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How dual threats of heat and COVID-19 exacerbate threats to vulnerable communities

Residents of San Antonio, Texas, are no strangers to record-breaking, and often dangerous, summertime temperatures. Last August, the city saw its third-longest streak in recorded history of days with temperatures reaching 100 degrees or more. So far in July, triple-digit temperatures have prompted San Antonio officials to issue drought restrictions.

But this year the city faced an additional challenge in managing its response to scorching heat: Many of the air-conditioned spaces that residents often flock to for relief, such as shopping malls or even public transportation, were closed or operating at minimum capacity due to the ongoing COVID-19 pandemic.

“Usually in the summer in our community, we have to deal with the high heat. But not having an overlay of another health threat, like a pandemic,” said Mario Martinez, the assistant director of San Antonio’s Metropolitan Health District. He said that his department had to pivot their strategy for dealing with record heat during this time, such as requiring social distancing at cooling centers.

Still, Martinez said, he’s worried that fewer San Antonio residents are using the cooling centers than in previous years, due to fears of getting sick.

As temperatures soared throughout the country in July, local and state officials had to adjust their crisis response plans to account for the ongoing threat of the coronavirus pandemic. Protecting Americans from the heat has been particularly challenging for areas of the country — such as Arizona, Texas and Florida — that are currently also experiencing a spike in cases of COVID-19.

“Now with COVID-19, and malls being closed, libraries being closed, many communities are not opening their cooling centers because they’re worried about not being able to ensure social physical distancing. And so you have these drivers of risk piling onto each other,” said Helene Margolis, a professor of environmental health at University of California, Davis.

For climate experts, these compounding public health crises are a warning of what communities could experience in the coming years as global warming worsens. Many say that if communities don’t change their current infrastructure, the most vulnerable could see their health endangered by rising heat and other natural disasters, even when the COVID-19 pandemic has slowed.

How the heat exposes already existing vulnerabilities

In cities like San Antonio and Phoenix, residents are well accustomed to dealing with the heat each summer. But this year, some of the most vulnerable populations — such as the elderly, homeless or housing insecure — have had to contend with the threat of a deadly virus on top of record-breaking heat.

“We had to be really careful as to how those centers operate,” Martinez said of the San Antonio Metro Health Department’s decision to open cooling centers even as cases of COVID-19 continued to rise in the area.

Martinez said that his bureau partnered with a number of libraries in the area to set up cooling centers with social distancing measures in place. Staff and patrons are required to wear face coverings, and everyone who enters has their temperature and symptoms checked at the door.

The challenge amid the pandemic, Martinez said, has not necessarily been enforcing these preventative measures, but convincing San Antonio’s vulnerable residents to use the cooling centers. Martinez noted that many of the elderly or immunocompromised may struggle to access air conditioning, but may also be afraid to leave the house. “I’m sure they were thinking, ‘Wow, I’m at high risk because of my age, or age and medical condition. Should I even go there?’”

The local NBC News affiliate in San Antonio reported that library branch managers in San Antonio said they saw little to no people using the recently opened cooling centers, despite the city’s efforts to extend hours during a period of intense heat in mid-July.

Amy Schwabenlender, who runs Phoenix’s Human Services Campus, said her organization typically operates a 275-person cooling center for the homeless population during the summer. Because of the COVID-19 pandemic, they had to partner with Maricopa County to secure three separate buildings for homeless seeking relief from the heat, most of which have a smaller maximum capacity of around 80.

Schwabenlender said that because so many of Phoenix’s homeless are used to going through a number of processes in order to enter shelters, the extra protocol they had to put in place amid the pandemic did not necessarily deter vulnerable individuals from using the cooling centers.

“I think some of them feel everywhere you go, if you’re experiencing homelessness, you’re asked a bunch of questions, you’re given a bunch of rules,” Schwabenlender said, noting that the community quickly adapted to wearing masks in order to access shelter from the heat. “Their perspective is so different than for those of us who are housed.”

Basav Sen, the climate project justice director at the Institute for Policy Studies, said many towns and cities across the U.S. will be less inclined to open cooling centers this summer due to the pandemic. At the same time, the recession has rendered fewer Americans able to afford a costly electric bill: “You’re likely to have more people who either cannot afford to pay their utility bills….or even if they’ve kept up with their utility bills, they just cannot afford to run their air conditioning because air conditioning is one of the biggest users of electricity at home.”

Kristie Ebi, a professor at the University of Washington specializing in the health risks of climate variability and change, said that protecting communities from both the heat and COVID-19 was critical for local and state officials to consider, particularly because most of the deaths in a heat wave are preventable. Nevertheless people can and do die from the heat each year — an average of 700 people annually in the U.S., according to 2018 figures from the CDC.

