Heat Is On: Extreme Heat Wave Taking a Deadly Toll

Kathleen Doheny

July 01, 2021

Lisa Jaffe is a Washington state native who has lived in her 115-year-old house for 5 years. Like many residents of Seattle, she has no central air conditioning but relies just on a portable unit, which she normally doesn't need. "I have a big tree that gives me shade," says Jaffe, a freelance journalist. That all worked fine until recently, when the unprecedented heat wave hit the Pacific Northwest.

Temperatures soared in Washington state and Oregon on Monday. "It got up to 107," she says, "and it didn't get below 86 in the house. My weather app said it feels like 110. And I wanted to know, to who?"

That kind of heat is universally uncomfortable, but for Jaffe, it adds to existing discomfort. She has rheumatoid arthritis, and doctors say extreme temperatures can especially challenge those with health conditions and those on medications for chronic conditions.

"It was too hot to sleep," she says. Yet she kept working, writing with a fan pointed on her. And she put the 4x6 gel packs that are used to transport her arthritis medication to good use as cooling agents. Then there was the issue with her dog, who was angry with her because Jaffe wouldn't allow her outside in the oven-like temperatures.

Millions of other residents in Washington, Oregon, and even up into Canada can relate as they've struggled through record-shattering, dangerous heat. Hundreds of emergency room visits and hundreds of deaths are being blamed on the heat.

While the temperature was cooling in Seattle on Wednesday — a balmy 69 in the early afternoon — that wasn't true regionwide. The National Weather Service is warning that, "Dangerous heat continues across interior sections of the Northwest and Northern Rockies, while extending into the Northern High Plains."

While the Pacific Northwest has borne the brunt of the heat, other areas are affected, too. The Weather Service says there will be 1 more day of oppressive heat throughout the Mid-Atlantic and Northeast, followed by a cold front producing rain and chances of severe weather.

Emergency Rooms Overflow

Steve Mitchell, MD, medical director of the Emergency Department at the University of Washington Medicine/Harborview Medical Center, started his usual clinic shift at 6 a.m. on Monday, the peak of the heat. He didn't leave until 2:30 p.m. on Tuesday as the heat-related cases began arriving at the emergency room. "I worked my normal clinic shift and then realized we needed to shift to regional disaster mode."

He activated the regional Disaster Medical Coordination Center. Harborview and about 30 other hospitals are part of the center — hospitals where medical personnel coordinate patient movement during an incident, such as the heat wave, that may overwhelm the healthcare community.

"We started managing ambulance arrivals throughout King County to distribute those patients as equally as we could," Mitchell says, to avoid overwhelming any one hospital. "Monday was our worst day. We reached 110[º F] in most areas."

A common reason for emergency department visits was heatstroke, which he says is usually "a very rare event in our region."

Heatstroke — when body temperature reaches 103º F or higher — "is a true emergency where the entire team has to act quickly to bring their temperature down to save their organs," Mitchell says. "You have to rapidly cool them. You literally pack them in ice." He suspects that "there was more ice being used in Washington emergency departments than ever in history."

As for how that heat affected hospital emergency departments and admissions, he says, "we are trying to get a handle on that. We don't have great stats exactly on the impact. Some hospitals were reporting all-time highs for the emergency departments."

"I think it would be safe to say that ER use across the region went up probably 25%," Mitchell says. "But in some circumstances, it was more than double." As for hospital admissions, "we had a much higher volume of very severe cases related to heat."

Keeping Track of Statistics

Keeping track of heat-related deaths and emergency department visits is a challenge, officials say. As of Wednesday, 13 heat-related deaths and one drowning have been reported, health officials in King County, Washington, say.

From Saturday through Monday, 465 emergency department visits were for heat-related illnesses. On Monday, about 10% of all emergency department visits were for heat-related issues, the King County Medical Examiner's Office says, with 226 visits logged. The previous 1-day record for heat-related visits was nine, in 2018.

Of the 226 patients, 30.5% were admitted to the hospital. The majority were over age 65 years. Those admitted most often had a diagnosis of kidney failure, changes in brain function (encephalopathy), or fever.

