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Climate Forward

How Extreme Heat Causes Cascading Crises

Power grids and hospitals can be overwhelmed, but there are fixes.

A wide view of the Phoenix skyline with buildings in the foreground and mountains in the background.
Multiday blackouts amid extreme heat could send almost half the population of Phoenix to the emergency room, researchers concluded.Credit...Caitlin O'Hara for The New York Times

Extreme heat can bring on some extremely dangerous feedback loops for American hospitals and clinics.

The good news is that there are some practical fixes.

The time to prepare is now. Because the heat is likely to get worse. Much worse. Quite soon.

First, the heat news.

You know all about how rising fossil fuel emissions are raising global average temperatures, making heat waves more frequent and intense.

The global average is already around 1.1 degrees Celsius, or 2 degrees Fahrenheit, higher than it was 150 years ago. Imagine if your body temperature was always 2 degrees Fahrenheit higher. You wouldn’t feel very well.

There’s another thing coming: a natural weather pattern known as El Niño. Global surface temperatures tend to be hotter during El Niño years. Its cool sibling is La Niña. Global surface temperatures tend to be cooler in its presence. We’ve been rolling with La Niña for the last three years. Lucky us.

The last record hot year, 2016, was an El Niño year.

Scientists project the return of El Niño conditions later this summer.

That, plus human-induced global warming, will most likely drive global temperatures to record highs over the next five years, the World Meteorological Organization concluded last week. Unprepared us.

A dire projection makes it urgent for hospitals to prepare.

Researchers this week laid out the possibility of the compounding health risks. They tried to divine what could happen if a bad heat wave in a hot city coincided with overloaded electricity grids, leading to blackouts for many days.

Using data from previous heat waves, they modeled the consequences of multiday blackouts amid extreme heat. They concluded that in Phoenix, a scorching desert city where people depend on air-conditioning throughout the summer, such conditions could send an estimated 789,600 people to the emergency room for heat-related illnesses. That’s nearly half the population. The city has only 3,000 emergency room beds. (You can read the story here.)

We’ve already had a preview.

Recall what happened in the Pacific Northwest during a record heat wave in 2021. Portland, Ore., hit a record, almost 47 degrees Celsius, or 116 degrees Fahrenheit. Parts of British Columbia hit a record 49 degrees Celsius.

Thousands of people lost power. More than 3,500 people went to emergency rooms for heat-related illnesses. There were at least 600 excess deaths. Without human-induced climate change, brought on largely by the burning of oil, gas and coal, such extreme temperatures would not have occurred, researchers concluded.

Not just the Pacific Northwest. Public health researchers from Harvard University surveyed health clinics across the United States. They found that 81 percent of clinic staff members said their facilities had experienced “some kind of disruption due to extreme weather within the past three years.” More than three-fourths of those surveyed said they lacked the “knowledge or tools” to prepare for climate impacts.

In a pilot project, Harvard public health experts and Climate Central, a research group, are sending early warning alerts to particular cities two days before temperatures are forecast to rise to dangerous levels. So far 12 clinics are part of the project, including one in Portland.

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Taking shelter at the Oregon Convention Center cooling station in Portland in 2021, when temperatures reached 116 degrees Fahrenheit.Credit...Kathryn Elsesser/Getty Images

There are fixes.

The study on heat and blackouts estimated that more tree cover and reflective white paint on rooftops would significantly reduce exposure to heat stress.

The nation’s electrical system needs urgent fixing. Our electricity networks are antiquated, as Brad Plumer wrote recently. (Winter storms, some of which can be aggravated by climate change, have overwhelmed the electricity infrastructure, too, as residents of the South and the Midwest will recall from 2021.)

In the meantime, hospitals and health centers need to get backup power.

And tipsheets for caregivers.

Harvard public health researchers and Americares, a nonprofit group, have put together resources to help health providers and patients prepare for heat-related illnesses.

There are tips for patients with diabetes (don’t keep your insulin pump or blood sugar monitor in a hot car or in direct sunlight, or else it will get damaged), and for those taking care of people with asthma (check the air quality, not just the temperature).

For doctors, nurses and paramedics, there are tipsheets on people who are especially vulnerable (people with psychotic conditions are at high risk because heat exposure can impair judgment and they may be less likely to have access to air-conditioning). Medications to treat conditions associated with multiple sclerosis and cardiovascular disease increase the risk of heat-related hospitalizations.

For hospital and clinic administrators, there’s a checklist to make sure their facilities are ready for extreme heat. (For example, dust off fans and window blinds, and remove ice and frost piled up in refrigerators).

Heat is a serious health hazard. There’s a lot we can do to keep each other safer. It starts with knowing the risks and checking in on people around you who might be especially vulnerable.


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The justices’ decision was the second major setback to the E.P.A.’s ability to tackle pollution.Credit...Erin Schaff/The New York Times

Shrinking clean water protections: The Supreme Court severely narrowed the kinds of wetlands that the Environmental Protection Agency can regulate under the Clean Water Act.

Stitching a city back together: Highways have sliced through communities of color and split up neighborhoods. The Biden administration is funding projects that aim to undo the damage.

Trouble in the Arctic dating scene? Climate change appears to be making female ground squirrels emerge from hibernation earlier. That could disrupt mating season.

A pale shade of green: France has banned some short domestic flights. But the rule is riddled with exceptions that critics say make it toothless.

Whales are ramming boats: A group of orcas has sunk three sailboats off southern Europe. Researchers say they don’t know what is driving the behavior, or how to stop it.

Innovation as a survival skill: Rising seas and the threat of hurricanes have forced the Bahamas to become a laboratory for climate adaptation.

Corporate climate disclosure: It’s been over a year since the Securities and Exchange Commission proposed requiring companies to report their emissions, but worries about a conservative Supreme Court have delayed the rules.


Reducing plastic pollution might be easier than we think: By one estimate, nearly 80 percent of plastic in the oceans comes from just 1,000 rivers. Cleanup efforts should start there.


  • From Reuters: The International Energy Agency expects investments in solar power to outpace those in oil production in 2023, according to its latest report. It would be a first.

  • Carbon Brief explained why a treaty that was supposed to protect the ozone layer has accidentally slowed the loss of Arctic sea ice.

  • The German police conducted raids against activists who are known for gluing themselves to roads and targeting works of art to raise awareness about climate change, The Washington Post reported.

  • According to E&E News, a United Nations panel said that projects that use machines to remove carbon dioxide from the air and the sea are unproven and risky.


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Eelgrass, a type of seagrass, off Virginia. As seagrass meadows are restored, they help clean the water and stabilize the shore.Credit...Jay Fleming, via The Nature Conservancy

They bolster the coastlines, provide housing for fish and store as much as 5 percent of the world’s carbon dioxide. Are these miracle machines the latest shiny tech invention? Nope. They are among nature’s earliest creations: seagrasses. Restoring them is a powerful tool for combating climate change and adapting to it.


Manuela Andreoni, Claire O’Neill, Chris Plourde and Douglas Alteen contributed to Climate Forward.

Somini Sengupta is The Times’s international climate correspondent. She has also covered the Middle East, West Africa and South Asia and is the author of the book, “The End of Karma: Hope and Fury Among India’s Young.” More about Somini Sengupta

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