North Carolina’s Recovery from Hurricane Ian

July 28, 2026 | Emma Talkington, Nick Porter

Hurricane preparedness, response, and recovery work continues to be a top priority for state and territorial health departments. Damaging winds, historic storm surge, and intense rainfall pose severe risks to those caught in the path of these formidable storms, and the impacts can be felt for far longer than the immediate hazards.

In 2022, Hurricanes Ian, Fiona, and Nicole made landfall in the United States, causing dozens of deaths and billions of dollars in damage. Hurricane Ian alone caused 66 direct and 90 indirect deaths. In late 2023, and again in late 2024, CDC awarded funding from the FY23 Omnibus Disaster Supplemental to ASTHO to assist North Carolina in building capacity to recover from the environmental health impacts brought on by Hurricane Ian and to respond to future hurricanes. ASTHO worked closely with staff from CDC’s National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) Office of the Director and staff from the North Carolina Department of Health and Human Services (NCDHHS) to implement capacity building projects to bolster environmental health preparedness, response, and recovery capabilities identified as gaps following Hurricane Ian.

Identifying Gaps and Needs from Hurricane Ian

NCDHHS focused on building out their environmental health preparedness, response, and recovery program capacity by creating needed communication materials on disaster-related environmental health topics, developing training and exercise materials, and sharing this information with partners and the public. They noted these activities are difficult to complete with competing priorities and a lack of dedicated staff and identified them as needs following Hurricane Ian. The support from NCEH/ATSDR and ASTHO provided NCDHHS with the resources needed to complete this work.

Updating Communications and Training Materials

The primary focus during NCDHHS’s first year of this project was updating communication and training materials, particularly around environmental health issues associated with hurricanes. With existing staff in the Environmental Health Section and two additional temporary staff, NCDHHS separated the activities into two categories: training/exercise preparation, and emergency preparedness communication preparation. Staff developed training materials, after action reporting policies, and topic-specific communication resources (childcare in shelters, norovirus outbreaks, donated food, etc.).

Utilizing Capacity Building Efforts from Hurricane Ian to Assist with Hurricane Helene Response

Ahead of the second year of this work, North Carolina was heavily impacted by Hurricane Helene in September 2025. As a result, NCDHHS largely focused on responding to and recovering from the impacts of the hurricane. The ASTHO and NCEH/ATSDR supported capacity building efforts related to Hurricane Ian recovery allowed NCDHHS to work through issues such as when to reopen public parks after major flooding, the identification of resources for homeowners on mold assessments, and providing guidance on mudslides and slope destabilization after hurricanes.

Developing Training and Resource Materials for Drinking Water Emergencies

Once NCDHHS transitioned resources back to this project, they expressed a need to conduct training focused on drinking water emergencies, a gap identified following Hurricanes Ian and Helene. In response to this need, NCDHHS developed several guidance documents for local health departments and food establishments during a water emergency, with assistance provided by their two temporary staff members. Several of those resources, as well as other newly developed and updated resources as a part of this project, can be found on their new Emergency Preparedness and Response webpage. NCDHHS and the temporary staff also developed and executed a water emergency tabletop exercise with local health department staff in April 2025. For more information on these efforts, please refer to the June 2026 edition of the Journal of Environmental Health publication on the topic.

Developing and Launching the Community Meals Food Safety Training

Another training priority identified by NCDHHS included the need for a curriculum targeted towards individuals and groups interested in hosting free or reduced cost meal events after a hurricane. The curriculum would provide actionable food safety knowledge and principles to these groups to help prevent foodborne disease outbreaks after a disaster. ASTHO worked with NCDHHS staff and North Carolina State University’s Safe Plates Program to develop a plain language training curriculum that covered these topics. The Community Meals Food Safety Training resulted from this collaboration and includes food safety resources for community groups in both English and Spanish. The first training was provided in June 2025, and as of June 2026 it has been provided eight times and has been well received by trainees based on participant evaluations. Just-in-time training is also available, with a recorded version of the course posted to the course website.

Procuring Supplies and Identifying Printing Needs to Address Response Gaps

During the final year of the project, NCDHHS primarily focused on continuing to provide and promote the Community Meals Food Safety Training to communities across the state. They also developed handouts to supplement the information provided in the training, focusing on topics such as food service in disasters, meal events in temporary facilities, and water safety. ASTHO supported the printing of materials associated with the training, as well as travel funding for NCDHHS staff to attend the Council of State and Territorial Epidemiologists Annual Conference in June 2026 to present on these community training efforts. NCDHHS also requested a short list of supplies that would assist them in conducting shelter assessments and staying connected in the field during response activities. ASTHO provided these supplies using funds associated with this project.

Conclusion

Support provided from ASTHO and NCEH/ATSDR allowed NCDHHS to build capacity in key environmental health preparedness topic areas, including food safety, drinking water safety, and shelter assessments, among other topics. Moving forward, the Community Meals Food Safety Training curriculum will be utilized to train the trainer and assist in the prevention of foodborne disease outbreaks following hurricanes. Other resources developed will help both NCDHHS and the public prepare for and respond to hurricane-linked environmental health hazards.

Acknowledgements

Thank you to the staff within NCDHHS that worked tirelessly to implement this project, including the temporary staff. Thank you also to CDC’s NCEH/ATSDR staff who oversaw this project. Without their support, none of this work would have been possible.

This publication is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $770,915 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.