California: Now 11 (Presumed & Confirmed) Human H5 Infections

 
Note: Does not reflect latest Michigan Herd

UPDATED:  No sooner had I posted this, the USDA announced another 15 infected herds in California (N=120)

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Twelve days ago, before I was so rudely interrupted by Hurricane Milton, California's CDPH was Investigating their 3rd Suspected Case Of H5 Avian Flu, and 56 dairies had reported H5 in cows. In less than two weeks, the number of infected dairies has nearly doubled (n=105), and the number of confirmed and presumed positive human cases has nearly quadrupled (n=11). 

October 16, 2024: H5N1 Bird Flu Confirmed in One Hundred Five Dairies in California

SACRAMENTO, CA — Following an investigation by the California Department of Food and Agriculture (CDFA) and rapid disease detection by California Animal Health and Food Safety Laboratory System (CAHFS), the U.S. Department of Agriculture’s (USDA) National Veterinary Services Laboratories (NVSL) has confirmed H5N1 Bird Flu in one hundred five dairies in Central California. CDFA has implemented a surveillance strategy with the goal of finding affected farms as early as possible. Early detection provides the opportunity to work with farms to quickly implement enhanced biosecurity, cow care, and employee protection.

This from the CDPH:

State Continues Proactive Testing for Human Cases of Bird Flu; Reports 6 Confirmed, 5 Possible Cases ​

​October 14, 2024
NR24-034

New possible cases identified over three-day stretch following direct contact with infected dairy cows in Central Valley ​

What You Need To Know: CDPH continues to work with federal, state and local partners to monitor and respond to human cases of bird flu in the state. The risk to the general public remains low, although individuals who interact with infected animals are at higher risk of getting bird flu.​

Sacramento – As California continues to proactively test symptomatic individuals for bird flu, the California Department of Public Health (CDPH) reports that new possible positive human bird flu cases have been identified in the Central Valley since last Friday. To date, the state has identified six confirmed and five possible human cases. The individuals had direct contact with infected dairy cattle at nine different farms.

The five possible human cases are pending confirmatory testing by the Centers for Disease Control and Prevention (CDC). Due to shipping delays late last week, and today’s federal holiday, the possible (or presumptive positive) specimens are expected to arrive at the CDC early this week.

Given the amount of exposure to infected cows, evidence continues to suggest only animal-to-human spread of the virus in California. Additionally, based on CDC’s genomic sequencing of three California bird flu cases, there is no evidence to suggest an increased ability for the virus to infect or spread between people and no known reduced susceptibility to antiviral medications. ​

All individuals with confirmed or possible cases of bird flu have experienced mild symptoms, including eye redness or discharge (conjunctivitis), and have been treated according to CDC guidance. None of the individuals have been hospitalized.

While the risk to the general public remains low, additional human cases of bird flu are expected to be identified and confirmed in California among individuals who have regular contact with infected dairy cattle. CDPH continues to work closely with local health jurisdictions to identify, track, test, confirm, and treat possible and confirmed human cases of bird flu.

More information on CDPH’s response can be found at CDPH’s Bird Flu website and in recent CDPH news releases. ​

While it is likely - based on anecdotal reporting of symptomatic farm workers who were never tested - that the official number is an undercount, so far in 2024 at least 25 people from 5 states have been confirmed to be infected with H5Nx. 

It has now been more than 8 weeks since Missouri's first (and only confirmed) H5 case was hospitalized, and while there were 7 symptomatic contacts, we've yet to hear anything about their serology testing.  Nor do we know how this index case was infected. 

Since testing - of both cattle and symptomatic workers - remains largely voluntary, it is frankly anyone's guess how far this virus has spread across the nation.  Until late August, California was assumed free of the disease.

Today, California accounts for more than 1/3rd (of all known) infected U.S. dairies, and nearly half of all human H5 infections in the nation. 

