David Friedman / NBC News

Kathleen Campbell, 85, stays with her daughter's family in Hawthorne, N.Y., while she is displaced from her home in Breezy Point. Campbell's daughter Ann Marie Pawlowicz, and granddaughters Kalina, 16, and Julia, 8, play with the family dog in the background.

Kathleen Campbell has had a bad night. It’s nothing a cup of fresh brewed tea won’t fix, but Campbell, 85, likely faces many more less-than-comfortable nights on her daughter’s living room sofa.

Just three months ago, Campbell was riding her three-wheeled cycle on the smooth and level streets of Breezy Point, a cheerful and close-knit community at the far end of the islands called the Rockaways in Queens. Now she is shuttling among three houses – her daughter Ann Marie Pawlowicz’s 1890s home in Westchester, N.Y., another daughter in New Jersey and her sister’s home near Philadelphia.

Campbell’s lifestyle is one of the many casualties of Superstorm Sandy, which sent floodwaters surging through homes when it hit Oct. 29, damaging more than 2,000 homes and starting a fire that burned more than 100 houses to the ground. The beachfront village, whose population plummeted from 12,000 in the summer to around 4,000 the rest of the year, provided a way of life not often seen in the sprawling suburbs of most cities. Generations of the same family jealously guarded their modest homes, and they took care of their own.

Like so many other elderly residents there, Campbell could “age in place”, living alone after her husband died in 2009, despite a heart condition and the onset of what might be dementia. It’s a concept that many communities have embraced, and that groups like the AARP and the National Council of State Legislatures are encouraging.  When people age in place, they stay in their homes, perhaps adapting them for more limited mobility, rather than moving to elder care facilities. And it’s a way of life that seems to have just evolved naturally in Breezy Point.

“It’s not uncommon to have three generations living within blocks of each other. It did offer that kind of stability and smalltown closeness,”says Msgr. Michael Curran of St. Thomas More Catholic Church, the main church on Breezy Point’s main drag and one of the places residents sheltered during the height of the storm.

Campbell’s house on Reid Avenue was completely flooded when Sandy hit. “It was like the ocean meeting the bay in your living room,” says Pawlowicz.

The house, which Campbell's late husband, Charlie, built in 1990, is on the first road to the left as you enter Breezy Point. Shelves at her house, filled with carefully catalogued photo albums, were soaked when the floodwaters filled the home. Campbell lost almost everything but the small suitcase she took with her when she fled to Pawlowicz’s home to wait out the storm.

Courtesy of Ann Marie Pawlowicz

Kathleen Campbell rides her tricycle in Breezy Point, N.Y., on Sept. 27, 2012.

Campbell was once a fixture of the community as she rode up and down the narrow alleys on her tricycle. Now it sits rusting in her empty, mudstained house.

The Westchester hamlet of Hawthorne where Pawlowicz lives doesn’t have many level streets. Its Victorian, Craftsman and Care Cod homes are tiered one above another along streets built into a steep, rocky hillside.

“I miss riding my tricycle,” says Campbell in a soft Irish accent. “I was on it twice a day.”

Although Campbell is clearly enveloped in the loving arms of her family, her independence is gone. “She felt safe,” Pawlowicz says. “Even though she has a touch of memory issues.” She sleeps on the sofa because she is uncomfortable with stairs.

Within walking distance to many Breezy Point homes in the 500-acre cooperative were a bank, auto repair shop, the Blarney Castle pub and Deirdre Maeve's Supermarket and, perhaps most important for Campbell, St. Thomas More Church. Most remain damaged and closed months after the disaster.

Breezy Point had naturally what states like Georgia and New Jersey have been spending money to develop – safe, walkable neighborhoods with homes friendly to arthritic bodies.

A survey AARP did in 2008 of Americans over age 50 showed more than half would like to walk, bike or use public transportation, but nearly 40 percent complained about a lack of sidewalks and safe crossings, bicycle lanes or safe places to catch the bus near their homes.

