Patient History

• Ask about recent flooding or water damage at home/work.
• Ask about disrupted access to medications, electricity (for oxygen), and clean water.
• Ask about or look for signs of mold growth, such as musty odors, visible mold patches, or water stains. Endotoxins released from fungi/bacteria can trigger systemic symptoms such as fever, malaise, and fatigue in addition to respiratory signs.
• Ask whether patients used personal protective equipment, such as an N95 or P100 mask, during cleanup. Demolition and cleanup can release dust and increase inhaled particulate matter.
• Identify high-risk groups, including children, the elderly, those with chronic lung disease, the immunocompromised, pregnant individuals, cleanup workers, and disadvantaged communities with delayed cleanup.

Exam Highlights and Red Flags

Exam

• On physical exam, look for nasal congestion and sinus tenderness.
• Listen for wheezing, crackles, or diminished breath sounds.
• Check oxygen saturation both at rest and with exertion.

Red Flags

• Refer urgently if the patient has hypoxemia, persistent fever, or worsening shortness of breath.
• Other concerning findings include nonresolving infiltrates on chest imaging or asthma/COPD exacerbations that do not respond to usual treatment.
• Lack of medication/oxygen access due to infrastructure disruptions can lead to worsening of chronic medical problems.

Prevention and Mitigation

• Encourage patients and workers to use N95 or P100 masks during cleanup to prevent inhalation of harmful particles.
• Remind patients that all wet materials should be removed and surfaces dried within 24–48 hours to prevent mold growth.
• Explain that visible mold growth alone is sufficient enough to warrant remediation and that testing is not necessary.
• Ensure continuity of care by helping patients maintain access to medications, oxygen therapy, and follow-up visits.