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A sign reads “heat kills” in Death Valley

We don’t know exactly how many people are dying from heat — here’s why

On the day he died, Florencio Gueta-Vargas woke up at 3 a.m. as he did each day for nearly two decades, so he could arrive early for work as a tractor driver at a hops farm in Yakima County, hand-made tortillas from his wife in hand.

On July 29, Gueta-Vargas didn’t return home. His wife, who works at a cherry warehouse, was notified by a cousin that Gueta-Vargas’s truck was still at the farm. The family arrived to the news from a sheriff’s deputy that the father of six had died.

“There was no reason for my dad, or anyone, to die at work,” his daughter Lorena Gonzalez, 29, told the PBS NewsHour.

The Yakima County coroner’s office said Gueta-Vargas, 69, died of an underlying heart condition, but that heat had contributed to his death. The outdoor temperatures were between 97 and 100 degrees that day.

Gueta-Varags’s death highlights a reality for farmworkers who experience extreme heat while at work. Heat-related deaths are a growing concern for anyone exposed to the elements for long periods of time, or whose health conditions or age make them particularly at-risk in extreme weather conditions, as climate change intensifies temperatures, researchers and advocates say. For instance, Multnomah County, Oregon, which surrounds most of the metro Portland area, had recorded only two deaths related to hyperthermia in the previous decade, in 2016 and 2018, respectively. But since June, it has recorded 54, according to a preliminary report from local health officials, with more cases pending investigation.

What data exists are the deaths we know about. Deaths from the heat are not always reported as such and experts say many are undercounted or misclassified. The Oregon medical examiner released a report last week that attributed 96 deaths to a heat wave in late June, an event that likely led to hundreds of deaths across the region. Those numbers will likely grow as investigations continue.

The federal government has pointed to this issue already this year. In an April report on heat-related deaths, the Environmental Protection Agency noted that dramatic increases in heat-related deaths are closely associated with heat waves and higher temperatures, but may not be reported as related to heat on death certificates. “This limitation, as well as considerable year-to-year variability in the data, make it difficult to determine whether the United States has experienced a meaningful increase or decrease in deaths classified as ‘heat-related’ over time,” the report said.

Dr. James Gill, President of the National Association of Medical Examiners, said it is important to accurately count heat deaths so that they can be prevented. If the scale of the problem isn’t known, it is difficult to roll out effective mitigation measures. Accurate data would potentially be able to push states and local jurisdictions toward addressing heat-related deaths more head-on, especially as temperatures continue to rise with climate change.

“Maybe there’s a certain community, a certain building that needs more education about what happens in a heat wave,” Gill said. “All those things to try and prevent future deaths are kind of what for [medical examiners and forensic pathologists] is the big picture. And to do that, you first need to identify the people who are dying.”

Heat becomes fatal when body temperature spikes higher than about 104 degrees and stays there, but a deadly temperature could be even lower if someone has underlying health conditions. When someone overheats, sweating will stop and the person will lose the ability to cool themselves down, putting pressure on vital organs and ultimately causing them to fail.

The only way to accurately know whether someone died of heat or if their death was related to heat is if their body temperature is taken right before or immediately after their death. If someone is found after the fact, first responders have to take note of environmental conditions, such as temperature, if the person was indoors, whether there was air conditioning or open windows, and access to water. But finding someone in time to take an accurate body temperature is rare, so medical examiners often have to rely on environmental conditions.

Dr. Gregory McDonald, chief deputy coroner of Montgomery County, Pennsylvania, and chairman of the Department of Forensic Medicine and Pathology at the Philadelphia College of Osteopathic Medicine, said while taking notes of these conditions would seem like common sense, they’re often missed.

He said first responders may instinctively open a window or turn on air conditioning without thinking about it and later forget that they did it, so it doesn’t make it in the notes. Environmental conditions also could simply not be thought to be considered, especially if the person was found days after they died.

“They’re not being malicious, they just forget about it or they don’t know the importance of it. And then that becomes a little bit more of a challenge for [medical examiners] to try and recreate exactly what happened,” he said. More training could help with this, he added.

Why data is important

The co-owner of the farm where Gueta-Vargas worked told the NewsHour he does not think heat contributed to his death. And because heat was suspected to exacerbate a pre-existing condition, Yakima County’s coroner’s office ruled the death as natural. Jim Curtice, the county coroner, said he cannot say whether Gueta-Vargas would still be alive if the temperature were not so high.

But McDonald said he would have ruled the death as an accident. “When you contribute [heat] to the death, at least even if it’s in part, that kind of takes it out of the realm of a natural death,” he said.

This points to another problem with tracking heat deaths: There isn’t a standard in how to record, count or classify them. Maricopa County, Arizona, updated its system in 2020 to better track deaths among people experiencing homelessness. But advocates say the reported number of heat deaths — 172, more than double the year before — is an undercount. Curtice told the PBS NewsHour that Gueta-Vargas’ death would likely show up in data as cardiac-related, but wasn’t sure if heat would be recorded in the data as well.

Gill said weather-related deaths are generally ruled as accidents, but that this becomes a grey area when someone’s primary cause of death is a pre-existing condition and the contributing factor is weather. The decision is more subjective and can be different depending on the medical examiner and jurisdiction.

All of these factors contribute to weather-related deaths being generally undercounted. Gill said the association is working on new terminology and classification for weather-related deaths to try to mitigate this. For example, if someone cannot receive their kidney dialysis because of a hurricane and they die of kidney disease, their death was not a direct result of the hurricane, but it was an indirect consequence of it. With today’s terms, that death may not be counted as weather-related. He said discussion is ongoing and no final terms have been released yet.

For natural disasters, the death toll is often estimated by calculating the “excess deaths,” or number of deaths that exceeded that time of year when circumstances were normal. This can be done more easily for isolated events, like a heat wave, but it is a lot harder to calculate this in places where heat is part of the everyday environment, and in the West, the everyday heat is getting hotter.

It is nearly impossible to understand the gravity and impact heat has on deaths, especially for people who work outdoors, without accurate data. Nicolas Lopez-Galvez, a public health researcher at San Diego State University who studies farmworkers’ health conditions, said the best way to understand this issue among farmworkers specifically is to follow farmworkers throughout their work and constantly monitor their vitals before they reach the hospital or succumb to the heat. But the logistics of actually executing that is complicated and expensive.

“Unfortunately, my feeling is that the moment that a real change is going to happen is only when we start seeing extraordinary numbers [of deaths]. We’re already seeing extraordinary numbers. Twenty times more farmworkers die out of heat stress compared to other occupations. But once we see even more, is maybe when people are going to start acting.”