When Hurricane Florence made landfall on September 14, it pummeled the Carolinas with high winds and staggering amounts of rainfall. The storm dumped more than 30 inches of rain in some areas, causing rivers and roads to flood. Then, this month, after it decimated homes in the Florida Panhandle, Hurricane Michael caused serious flooding in Virginia.

Now, thousands of victims will assess and repair the damage to their homes. Many will tear out flooring and drywall to try to get rid of mold.

Mold is a common result of residential flooding. When a home has water damage, mold starts to grow within 24 to 48 hours of water exposure on surfaces such as wood, ceiling tiles, wallpaper, carpets, drywall, and insulation. If it’s not removed, mold can cause respiratory issues, coughing, wheezing, and eye and skin irritation, according to the CDC. Infants, children, pregnant women, individuals with asthma or other respiratory conditions, those with impaired immune systems, and older adults, in particular, face higher risks of detrimental health effects from mold.

Theresa Blount, pediatric asthma program coordinator at Vidant Medical Center in Greenville, North Carolina, told CityLab that the center saw almost 100 more pediatric asthma cases than usual when Hurricane Matthew hit the area in 2016.

“Now, we’re expecting we’ll probably see another rise, with just having Florence come through,” Blount said. “And a lot of that’s attributed to the mold that we see in the homes.”

Last year’s Hurricane Harvey flooded over 300,000 structures in southeastern Texas, and some Texans still have mold in their homes as a result. Helen Conway’s house in the Houston neighborhood of Kashmere Gardens flooded after Harvey in August 2017. She stayed in a shelter and then a hotel until this April. Conway, 67, did not have flood insurance—she said she didn’t know she needed it when she moved into the house. (FEMA’s National Flood Insurance Program covers mold damage for policyholders if it determines they did not “fail to take action to prevent the growth and spread of mold.”)

Kashmere Gardens residents are predominantly black and Hispanic, and its median household income is about $23,000, or half the city median. Conway lives by herself and lacks internet access. For help with her mold problem, she called community organizations that people gave her numbers for, like local churches and Black Lives Matter. In December 2017, volunteers removed some mold and repaired walls and flooring in her house.

Although the patchwork of assistance Conway received has enabled her to live in her home again, it has been hard for her to navigate the web of philanthropic services without internet access and with limited government assistance. She still has mold in one room that has a leaky roof. She hasn’t experienced any health problems, but is concerned about when the room will be fixed, she told CityLab. “It’s raining right now. And the more it rains, the more will fall in,” she said.

Jonathan Wilson of the National Center for Healthy Housing says that even if mold appears to be contained to one room, the fungal spores can float to other parts of the home, since they are tiny particles. Mold growths, also called colonies, reproduce by spores that travel in the air, destroy organic material by digesting it, and spread to adjacent organic material. This reproduction process is why residents have to be careful that all of the mold is removed and wait to rebuild or return items until the area dries completely—otherwise the mold will just grow back again. The most common heating and cooling systems in the U.S. use forced air, drawing air from one room to another, and can spread mold particles from an affected room to elsewhere in a house.

“Our guidance is: get rid of the mold as quickly as possible, even if that room is unfinished and you’re going to take a while to restore that room,” said Wilson. “Make sure at least if you’re going to be living in the property that the mold is removed.”

Only healthy individuals without pre-existing conditions and with the proper protection, like face masks, should do the job themselves, Wilson said. People with the means can hire private mold remediators, but that costs $1,891 on average in Houston. Not only is remediation pricey, it can be financially infeasible to live elsewhere while waiting for mold to be removed completely.

Suratha Elango, a community pediatrics professor at Baylor College of Medicine and a pediatrician at Texas Children’s Hospital, has worked with families trying to recover from Harvey, which racked up $125 billion in damages. She heard from them that mold removal is too expensive and it’s difficult to learn what philanthropic help is available.

“The reality is many families, even today, living in homes that are moldy, that were improperly repaired,” Elango said. “There are still families living in bare-bones homes, and financially don’t have a recourse on how to address that.”

L. Faye Grimsley, the head of Xavier University of Louisiana’s Public Health Sciences department, suggested that the federal government, state governments, or both should prepare for future disasters by training mold-remediation workers who can help residents, so they don’t have to choose between paying out of pocket or living in a moldy home.

“Since we know we are going to have these disasters, mold remediation is going to be a concern,” she said. “It’s like with the emergency response to an oil spill: You have cleanup workers. It could be something similar for mold.”

Grimsley noted that not everyone has the resources to evacuate or to purchase flood insurance: “You know everyone is not going to be able to afford the insurance. They should have a mechanism to help individuals acquire flood insurance.” The Congressional Budget Office (CBO) reported that the median annual flood-insurance premium in 2016 was $520, though it varies based on location. That’s a hefty sum for people who are just making ends meet.

On top of that, many people don’t even realize they need flood insurance, especially if their area hasn’t flooded before. According to FEMA data, only some 330,000 homes have flood insurance in North and South Carolina, but millions of homes in those states were at risk of flooding because of Hurricane Florence.

As thousands across the South deal with the effects of flooding from Florence and Michael, and because water warmed by climate change will supercharge storms in the future, post-disaster mold is likely to become a bigger problem for public health. Addressing it could mean in-person outreach about flood insurance, more financial support for those who can’t afford it, government-funded mold-removal workers—or all of the above.

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First Come the Floodwaters, Then Comes the Mold