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Can Congress Find the Political Will to Solve Our Flood Problems?

Insights + Opinion
A 2017 flood in Elk Grove, California. Florence Low / California Department of Water Resources

By Tara Lohan

It's been the wettest 12 months on record in the continental United States. Parts of the High Plains and Midwest are still reeling from deadly, destructive and expensive spring floods — some of which have lasted for three months.

Mounting bills from natural disasters like these have prompted renewed calls to reform the National Flood Insurance Program, which is managed by Federal Emergency Management Agency and is now $20 billion in debt.


The program was established in 1968 as a way to provide flood insurance to properties with high flood risk — some of which is subsidized by taxpayers — and to use management programs to help reduce risk.

But Jessie Ritter, director of water resources and coastal policy at the National Wildlife Federation, says the program has unintentionally done the opposite over the years. By offering government-funded insurance where private companies wouldn't, it's made it easier to build in flood-prone areas. Local land-use decisions in some places haven't helped, either.

Most people agree that some reform of the National Flood Insurance Program is needed. Four former FEMA administrators recently sent a letter to Congress asking for just that. But legislators — who disagree how to accomplish that goal — have been kicking the can down the road by issuing short-term extensions since the program's last five-year authorization lapsed in September 2017.

Most recently the House of Representatives voted May 14 to approve the 11th short-term extension. If the Senate agrees, the program would then carry on as-is until September 30.

Meanwhile homes and communities continue to flood and the insurance program's losses keep stacking up.

"In the absence of reforms, costs in taxpayer dollars and lives lost will only get worse," the former FEMA administrators wrote in their letter urging action.

It's past time to make the necessary changes, Ritter says. "Congress has been unable politically to get to a place where we can meaningfully reform this program and address some of the underlying symptoms that are making disasters so costly in our country," she said. "A perpetuation of the status quo makes no sense at a time when we are spending billions annually on relief in response to a continual string of disasters." This spring the most destructive Mississippi River floods in 25 years resulted in thousands of lost homes, damaged businesses and flooded farms.

House Financial Services Committee Chair Maxine Waters said the most recent extension, which she co-authored, gives more time for a bipartisan bill to attempt a larger reform of the program — and that this will be the last short-term extension. Waters has been a longstanding advocate for reforming the program and sponsored 2017 legislation that cancelled $16 billion of its debt, which had climbed to $30 billion that year in the wake of Hurricane Harvey and other disasters. Further reforms promised by Congress that year did not materialize.

Mapping the Flood Line

The program's growing debt is only part of the issue.

FEMA has been criticized for using outdated flood maps that don't accurately portray the risk that communities face, either now or in the near future. Kathleen Schaefer, a researcher at the University of California, Davis who spent a decade working as regional engineer for FEMA producing flood insurance maps for California, says that the current process to update maps is time-consuming, bureaucratic and costly.

And the data that the agency does have isn't granular enough to communicate property-level risk.

"One property to the next may have very different levels of risk based upon their actual elevation," explains Ritter. Soil type and land use on each property can also affect flooding. "And right now FEMA just doesn't have that level of sophistication in their flood maps."

It's not that the technology to do that doesn't exist — North Carolina is using it— but it hasn't been mandated nationally for FEMA.

Another issue is the accuracy of the maps. If a property falls into what FEMA determines is a 100-year floodplain, owners with federally backed mortgages are required to purchase flood insurance. "Some of those maps are super outdated, and that floodplain line in some places, because of climate change, is probably no longer accurate," said Ritter.

The floodplain line also creates a false sense of security for those who own property outside of it and aren't required to purchase flood insurance but may still have some level of risk. FEMA's current system reduces flood risk to "in" or "out" — black or white. "And that's not how risk works," said Ritter. "Risk is shades of gray."

Schaefer and other researchers from the UC Davis Natural Hazards Research and Mitigation Group looked at severe flooding that claimed 13 lives in the Baton Rouge area in 2016. They found that a third of the flooding was outside FEMA's 100-year flood zone.

Extensive flooding in southeast Texas from Hurricane Harvey

Photo by Penn State, CC BY-NC-ND 2.0

"Many floodplain residents and political leaders falsely believe that flooding cannot occur beyond the mapped 100-year line," the researchers wrote. "But nationwide, roughly 25 percent of National Flood Insurance Program flood-damage claims occur outside of 100-year zones."

Environmental Costs — and Solutions

It's not just bad for property owners and taxpayers. There are environmental implications, too.

