The blazing heat that has become an unfortunate staple of the American summer is upon us again. And while it can create a host of health issues, there are also strategies for individuals and communities alike to employ to get through the worst of it.
Three Duke scholars discussed the heat's impact on health and ways to mitigate it during a virtual briefing for journalists Tuesday.
The experts included:
Dr. Lauren Siewny , medical director of the Duke University Hospital Emergency Department; Dr. Robert Tighe , director of the Climate and Health Research Initiative at the Duke University School of Medicine; and Ashley Ward , who directs the Heat Policy Innovation Hub at Duke University's Nicholas Institute for Energy, Environment & Sustainability.
Here are edited excerpts from that conversation:
Heat and Risk
Lauren Siewny, emergency room physician
"When we talk about who's actually at risk, I think there are some misconceptions. While athletes and outdoor workers are certainly at risk, many of the patients we see in the emergency department are just people simply going about their daily lives."
"People like older adults, young children, pregnant individuals, and people with chronic illnesses - like heart disease, lung disease, kidney disease and diabetes - can all be vulnerable. Heat emergencies can also happen indoors, especially in homes without adequate air conditioning."
"Heat doesn't cause just heat stroke. It really stresses nearly every organ in our body, and it worsens existing medical conditions, which can push just about anybody over the edge. This is why extreme heat is one of the most dangerous weather hazards that we face."
Heat and the Respiratory System
Robert Tighe, pulmonologist
"A lot of what I see over the summer are people who become short of breath while doing regular activities. They don't always know whether something is worsening with their lung disease, so they end up going to the emergency room or calling because they don't feel well."
"In many cases, they try to stay inside their homes and become even less active than before. Then they get out of shape, and their breathing worsens further. Summer is usually a time when I lose a lot of traction with my patients in terms of their ability to function because of the consequences of inactivity during the hotter months."
Overnight Heat
Ashley Ward, heat policy scholar
"When we have high temperatures during the day and persistently high temperatures overnight, it's really one of the most dangerous periods. Everything needs a reprieve. Our bodies need a reprieve. Plants and animals need a reprieve. Our energy systems and infrastructure rely on that recovery as well."
"If you're a person who works in a high-heat-exposure job and come home counting on being able to cool yourself at night, you need that recovery from daytime exposure. If you don't have adequate air conditioning or can't afford to run it, you can't rely on opening windows or enjoying a cool breeze to lower your body temperature or cool your home."
"People might think, 'Oh, 75 degrees or 80 degrees at night isn't too bad; it was over 100 today.' But it's actually a very dangerous time. Our research shows that overnight temperatures above 75 degrees can really drive vulnerable individuals into a health crisis."
Heat Symptoms to Look for
Lauren Siewny
"Heat illness exists on a spectrum. Early warning signs of heat exhaustion can include excessive fatigue, dizziness, headache, nausea, muscle cramps and heavy sweating. If you recognize these symptoms early, get to a cool environment, take a cool shower.
"What worries us in the emergency department is when these symptoms progress to confusion, difficulty walking, fainting and seizures. These are signs of heat stroke, which is a true 911 emergency."
Air Conditioning Access
Ashley Ward
"The truth is, there are a lot of people in North Carolina and around the country who make difficult decisions every summer - rationing energy use so they can afford medicine or food. There are also many people, especially in regions recently affected by heat domes, who simply don't have air conditioning."
"If you can only afford one window unit, prioritize cooling your bedroom. It's a smaller area to cool, less expensive, and it allows your body critical recovery time overnight."
"If you don't have air conditioning at all, there are still things you can do. Use fans to move air, although once temperatures exceed about 101 degrees, you're mostly moving hot air; continue drinking water and staying hydrated; and remember that once you start sweating, water can also be used outside the body to lower core temperature."
"A lot of people tell me they did yard work at 3 p.m. and then simply sat in air conditioning to cool off. You can help your body tremendously by taking a cool shower first. These kinds of techniques are low-cost, easy to do, and can truly be lifesaving."
