Heatwave alert may be too late to prevent deaths

Posted on 24 Jun 2020 in Commentary

The declaration today of an official Level 3 heat-health alert by the Met Office and Public Health England may have come too late for many of the people who are most vulnerable to the potentially lethal effects of hot weather, including patients suffering from COVID-19.

An official review of the Government’s ‘Heatwave Plan for England’ has revealed that the threshold temperatures for the Heat-Health Watch Service are too high and that many people die before they are reached.

More than 3000 “excess deaths” in total have been linked by Public Health England to summer heatwave conditions in 2016, 2017, 2018 and 2019. But the report by the Policy Innovation and Evaluation Research Unit at the London School of Hygiene and Tropical Medicine concluded that more than 90 per of deaths in many parts of the country have been occurring outside alert periods.

The report states: “Given the relative infrequency of temperatures at which an alert is currently triggered, only a small fraction of heat-related deaths occur on alert days – less than 10% in the case of London and the West Midlands, and a similar pattern is seen in all other regions also”.

Although the Department for Health and Social Care, which commissioned the review, has had the final report for at least six months, it made no changes to the Heat-Health Watch Service ahead of the occurrence of hot weather this summer. The report was published alongside a blog by the authors on 27 May 2020.

I have written to the Secretary of State for Health and Social Care to urge him to take immediate action to adjust the temperature thresholds for the Heat-Health Watch Service.

The Heat-Health Watch Service has five alert levels from 0 to 4. Level 0 operates outside the summer months, and Level 1 is the default between 1 June and 15 September. A Level 2 alert is issued when there is a high chance that one or more temperature thresholds across the country will be exceeded within the next few days. The alert moves to Level 3 when the thresholds have been exceeded, and Level 4 is reached when a prolonged hot spell becomes severe.

The report by the Policy Innovation and Evaluation Research Unit concluded: “Since the largest number of excess deaths and hospital admissions associated with heat take place outside of heatwave alert periods, this raises questions about the appropriateness of current threshold levels as well as the need to place more emphasis on general preparedness strategies as represented by levels 0 and 1 of the HWP [Heatwave Plan for England].”

The failure by the Government to act on this finding could place many more people at risk over the coming months, particularly those who are vulnerable to hot weather because they have underlying illnesses such as respiratory disease.

The Government has acknowledged that heatwaves could make it more difficult to tackle COVID-19. It published a leaflet that pointed out: “Many of those who are at risk of harm from heat are also at greater risk of severe illness due to COVID-19 and may need to spend more time at home than they would usually”.

The leaflet accompanied the re-issuing of the ‘Heatwave Plan for England’, which highlights the importance of the alerts from the Heat-Health Watch Service for health and social care providers, as well as the public.

The Met Office warned at the start of this week that hot weather was on its way across England, with temperatures in many areas likely to exceed 30˚C, and it raised the alert to Level 2 for the Heat-Health Watch Service. The alert was increased to Level 3 this morning.

The thresholds for a Level 2 alert apply to both daytime and night-time temperatures, and vary across England. For instance, the daytime and night-time temperature thresholds for North-East England are 28˚C and 15˚C, respectively, compared with 32˚C and 18˚C in London.

According to the official guidance on the Met Office’s website, Level 2 “is an important stage for social and healthcare services who will be working to ensure readiness and swift action to reduce harm from a potential heatwave”.

Level 3 means that the Met Office has confirmed threshold temperatures for one of more regions have been reached for one day and the following night, and the forecast for the next day has a greater than 90 per cent confidence level that the day threshold temperature will be met. The Met Office’s website indicates that Level 3 “requires social and healthcare services to target specific actions at high-risk groups”.

However, the review by the Policy Innovation and Evaluation Research Unit shows that vulnerable people, including those in hospitals and care homes, require targeted protection before Level 3 is reached.

It presents evidence that people start dying when the temperature reaches 24 degrees Celsius in London, and 23 degrees Celsius in the West Midlands, well below the regional thresholds of the Heat Health-Watch Service.

The current thresholds seem to have been set primarily to provide protection to healthy people, and neglect the needs of those who are vulnerable to heat.

Climate change is increasing the frequency and intensity of hot weather and heatwaves in the UK and around the world. The highest UK daytime temperature of 38.7˚C occurred last July. The Met Office has calculated that the high average temperature during summer 2018, tied with 1976, 2003 and 2006 as the warmest on record, was 30 times more probable because of climate change.

Last summer, the Committee on Climate Change told the Government that little progress was being made on addressing the risks posed by rising temperatures.

The Committee’s annual report to Parliament concluded: “Homes are not adapted for current or future high temperatures, there is a lack of awareness of the risks to health from high indoor temperatures, and a lack of appropriate planning in health and social care”.

It noted that “around 20% of existing homes currently overheat even in cool summers”, and that “overheating risks are not adequately addressed in the current Building Regulations”. It also called for the Department of Health and Social Care to develop a plan “to address the risks of overheating in care homes and care facilities, including consideration of home-based care”.

The Government’s response in October claimed that it was “taking forward initiatives to address these risks”. It also acknowledged the existence of the independent review of the heatwave plan by the Policy Innovation and Evaluation Research Unit, and indicated that “the findings will provide useful intelligence to support sector engagement on planning to reduce risks to patients and the public, and to support health service delivery in heatwave”.

But the Government has so far failed to amend the Heat-Health Watch Service so that it provides better protection for people who are particularly at risk from the effects of heat this summer

Bob Ward is policy and communications director at the Grantham Research Institute on Climate Change and the Environment and the ESRC Centre for Climate Change Economics and Policy at the London School of Economics and Political Science.