissionais e população, do preparo para enfrentá-los, considerando as medidas que devem ser tomadas em relação a vulnerabilidade. Organizações internacionais indicam a necessidade de maior consciência da importância da redução de desastres, a fim de tornar as comunidades resilientes ao risco natural. Este artigo tem por objetivo apresentar uma reflexão sobre asimplicações para a enfermagem, baseada nos tipos de vulnerabilidade. A situação de desastre mobiliza vários atores, representantes da sociedade civil organizada, serviços de saúde, os quais desempenham papel relevante na prevenção, preparo, resposta e reconstrução. Essas situações têm repercutido internacionalmente, devido à disseminação de informações a respeito da vulnerabilidade das vítimas. Para o enfrentamento dessas problemáticas, apresentamos as implicações para a enfermagem nesses cenários, visto que esses profissionais compõem os recursos humanos da área da saúde em qualquer nível de atenção. Sua atuação deve dar-se tanto no preparo como na resposta à situação de desastre, que demanda atendimento imediato, eficaz e de qualidade, a fim de minimizar o risco às vítimas.

The increasing occurrence of natural disasters in contemporary times and their increased intensity and severity bring the challenge, for managers, professionals, and the population, to be prepared for facing them, considering the measures that must be taken regarding vulnerability. International organizations point out the need for greater awareness of the importance to reduce disasters, in order to make communities resilient to natural hazards. This article aims to present a reflection on the implications for nursing, based on the types of vulnerability. The disaster situation mobilizes various actors, representatives of the organized civil society, health services, which play a significant role in prevention, preparation, response, and reconstruction. These situations have reverberated internationally, due to the dissemination of information regarding the vulnerability of victims. To face these problems, we introduce the implications for nursing in these scenarios, since these professionals make up the human resources in the health care field at any level of care. Their work must be observed both in the preparation and response to a disaster situation, which demands immediate, effective, and good quality attention, in order to minimize risk to victims

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