How heat puts a vulnerable community at risk.
- Seniors can be at serious risk, as heat and dehydration already stress the body due to age and chronic medical conditions or become more vulnerable due to certain medications.
- Most people in Worcester can expect eight times the number of 90-plus degree days a year when they reach retirement, compared to the number of hot days when they were children.
WORCESTER – Calvin Gray is homeless, and one of his favorite places to stay quiet is under a tree that provides shade on Harding Street.
That’s where Gray was this week, carrying his personal belongings, and he wasn’t alone. Other homeless adults joined him under the tree, with a jug of ice water to share among the group.
“It’s hot,” 50-year-old Gray said, noting that he lost a lot of weight due to the heat, and this is what worries him because he suffers from diabetes and congenital heart disease. Gray is one of hundreds of homeless people in Worcester, with 493 people in the city experiencing homelessness in June, according to the Central Massachusetts Housing Alliance.
It’s easy to forget that the extreme heat associated with climate change is hard on unhoused people, with headlines dominated by wildfire smoke emanating from Canada and heat domes to the south and west. But the heat and its negative health effects on the homeless are real, according to experts.
Dr. Eric Garcia of UMass Memorial Health has spent the past 29 years on the front lines of homeless care, and he will never forget a homeless man he recently treated who suffered second-degree burns on his feet from prolonged exposure to the sun.
“I’ve never seen a sunburn this bad,” Garcia said, noting that dehydration, pulmonary effects and worsening of pre-existing health conditions pose major concerns for homeless people due to the high heat.
“Heat has a profound impact on the homeless,” said Ashley Ward, director of the Center for Heat Policy Innovation at Duke University.
Aside from the high cost of housing that makes it difficult for many to buy an apartment, Ward described other worrying negative effects of high temperatures on those who do not have housing:
● Lack of access to refrigeration means food spoils, leading to increased risk of infection.
● Burns result from lying on surfaces that retain heat, especially in urban areas where concrete is abundant.
Outside of work increases heat risk
Bouts of unemployment can put people on the streets, where they experience serious health consequences from the heat. As Ricky Lozzo wheeled his suitcase across Worcester Common, he said he was homeless and looking for work.
“The humidity will kill you,” Lozzo said. “It’s brutal out here.”
To protect Lozo and other unhoused people in Worcester, Garcia said some steps are easy and relatively inexpensive, such as providing cooling centers. Worcester currently has two, one downtown at the Public Library on Salem Square, and one at the Senior Center on Providence Street. City officials said work is underway to increase the total number.
More ambitious programs include providing free public water dispensers to refill bottles, planting more trees and expanding green spaces, Garcia said. Mobile vans with cool spaces inside for unhoused people to beat the heat that has emerged in Canada is an idea worth exploring, Ward said.
Other meaningful ideas mentioned by Garcia include expanding the supply of affordable housing, and emergency and seasonal shelters.
Some medications weaken sun protection
Medications that reduce the body’s ability to protect itself from strong sunlight are a concern.
One such drug is doxycycline, Garcia said. The medication treats MRSA (methicillin-resistant Staphylococcus aureus), an infection caused by a type of staph bacteria that has become resistant to many of the antibiotics used to treat common staph infections.
Garcia said MRSA poses a “major risk” for those with substance use disorder and those who live in groups, conditions that are common in the unhoused community.
“(Doxycillin) would reduce the ability to tolerate sun exposure, and patients may not be aware of the damage (to their skin),” said Garcia, who noted that the damage could range from a rash to a “horrific sunburn.”
Fear that heat deaths in Arizona could be repeated in Worcester
Garcia is closely monitoring this summer’s record heat wave in Maricopa County, Arizona, where more than 20 heat-related deaths have been confirmed and more than 200 deaths are being investigated.
If Worcester experiences a similar heat wave, Garcia is concerned about the ability of the city’s population in general to cope, especially the homeless community.
“If we saw that level (of heat in Arizona), we would probably see the level of deaths that we see (in Maricopa County),” Garcia said. “We as a society have to make investments to keep people safe.”
Ward echoed that sentiment. She believes government agencies devote resources to preparing for weather-related disasters like hurricanes and floods, but not for heat.
“We don’t have real congressional action on this,” Ward said. “We have to step up our efforts here and think about ways to use legislation to direct federal dollars to the state and local level, especially for heating purposes.”
How many homeless people die from extreme heat?
It is unknown how many people under constant shelter die from heat exposure.
However, Ward said a clearer picture could be determined if emergency departments used existing medical codes for weather-related exposures that can be linked to health emergencies such as cardiac arrest and kidney failure. Ward said there is no incentive to use these codes, because they do not provide government reimbursement for the cost of care.
“This is a systemic issue,” Ward said. “Physicians are doing a great job, but the incentive to incorporate these codes is not there in the current system.”
Worcester emergency departments generally don’t look at weather-related issues that could be responsible for a patient being admitted after frostbite, Garcia said. It is believed that systems could be created to provide follow-up care to assist non-hospitalized patients and other patients who have experienced heat-related illnesses, such as those for patients with substance use disorders after discharge from the emergency room.
“A similar effort on weather-related issues specifically regarding exposure to heat and cold would make a lot of sense,” Garcia said.
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The Telegram & Gazette investigates the effects of a rapidly warming planet on the people living in our city. Follow along with “City on Fire” as we report on the struggle with summer temperatures, even in New England. This is part of a risky course for the USA TODAY project. Contact reporter Henry Schwan to be included in the story if you are affected by the heat: the cost of air conditioning or lack thereof, health risks, lack of access to green spaces, concern about pets and animals in summer conditions, concern about an aging loved one, etc.
Contact Henry Schwan at firstname.lastname@example.org. Follow him on Twitter: @henrytelegram.