WASHINGTON, DC—From day one of the Deepwater Horizon oil spill, federal health officials have been on the ground and in the water around the Gulf Coast, helping coordinate clean up, train recovery workers, and beginning the long-term task of assessing the health effects of the spill.

At least 11 people were killed and 15 injured by the initial explosion on April 20, when the BP oil-drilling platform exploded and began spilling oil into the Gulf of Mexico. However, those injuries are only the leading edge of what health officers expect will be many in the weeks and years to come, as recovery workers and citizens of the region experience effects of the toxic material being released into the environment.

Coordinating Health Response

HHS and the health agencies that fall under its purview have been coordinating the federal health response since the April 20 explosion. In close communication with state emergency and health officials, HHS liaison officers were deployed to the Unified Area Command team in Robert, LA and to Incident Command Centers in Houma, LA and Mobile, AL. The officers function as medical unit leaders and provide coordination and oversight of federal medical care.

Testifying before the Energy and Commerce Health Subcommittee last month, Lisa Kaplowitz, MD, HHS deputy assistant secretary for policy, explained that the work being done now by health officials in the Gulf region will lay a foundation for dealing with the health effects in the long run. “The impacts of a disaster such as this must be considered in the time frame of not weeks and months, but years. Oil can remain toxic in the environment for years and we do not know the long-term impact it could have on human health.”

On May 31, HHS set up a mobile medical unit in Venice, LA to provide triage and basic care for responders and residents concerned about health effects of the oil spill. HHS Secretary Kathleen Sebelius activated the National Disaster Medical System and deployed a medical strike team from Arkansas to staff the first rotation of the medical unit.

Since then, the unit has seen 140 patients whose complaints have been consistent with those seen across the area. Of those patients, 38% were treated for acute respiratory conditions, and 27 had dermatologic, eye, or gastrointestinal problems. There were also a number of individuals treated for injuries.

The agency is also deploying resources in the area to address the behavioral health issues arising from the oil spill. “Our experience with previous disasters, including the Exxon Valdez spill, allows us to anticipate and prepare for potential behavioral health needs, including anxiety, depression, and other emotional and psychological effects,” Kaplowitz stated. SAMHSA has been taking the lead in this, working with state and local efforts to assess and meet the behavioral health needs of Gulf residents and rescue effort workers.

Sebelius has asked IoM to convene an independent panel of experts to explore the range of health issues related to the oil spill.

Tracking Long-term Effects

The first step in tracking health effects long-term is to get a comprehensive list of who was exposed and what symptoms they’re experiencing now—not an easy task when the environmental impact is spread across so large an area. Officials from CDC’s National Institute for Occupational Safety and Health has 170 staff members responding to the disaster, and 17 staffers are on site in the Gulf region.

NIOSH is working with state and local health agencies to track symptoms and health complaints that could be related to the oil spill. They are tracking information coming into 60 poison control centers throughout the Gulf region, as well as collecting data from the Biosense surveillance system—a national program that monitors the health of the population. This includes 86 health care facilities, clinical labs, hospital systems, and ambulatory care systems throughout the area that are collecting data on any increase in illness or adverse health effects.

At the hearing, NIOSH director John Howard, MD, told legislators that they had received between 400–500 calls, about 75% of which were coming from recovery workers. “We’re not seeing a large number of calls now but what we’re doing is looking at the types of information we’re getting, both from calls and from appearances at a health care facility, and then comparing that to the three previous years as a way of looking at a baseline. Are we seeing more throat and eye irritation? More coughing?”

Asked how NIOSH could get a reliable baseline on specific patients showing their health before the incident, Howard admitted that initial data would be self-reported and relatively unreliable. “Certainly self-identified issues in a questionnaire should be corroborated in a better study with actual medical data.”

At the time of the hearing, NIOSH had rostered 13,000 people exposed to the site. However, Howard expects that number should be in the 15,000 to 20,000 range. “Sometimes we don’t know what we don’t have. That’s the most serious issue. What I know we don’t have, and we’ve asked BP for, is an actual list of the [people at the site]. We’ve made that request several times in the last few weeks and we have yet to receive that.”

Filling the Research Gap

Both the crude oil spilling out of the Deepwater Horizon site and the chemicals being used to disperse and clean the oil spill contain harmful substances, whose long-term health effects are poorly understood. The oil nearest to the spill contains high levels of volatile and toxic components, such as benzene, toluene, and xylene. Along with other volatile organic compounds, they can cause acute toxicity. And oil that has been exposed to the air and water for an increased period of time, while having lost many of those organic compounds, still poses serious health effects. Aerosolized by wind and water, it can be breathed in, causing serious respiratory problems.

The dispersants that are being used contain the same sort of chemicals found in household detergents. But the content level of the chemical and the sheer quantity of it being used leaves health officials worried about the long-term consequences of putting so much of it into an already damaged environment.

“While experts agree that potential for human health hazards exists from these oil spills, these effects have not been well-studied,” according to Aubrey Miller, MD, senior medical advisor at the National Institute of Environmental Health Sciences. “[A recent review article looking at data from past] oil spills made very clear that there is very little data concerning exposed individuals, and only for a handful of these incidents. Historically, the workers involved in such clean up have the highest level of illness and the most symptoms.”

A few studies have been done on the psychological health effects on recovery workers, and communities and health officials expect to see increased cases of depression and anxiety in coming months. “We need to keep the less obvious illnesses in mind as we’re considering the overall health impact of this disaster,” Miller declared.

NIH Secretary Francis Collins, MD, PhD, announced that the research agency would be reserving $10 million for the study of effects on workers involved in the oil spill cleanup. “We expect a number of researchers to apply for our time-sensitive awards,” Miller told legislators. “Proposals are accepted each month and reviewed and funded within three months.”

He added, “Our take away message here is that there is a clear need for additional health monitoring and research to underpin our public health decisions.”

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