This slow-rolling of information, and a general lack of urgency - particularly at the local level - is both perplexing and frustrating.  And if this were happening in another country, our own government would be decrying the lack of progress. 

It is, of course, possible that HPAI H5 is currently incapable of sparking a larger public health crisis.  We've seen it threaten before - in Egypt, and Indonesia, and Vietnam - only to fizzle and recede. 

But we've never seen HPAI H5 affects so many mammals (cattle, cats, dolphins, seals, bears, skunks, foxes, mice, mink, etc.) before.  The longer it persists in cattle, and the more it spreads to other species, the more chances it will have to adapt or mutate into a more formidable foe.

Even if the odds are greatly against the virus, the downsides of a long-shot coming in could be enormous. 

Signs of Life

Credit NOAA
 

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Sometime overnight, my internet came back to life. Considering the amount of damage my community (Zephyrhills) sustained from Milton, the restoration of my power (after 4 days) and internet after a week, border on miraculous. 

Not everyone here has power, though.  Many neighborhoods, and roads, are still under water.  Thousands of homes here are damaged, some may be total losses.  Utility trucks and crews are everywhere.   Without internet, the predominant sound your hear are chainsaws. 

I was lucky.  I had a safe place to go, thanks to my `disaster buddy'.  Over the years we've come to each others aid - for problems large and small - dozens of times.  I also had a home to come back to.  My neighborhood did not flood, although it was isolated by downed trees and flood waters for several days. 

My home took moderate damage - and sprang a few leaks - but is habitable. My gutters are gone, metal shutters stripped from the outside, but the roof held.  Everything was damp inside, as torrential rains driven by hurricane force winds, found every ingress (wall A/C units, jalousie windows, minor leaks around windows, etc.). 

All in all, I count myself very lucky. 

My preps provide us with light and NWS emergency radio information during our (relatively brief) loss of power and internet at my bug-out location during the storm.  Since returning home on Monday, they have been of greater use.

In a disaster area, cash is king.  Many stores are unable to process debit and credit cards right now.  All refrigerated food stuffs - meat, dairy, frozen foods - were lost during the storm and right now - many grocery store shelves are devoid of such luxuries. 

Yes, I could drive 12-15 miles out of the area to shop, but the roads are a mess and gasoline has been a precious commodity. Besides, I've got my hurricane canned food stash to eat out of.  

One of my neighbors is still without electricity.  I was able to lend him a propane camp stove, so they can cook.   A redundant prep, since I have a propane stove, but glad it was useful for someone. 

Without Internet, I'm fairly isolated.  No TV . . . my primary access to the outside world coming from phone calls and text messages from friends (many thanks to Sharon Sanders of FluTrackers).  

I do have a small multi-media DVD player, and an ample supply of music and movies.  A small creature comfort that I highly recommend.  I also have a personal MP3 player, and hundreds of hours of music and podcasts if needed.

My `big ticket' preps, solar panels and 12-volt LiFePo batteries did not come into play, although if I'd not had a safe place to go, they would have provided me with badly needed power for those first 4 days after the storm.  

People often ask me why I prep.  

• Why I keep 30+ gals of stored water, 2 weeks worth of canned food in the pantry, an emergency radio, (several) first aid kits, solar panels, and an array of LED lanterns, battery operated fans, water filters, and a camp stove.

• Why I have an evacuation plan, and a `disaster buddy'. 

This is my 3rd forced evacuation since 2017, and the worst disaster this region has seen in > 100 years.  As bad as is was here, it could have been far worse.  Had the storm come in 30 miles further north, the entire Tampa Bay region would have taken a terrible blow.

As it is, my neighbors further down the coast took the brunt of the storm.  Where I live, most of the damage has come from record inland flooding, which in many places has not receded. 

If we are lucky, we won't see the likes of this again for another hundred years.  But there are no guarantees of that.  

Two weeks prior to Milton, hurricane Helene passed to our west, inundating Florida's west coast with the worst coast flooding in decades. 

