Defining heat waves and extreme heat events using sub-regional meteorological data to maximize benefits of early warning systems to population health

The graded heat-health risk forecast and early warning with full-season coverage across China: a predicting model development and evaluation study

Background

Due to global climate change, high temperature and heatwaves have become critical issues that pose a threat to human health. An effective early warning system is essential to mitigate the health risks associated with high temperature and heatwaves. However, most of the current heatwave early warning systems are not adequately developed based on the heat-health risk model, and the health impact of hot weather has not been well managed in most countries.

Methods

This study proposed a "full-season coverage and population health-oriented graded early-warning" concept and developed a heat-health surveillance, forecast and early warning (HHSEW) model. The exposure-response (E-R) relationship between temperature and mortality was analyzed through a two-stage approach using time-series analysis data from 323 counties across China for the period 2013-2018. The premature mortality curve at each temperature percentile was plotted and four temperature-percentile points on the curve were determined as the thresholds of the pre-warning and warning levels 1-3 based on the variations in the rates of the segmental slopes on the curve. The HHSEW model was evaluated by comparing the frequency, the mortality risk of all-cause and cause-specific diseases, the predicted numbers of premature deaths, and the heat-related health economic burden at each warning level with those of the current high temperature early warning systems.

Findings

The HHSEW model determined five levels, including seasonal surveillance, pre-warning, and warning levels 1-3. There was a gradual increase in the mortality risks of all-cause and cause-specific diseases along with the increase of warning levels. The risk of all-cause mortality increased by 9.79% (95% CI: 8.59%-11.01%), 22.62% (95% CI: 19.49%-25.83%), 28.36% (95% CI: 24.72%-32.10%), and 33.87% (95% CI: 28.89%-39.06%) at the pre-warning level, warning level 1, warning level 2, and warning level 3, respectively. Through our HHSEW model, 94,008 heat-related all-cause deaths were predicted annually in the 337 major cities of China, which was much larger than the number (14,858) of the China Meteorological Administration (CMA) heatwave early-warning system currently used in China. It was estimated that the proper implementation of the HHSEW-based early warning system would save 220 billion CNY in heat-related health burden compared to the current heatwave early-warning system.

Interpretation

The HHSEW model has been proven to surpass the current heatwave early warning system. With its full-season coverage and graded warning levels for heat-related health risks, the HHSEW model and system can provide timely early warnings to the public, leading to significant health benefits. This methodology, labeled "full-season coverage and population health-oriented graded early-warning", should be implemented globally to mitigate the escalating health risks associated with high temperature.

Funding

National Natural Science Foundation of China (82425051, 42071433, 42305196, 82241051) and the Special Foundation of Basic Science and Technology Resources Survey of Ministry of Science and Technology of China (2017FY101204).

The spatial distribution of heat related hospitalizations and classification of the most dangerous heat events in California at a small-scale level

Many studies have explored the impact of extreme heat on health, but few have investigated localized heat-health outcomes across a wide area. We examined fine-scale variability in vulnerable areas, considering population distribution, local weather, and landscape characteristics. Using 36 different heat event definitions, we identified the most dangerous types of heat events based on minimum, maximum, and diurnal temperatures with varying thresholds and durations. Focusing on California's diverse climate, elevation, and population distribution, we analyzed hospital admissions for various causes of admission (2004-2013). Our matching approach identified vulnerable zip codes, even with small populations, on absolute and relative scales. Bayesian Hierarchical models leveraged spatial correlation. We ranked the 36 heat event types by attributable hospital admissions per zip code and provided code, simulated data, and an interactive web app for reproducibility. Our findings showed high variation in heat-related hospitalizations in coastal cities and substantial heat burdens in the Central Valley. Diurnal heat events had the greatest impact in the Central Valley, while nighttime extreme heat events drove burdens in the southeastern desert. This spatially informed approach guides local policies, prioritizing dangerous heat events to reduce the heat-health burden. The methodology is applicable to other regions, informing early warning systems and characterizing extreme heat impacts.

