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It’s Too Darn Hot

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Burden S. Lundgren
August 18, 2023

“Mad Dogs and Englishmen Go Out in the Noonday Sun” – Noel Coward, 1931

Increases in severe storms, flooding, melting ice, rising seas and wildfires—all are well documented effects of global warming. But these constitute slow-moving disasters. There is a heat-related catastrophe happening right now: direct heat-related deaths. Unlike storms, floods and lonely polar bears, heat-related deaths don’t make for frightening television images. Although excessive heat has been the leading climate-related cause of death for many years, it is a silent epidemic.

We have had previews, the most notable being the 1995 experience. During a one week heat wave in Chicago, deaths doubled from the previous year. In France, there were 11,000 excess deaths during the first two weeks of August. In both cases, the ambient temperature was only 104°F, although in Chicago, humidity raised the heat index to 119˚F. Despite active measures taken on the part of some governments, it is estimated that an average of 20,000 Europeans have died from extreme heat every year since 2020, including 70,000 in 2003 and 61,000 last summer. It should be noted that 90 percent of European homes do not have air conditioning.  

Unlike many other species, humans have the ability to adapt to differing heat environments—evaporative cooling is achieved by sweating. It can be impaired by high humidity, but at a certain point, humidity becomes near irrelevant. Blood vessels dilate dropping blood pressure making vital organs such as the heart, lungs and kidneys work harder, also increasing the need for fluid replacement. If the temperatures are too extreme, the body cannot keep up. The very young, the very old and those with chronic illnesses are the most vulnerable.

But the effects of heat are distributed along socio-economic lines too. Poor neighborhoods mean greater risk because they usually have more hard, heat-absorbing surfaces, fewer trees and less air conditioning. Outdoor work also presents high risks, and the unhoused may be at the greatest risk of all. Living alone can be high risk since the progression from not feeling well to collapse can be rapid. 

This summer is reported to be the hottest on record. That includes not only the countries we expect to be hot (temperatures reaching 113˚F in India, 123˚F in Pakistan, 124˚F in Algeria), but right here in the United States with similar readings in Las Vegas, Phoenix and California’s Central Valley among other places. But the heat is not just in scattered areas. At almost any time, TV viewers can look at a map of the United States and find that it is mostly red. Hundreds of millions of Americans have been under some kind of heat alert this summer.

How much heat can the human body stand? Research is somewhat meager. Clearly, there are important individual differences. Young healthy people can withstand higher temperatures than older, sicker people although there are plenty of deaths among young, healthy people too. We begin sweating at about 89˚F and display an increased metabolic rate at 104˚F. Temperatures of 122˚F may be incompatible with life no matter what your age or condition.

The heat is costly in terms of health, but also in dollars. A recent study reported that there were an excess of 234,000 excess emergency department visits tied to heat event days between 2010 and 2016. Other studies estimated that the excess heat-related care can amount to $1 billion in additional health care costs and $100 billion in lost productivity in the United States.

What are we doing in the face of the heat threat? Probably the most infamous response is that of Texas which has made water breaks for outdoor workers illegal. News reports present a split screen. I am looking at pictures of people running around in the sun as if 110˚F heat was an invitation to play. One headline advised that now is the time to start preparing to run September marathons. Another informed me that seniors are rapidly moving to the hottest states. These were the very same news sources that featured front-page articles on the extreme heat.

Our experience with COVID is not promising when it comes to meeting another public health calamity.  We still have a politically charged population. Poor communications from the CDC during the pandemic lessened the public’s trust in the government institutions that are charged with their protection. And it can be a hard sell. When the French government tried to warn the population about the dangers of heat after the deadly summer of 2003, a researcher with the French Public Health Agency said “The idea that summer heat could actually be dangerous struck people as a bit ridiculous.”

President Biden has announced some federal measures to ease the pain. We need a robust regulatory response. Above all, we need to convince the public how dangerous the heat is and what they can do to protect themselves. Protective measures can be surprisingly simple—like staying out of that noonday sun. Resistance to adapting to a changed environment cost untold lives during COVID. It looks like an experience we are about to repeat.

Author: Burden S Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care.  After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA.  She has served as a consultant to a number of non-profit groups.  Presently, she divides her time between Virginia and Maryland. She can be reached at [email protected].

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