Nature has no memory.  We may go years without another major strike, or it could happen again next year.  My town was well inland, at a high (for Florida) elevation, and had never flooded like this before. But rainfall rates of 3 to 5 inches per hour, with some places getting 18 inches - after an extremely wet summer - was simply too much. 

The impacts last month from Hurricane Helene in Georgia and in North & South Carolina remind us that you don't have to live along the coast to suffer extreme (and unexpected) damage from these tropical systems. 

And it isn't as if hurricanes are the only threat we face (see #NatlPrep: Prolonged Grid Down Preparedness).

Earthquakes, wild fires, tornado outbreaks, blizzards, ice storms, infrastructure failures, cyber attacks, and even solar storms are all potential threats, and can affect anyone at almost any time. 

So . . . if a disaster struck your region today, and the power went out, stores closed their doors, and water stopped flowing from your kitchen tap for the next 7 to 14 days . . . do you already have:

• A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials
• A decent first-aid kit, so that you can treat injuries
• Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration
• A way to provide light when the grid is down.
• A way to cook safely without electricity
• A way to purify or filter water
• A way to stay cool (fans) or warm when the power is out.
• A small supply of cash to use in case credit/debit machines are not working
• An emergency plan, including meeting places, emergency out-of-state contact numbers, a disaster buddy, and in case you must evacuate, a bug-out bag
• Spare supply of essential prescription medicines that you or your family may need
• A way to entertain yourself, or your kids, during a prolonged blackout

If your answer is `no’, you have some work to do. 

Disasters often boil down to unscheduled camping - for days, or sometimes weeks - in your home, in a community shelter, or possibly in your backyard. If you think of preparedness that way, it becomes far less daunting.

 

FEMA, Ready.gov and a myriad of other state and national entities know the risks we face, and would like to see Americans adopt and embrace a culture of preparedness.

But you need to act now, before the next disaster strikes.

P.S. - I'll be slowly resuming my regular blogging schedule.  I've a lot of catching up to do, and a fair amount of work still left to do on the ground here.

NHC 5am Milton Update - Key Messages - Bugging Out

 

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Hurricane Milton continues to exceed expectations and is still a CAT 5 storm roughly 20 hours before its expected landfall on Florida's West coast.   It is still expected to lose some strength, although possibly only down to CAT 4.  

While landfall is currently south of the mouth of Tampa Bay, the eye continues to wobble, and some track changes are inevitable before landfall. The latest advisory moved north a few miles, after dropping south last night. 

The worst surge will be immediately to the right of where the eye makes landfall.  The latest projections indicate 10-15 feet above ground level in some places. 

The latest Key Messages from the National Hurricane Center follow:

As for me and my cat (Jin-Jin), our bags are packed and staged near the front door. During the next break in the rain, I'll load my car, and hopefully in the next couple of hours we'll set off to my bug out location.  Plans are to be there before noon. 

I expect we'll lose both power and internet later tonight - possibly lasting for several days - and I doubt I'll be able to post again until after those services return.

Until then, you can get the latest infectious disease information from FluTrackers, Crof, CIDRAP, Dr. Ian Mackay, and our newcomer Hogvet54  - all excellent sources of information and analysis. 

Stay safe, everybody.

MMWR: Interim Effectiveness Estimates of 2024 Southern Hemisphere Influenza Vaccines

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Although Florida is now less than 48 hours from the expected arrival of Hurricane Milton, one of my pre-evacuation preps yesterday was to get my seasonal flu shot.  Two weeks ago, in preparation for our close encounter with Helene, I got my fall COVID vaccine.  

Last year, I also updated my Tetanus shot (Tdap).  

As I've explained previously (see #NatlPrep: Giving Your Preparedness Plan A Shot In The Arm), the last thing you want to have to deal with during an emergency is being sick.  And when you are stressed, and fatigued - and maybe cooped up with a lot of other people - your chances of catching something go up. 