In British Columbia, which was also hard-hit, Chief Coroner Lisa Lapointe on Wednesday issued a statement noting that the number of deaths was up 195% over the previous 5 days — 486, compared to the 165 that are typical in that time period.

"While it is too early to say with certainty how many of these deaths are heat-related, it is believed likely that the significant increase in deaths reported is attributable to the extreme weather BC has experienced and continues to impact many parts of our province," she said.

Likewise, officials in Washington and Oregon are trying to analyze how many recent deaths are heat-related. "As of June 30, the [Oregon] State Medical Examiner's Office has received reports of 63 deaths that preliminary investigation suggests may be associated with the Pacific Northwest heat wave," according to Capt. Timothy R. Fox, a spokesperson for the Oregon State Police.

From June 25 to June 29, the Oregon Health Authority received 633 reports of heat-related visits to emergency departments or urgent care centers, says Delia Hernandez, a spokesperson.

Not surprisingly, Mitchell says, the heat is hitting older adults especially hard. With age, he says, the ability to regulate body heat declines. Another factor, he says, are the medications many older people take. "A lot of the medications people take for chronic conditions impact the body's ability to respond to the heat," he says.

Doctors at Providence Health in Oregon, a network of hospitals, clinics, and other services, are too overwhelmed now, caring for patients, to respond to media requests for interviews, public information people told WebMD.

Heatstroke and Beyond

Heatstroke is marked not just by high body temperature, but by skin that is hot, red, dry, or damp, according to the CDC. The pulse is strong and fast. Headache, dizziness, nausea, confusion, and passing out can occur.

Medical attention is needed right away. Until an ambulance or other emergency help arrives, don't give the person anything to drink, the CDC advises, and help lower the temperature with cool cloths or a cool bath.

"Confusion and altered mental status are typically late features, but it is very concerning," says Sean McGann, MD, an emergency doctor in Philadelphia and a spokesperson for the American College of Emergency Physicians.

There are other heat-related illnesses that people should be aware of, according to the CDC and McGann:

Heat exhaustion: Symptoms include heavy sweating; skin that's cold, pale, and clammy; and a fast but weak pulse. Nausea, vomiting, muscle cramps, dizziness, headache, and fainting can also occur. Move the affected person to a cool place, loosen their clothes, and apply cool clothes or put the person in a cool bath. Have them sip water. If vomiting occurs, symptoms last longer than an hour, or the symptoms worsen, get medical help right away.

Heat cramps: Muscle pain or spasms are symptoms, as well as heavy sweating while exercising vigorously. Stop the activity, move to a cool place, and drink water or a sports drink. Rest until the cramps subside. Get medical help if cramps last longer than an hour, or if the person is on a low-sodium diet or has heart problems.

Sunburn: Skin can be not only red and warm, but painful. Blisters can form. Apply cool cloths or take a cool bath. Don't break the blisters.

Heat rash: Small clusters of blisters that look like pimples can form, usually on the neck, groin, chest, or in elbow creases. Stay out of the heat, and keep the rash dry. Use a powder such as baby powder to ease discomfort.

"Heat rash and sunburn are less acutely dangerous," McGann says, "but can be prevented with appropriate clothing and skin protection, limiting time in the sun, and moving to cooler environments whenever you begin to feel overheated."

Other tips from McGann: Stay hydrated and "be careful with alcohol, which can lead to dehydration." Also, don't push through heat-related symptoms; get help.

Effects on Everyday Life

Residents of the Pacific Northwest say they can't remember these temperature levels, ever. The heat wave definitely is affecting everyday life, says Elisa Claassen, who lives in Nooksack, about 100 miles from Seattle. "On Saturday in the middle of the heat, a section of our county actually lost power. A number of people felt quite panicked, and they were able to repair it in a few hours. But I think it showed that they had a weakness that many people did not know."

"We're used to just opening our windows or sitting outside, but this was far different," says Claassen, who owns a couple of fans, but one was not working. Luckily, she says, "a friend gave me an extra fan since so many of the stores were running low."

Many restaurants near her closed, she says, concerned about the health effects of the heat on the staff.

Animals were affected, too, of course. Classen often gets visits from a neighborhood raccoon. "A couple days ago, it popped up at 7 in the morning, looking very desperate for food and water. And yes, I did help it."