'A hidden little gem'
At Breezy Point, three of Campbell's cousins and a neighbor used to regularly look in on her, making sure she ate her meals and keeping her company. Now they're all displaced too.

David Friedman / NBC News file

Veets Pawlowicz, second from right, is aided by a gang of family, friends and even volunteering strangers as they clean up his mother-in-law Kathleen Campbell's house on Nov. 2, 2012, in Breezy Point.

“I feel like a lot of the neighbors looked out for each other. It was a very simple life. It was great,” Pawlowicz adds as she sets a cup of tea in front of her mother. “It’s all gone now.”

Pawlowicz, 41 and the mother of two girls aged 8 and 16, finds herself a member of the “sandwich generation” – trying to juggle her job as a nurse with raising children and caring for an elderly parent. On weekends she and her husband, Witold, make the hour-long drive to Breezy Point to try to rip out drywall and salvage what belongings they can in Campbell’s home. It’s not clear what it will take to rebuild.

“We have pumped out the basement like 35 times. Whatever happened with this storm, it shifted everything. Now it’s like it’s on a spring,” Pawlowicz says. Getting insurance sorted out has been a chore for many Breezy Point owners.

“I haven’t been back to see it yet. Please, God, let’s get back there,” Campbell says.

“Not now, Mom,” Pawlowicz answers gently. “It’s a ghost town.”

The seaside neighborhoods in the Rockaways are among the last to recover from Sandy. Breezy Point is nowhere close to being back to normal. Empty foundations yawn open on the blocks that burned. Elsewhere, houses remain shifted off their foundations. There is still no electricity, so almost everyone clears out as the sun sets. Breezy Point is the last New York neighborhood left without clean water.

Like Campbell, many long to go back home. But for seniors, that will be especially hard, even with family support. “It is going to be tough for an elderly person living alone in a badly damaged home to get that home restored,” says New York’s health commissioner, Dr. Thomas Farley.

Curran tries to remain in touch with the seniors who are now scattered to new homes. They're resilient, he says, but "late in life it’s a big adjustment that folks are making.”

Just as they found their own solution when the community was whole, the elderly of Breezy Point have found their own solutions to being homeless. “Most people were able to find a family member or a friend they could move in with and have their needs met,” says Curran, who now commutes himself to attend to his duties at St. Thomas More.

Many families don’t want to talk publicly any more about their situations – a man who moved his elderly father to Dallas, a family who brought their aging parents to Long Island. “I was just talking to a couple – they took their parents in, they are safe,” says Curran. “But they are 85-plus and this is the first time they have ever lived in an apartment.”

Campbell misses the beach, but she doesn’t complain. “We’re on top of the hill,” she says, smiling as she gazes around her daughter’s antique-filled home. “It’s beautiful.” But she mentions again that she misses her tricycle.

“I always say everyone should have a touch of dementia during a disaster,” says Pawlowicz. “The best thing about dementia – my mother laughs. We have been able to cry a little bit, but nobody died.”

Related stories:

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• Elderly sisters find time to laugh after Sandy
• Temporary housing will never be the same post-Sandy

Hurricane Sandy is already stressing millions of people living on the eastern seaboard, but it’s not likely to kill anywhere near the number of people who would have died in such a storm 100 years ago. That’s because weather and emergency officials can get people out of the worst flood zones in time.

So what are the most likely 21^st century causes of death? Carbon monoxide poisoning often leads the list, as people turn to grills and gas stoves in power outages. Flash flooding and storm surges are also big killers.

Each hurricane is different and while a large percentage of deaths are from drowning, it’s not necessarily always the main cause. Heart attacks can also kill people, especially the elderly.

Katrina, which hit the Gulf Coast in 2005, was the deadliest hurricane this century. Officials tried to evacuate residents in low-lying areas, but several hundred people died in Louisiana when levees failed and floodwaters poured in, quickly and silently, as people slept.

