The Double Exposure: When the Summer Heat Meets the Pandemic
By Sabrina McCormick
In August 2003, Paris stood still, the streets largely empty, foot traffic slowed to a trickle, the sound of sirens resounding through the streets. This wasn’t a case of COVID-19. It was the world’s deadliest heat wave that killed up to 70,000 people in a period of weeks. The effects of this heat wave looked a lot like COVID-19 has looked for many places around the world, overflowing morgues, refrigerated trucks full of victims, health care workers rushing into homes to try to save those on the verge of death but with little luck.
In the coming weeks, America, including big cities like New York, Chicago and Los Angeles, will face the double impacts of heat and COVID-19 with the combination being particularly deadly for specific communities. COVID-19 is having clear, disproportionate effects on Blacks and Latinos. While this extremity of impact seems newly disproportionate, it is actually an echo of this previously dangerous environmental health phenomenon caused by an even larger, looming public health crisis — extreme heat exposure driven by climate change.
What I call a double exposure of heat and COVID-19 promises to creep silently, but all too quickly, into the neighborhoods where heat has hit before and where COVID-19 is already rife. In many low-income communities, air conditioning is too expensive to be used, or building infrastructure is too weak to support its use. Those who would normally be able to leave their homes will be unable to go to a cooling center or library due to necessary social distancing measures in cities. The end result? Apartments will turn into ovens, threatening those who are unable to thermoregulate properly. That threat is insidious because heat can interfere with the biological process that even alerts a person to the fact that they are actually too hot to survive.
Many of these deaths will remain invisible for weeks. Our research in New York City on identifying deaths from heat wave exposures shows that identification of deaths is often delayed and vastly underestimated. We examined several years during which heat rose above average temperatures and found that even a city with excellent public health officials like New York is unprepared to assess who is truly dying from heat waves. These same challenges may arise in COVID-19/heat death counts, meaning we may be missing many deaths for some time, disguising the true burden and the need to act to protect the most vulnerable immediately.
Across this country, race and the intensity of localized heat exposure is tightly correlated, meaning that people of color are generally at much higher rates of exposure to heat. As such, COVID-19 as an environmental health concern — one whose exposure originates primarily in the air we breathe — combined with heat exposure reveals the critical and immediate need to improve our environment to save lives.
The good news is there is a way to address both COVID-19 and heat at the same time. In fact, the resolution to both is one in the same — making our air cleaner than ever. Cleaning the air addresses both pollution driving climate change which pushes temperatures up and that increases the risk of COVID-19 mortality. While we act to address COVID-19, we would be remiss to not also think about transforming our public health preparedness for this pending catastrophe. In the short term, we must develop green spaces where people can go to cool off in a socially distanced way. This must be a policy measure that our leaders move forward on at every level of governance. By thinking about the double exposure of heat and COVID-19, we will be able to address the long term, and much larger pending disaster of climate change. Let’s promise each other that we will finally come to see how protecting the most vulnerable shows us the way to protecting all of society both now and in the future.
Sabrina McCormick, PhD, is an associate professor of environmental and occupational health at the GW Milken Institute School of Public Health.
