Just as an active Atlantic hurricane season begins in 2020, the entire U.S. hurricane coast, from Texas to the Carolinas, is witnessing explosive outbreaks of Covid-19 cases in communities where physical distancing restrictions have been eased. As a wake-up call, Tropical Storm Christopher made landfall in Louisiana on June 7, triggering coastal evacuation orders and a federal emergency declaration. At the same time, temperatures continue to set records across the southern United States, while Arizona has been battling multiple historic wildfires that also require communities to evacuate their homes. All this as the summer had just begun.
These events suggest that the United States will increasingly face complex and challenging scenarios, given the confluence of our two most pressing global health threats: the rapid emergence of the Covid-19 pandemic and the insidiously evolving climate crisis. Both crises disproportionately harm the health of vulnerable and economically disadvantaged people, including those affected by structural racism. Understanding the challenges posed by this conjunction is essential if we want to design effective and equitable strategies to protect and improve health. Attention should be directed to the key pathways through which the climate crisis threatens efforts to contain SARS-CoV-2 transmission and improve Covid-19 outcomes, including the difficulty in maintaining physical distance, the exacerbation of coexisting conditions and disruption of health care services.
The intensity, frequency, and duration of extreme weather-related events, including hurricanes, forest fires, floods, heat waves, and droughts, are increasing, and these events often overlap temporally and geographically,one jeopardizing the control of SARS-CoV-2 infections. Atlantic hurricane and wildfire seasons in the west are forecast to be worse than the average in 2020. But proven standard disaster mitigation strategies (mass shelter and population evacuation) increase the risk of viral transmission to the move large groups of people and gather them. For example, evacuation orders were issued for more than 1 million people during Hurricane Florence in 2018. The health risks of Covid-19 are even greater when weather events are more intense, as widespread catastrophic damage causes the massive displacement, which risks introducing the virus into new premises and grouping of vulnerable survivors in temporary accommodation.
No other year in recorded history has been as hot as the years between 2014 and 2019, and 2020 has a high probability of being the hottest year in history. Despite the hypothesis that higher temperatures and humidity could reduce SARS-CoV-2 transmission, Covid-19 cases are increasing rapidly in the hot southern states, confirming expert predictions.two Extreme heat poses additional challenges to Covid-19’s mitigation efforts. For example, wearing a face mask, especially an N95, is uncomfortable in high heat and humidity and can exacerbate the risks of heat-related illness.3; conversely, not wearing a mask increases the probability of spreading Covid-19. During heat waves, cooler indoor locations, including designated cooling centers, can be crowded with residents of homes that lack air conditioning or face heat-related electrical blackouts.
Chronic cardiovascular and lung diseases, recognized risk factors for severe Covid-19, are closely related to climate change, through effects including extreme heat, ground-level ozone, forest fire smoke, and increased pollen counts. for longer seasons.4 4 Furthermore, air pollution by fine particles, linked to the combustion of fossil fuels, increases the prevalence of both conditions. Marginalized groups are at greater risk than others from exposure to high levels of air pollution and associated chronic diseases, as well as from Covid-19 related illnesses and deaths. Recent unpublished data has suggested direct associations between long-term exposure to particulate air pollution and the risk of death associated with Covid-19.5 5
Climate change also complicates the ability of Covid-19 patients to access and receive the best health care services available. Heat waves and weather-related disasters can generate a wave of “weather victims” seeking care in facilities that are already full of Covid-19 patients.4 4 Conversely, access to healthcare for these patients can be severely compromised after extreme weather events, due to physical damage to facilities, power outages, supply chain disruptions, and staff exhaustion, resulting in leading to cascading outages of services.
Our responses in the United States to climate change in recent years and to the Covid-19 pandemic in recent months have been inadequate and dangerous, disproportionately harming the most vulnerable communities. Both responses have been characterized by deferred and disjointed government actions, denigration of scientific evidence, distortion of the truth, withdrawal of critical global alliances, and reliance on outdated public health infrastructure and fragile healthcare systems. To effectively manage both crises, we need an integrated response, firmly based on science, that values health as a fundamental right for all. As we collectively reinvent an equitable and responsive health infrastructure, we will have to take concrete action focused on the key intersections between climate change and the Covid-19 pandemic.