Louisiana’s chief health official, Dr. Raoult Ratard, and colleagues counted 971 deaths in Louisiana alone that could be directly blamed on Katrina. Forty percent had drowned, 25 percent of people died from injuries including carbon monoxide poisoning and 11 percent died from heart conditions, which may have been exacerbated by stress or lack of access to medical care. Nearly, half, 49 percent, of the victims were aged 75 or older – showing how the frail are often most at risk.

Carbon monoxide poisoning – usually listed under injuries – killed 10 people in Alabama and Texas after Katrina and a second hurricane, Rita, hit and power went out, often for weeks.

“Few homes had functioning carbon monoxide detectors,” Centers for Disease Control and Prevention and state health officials wrote in a report published afterwards. “CDC continues to recommend that generators be placed far from homes, away from window air conditioners,  and that carbon monoxide detectors be used by all households operating gasoline-powered appliances (e.g., generators and gas furnaces), with batteries replaced yearly.”

Watch now: Multiple live video streams of Sandy coverage

Carbon monoxide is an odorless gas generated when natural gas, gasoline, coal and other fuels are burned. Victims usually don’t notice they are being affected and they can die in their sleep. The first symptom is often sleepiness or nausea, as well as headache.

It can be a problem any time of year but especially during power outages as people turn to other sources to cook and to heat or cool their homes. “Don't run a car or truck inside a garage attached to your house, even if you leave the door open. Don't heat your house with a gas oven,” CDC cautions.

In 2008, Hurricane Ike hit the Texas coast near Galveston, killing 74 people in Texas and Louisiana. The largest percentage were people who died from carbon monoxide poisoning after the storm had passed and left 2.3 million people without power – 13 people died this way, state health offiicials reported. Eight people drowned and 12 died of heart attacks, strokes and other heart-related causes.

Anthony Arguez and James Elsner of Florida State University analyzed hurricane deaths and found that, even though more people live along the coasts, they are far less likely to die in hurricanes than in the days before highways and warning systems made it easy to escape the most dangerous areas.

In the past 100 years or so, they found, hurricanes have killed about 15,000 people – about half of them in 1900 when Galveston, Texas was destroyed by a hurricane. The storm surge – created when winds blow seawater up onto coastal areas -- was the biggest killer. Storm surges have been among Sandy's first effects on New York, New Jersey and Delaware.

“At least 1,500 persons lost their lives during Katrina and many of those deaths occurred directly, or indirectly, as a result of storm surge,” the National Hurricane Center says on its website.

Flash floods can also be a risk – not so much to people in homes, but to those out and about on foot and in cars. Even six inches of fast-moving water and pull a person down if they’re wading in it, and cars can be pulled into rivers or streams.

Live blog: Updates on Hurricane Sandy

When Hurricane Floyd hit North Carolina in 1999, dropping 20 inches of rain, most of those who died drowned when they were trapped in cars trying to navigate floodwaters, state health officials reported. Of the 52 people who died during and directly after Floyd, 24 died in cars, and seven, including five rescue workers, died trying to escape floodwaters by boat.

While people may worry about infectious diseases after hurricanes cause floods, they haven't historically been a major cause of death or illness. Health officials also issue detailed warnings about food poisoning -- a danger when power outages knock out refrigerators. But statistics don't indicate many deaths from foodborne illness after U.S. hurricanes.

Related news:

What food to save, throw out if you lose power

It's a wash for West Nile virus after Hurricane Isaac

Why people stay behind during hurricanes

West Nile virus is now in 48 states, has made nearly 1,600 people ill and killed 66 of them, federal health officials said on Wednesday. But don’t expect Hurricane Isaac, which is now dumping tons of rain on Louisiana, to make matters any worse, they said.

The case count keeps 2012 on track to be the worst year for West Nile since the virus first came to the United States in 1999, the Centers for Disease Control and Prevention said. And some of the sickest people will never fully recover, the CDC says.

