Death by Extreme Heat is a 21st Century Death

July has ended, and with it the hottest month ever recorded in human history.

Last week, in Maricopa County, Arizona, home to the city of Phoenix, the chief medical examiner warned the region could be on its way to a record number of heat deaths and brought in 10 refrigerated containers to be used as backup storage for bodies. There have already been 39 heat-related deaths in Maricopa County this year, a number certain to rise as the process of counting deaths from heat involves a time lag—last year, there was a record-breaking 425, and this year’s numbers are expected to eventually surpass that. The scenes from Phoenix and across southern Arizona are truly apocalyptic.

“Patients with heat stroke and burns from the asphalt are swamping hospitals,” the New York Times reported last month. That is, people who burn their legs and backs by falling on pavement that can reach up to an astonishing 180 degrees—according to a post by the University of Illinois, this is more than hot enough to fry an egg, which only requires a temperature of 158 degrees. The New York Times reported a harrowing story of “a woman in her 80s” who “came to the hospital for burn treatment after falling outside her home, then lying on the searing pavement for two hours before anyone heard her calls for help.” The paper also reported that emergency rooms have treated more homeless patients and drug users with heat-related illnesses. People living in inadequate structures or who spend the day on the street are most at risk.

And it is not just the humans that are suffering. “Towering saguaro cactuses are collapsing from the heat, and the agaves, creosote bushes, and stubby barrel cactuses that spangle highways are turning yellow,” the New York Times reported. “Hiking trails have been closed at midday for more than a month to protect hikers (and the paramedics who have to rescue them).” Monday, July 31, marked the first day since June 28 that Phoenix did not see 110 degrees or higher. Temperatures hit only 108.

“We are seeing the full spectrum of risks, from heat exhaustion to more injuries from dehydration to even new food or waterborne illnesses because bacteria can replicate faster in warmer weather,” Gregory Wellenius, an expert in environmental health at Boston University School of Public Health, told the British newspaper, the Guardian. “My guess is that 2023 will prove to be one of the years with the most heat-related excess deaths on record in recent memory.”

Meanwhile, in National Parks, where millions of Americans and visitors from around the world go to camp, hike and experience some of the nation’s natural wonders, there has been a rash of extreme heat deaths. “Extreme heat appears to be killing people in America’s national parks at an alarming pace this year, highlighting both its severity and the changing calculus of personal risk in the country’s natural places as climate change fuels more weather extremes,” CNN reported recently. By July 23, there had been five heat-related deaths in National Parks, more than any other year since 2007, when data first began to be kept. The deaths have taken place in three national parks notorious for their desert landscapes and heat: Grand Canyon National Park in Arizona, Death Valley National Park in California, and Big Bend National Park, in Texas. These three parks are responsible for more than half of the 68 heat-related deaths reported by the park service since 2007. The Grand Canyon is the deadliest park for extreme heat, with 16 deaths since 2007.

But data from cities across the country show that most of the deaths from extreme heat will not necessarily hit hikers and those moving freely about the outdoors, but those stuck indoors, without proper air conditioning, or those stuck living out on the streets, with little or no ability to cool themselves down. Data from years past show heat deaths are intertwined with the opioid and housing crises in the Phoenix area, NBC reported. “Last year, heat contributed to 425 deaths in Maricopa County, which was about 25% more than the previous year,” and “about 56% of the heat deaths involved people experiencing homelessness.”

Homelessness was something that Digital Dying discussed in an article we posted in 2021 on extreme heat-related deaths, “Temperatures Soar And A New Way Of Dying Emerges—Death By Heat.” We quoted Dr. Vivek Shandas, a researcher who studies cities and climate at Portland State University. Shandas had explained to NPR that the highest temperatures recorded in a study he had done on extreme heat was at homeless encampments. “Those were about 135 degrees, and that is clearly enough to kill somebody if you’re exposed to that,” he had stated.

More recently, the New York Times has addressed that very issue. “Those most likely to die from heat, however, tend to be older people, migrants, those in poverty, those experiencing homelessness or inadequate housing, and those who work outside, like construction workers and agricultural laborers,” a recent opinion piece reported. “It is unconscionable that in our wealthy country, we let blue-collar workers and the economically disadvantaged needlessly die in oppressive heat.”

“We, as a society, cannot simply wash our hands of these deaths, passively blaming them on a number on a thermometer,” the piece continued, written by Tish Harrison Warren, a pastor. “Human society and industry have contributed to the rising heat of climate change. And human society — the government, the church, and individuals alike — have failed to ensure that those most at risk are kept safe. So, as heat deaths rise, when we speak of those who die, don’t just say they died of heat. We say they died of poverty, of neglect, of a world that values the wealthy more than those who are not, of a society that looks away from the preventable suffering of the vulnerable.”

And the problems of extreme heat have spread beyond the typically hot desert state of Arizona. The last month saw much of America experience temperatures near or above 100 degrees, often with high humidity levels too. “The heat dangers long known in greater Phoenix are becoming familiar nationwide as global warming creates new challenges to protect the aged,” stated an article published earlier this spring by the Associated Press. “From the Pacific Northwest to Chicago to North Carolina, health clinics, utilities, and local governments are being tested to keep older people safe when temperatures soar. They’re adopting rules for disconnecting electricity, mandating when to switch on communal air conditioning, and improving communication with at-risk people living alone.”