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Other cities and localities that aren’t in the Sun Belt have had to keep cooling centers and public pools closed due to the pandemic, leaving residents more vulnerable than in previous years. In St. Louis, for example, most spaces that would normally serve as cooling centers have been unable to do so this year — the city has instead directed residents to use libraries, which have a browsing time limit of 30 minutes. Philadelphia has kept many of its pools closed, leaving the Parks and Recreation Commissioner to raise private funds to supplement its Playstreets program with tents, misting fans and neck cooling rags for people to stay cool while outside.

From 2004-2018, Native and Black Americans died from the heat at higher rates than white Americans. And people of color are more likely to live in dense urban areas with little greenery — these so-called “heat islands” can be up to 22 degrees hotter than their surroundings. These same groups are now experiencing higher rates of death from COVID-19, putting them in an especially vulnerable position when temperatures rise.

Margolis noted that some local officials’ efforts to protect residents from the heat could inadvertently harm them in other ways. Detroit, for example, recently said it would turn on fire hydrants in response to the heat. But in a state where some residents went years without clean water, Margolis said she wasn’t sure that was the best solution amid the pandemic. “Across the country, one of the big concerns is access to potable water, and here we are shutting down controlled sprinklers and talking about fire hydrants. I think what that says is we are not prepared for these double, triple threats.”

What these overlapping crises say about future health crises and climate change

Record-breaking temperatures are far from the only challenge that communities will face as the pandemic continues to worsen in certain parts of the United States. Hurricane Hanna hit the Gulf Coast of Southern Texas on July 25, causing flash floods and power outages in an area already reeling from the coronavirus crisis.

“I don’t think most communities are prepared for multiple shocks,” Margolis said. “With climate change, it’s not just going to be a heat wave, it’s probably going to be a heat wave with a drought, or fires.”

FEMA Administrator Peter Gaynor expressed concern about this during a House Committee Hearing on July 24, saying that the response to COVID-19 and national disasters in the U.S. in 2020 is a “more difficult task of managing finite medical supplies and equipment,” and that “rather than managing resources” the agency is “managing shortages” during the pandemic.

As global temperatures continue to rise, climate scientists predict that people all over the world will experience more extreme weather events. A 2017 report released by the American Meteorological Society found that without global warming due to human activity, parts of the world would have avoided disasters such as severe wildfires, drought and high levels of winter rainfall.

Emergency managers are well aware of the compounding threats that communities are facing amid the pandemic. “We’re no stranger to dealing with multiple threats at one time. We’ve dealt with Ebola and Zika before during hurricane season. You have all these layers — the concept of dealing with multiple threats isn’t new,” said Francisco Sanchez, the deputy emergency management coordinator for Harris County, Texas, which experienced devastating flooding following Hurricane Harvey back in 2017.

Departments like Sanchez’s are adapting their emergency response plans this year to account for the coronavirus pandemic, with the expectation that they will be able to evacuate fewer people into shelters than in previous years should a natural disaster such as a hurricane hit.

But experts like Ebi, Margolis and Sen, who all study the intersection of climate change and social justice, argue that the approach needs to go beyond emergency response, and that communities need to focus on adopting long-term policies that will reduce inequity and make more residents able to sustain compounding public health crises from the start.

A study published this January found that urban communities that have experienced policies such as redlining and segregation in the past generally have fewer trees and more densely-packed apartment buildings, making them more vulnerable to heat.

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“It’s long been known that poor and marginalized communities are at higher risk to the heat — and now everyone can see that,” Ebi said, but the pandemic has prompted “greater public awareness that there are reasons for these inequities.”

“The story of COVID is that we have major structural deficits in terms of community and health promotion and access to care,” Margolis said. Already, communities of color have less access to health care and higher rates of chronic health conditions that make them more vulnerable to COVID-19, such as cardiovascular disease. Margolis said that many of the same structural drivers of risk that endanger these communities from birth — whether lack of prenatal care, housing insecurity, or the myriad other factors that can affect an individual’s health — are becoming even more apparent now.

One way she thinks these deficits could be addressed is by putting more resources toward affordable housing, as well as telemedicine, in order to expand access for low-income patients.

Sen said he hopes the confluence of heat waves and the COVID-19 pandemic will prompt more state and local officials to pay attention to energy insecurity in the U.S., which affects roughly one in three households. As of May, 13 percent of Americans had been unable to pay an energy bill the prior month, and 9 percent had received an electricity shutoff notice. While some states have instituted a moratorium on shutting off utility connections during the pandemic, there are still many parts of the country where people could lose access to electricity or water if they fail to pay their bills.

But Sen said beyond these policy considerations, he believes more American policymakers should accept the widely regarded scientific realities of climate change, and what that will mean for communities across the U.S. While an increasing number of Americans recognize the severity of climate change, it remains a polarizing issue among lawmakers, and President Donald Trump has repeatedly denied the existence of global warming. Sen argues that if more lawmakers don’t take stronger action to address climate change, communities will continue to face compounding public health crises similar to what is occurring this summer.

“Regardless of what we do with emissions, we are going to have worsening heat waves in the years ahead. And we are certainly not showing any sign in this country of taking a kind of proactive, planned national action that’s needed to cut our emissions,” Sen said.

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