“As of August 28, 2012, 48 states have reported West Nile virus infections in people, birds, or mosquitoes. A total of 1,590 cases of West Nile virus disease in people, including 66 deaths, have been reported to CDC,” the agency says.

“Over 70 percent of the cases have been reported from six states (Texas, South Dakota, Mississippi, Oklahoma, Louisiana, and Michigan) and over 45 percent of all cases have been reported from Texas.”

Health officials are not sure why West Nile is so bad this year or why Texas has been so hard-hit. The very hot summer may have been a factor, but viruses like West Nile have complicated and hard-to-follow life cycles, they said.

West Nile is spread by infected mosquitoes, which breed in water. But CDC officials said they doubted Hurricane Isaac would worsen the epidemic, because mosquitoes like stale, standing water, which is likely to be washed away by a hurricane.

The CDC’s Dr. Lyle Petersen, an expert on mosquito-transmitted disease, says the virus has to pass from mosquitoes to birds and back to mosquitoes to take hold in an area, and big storms mess up that cycle of transmission. “The end result is that hurricanes and floods do not have a major impact,” Petersen told reporters in a conference call.

“Heavy rainfall can certainly eliminate breeding sites rather create them,” he added. But in the weeks after a storm, pools of water can form and make new sites for the insects, he added. After Hurricane Katrina struck the Gulf coast in 2005, a few more cases of West Nile were reported but that was more likely because so many people were outside, repairing homes and cleaning up debris, he said.

“We continue to preach the message of making sure you are raining your yards,” said Texas state health commissioner Dr. David Lakey.

Heat could be a factor, also, if it incompletely dries up pools of standing water. “There has been a lot of speculation about the heat wave this year and could this partially have caused this effect, and the answer is yes,” Petersen said. But, he added, other heat waves have not led to outbreaks.  

 Officials in the Dallas area have been spraying pesticides to kill mosquitoes and Lakey and Peterson both said that should start cutting reported cases of West Nile there. It takes a few weeks for cases to be reported, so they said the number of reported cases will probably rise before it starts to fall.

More than half the cases reported so far this year have been of neuroinvasive disease – meaning the brain and spinal cord are affected. Peterson said it’s unlikely there’s an unusually high proportion of severe cases compared to years past. He notes that 80 percent of people infected with West Nile never even feel particularly sick, and it’s the serious cases that are more likely to get noticed and counted.

But people with neurological symptoms can be in serious trouble. There are three types – meningitis, which is inflammation of the spinal cord; encephalitis, which is when the brain is infected and inflamed; and acute flaccid paralysis, caused when both the brain and spinal cord are damaged. About one in 150 people infected with West Nile develop severe illness, according to the National Institutes of Health.

Patients with meningitis must be hospitalized but usually recover, Petersen said. About 10 percent of patients with encephalitis die, and those who survive may have subtle neurological effects long term. Patients who develop paralysis are in the worst trouble – a third recover, a third have some weakness long term and a third never recover, Petersen said. Some patients have had paralyzed limbs for years now.

Lakey says people of all ages have been affected, but the older people are, the more likely they are to be seriously ill. People with damaged immune systems, such as cancer patients, are at higher risk.

By the time patients with neurological symptoms get to the hospital, the virus has already invaded the nervous system, Petersen says. There’s no drug to treat West Nile virus anyway, and this effect makes it hard to develop one, because it’s hard to make a drug that can penetrate the central nervous system.

And because West Nile is so spread out and sporadic, it’s hard to even try to develop a drug or vaccine to fight it, Petersen said. Drug companies need lots of guaranteed cases of a disease to test whether a new vaccine or drug actually works.

“We are dealing with a low-incidence disease most years, (with) cases that are widely dispersed,” Petersen said. “The thought of trying to produce a phase 3 clinical trial to show efficacy is fairly daunting."

Related links:

Is spraying for West Nile safe?

Cluster of hantavirus cases worries officials

Five things you need to know about West Nile virus