Admittedly, Flu and COVID vaccines only provide modest protection against infection, but they usually do a better job at reducing severe illness and hospitalization. And since severe influenza infection is linked to strokes and heart attacks, even a modest amount protection can be lifesaving. 

Yesterday the CDC's MMWR published the results of a study of this year's flu vaccine effectiveness (VE) in 5 South American countries (Argentina, Brazil, Chile, Paraguay, and Uruguay) - which has the same components as the Northern Hemisphere's fall vaccine - and reports that it reduced the risk of hospitalization in high-risk patients by 35%.

While far from a stellar result, it is a significant reduction of risk. One that I'm more than happy to have on board, given the challenges ahead. 

I've only reproduced the Abstract and summary.  Follow the link to read the report in its entirety.  I

Interim Effectiveness Estimates of 2024 Southern Hemisphere Influenza Vaccines in Preventing Influenza-Associated Hospitalization — REVELAC-i Network, Five South American Countries, March–July 2024

Weekly / October 3, 2024 / 73(39);861–868

Erica E. Zeno, PhD1,2,*; Francisco Nogareda, MPH3,*; Annette Regan, PhD3,4; Paula Couto, MD3; Marc Rondy, PhD3; Jorge Jara, MD3; Carla Voto, MD5; Maria Paz Rojas Mena, MD5; Nathalia Katz, MD6; Maria del Valle Juarez, MPH6; Estefanía Benedetti, MPH7; Francisco José de Paula Júnior, MD8; Walquiria Aparecida Ferreira da Almeida, PhD8; Carlos Edson Hott, MBA8; Paula Rodríguez Ferrari, MSN9; Natalia Vergara Mallegas, MPH9; Marcela Avendaño Vigueras9; Chavely Domínguez, MD10; Marta von Horoch, MD11; Cynthia Vazquez, Phd12; Eduardo Silvera13; Hector Chiparelli, MD14; Natalia Goni, PhD14; Laura Castro, DrPH1; Perrine Marcenac, PhD1; Rebecca J. Kondor, PhD1; Juliana Leite, PhD3; Martha Velandia, MD3; Eduardo Azziz-Baumgartner1; Ashley L. Fowlkes, ScD1; Daniel Salas, MD3; REVELAC-i Network 

Summary

What is already known about this topic?

Influenza vaccine effectiveness (VE) varies by season.

What is added by this report?

In five South American countries (Argentina, Brazil, Chile, Paraguay, and Uruguay) the 2024 Southern Hemisphere seasonal influenza vaccine reduced the risk for influenza-associated hospitalization among high-risk groups by 35%. VE might be similar in the Northern Hemisphere if similar A(H3N2) viruses predominate during the 2024–25 influenza season.

What are the implications for public health practice?

CDC recommends that all eligible persons aged ≥6 months receive seasonal influenza vaccine. Early antiviral treatment can complement vaccination to protect against severe influenza-related morbidity.

Full Issue PDF

Abstract

To reduce influenza-associated morbidity and mortality, countries in South America recommend annual influenza vaccination for persons at high risk for severe influenza illness, including young children, persons with preexisting health conditions, and older adults. Interim estimates of influenza vaccine effectiveness (VE) from Southern Hemisphere countries can provide early information about the protective effects of vaccination and help guide Northern Hemisphere countries in advance of their season.

Using data from a multicountry network, investigators estimated interim VE against influenza-associated severe acute respiratory illness (SARI) hospitalization using a test-negative case-control design. During March 13–July 19, 2024, Argentina, Brazil, Chile, Paraguay, and Uruguay identified 11,751 influenza-associated SARI cases; on average, 21.3% of patients were vaccinated against influenza, and the adjusted VE against hospitalization was 34.5%. The adjusted VE against the predominating subtype A(H3N2) was 36.5% and against A(H1N1)pdm09 was 37.1%.