"Subsidizing insurance rates inadvertently encouraged development in floodplains that never should have been developed in the first place," said Ritter. "Not only does that decrease community resilience, it impacts habitat and wildlife." Natural floodplains are incredibly rich ecosystems that support fish, birds, plants and a host of other species.

Ritter says her organization would like to see more money from the program spent trying to prevent flood damages instead of paying billions to rebuild after a disaster — especially in areas with recurrent flooding. There's also a lot of untapped potential to restore natural features such as wetlands and floodplain habitat, which can reduce flood risk, protect communities and create environmental benefits, she says.

"Where those types of nature-based approaches can work, they should be incentivized and given first consideration," said Ritter. "If communities can reduce their rates by proactively reducing their risk, then it's a win-win across the board for everyone."

Moving Forward

Having worked at FEMA, Schaefer thinks the 50-year-old federal program, tied to the congressional rulemaking process, can't provide the localized approach that's currently needed.

"Any changes that you're going to make to the program, you'd have to make on a nationwide scale," she said. "And people on the Gulf Coast think about their flood risk differently than people in California's Central Valley — you're not going to be able to find the compromise that is going to get you where you need to go."

Schaefer instead sees an opportunity for a bigger role for the private market and community flood insurance programs that would allow for more detailed modeling to assess and mitigate risk.

Climate change should be creating a sense of urgency for program reforms, said Ritter. Average temperatures are increasing and the U.S. is seeing rising sea levels in some coastal communities. It's also getting wetter — 2018 was the sixth year in a row that average rainfall in the U.S. was more than the 20th-century average. Hurricanes are predicted to get stronger with climate change and natural disasters are already costing a fortune — $91 billion in the U.S. alone last year. Hurricanes Michael and Florence accounted for $49.4 billion of those costs and resulted in more than 100 deaths.

"There is an important link between the National Flood Insurance Program and climate resiliency," said Ritter. Reforming the program "is a big opportunity to improve how we as a nation respond to and prepare for worsening impacts of climate change."

Tara Lohan is deputy editor of The Revelator.

Reposted with permission from our media associate The Revelator.

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Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Niq Steele / Getty Images

By Sherry H-Y. Chou, Aarti Sarwal and Neha S. Dangayach

The patient in the case report (let's call him Tom) was 54 and in good health. For two days in May, he felt unwell and was too weak to get out of bed. When his family finally brought him to the hospital, doctors found that he had a fever and signs of a severe infection, or sepsis. He tested positive for SARS-CoV-2, the virus that causes COVID-19 infection. In addition to symptoms of COVID-19, he was also too weak to move his legs.

When a neurologist examined him, Tom was diagnosed with Guillain-Barre Syndrome, an autoimmune disease that causes abnormal sensation and weakness due to delays in sending signals through the nerves. Usually reversible, in severe cases it can cause prolonged paralysis involving breathing muscles, require ventilator support and sometimes leave permanent neurological deficits. Early recognition by expert neurologists is key to proper treatment.

We are neurologists specializing in intensive care and leading studies related to neurological complications from COVID-19. Given the occurrence of Guillain-Barre Syndrome in prior pandemics with other corona viruses like SARS and MERS, we are investigating a possible link between Guillain-Barre Syndrome and COVID-19 and tracking published reports to see if there is any link between Guillain-Barre Syndrome and COVID-19.

Some patients may not seek timely medical care for neurological symptoms like prolonged headache, vision loss and new muscle weakness due to fear of getting exposed to virus in the emergency setting. People need to know that medical facilities have taken full precautions to protect patients. Seeking timely medical evaluation for neurological symptoms can help treat many of these diseases.

What Is Guillain-Barre Syndrome?

Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Most commonly, the injury involves the protective sheath, or myelin, that wraps nerves and is essential to nerve function.

Without the myelin sheath, signals that go through a nerve are slowed or lost, which causes the nerve to malfunction.

To diagnose Guillain-Barre Syndrome, neurologists perform a detailed neurological exam. Due to the nerve injury, patients often may have loss of reflexes on examination. Doctors often need to perform a lumbar puncture, otherwise known as spinal tap, to sample spinal fluid and look for signs of inflammation and abnormal antibodies.

Studies have shown that giving patients an infusion of antibodies derived from donated blood or plasma exchange – a process that cleans patients' blood of harmful antibodies - can speed up recovery. A very small subset of patients may need these therapies long-term.

The majority of Guillain-Barre Syndrome patients improve within a few weeks and eventually can make a full recovery. However, some patients with Guillain-Barre Syndrome have lingering symptoms including weakness and abnormal sensations in arms and/or legs; rarely patients may be bedridden or disabled long-term.

