Florence made landfall on the southeastern coast of North Carolina (NC) generating torrential rainfall and severe flooding that led to 53 fatalities in three states (NC, SC, and VA) and $16-$40 billion in damage. Seventy-seven percent (77%) of the fatalities occurred in the rural flood plains of NC with Duplin county reporting a high of eight deaths. Approximately 50% of the total number of hurricane-related fatalities across the three states were vehicle-related. The predominant demographic at risk were males over the age of 50 years. The type of property damage was in line with other major hurricanes and predominantly affected residential structures (93% of the total number of damaged buildings). Florence is among the top 10 costliest hurricanes in U.S. history with approximately 50% of the damage projected as uninsured losses due to residential flooding. The cumulative 5-day rainfall resulted in major flooding along the Cape Fear, Lumberton, and Neuse rivers where many industrial waste sites (hog manure lagoons and coal ash pits) are located. Several of these waste sites located in the flood plain were breached and have likely cross-contaminated the waterways and water treatment operations. The observed extent of the flooding, environmental contamination, and impact to public health caused by Florence will add to the long-term disaster related mortality and morbidity rates and suggests an expansion of the 100-yr flood hazard zone to communicate the expanded risk to the public.