These interim VE estimates suggest that although the proportion of hospitalized patients who were vaccinated was modest, vaccination with the Southern Hemisphere influenza vaccine significantly lowered the risk for hospitalization. Northern Hemisphere countries should, therefore, anticipate the need for robust influenza vaccination campaigns and early antiviral treatment to achieve optimal protection against influenza-associated complications.

         (Continue . . . )
 

There is still time for Floridians in the path of Milton to get the flu/COVID vaccines, as well as those struggling to deal with the aftermath of Helene. I know it may seem pretty far down your list of things to do.

But during an extended disaster, you need every edge you can get. 

Hurricane Watches Raised For Most of Florida's West Coast

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In their 5 am advisory, the NHC posted Hurricane & Tropical storm watches for the entire west coast of Florida in anticipation of the arrival of Hurricane Milton late Wednesday afternoon.  As the graphic above shows, Hurricane conditions are expected well inland. 

Milton, currently a CAT 3 storm still in the far western Gulf of Mexico, is expected to grow to a CAT 4 or 5 storm over the next 36 hours, but is forecast to weaken somewhat before landfall. Probably to a CAT 3 or (hopefully) lower. 

But even if that happens, it will be pushing a massive wall of water ahead of it towards the coast. Record surge tides are expected to the right of where the eye makes landfall, but exactly where that will be is still unknown.  

Because of this uncertainty, a lot of people are going to be forced to evacuate low-lying coastal areas, even though some may be spared the worst.  While surge is the biggest risk to life and property, the effects of Milton are likely to be widespread and long-lasting. 

Extended power outages are inevitable. Millions are likely to find themselves without power, water, internet, or sewer for days or even weeks. Others may find their homes flooded, or damaged from high winds, and unlivable without extensive repairs. 

As far as what people can expect inland, away from the coast the National Weather Service has released this local product:

 For the purple colored regions they forecast:

Threat Level - Potential for wind greater than 110 mph

Potential Impacts Include:

*Structural damage to sturdy buildings, some with complete roof and wall failures. Complete destruction of mobile homes. Damage greatly accentuated by large airborne projectiles. Locations may be uninhabitable for weeks or months.

*Numerous large trees snapped or uprooted along with fences and roadway signs blown over.

*Many roads impassable from large debris, and more within urban or heavily wooded places. Many bridges, causeways, and access routes impassable.

*Widespread power and communications outages.

For the red colored area:

Threat Level - Potential for wind 74 to 110 mph

Potential Impacts Include:

*Considerable roof damage to sturdy buildings, with some having window, door, and garage door failures leading to structural damage. Mobile homes severely damaged, with some destroyed. Damage accentuated by airborne projectiles. Locations may be uninhabitable for weeks.

*Many large trees snapped or uprooted along with fences and roadway signs blown over. 

*Some roads impassable from large debris, and more within urban or heavily wooded places. Several bridges, causeways, and access routes impassable.

*Large areas with power and communications outages.

While not everyone in these warned areas will see these extreme conditions, everyone in Milton's path needs to prepare as if they could.  

Since I live in a mobile home in the red area, I'll be evacuating to a friend's house (also in the red area).  Luckily, I'm well inland and don't have to worry about flood damage to my home, but the wind is another matter.

As I've written often, most disasters boil down to unscheduled camping.  Living without power, internet, heat or A/C, running water (and sometimes even flushing toilets) . . . sometimes for weeks.  Most of my preps are built upon that premise. 

While the 12 hours or so that Milton pounds Florida will be traumatic and damaging, the biggest dangers from a hurricane often come in the days and weeks after the storm has passed, due to injuries or illness that occur during the `recovery' period.