In the short term, to minimize SARS-CoV-2 transmission during extreme weather events intensified by climate, standard shelter, evacuation, and related strategies should be modified (see box). Long-term actions, with implications for future resilience, include prioritizing federal and state funds for mitigation plans to prepare for a future of climate intensification from extreme weather events and overlapping events, using an approach that takes into account all dangers.
Short-term strategies for managing extreme weather-related events during the Covid-19 pandemic.
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Extreme events (eg, Hurricanes, forest fires): evacuation and shelter
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Clearly communicate to the public that the Covid-19 pandemic does not change the imperative to evacuate, given the substantial risks of staying in place during extreme weather risks.
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Use existing community pandemic communication channels to disseminate critical information.
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Increase the number of shelters available, with less occupancy per site, more separate spaces within sites, and more space per resident (for example, using smaller “congregate shelters”).
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Use the shelter’s standard registration information (name, contact phone number) for everyone who enters, to make it easier to trace contacts in case Covid-19 is diagnosed in people who used the shelter.
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Implement shelter protocols for infection control, including daily symptom checks, isolation of symptomatic individuals, mandatory use of face masks, abundant supplies of hand sanitizer, hand washing stations, and meals provided in disposable containers.
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Adapt the guidelines to minimize viral transmission of Covid-19 in mass care settings for use in home shelters, because many evacuees take refuge with family and friends.
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Extreme heat: stay at home and cool places
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Provide electricity subsidies and extend moratoriums to prevent power and water cuts for people with pandemic-related unemployment and economic hardship to allow them to stay home.
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Ensure effective alternatives to minimize exposure to heat if designated cooling centers or popular indoor air-conditioned locations are closed.
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Make sure the cooling centers follow guidelines similar to the best practice guidelines mentioned above.
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Minimize transmission risks by limiting occupancy and providing or requiring masks and hand sanitizers in air-conditioned locations open to the public, such as shopping malls or movie theaters.
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Use phone text messages, such as those used for pandemic communication, for heat health notifications.
During extreme heat events, interventions are needed to ensure that people who are most susceptible to heat-related illness and severe Covid-19 disease can stay home safely or have safe cooling options. More sustained approaches include alterations to the built environment (for example, expanding green space, making roofs whiter), and community outreach programs for the most vulnerable.
Continuous adaptations and transformations in health care delivery, fueled by the Covid-19 pandemic, can also be effectively applied to extreme weather events. In particular, the expansion of telemedicine, in areas where computer or telephone service is intact, and the use of community paramedicine services can improve our ability to address medical and psychological needs and minimize exposure to SARS-CoV-2. , for people who cannot get care Investments in strengthening our health care infrastructure and delivery systems, such as supply chains, are also essential to ensure resilience during pandemic or climate crises.
Although evidence-based guidance from federal agencies is important and would be welcome, implementing strategies at the state and local levels requires capacity, coordination, and attention to subnational needs. Since states were forced to prioritize budget allocations due to the pandemic, meeting future challenges will require coordinated federal policy and dedicated funds.
In recent months, increasing global attention to the urgency of tackling climate change has been neglected by the pandemic and the critical calculation of racial inequality. However, the interconnectedness of these challenges underscores the need for integrated policy initiatives. As emphasized in a letter from 40 million health professionals to G20 leaders, governments must prioritize investments in clean health, clean air and water, and a stable climate in stimulus packages to recover from the Covid pandemic -19.
The reductions in greenhouse gas emissions and air pollution that were observed while applying globally applied blocking measures to curb the spread of Covid-19 are proving to be temporary. Interventions to create sustained reductions in fossil fuel use can reduce the risks of multiple medical conditions, especially in vulnerable communities, by improving air quality and limiting damage to health downstream from the climate crisis.
Until the development and mass deployment of a safe and effective vaccine enables the United States to overcome the Covid-19 pandemic, the climate crisis will challenge our responses to the pandemic; Beyond the pandemic, the climate crisis will continue to pose existential risks. It is high time to implement robust and equitable responses for both.