It is not just the US experiencing this heat but the world. “Extreme heat is killing more people – and the worst is yet to come,” USA Today reported in an article published last month by Richard Keller, a professor in the Department of Medical History and Bioethics at the University of Wisconsin in Madison. “The world is witnessing temperatures never experienced in recorded history,” the USA Today article continued. “On July 6, Algeria recorded the highest nighttime low temperature in African history – just over 103 degrees. A powerful heat dome has descended on Europe, bringing land surface temperatures to 140 degrees in Spain. And among the most important signs of extreme weather is the rising death rate. The future of climate change is here, bringing escalating mortality with it.”

The article cites a number of concerning data points and findings, including a report released in June by Santé Publique France, the country’s chief public health agency, documenting steadily rising heat mortality since 2014. A recent analysis in the scientific journal, Lancet Planetary Health, indicates that every year since 2000, an average of 20,000 people have died from extreme heat in European cities. And a new study in Nature Medicine reports that more than 61,000 Europeans died from extreme heat in the summer of 2022, the deadliest summer since the devastating heat waves of 2003 in Europe caused 70,000 excess deaths.

Digital Dying provided some important scientific information on extreme heat when we ran a post on the topic in 2017, “Just How Many People Will Climate Change Kill?”

“Hot weather alone is not dangerous,” explains a 2012 LiveScience article, quoting environmental physiologist Chris Minson. “Instead, it’s a combination of hot temperatures, high humidity, and often pre-existing health conditions.” The normal human body temperature is about 98.6 Fahrenheit, but these factors can push that temperature up to 104 F, considered the danger zone. “At that point,” the article continues, “the nervous system goes haywire, the heart experiences excessive stress and organ systems begin to fail.”

“The analogy we use is if you’re driving a car and you notice that the temperature light comes on,” reads an article in Scientific American on how heat kills. “What’s happening is the cooling system of the car is becoming overwhelmed. If you turn off the car and let it cool eventually, you can start driving again. But if you continue to drive the car, the problem goes beyond the cooling system to affect the engine, and eventually, the car will stop.”

Blood is like our body’s thermostat. To keep the body cool in these extreme temperatures, the heart pumps more blood to the skin, which causes blood vessels here to expand. This provides more surface area for the blood’s heat to dissipate, thus having a cooling effect on the body. In hot weather, the body produces more sweat, which also has a cooling effect as it evaporates off the surface of the skin. This, in turn, cools the blood near the skin’s surface, which returns cooler blood back toward the heart and can help prevent the core from overheating.

But with too much heat, this sweat and blood-powered air conditioning system breaks down. “Evaporating beads of perspiration are replaced by pouring rivulets of sweat,” explains the LiveScience article. And “rivers of sweat do nothing to lower core temperatures.”

Another issue with heat lies in our brains. “The brain and central nervous system are particularly sensitive to high internal temperatures,” says LiveScience, “which can cause confusion, strange behaviors, loss of memory, and an inability to think clearly.” And this makes the situation particularly frightening because it takes away an individual’s natural ability to understand their deteriorating condition. All of this, the article adds, “makes it extremely difficult for a heat-stressed person to realize that he’s in trouble.”

One of the most vulnerable groups when it comes to extreme heat is incarcerated individuals. According to a recent Time Magazine article, citing research by Dr. Julie Skarha, an environmental epidemiologist at Brown University’s School of Public Health, 271 prisoners died of heat-related causes in un-air-conditioned Texas prisons between 2001 and 2019. The Time article reports that 70 percent of Texas prisons lack air conditioning in cells and common areas, and the rest of the United States is not much better. “Yet prisons house a growing number of people with medical conditions and mental health concerns that make them particularly susceptible to heat-related illnesses,” reports Time. “This leaves a vulnerable population even more at risk.”

As the Time article points out, unless aggressive action is taken to limit fossil fuel emissions, the number of days per year above 105 Fahrenheit will quadruple by mid-century, according to an analysis by the Union of Concerned Scientists. “By the end of the century, thousands of U.S. prisons will know the kind of heat Texas has today,” the article states. “Without air conditioning, that risks turning temporary incarceration into a death sentence.” Texas does have protocols in place for heatwaves. Fans should be brought in. Inmates are supposed to be provided with extra water and ice and offered the opportunity for cold showers. But, according to the article, the protocols are unevenly applied.

In late July, President Joe Biden announced new measures aimed at helping those exposed to extreme heat, and UN secretary general António Guterres made an impassioned speech on the topic in which he stated: the era of global warming has ended, and “the era of global boiling has arrived.”

In an era of extreme heat, and considering the unfortunate deaths of many and the stages of the funerary process, an important logistical question comes to mind: how do you dig a grave for someone, which inherently requires working outdoors, when it is 120 degrees outside? This is a question that Digital Dying is examining by seeking answers from those in the industry, and we will report back in the coming weeks. Until then, stay cool, everyone, and stay safe~