Some of the many dangers include:

• Carbon Monoxide Poisoning (see CDC HAN 00415: Hurricane Florence — Clinical Guidance For Carbon Monoxide (CO) Poisoning)
• Food poisoning (see A Consumer's Guide to Food Safety: Severe Storms and Hurricanes)
• Chain saw accidents (see Preventing Chain Saw Injuries During Tree Removal After a Disaster)
• Toxic mold and mildew (see CDC Mold After a Disaster).
• And even psychological impacts (including PTSD) (see Sandy 1 Year Later: Coping With The Aftermath).

One of the most common, and dangerous threats comes from floodwaters which may linger for days, or even weeks following the storm. Waters that may contain toxic chemicals, dangerous viruses and bacteria, and hidden hazards like snakes, rats, and broken glass, sharp metal, or even live electrical wires.

The CDC maintains a web page on the dangers of Flood Waters or Standing Waters and in 2022 we looked at Florida: Uptick Of Vibrio Infections Following Hurricane Ian.

And lastly, the physical and mental impact of a major disaster should not be underestimated.  Many people are going to lose their homes, businesses, and their savings due to this storm. 

In March of 2009, in a study led by Dr. Anand Irimpen (Associate Professor of clinical medicine at Tulane), it was disclosed that residents of New Orleans saw a 300% increase in heart attacks in the first 2 years after hurricane Katrina.

A follow up, published in 2014 (see Tulane University: Post-Katrina Heart Attack Rates - Revisited), once again found the impact of Katrina on cardiac health remained pronounced.

In the wake of Hurricane Katrina, a study funded by the National Institute of Mental Health, which surveyed 1,043 survivors,  found:

• More than 11% were diagnosed with a serious mental illness following the storm. This compares to just over 6% before the hurricane.
• 9.9% had mild-moderate mental illness, compared to 9.7% before Katrina.
• They estimated  200,000 people facing serious mental problems, such as PTSS (Post Traumatic Stress Syndrome) and depression, in the three states most affected.

In 2014, in Post-Disaster Stress Cardiomyopathy: A Broken-Hearted Malady, we looked at a rare condition known as Takotsubo cardiomyopathy – or stress induced cardiomyopathy which is often linked to extreme grief or stress, as might be experienced following a disaster.

Also known as broken heart syndrome, this acute ballooning of the heart ventricles is a well-recognized cause of acute heart failure and dangerous cardiac arrhythmia's. 

While often hidden from view, the psychological impact of a disaster can be enormous and ongoing. In 2011, in Post Disaster Stress & Suicide Rates, we looked at the impacts of disaster-related PTSD (Post Traumatic Stress Disorder). 

A small reminder that in the wake of a disaster not all wounds bleed, not all fractures show up on an X-ray, and that the best treatment can't always be found inside your first aid kit.

With Milton, Evacuation Is The Better Part Of Valor

NOTE: As of this posting, there are no Hurricane watches or warnings for Florida, and no evacuation orders.  But both are coming (either later today or early Monday). 

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With the dual caveats that soon-to-be Hurricane Milton is still 80 hours away, and both its forecast track and intensity (CAT 3) at landfall are subject to change, it is difficult as someone born and raised in St. Petersburg not to shudder at the implications of the NHC graphic above.

For Tampa Bay - home to more than 3 million people - this is pretty close to the worst-case scenario, as it would drive a huge storm surge up into the bay.   

A CAT 4 or 5 storm, or a track another 15-20 miles further up the coast would be worse, of course. While a landfall even 30 to 40 miles further south would greatly reduce the storm surge in Tampa bay. 

But that would only shift the disaster to other coastal communities who are still reeling from last week's devastation from Hurricane Helene. 

Even tiny shifts in the track can have huge impacts on storm surge and who needs to evacuate. The flood zones for the Tampa Bay area (below) illustrates just how vulnerable this region is. 

But the broader threat from Milton extends across much of the state.  Because of the enormity of this threat, last night the Governor issued a State of Emergency for 35 counties.  

This will, among other things, allow people to get a 30-day emergency supply of Rx meds. 

