Why Puerto Rico’s power outages could prove very deadly, in one chart

Horrifying stories of Hurricane Maria’s impact on Puerto Rico’s sickest and most vulnerable are now trickling in: a newborn who couldn’t get a scheduled surgery for her heart defect because the storm closed down her hospital, an elderly woman with diabetes struggling to keep her life-sustaining insulin cool.

One theme underlies many of these tales: Power outages can throw health care systems into chaos. As Vox’s Brian Resnick explained, the storm knocked out power for the entire island, and six days later, most of Puerto Rico’s 3.4 million residents are still in the dark. Only 11 of Puerto Rico’s 69 hospitals currently have power or a fuel supply, and it could take up to a year to restore electricity to the island.

We often take electricity for granted, and don’t typically associate it with public health. A lot of the ways they’re tied together are hidden. But when the power is out, it becomes painfully clear how much the medical, public health, and sanitation systems rely on the electrical grid to keep people safe and healthy.

Not long ago, researchers at Public Health England decided to scan the medical literature to learn what was known about power outages and health with more extreme weather events threatening power systems around the world. They summarized their findings in the only systematic review of the research on the subject — and in this useful chart:

As you can see here, going dark has many public health implications, some of them more subtle than others.

Take water, sanitation, and sewage disposal systems, for instance, which often require electricity to operate. Right now, nearly half (44 percent) of Puerto Rico’s population is currently without potable water. Across the island, people need electricity to get clean water from the faucet and flush the toilet. They also need it to keep their air-conditioning systems running. Without it, there’s the looming risk of people getting sick from dirty water, waste that can’t be disposed, or heatstroke.

We also need electricity to cool the food supply and keep harmful types of bacteria at bay. It’s no surprise that the authors found an association between power outages and an uptick in diarrheal diseases related to food poisoning.

Just about every interaction with the health system now involves electricity, from calling a hospital for help to accessing electronic medical records and powering lifesaving equipment like hemodialysis machines or ventilators.

“Most hospitals have generator backup for only eight hours,” the researchers warned.

But in many natural disasters, such as Maria, power outages can last much longer. And when communications and transportation networks have also been damaged, gaining access to fuel for generators becomes tricky. Another related health risk: When people do access generators, they sometimes use them incorrectly; carbon monoxide poisonings often peak during extreme weather events.

So Puerto Rico’s power outages could prove deadly in more ways than one, which is why it’s so critical that the US government responds and helps restore power to the island as soon as possible. So far, the Trump administration has been criticized for not acting quickly enough, and the island’s governor has been pleading for more aid to deal with the “unprecedented disaster.”

“Given Puerto Rico’s fragile economic recovery prior to the storms,” said Gov. Ricardo Rosselló in a statement today, “we ask the Trump Administration and the U.S. Congress to take swift action to help Puerto Rico rebuild.” A faster and more robust response to rebuild the island’s power grid will also save more lives.