One week after Tropical Storm Helene hit Western North Carolina, Asheville resident Sonya Lynn woke up with stomach cramps that she could only compare to going into labor.
"The cramps woke me out of a dead sleep," Lynn told Carolina Public Press. "I started noticing severe bloating, constant diarrhea and nausea."
Lynn went to Mercy Urgent Care, where she was diagnosed with E. coli. The facility put her on antibiotics, but a few days later she was in the emergency room with extreme dehydration.
Lynn is just one of thousands of Western North Carolinians who have experienced -- or will experience -- adverse health effects brought about by the damage caused by Tropical Storm Helene. Contaminated drinking water caused by flooded private wells, damaged municipal water systems, and compromised septic systems is one of the chief public health concerns.
Lynn isn't sure how she contracted E. coli. Did she rinse her dentures under the tap in her bathroom sink? Did she use ice from her freezer in a drink? Did she wash her dishes in the kitchen sink out of habit? Did she eat some bad food that had been donated to Homeward Bound, the homeless shelter where she works?
"We're seeing unprecedented issues in terms of the very prolonged disruption to basic services like water and sewer," North Carolina state epidemiologist Zack Moore told Carolina Public Press.
"That raises a lot of concerns around gastrointestinal infections, things that come from contact with sewage, eating food that hasn't been maintained properly, or not having the same access to hand hygiene that you normally would. We're worried about Legionnaires Disease, Hepatitis A, Campylobacter and other infections."
Most people who experience gastrointestinal illness don't immediately head to the doctor or emergency room, making the actual rate of these illnesses in Western North Carolina difficult to track, Moore said.
Lynn is now healthy and back at work. But even so, she and all Western North Carolina residents will have to look out for additional public health issues as the region continues to recover from Helene.
Weeks of dry weather following the storm turned flood mud, chock full of raw sewage and industrial contaminants, into airborne dust, raising concerns about respiratory diseases.
Flooded basements and homes are rife with dangerous mold.
Moore recommends people wear N-95 masks when doing any cleanup project. FEMA offers to remove water-damaged material for free under the agency's individual assistance programs.
Plus, flu, Covid and RSV seasons are upon us, and public health professionals are encouraging Western North Carolinians to make time to get fall vaccinations, despite the chaos of the storm's aftermath.
"Unfortunately, there are many still in shelters and campsites living in close quarters where they're more likely to be exposed to respiratory viruses," Moore said.
Asheville nurse Elle Kruta told CPP that in addition to an increase in communicable respiratory illnesses, GI issues and dehydration at Mission Hospital in Asheville, she has noticed that those with asthma and COPD are struggling due to the dust in the air.
The number of patients at the hospital is lower than average, according to Kruta, but more patients are staying longer than usual.
"There are a lot of people who cannot be discharged from the hospital into a nursing facility, because those rehabs don't have potable water or space," Kruta said.
"And some patients may not have homes to go back to. With shelters starting to close, people are staying in the hospital longer."
UNC Asheville health sciences professor Fabrice Julien is teaching a course called 'Public Health in Disasters' this semester. He and his students had just gotten through their unit on Hurricane Katrina when Helene struck Asheville.
One health concern he has is injuries.
"Driving by the River Arts District (in Asheville), I saw a lot of folks among the rubble doing construction, extraction and cleaning," Julien told CPP. "A lot of them are up on ladders."
"When you're up on a ladder, leaning up against a foundation or structure that could cave in and collapse at any time, your risk of serious injury is very high."
It is important to consider social determinants of health in an emergency like this one, according to Adam Hege, director of Appalachian State University's public health program.
"The most immediate impacts are on those facing financial challenges, or those with access to less resources for their health," Hege told CPP. "They may not be able to afford the care they need, or rebuild their lives in a way that sets them up for optimal health.
"When you look at disadvantaged communities, you start to see that how their houses are built and where they are built make them the most susceptible to the worst outcomes."
On the frontlines of the fight to keep Helene survivors healthy long term are local public health departments.
Officials are having disparate experiences of the threat: Henderson County's health director Dave Jenkins says he has minimal concerns, while Joshua Kennedy, the health director in adjacent Polk County, is anxious about the county's ability to serve vulnerable populations.
One of those vulnerable populations on Kennedy's mind is the elderly.
"We've seen an increase in the number of senior citizens needing home-delivered meals through our nutrition programs," Kennedy told CPP.
"We're working to get those folks fed, but the cost of food is high right now. We see that as a budgetary concern long-term."
The North Carolina legislature's Helene relief bill allocated $12 million to local health departments to deal with these myriad issues, including helping residents with testing, decontaminating, and repairing their flooded wells.
Thirty percent of water samples from wells in Ashe and Watauga counties have tested positive for dangerous bacteria, AppHealthCare director Jen Greene told CPP.
"Even if your water smells fine and looks fine, it is very possible that it is not fine," Greene said.
"If you have any concerns that your well may have flooded, we encourage you to come in and get your water tested."
County governments are providing tests and well decontamination kits at no charge.
"Well decontamination is pretty quick and easy," Kennedy said.
"We have kits provided by the state, so after folks come pick those up, it generally doesn't take much time before their well is back in order."