Guillain-Barre Syndrome and Pandemics

As the COVID-19 pandemic sweeps across the globe, many neurologic specialists have been on the lookout for potentially serious nervous system complications such as Guillain-Barre Syndrome.

Though Guillain-Barre Syndrome is rare, it is well known to emerge following bacterial infections, such as Campylobacter jejuni, a common cause of food poisoning, and a multitude of viral infections including the flu virus, Zika virus and other coronaviruses.

Studies showed an increase in Guillain-Barre Syndrome cases following the 2009 H1N1 flu pandemic, suggesting a possible connection. The presumed cause for this link is that the body's own immune response to fight the infection turns on itself and attacks the peripheral nerves. This is called an "autoimmune" condition. When a pandemic affects as many people as our current COVID-19 crisis, even a rare complication can become a significant public health problem. That is especially true for one that causes neurological dysfunction where the recovery takes a long time and may be incomplete.

The first reports of Guillain-Barre Syndrome in COVID-19 pandemic originated from Italy, Spain and China, where the pandemic surged before the U.S. crisis.

Though there is clear clinical suspicion that COVID-19 can lead to Guillain-Barre Syndrome, many important questions remain. What are the chances that someone gets Guillain-Barre Syndrome during or following a COVID-19 infection? Does Guillain-Barre Syndrome happen more often in those who have been infected with COVID-19 compared to other types of infections, such as the flu?

The only way to get answers is through a prospective study where doctors perform systematic surveillance and collect data on a large group of patients. There are ongoing large research consortia hard at work to figure out answers to these questions.

Understanding the Association Between COVID-19 and Guillain-Barre Syndrome

While large research studies are underway, overall it appears that Guillain-Barre Syndrome is a rare but serious phenomenon possibly linked to COVID-19. Given that more than 10.7 million cases have been reported for COVID-19, there have been 10 reported cases of COVID-19 patients with Guillain-Barre Syndrome so far – only two reported cases in the U.S., five in Italy, two cases in Iran and one from Wuhan, China.

It is certainly possible that there are other cases that have not been reported. The Global Consortium Study of Neurological Dysfunctions in COVID-19 is actively underway to find out how often neurological problems like Guillain-Barre Syndrome is seen in hospitalized COVID-19 patients. Also, just because Guillain-Barre Syndrome occurs in a patient diagnosed with COVID-19, that does not imply that it was caused by the virus; this still may be a coincident occurrence. More research is needed to understand how the two events are related.

Due to the pandemic and infection-containment considerations, diagnostic tests, such as a nerve conduction study that used to be routine for patients with suspected Guillain-Barre Syndrome, are more difficult to do. In both U.S. cases, the initial diagnosis and treatment were all based on clinical examination by a neurological experts rather than any tests. Both patients survived but with significant residual weakness at the time these case reports came out, but that is not uncommon for Guillain-Barre Syndrome patients. The road to recovery may sometimes be long, but many patients can make a full recovery with time.

Though the reported cases of Guillain-Barre Syndrome so far all have severe symptoms, this is not uncommon in a pandemic situation where the less sick patients may stay home and not present for medical care for fear of being exposed to the virus. This, plus the limited COVID-19 testing capability across the U.S., may skew our current detection of Guillain-Barre Syndrome cases toward the sicker patients who have to go to a hospital. In general, the majority of Guillain-Barre Syndrome patients do recover, given enough time. We do not yet know whether this is true for COVID-19-related cases at this stage of the pandemic. We and colleagues around the world are working around the clock to find answers to these critical questions.

Sherry H-Y. Chou is an Associate Professor of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh.

Aarti Sarwal is an Associate Professor, Neurology, Wake Forest University.

Neha S. Dangayach is an Assistant Professor of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai.

Disclosure statement: Sherry H-Y. Chou receives funding from The University of Pittsburgh Clinical Translational Science Institute (CTSI), the National Institute of Health, and the University of Pittsburgh School of Medicine Dean's Faculty Advancement Award. Sherry H-Y. Chou is a member of Board of Directors for the Neurocritical Care Society. Neha S. Dangayach receives funding from the Bee Foundation, the Friedman Brain Institute, the Neurocritical Care Society, InCHIP-UConn Center for mHealth and Social Media Seed Grant. She is faculty for emcrit.org and for AiSinai. Aarti Sarwal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Reposted with permission from The Conversation.