![]() ![]() Among 27 high-priority patients with active TB, 19 (70%) were accounted for within 15 working days and all 27 (100%) within 21 working days after the hurricane. PRTB resumed minimal operations on the fifth day after Hurricane Maria passed, with few staff members able to report for duty, and prioritized contacting patients receiving treatment for active TB. The Puerto Rico Department of Health recommended that shelters implement screening procedures for infectious diseases, such as rabies, TB, leptospirosis, and others, at the time of entry. In anticipation of the hurricane, as specified in its preparedness plan, PRTB provided all patients receiving treatment for active TB with a 1-month supply of anti-TB medications before the hurricane and encouraged patients to tell health officers at shelters about their diagnosis if they had to be relocated from their homes. However, the widespread and extended interruption in power and wireless communication made vDOT unavailable after the hurricane. Beginning in mid-2016, PRTB had transitioned some patients from self-administered or directly observed therapy to video-observed therapy (vDOT) using a smartphone. PRTB uses directly observed therapy as the standard of care to ensure adherence to treatment. The Puerto Rico Department of Health Tuberculosis Control Program (PRTB) conducts tuberculosis (TB) surveillance and control activities through six regional clinics, directed by a central office in San Juan. Although the island’s entire population was affected by Hurricane Maria, the poorer, more remote, and economically disadvantaged communities, as well as those with larger numbers of bedridden and elderly persons, fared worse ( 4) because they had less access to already depleted health care services, more fragile homes, and no alternative means for electricity generation. The devastation led to declaration of a major disaster, just 10 days after a similar declaration for Hurricane Irma, a Category 5 storm that left 1 million Puerto Ricans without electricity after its center passed approximately 57 miles north of Puerto Rico ( 2, 3). On the sixth day after the event, 58 (84%) of 69 hospitals on the island had no electric power or fuel for generators ( 1). The storm destroyed electricity and communication systems, left large areas without water service, and caused widespread damage to critical infrastructure, transportation, health care, and agriculture. The study provides insight into the sensitivity and recovery of vegetation after a major land-falling hurricane, and may lead to improved vegetation protection strategies.On September 20, 2017, Hurricane Maria made landfall in Puerto Rico as a Category 4 storm, with sustained winds of 130–156 miles per hour, and 15–40 inches of rain causing catastrophic flash floods. For Dominica, where the whole island is within Hurricane Maria’s radius of maximum wind, the vegetation damage has no obvious relationship to elevation or distance. ![]() The results show that (1) there is a sudden drop in NDVI values after Hurricane Maria’s landfall (decreased about 0.2) which returns to near normal vegetation after 1.5 months (2) different land cover types have different sensitivities to Hurricane Maria, whereby forest is the most sensitive type, then followed by wetland, built-up, and natural grassland and (3) for Puerto Rico, the vegetation damage is highly correlated with distance from the storm center and elevation. ![]() Moreover, the changes in the normalized difference vegetation index (NDVI) in the year 2017 are compared to reference years (20). In this paper, multitemporal Landsat 8 OLI and Sentinel-2 data are used to investigate vegetation damage on Dominica and Puerto Rico by Hurricane Maria, and related influencing factors are analyzed. As the worst natural disaster on record in Dominica and Puerto Rico, Hurricane Maria in September 2017 had a large impact on the vegetation of these islands. ![]()
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