Regardless of where Milton makes landfall, power outages are likely to be extensive and prolonged.  Water and sewer services may be offline, roads and bridges may be blocked, flooded, or damaged, and emergency services (EMS, fire, police) may be severely degraded. 

Banks, gas stations, grocery stores, pharmacies, doctors, and other essential services may be shuttered for days or weeks. Stores that are able to reopen may not be able to process Credit or Debit cards. And for thousands of families, there may be no home to return to after the storm.  

Barring some major shift in the path, I'll be among the millions who will be forced to evacuate on Tuesday, taking only what I can fit in my car.  Thankfully, I have a `Disaster Buddy', who will take me and the cat in.  

Not everyone is that lucky, and many may end up in emergency shelters for days. Those who live on the barrier islands may not be able to return for weeks.  

The last time a major hurricane made a direct hit on Tampa Bay (1921), its population was 1/10th what it is today, and practically no one lived on the beaches, or the barrier islands. The damage from Helene just last week is the worst we've taken since then.

We've had close calls, of course.  

Hurricane `Easy' in 1950. Hurricane Donna in 1960, Agnes in 1972, and the no name `storm of the century' in March 1993.  In 2004 Cat 4 Hurricane Charley was headed directly for Tampa when it unexpectedly veered east into Ft. Myers. 

While I'm hoping for a reprieve, I'll be spending the next 2 days preparing to bug-out.  I've got my flu shot scheduled for tomorrow morning (they may be hard to get post-Milton), just like I got my COVID shot before Helene.  

I'm going to try to get an emergency 30-day supply of my Rx meds (allowed under the State of Emergency), and I'll be staging what I am able take with me (clothes, Rx meds, important papers, Emergency gear, etc.), so I can quickly pack the car on Tuesday. 

Evacuation could be a nightmare, since millions may be ordered to leave, there are limited roads and bridges out of the affected areas, and the weather is expected to deteriorate on Monday (heavy rains).  I expect it will take hours to drive the 40 miles to my bug-out location. 

I'll take my laptop, but I fully expect to be incommunicado for some time.  I'll try to get word to Sharon at FluTrackers (who is also in the path), after the storm. 

I'll be taking my solar panels, batteries, and accessories (see How Not To Swelter In Place).  The one (minor) consolation is that it isn't August, and excessive heat should be less of a problem.

These preps should give us a few basic creature comforts like lights, radios, fans, MP3 players, and charged cell phones. We've got a camp stove, plenty of canned food, and enough propane for several weeks of cooking. 

In the end, you can only do what you can do, and hope it turns out to be enough. 

So, if you live anywhere near the west coast of Florida, in a flood-prone region, or live (as I do) in a mobile home away from the coast, now is the time to start planning what you will do tomorrow, and Tuesday, as the storm approaches. 

The danger is that too many people will wait too long before deciding whether they will evacuate. Some may be lulled by a forecast track that seems to spare them - but forecasts can change - leaving little time to act.

While I'll be doing usual hurricane preparedness blogs - and I follow (and highly recommend) Mark Sudduth's Hurricane Track, and Mike's Weather page - your primary source of forecast information should always be the National Hurricane Center in Miami, Florida.

These are the real experts, and the only ones you should rely on to track and forecast the storm.

If you are on Twitter, you should also follow @FEMA, @NHC_Atlantic, @NHC_Pacific and @ReadyGov, and of course take direction from your local Emergency Management Office.

For more Hurricane resources from NOAA, you'll want to follow these links.

HURRICANE SAFETY

• NWS: Hurricane Safety Tips and Resources
• NOAA Education: Hurricane Safety, explained
• Ocean Today: Hurricane Safe videos
• CDC: Hurricanes and COVID-19
• CDC: Public Shelters During COVID-19

ADDITIONAL RESOURCES

• Delivering the Right Message: Understanding Forecasts & Impacts
• Current NHC Forecast
• Ready.gov
• #HurricaneStrong