Who Does Heat Affect?
Lauren Siewny
"With this early heat wave, we're definitely seeing an increased number of heat-related cases earlier in the season. This often happens because our sweating mechanisms are less efficient before we've fully acclimated to hotter weather."
"As heat arrives earlier in the year, it's important to remember that this isn't just a summer problem anymore. It's something we need to be prepared for year-round."
"While outdoor workers and athletes are certainly among the people we see, they're not the only ones. We also see otherwise healthy adults who become dehydrated while working in the yard, attending outdoor events, exercising or spending extended periods outdoors."
Extreme Heat Is the New Normal, But Not Normal
Robert Tighe
"There's a tendency to sort of think it's always been hot in North Carolina. The summer is always full of temperature and humidity, and this is just normal. But this is not normal. Several days of over 100-degree heat that happen multiple times over the course of the summer, the fact that that goes from no longer the spring, but something after the winter, to all the way through the fall. These are not normal. This is a change. And so, it's easy to sort of see this as being sort of business as usual. But I really think that the heat, particularly in this part of the country, is really something that we have not experienced before."
"We have to treat this as the emergency than it is. And not just recognize these short periods over the last weekend, where the temperatures are 103 and 104, but really identify the prolonged things that are happening over time, and how that's affecting us, both from the standpoint of our health, but also from the standpoint of our wellbeing."
Heat Affects Communities Differently
Ashley Ward
"A cooling center in an urban community can be highly effective at saving lives if people know where it is, when it is open, and how to get there. Cooling centers are generally not as effective in rural communities because people are not going to drive 30 miles to reach one. Instead, we have to think about other community anchors, such as churches and civic organizations like Rotary clubs, which can help support residents during periods of extreme heat."
"People may have difficulty getting to a doctor, emergency department, or hospital, making it harder to manage chronic illnesses. Housing tends to be older in rural areas, energy costs can be very high, and power outages often last longer. Utilities understandably prioritize restoring power to more densely populated areas. As a result, a summer thunderstorm in North Carolina can leave some rural communities without electricity for 12 to 24 hours or longer."
"Local governments are working hard to identify vulnerable residents and make sure they can be reached during periods of extreme heat. They partner with volunteer fire departments, Meals on Wheels programs, and other community organizations that already have strong local connections."
"Faith-based institutions are also critical partners in rural communities. People trust them, they know who is most vulnerable, and they conduct a great deal of outreach."
Surviving the Heat
Lauren Siewny
"Make sure you're staying well hydrated, even before you feel thirsty, and water is going to be the best choice for staying hydrated. But hydration is only one piece of the puzzle. If you're continuously exposed to extreme heat, then water alone won't protect you. You need to find opportunities to cool down. This might mean planning outdoor activities in the mornings or evenings. Whenever possible, take frequent breaks in the shade or air conditioning, move those events indoors when possible. I know I had a family event over the July 4th holiday that we moved indoors because of the heat."
"Wear lightweight, light colored clothing, and don't underestimate that impact that humidity can have because humidity does make it harder for your body to cool itself down. And the last thing I recommend is to check on each other. Check on your neighbors, anyone living without air conditioning, serious heat illness can occur when people become quietly overheated many days in a row. So we really need to look out for each other, to support each other through this very, very prolonged and early heat season."
Surprise Findings From Heat Research
Robert Tighe
"We think of the young and the old as being particularly vulnerable, but what we're also learning is that there are particular groups that are also exhibiting things that we haven't seen before. We've identified not only across the globe, but also within North Carolina and South Carolina, communities of individuals who are getting early kidney disease and early kidney failure."
"In Sri Lanka, there's almost 30% of the male population in their 30s who have overt signs of kidney failure. And the reason that that's happening … is a combination of the stress of the heat, and also probably some exposures to things in farming communities, like agrochemicals, that are leading to this kind of kidney disease that's happening way accelerated and way early. It is really a direct relationship to the heat in our environment.
