Talking the relation between climate change, COVID-19 and public health with U of M

Vishnu Laalitha Surapaneni

2019 was the second hottest year ever recorded since the National Oceanic and Atmospheric Administration started keeping records in 1880. The past five years were the hottest on record.

According to the Minnesota Pollution Agency, Minnesota is approximately 3 degrees warmer than it was in 1951. As our climate heats up, there are health repercussions from air pollution, rise in pollen, extreme heat, floods and droughts, and other ecosystem damages. 

Vishnu Laalitha Surapaneni, an assistant professor in the University of Minnesota Medical School and Climate Change and Health champion, explains how health repercussions from the changing climate unequally impact certain Minnesota populations and how the COVID-19 pandemic compounds these health harms.

Q: Is extreme heat-related illness a concern in Minnesota?
Dr. Surapaneni
: Minnesota is warming up and extreme heat events are becoming more common, even in our state which is known for its cold weather. Extreme heat is one of the leading causes of weather-related deaths in the United States. The Minnesota Department of Health warns that extreme heat-related events are expected to become more common and more severe as climate change accelerates. 

Q: With Minnesota warming, who is at risk for heat-related illness?
Dr. Surapaneni
: To identify who is at most risk for health impacts from environmental stressors, we rely on a vulnerability framework that has three key components — exposure, sensitivity and adaptive capacity.

An increase in exposure to heat, as is the case for athletes, outdoor workers in construction, delivery services and agriculture workers, increases their vulnerability to heat-related illnesses. Other people affected are those living in urban heat islands and patients experiencing homelessness.

Sensitivity on the other hand, is the pathophysiology that is inherent to each person. For example, children and elderly are less able to regulate their body temperature in response to extreme heat. Patients with illnesses such as renal disease, hypertension and heart failure are at increased risk for dehydration due to extreme heat. 

Adaptive capacity is our ability to counteract the impacts of heat. For example, access to air conditioning and drinking water, and workplace regulations that allow breaks during excess heat are some measures that come to mind. Minnesotans who cannot minimize exposure, are highly sensitive to heat due to their health condition, and lack the ability to improve adaptive capacity are the ones at highest risk to suffer the health impacts of extreme heat.

Q: Which populations in Minnesota are disproportionately impacted by extreme heat and how does the COVID-19 pandemic exacerbate these inequities?
Dr. Surapaneni
: When viewed through the lens of vulnerability assessment, it becomes very apparent that the health impacts of extreme heat due to climate change are felt disproportionately. Children, elderly, low-income, migrant and refugee communities, and communities of color are most impacted. For example, consider the migrant agricultural worker who works in extreme heat and cannot take a break due to lack of workplace regulations. They are unable to cool off at the end of the day due to lack of access to air conditioning.

With the COVID-19 pandemic, a lot of these vulnerabilities have been magnified. For example — during a heatwave, public health departments used to direct communities to cooling centers. With concerns around social distancing, the typical cooling centers in Hennepin County, like the Skyway and the Hennepin County library, have been partially or completely shut down. This concern is two-folded for low-income neighborhoods that have less access to green spaces thus decreasing their adaptive capacity. 

Another concern is for families facing job loss during the pandemic who are at risk of being unable to pay utility bills and lose access to air conditioning. This is especially relevant for families living in urban heat islands. Historically redlined districts are more likely to have urban heat islands, thus placing communities of color and at disproportionately high risk for heat-related health impacts. 

Q: What can people who are directly impacted by extreme heat do to help mitigate these negative impacts?
Dr. Surapaneni
: Minnesotans have very low heat-risk awareness due to our history of being a cold state. One of the most important things is for residents to know that Minnesota is warming and we are all at risk for extreme heat-related illnesses. This is especially the case with higher than normal temperatures in spring and summer, when we have not yet physiologically acclimatized to the changing weather. 

On an individual level, minimizing exposure to heat, staying hydrated and restricting the use of fans when the temperatures are above 95 degrees are important steps. Recognizing and intervening on early signs of heat exhaustion like sweating, muscle cramps, nausea and dizziness can prevent serious health impacts. We also need to learn to identify more dangerous signs like high body temperature, confusion and unconsciousness and seek immediate medical attention. The Center for Disease Control has an easy-to-read guide for how to prepare for extreme heat. 

Q: How are health care professionals addressing this problem?
Dr. Surapaneni
: Climate change is a health emergency. As health professionals, it is our imperative to protect the health of our planet if we want to protect the health of the communities we serve. We need to take action to reduce our carbon footprint and protect our patients from the health impacts of climate damage.

The U.S. healthcare industry contributes to about 10% of the country’s annual carbon footprint. Rising temperatures mean more air conditioning which leads us to a vicious cycle. However, healthcare systems can reduce their footprint by implementing green roofs to cool buildings and improve energy efficiency to minimize energy use. Switching to local, renewable energy sources like wind and solar would not only decrease our emissions, but also makes us self-reliant and resilient in case of future disasters. 

Given the disproportionate impacts of extreme heat, health professionals need to advocate for science-based climate policies that help us transition off fossil-fuels. We should also work with local governmental agencies to improve climate resiliency of vulnerable communities. For example, University-community partnerships could implement interventions to reduce urban heat islands through translational research projects. 

Health professionals interested in taking action can join the Climate Health Action Program, a collaborative effort of University physicians to create a sustainable healthcare system. Another option is Health Professionals for a Healthy Climate, a local non-profit of Minnesota health professionals advocating for sound climate policy. 

Q: As a hospitalist, how is extreme heat-related illness relevant to your practice?
Dr. Surapaneni
: As health care providers, when we think of heat-related illness, we typically think of a heat stroke. However, it is important to recognize that heat-related illness can show up with a range of different presentations. For example, in patients with sickle cell disease, dehydration can provoke a crisis. Patients who take medications for high blood pressure, such as diuretics, may have a passing out episode, electrolyte abnormalities or kidney injury. Hot weather worsens air quality and can also trigger attacks in asthmatics and people with chronic lung disease. 

It is essential for us to understand the unique vulnerabilities of our patients so that we can prescribe tailored interventions. For example, for the postal worker taking diuretics, we would recommend carrying a water bottle to stay hydrated and taking the diuretics at bedtime. For the elderly patient living alone, in addition to ensuring general measures to minimize heat-stress, we would advocate for a family member or neighbor to check-in regularly as heat-stress can often present itself as lethargy and confusion. It is also essential that we document heat-stress in our medical records, when appropriate. This helps us understand the health burden of our changing climate  and helps devote resources to impacted communities.

Vishnu Laalitha Surapaneni, MBBS, MPH, is an assistant professor at the Medical School and a hospitalist at the M Health Fairview University of Minnesota Medical Center. She specializes in climate change and its impact on human health. Surapaneni works with community organizations to advocate for just climate policies and has provided expert testimony at the Minnesota State Capitol on the public health impacts of climate change. Her work has been featured in MPR, City Pages, Minnesota Daily, Common Dreams and the Associated Press. Follow her @LaaliMD on Twitter for information on how climate change impacts our health and the role health professionals can play in climate action. 

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07/20/2020