28 Comments

I am intrigued that the main solution here is "stay in the AC more", because I don't think it's a long term sustainable solution. The energy output required and environment affects (which then can just contribute to fossil fuel use and more greenhouse gases) seems self defeating. And then when the power is out, as you've mentioned, there is a wave of heat injuries. Also, in general terms, humans need to adapt, not depend on living in an artificial environment.

One thing I noticed living as a teenager at a US military installation in the Australian desert, is that the non-local American adults lived in extreme air conditioning at work for most of their day and then when they did come outside, they couldn't deal with the heat. A lot of town didn't have AC, and neither did my school - and the American students adapted to heat after several months and then started to feel comfortable like the locals. I know there are physiological reasons for this, although I'm not an expert in that area.

I've long thought the Americans with our willingness to spend huge energy expenditures and crank the AC super cold (hello women who freeze in offices on the regular!) do ourselves a disservice because we just never adapt to outside temperatures. I have no idea how you could actually have an intervention on this, but do you think there could be merit in getting people outside MORE, dressing more appropriately, hydrating more appropriately, and importantly, designing our built structures to cool interiors WITHOUT the use of AC?

Of course, as mentioned the homeless population are the hardest hit and those with AC are currently doing better, as you've shown. But I think there are better answers than "get in the AC", including for the homeless population- better access to water, shade, clothing etc

Expand full comment
Jul 27, 2023·edited Jul 27, 2023

It is worth mentioning that cold extremes kill ~10 times as many people as warm extremes both globally and in Europe. So warming, which reduces cold extremes, will result in a reduction in deaths from extreme temperatures. Apparently 500,000 fewer lives were lost in the UK from 2001 to 2019 because of milder winters.

We can protect from temperature extremes by ensuring that electricity is cheap and reliable and domestic heating and cooling are readily available. This requires economic growth and cheaper energy.

Expand full comment

"Like many things in public health, the HRI surveillance is a suboptimal patchwork of data, and only some states are reporting, creating a fragmented picture." For the far right, this is a feature rather than a bug. If our data on a problem for which they have no solution are incomplete or non-existent, it's easier to pretend the problem doesn't exist.

Expand full comment

Thank you for this summary and for the data. I'm so sorry to hear about your little girl. I hope that she is fully recovered and that all of you can stay cool. I also hope that we as a country and a world can get it together to more rapidly and effectively address climate change.

Expand full comment

At least we now have, from gov't funded atmosphere/ocean researchers, frequent global measurements of air temperature. This is part of the broad weather, climate, air-quality data flow, from orbiting satellites to deep diving ocean probes. It can aid our response, and especially, warns of the spread of UNinhabitable regions. For example, google NASA WorldView..... https://worldview.earthdata.nasa.gov

Expand full comment

What do you consider to be the Midwest? Illinois, Wisconsin, Iowa, etc are midwest to me, yet I see no charts with these states in them.

"While state data is lagged (last update was 2021), data by region is impressively available in almost real-time. 2023 is shaping up to be unique in the Midwest, with higher rates of HRI than in previous years."

Expand full comment

Good job. What IVD-10 diagnostic codes are being used to find heat related illnesses? As a physician myself, I was especially interested in this statement, “Reporting behavior. If more physicians are aware of HRI, they are more likely to categorize it as such in a patient’s chart. Over time, it will look like more HRI when, in reality, it’s a product of increased reporting.”

Expand full comment

Comment on a different subject: I suggest looking at a paper in Nature, 20 July 2023. Title is: How Many Clinical Trials Can't be Trusted?", by Richard Van Noorden. Sounds like the magnitude of faked clinical trials and faked or altered data is significant.

Expand full comment

Agreed. You can't tell 8 million people to crank up their AC without straining the power grid, and if that goes, we're all buggered.

Considering how incensed people got about the minor nuisance of wearing a mask, I'm not optimistic that people are going to behave altruistically (certainly not voluntarily) when we start having to ration air conditioning to people who are deemed to need it the most.

Expand full comment
founding

This is so good to increase understanding of what’s going on. Applause to Dr. Jetelina for once again doing comes naturally, as in “So, naturally, I went down the epi rabbit hole of curiosity.” 💕👏💕👏💕

Expand full comment

First thank you for addressing the impact of environmental determinants on health (EDOH). As I've read and heard, HRI are severely underreported. The impact of extreme heat on overdose, respiratory illness, cardiovascular events, etc. are generally not included in these stats. How can we present this data when what I've read is that Heat Related mortality is probably 10X what is reported?

Expand full comment

I'm very concerned about a covid vs excessive heat/poor air quality "rock and a hard place" effect emerging this summer.

Expand full comment

Glad you wrote about this Katelyn, I think it's a worthy topic to follow, along with other climate change related issues that impact health.

Expand full comment