As summer arrives, how will the most vulnerable escape deadly heat and COVID-19?

A dangerous and uncharted trifecta of the pandemic, high unemployment, and extreme heat is looming, and cities are scrambling to make plans.

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A fountain provides relief from the summer heat in Queens, New York City, in July 2019. New York—and the rest of the United States—faces an unusually hot summer, and city officials are honing plans for how to relieve those most vulnerable to the heat in the face of COVID-19 and high joblessness.

Imagine your mother is self-isolating because of health problems and fear of COVID-19. She says it’s 104 degrees Fahrenheit inside her mobile home. Would you advise her to risk exposure to the coronavirus by getting cool at an air-conditioned public shelter, assuming there are any open nearby?

The United States is facing an unprecedented trifecta: a pandemic, record unemployment, and summer temperatures that are forecast to be above average in much of the country. It’s going to be challenging for local authorities, says Patricia Solís, executive director of the Knowledge Exchange for Resilience at Arizona State University (ASU), a group focused on building community collaboration in times of crisis.

“We haven’t figured out how to handle all this,” she says.

Even though heat is the second leading weather-related cause of death in the U.S., the Federal Emergency Management Agency (FEMA) offers no funding for heat emergencies, leaving cities, counties, and states largely on their own, Solís adds.

The elderly are a special concern. With eight out of 10 COVID-19 deaths in adults 65 years old and older, the Centers for Disease Control and Prevention (CDC) advises them and those with a serious health condition to shelter in place. But that could be dangerous in extreme heat.

The human body’s normal internal temperature is between 98.6 and 100.4 degrees Fahrenheit (37 to 38 degrees Celsius). If the heat index (a combination of temperature and humidity) reaches 104 degrees Fahrenheit (40 degrees Celsius), indoors or out, our bodies heat up to that temperature over time. For the very young, people over 65 or those with compromised health, this can happen rapidly. And, if 104 degrees is reached, it can be deadly within 30 to 60 minutes.

As the summer sets in, local governments nationwide are adopting a range of measures to help vulnerable people stay cool and safe, from moratoriums on power shut-offs to giving away air conditioners to operating public cooling centers with social distancing rules in place.

Arizona hit first

Arizona had its earliest-ever hundred-degree heat wave in April. Because of COVID-19, everything was closed—including officially designated cooling centers such as community centers or libraries. A jump in coronavirus cases is currently threatening to overwhelm the state‘s hospitals.

Last summer, when Phoenix temperatures averaged 96 degrees at the airport, where official measurements are made, Solís and her colleagues got readings averaging 131 degrees at a local trailer park, which had little shade and a lot of asphalt. “It was 111 inside one mobile home,” she says.

The Phoenix metropolitan area recorded 197 heat-related deaths in 2019, the most ever. About 85 of these occurred indoors, Solís says, and nearly a third of those were in manufactured or mobile homes, which house 5 percent of the area’s four million people. Most of the people who died in mobile homes were elderly women.

In some Phoenix mobile home communities the median age is 75, and many residents are living alone. “They’re the most vulnerable when it comes to heat impacts,” says Solís, “as well as the most at risk from COVID-19.”

Across the U.S., “upward of 20 million people, often on low incomes or unemployed and elderly” live in mobile homes, Solís says. Such homes are twice as likely to be without air conditioning because poor insulation makes them costly to cool.

In Arizona, a moratorium on power shut-offs is in place this summer—but the bills will still pile up.

“Some people won’t use their air conditioning because they’re afraid of the bills,” says Solís. “They think they’re OK without it, but that’s how people die.”

The Phoenix area endured another heat wave at the end of May, with temperatures reaching 110 degrees. Only some official cooling centers were open; pools, parks, malls, libraries, and so on remained closed.

The neighboring city of Tempe converted a senior center into a cooling center. It screened people for fever before admitting them, provided and required face masks, and enforced physical distancing. “Many of the places people normally go to cool off and find relief are just not available right now,” said Tempe Mayor Mark Mitchell in a statement. For those without air conditioning or who are living outdoors, this lack of options can be deadly, Mitchell said.

The CDC has issued COVID-19 guidelines for cooling centers that suggest such measures and other standards for things like air filtration and cleaning—if resources allow. A center operated that way will inevitably be more costly and able to accommodate fewer people, says David Hondula, a senior sustainability scientist at ASU.

By mid-June, suspected heat-related deaths in the Phoenix area were three times higher than at the same point last summer, according to media reports.

Cities search for solutions

Other large cities are also developing plans to protect their most at-risk residents. New York City, for instance, will modify its existing cooling centers to allow social distancing requirements and create others at sports venues and auditoriums.

As part of a comprehensive $55 million COVID-19 Heat Wave Plan, the city will provide more than 74,000 free air conditioners to low-income seniors and help pay electricity bills for 450,000 residents. New York’s energy utility, ConEd, has suspended service disconnections and waived late payment fees.

“Using air conditioning, even just for a few hours, can make all the difference,” the city’s health commissioner Oxiris Barbot said in a statement.

Philadelphia will open outdoor spraygrounds in July, but public pools and libraries will remain closed. Preventing the spread of the virus is having an impact on the city’s traditional cooling plans, says Kelly Cofrancisco, Philadelphia’s deputy communications director. The city will also help residents with summer cooling bills, using funds from the federal Low Income Home Energy Assistance Program (LIHEAP) .

LIHEAP was set up primarily to help pay for home heating, then expanded to cover cooling costs, as well as the purchase of home air conditioners. But its annual budget of $3.6 billion has never been enough to provide what’s needed, says Mark Wolfe, an energy economist who represents the state directors of the program.

While some 28 million households are eligible for energy assistance, Wolfe says, “at least 20 percent of these households are without air conditioning.” And many mobile home residents aren’t eligible because some states require the homes to be fixed dwellings, and say they’re not.

Even with a $900 million boost from the Coronavirus Aid, Relief, and Economic Security (CARES) Act, LIHEAP doesn’t have the funding it needs during this public health crisis, Wolfe says. He estimates that record unemployment has created another five to six million eligible low-income households and that to serve them all the program would need another $4.3 billion.

“We’re in a hard experiment in motion,” says Joy Shumake-Guillemot, co-chair of the Geneva, Switzerland-based Global Heat Health Information Network .The network includes health experts from around the world working on how to best protect the public as COVID-19 amplifies the risks hot weather brings.

For example, some people will likely be turned away from cooling centers because their body temperature is too high. But is that from a fever, or because they’re suffering from heat stress, asks Shumake-Guillemot. There isn’t a way to differentiate this right now, she says.

“The challenges of COVID-19 and heat are bigger than we anticipated,” she says.

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