Extreme Heat Events and Emergency Department Visits among Older Adults in California from 2012-2019

Background and Objectives: Extreme heat events are increasing with climate change impacting human health. This study investigates the impact of extreme heat events on Emergency Department (ED) utilization by older adult patients. Materials and Methods: We conducted a study of all 324 non-federal hospital EDs in California during an 8-year period from data extracted from the California Department of Health Care Access and Information (HCAI). The study utilized a time-stratified case-crossover design to investigate ED visited in patients aged 65 years and older during 1-day and 2-day heat wave events. Extreme heat temperatures were measured and weighted using historical data at the zip code level at the 95th, 97.5th, and 99th percentiles 2012 through 2019. Conditional logistical regression was used to estimate the odds of ED visits during extreme heat events compared to non-extreme heat days. Stratified analyses by age and comorbidity status were conducted. Results: During the study period, 8,744,001 of ED visits among older patients were included in the study analysis. Odds ratios (OR) increased for during 1-day heat events (95th percentile (OR = 1.023, 95%CI: 1.020, 1.027), 97.5th percentile (OR = 1.030, 95%CI: 1.025, 1.035), 99th percentile (OR = 1.039, 95%CI: 1.032, 1.058)) and more so with 2-day heat wave events (95th percentile (OR = 1.031, 95%CI: 1.026, 1.036), 97.5th percentile (OR = 1.039, 95%CI: 1.031, 1.046), 99th percentile (OR = 1.044, 95%CI: 1.032, 1.058)). Older patients with three or more comorbidities had the highest odds of ED visits (OR = 1.085, 95%CI: 1.068, 1.112) at the 99th percentile. Conclusions: Our findings indicate that ED visits increase for older patients during extreme heat events, particularly with event intensity and duration. Older patients with at least one comorbidity were at greater risk.

Impact of apparent temperatures on park visitation behavior: A comprehensive analysis using large-scale mobility data

As many regions continue to show record temperatures and high frequencies of extreme climate events, climate change is disrupting human health and prosperity. This study focuses on how temperature changes and extreme heat as key climate components can impact park visitations (key physical activities indicator). Using the large mobility dataset SafeGraph, this study introduced a causal machine learning approach to estimate marginal heterogenous treatment effects (HTE) of daily apparent temperatures for different park properties and activity types. Our results revealed the declining effects of park visitations as apparent temperature increases and the significant disturbances under extreme heat. Different temperature thresholds that may harm park visitations were identified. Nearby green and public spaces (e.g. neighborhood parks) are the most susceptible category to summer heat. Dog parks, Playgrounds and Ball Field/Sports were well used during the heat. Pool/Splash pad and Community center have shown capabilities of mitigating heat stress. Effectiveness of other park facilities, including Restroom/Drinking Fountain, Water Body, Shade Area Facility were also presented. This study estimates climate impact on park behaviors for multiple usage and environmental situations. Our findings may help future planners, policymakers, landscape architects and park managers better understand climate-related risks when making investment and development decisions.

Disparities in the impact of heat wave definitions on emergency department visits during the first year of life among preterm and full-term infants in California

INTRODUCTION

Heat waves will be aggravated due to climate change, making this a critical public health threat. However, heat wave definitions to activate alert systems can be ambiguous, highlighting the need to assess a range of definitions to identify those that contribute to the most adverse health outcomes. Additionally, children are highly susceptible to the impacts of heat waves, especially infants, despite the lack of focus on this subpopulation. We aimed to assess the relationship between 30 heat wave definitions and the first all-cause emergency department (ED) visits for California infants. We also examined modification of this relationship by preterm birth status and demographic characteristics to identify possible health disparities.

METHODS

Live-born, singleton deliveries from the Study of Outcomes in Mothers and Infants born in 2014-2018 were included. Thirty heat wave definitions were assessed based on temperature metrics (minimum/maximum temperatures), thresholds (90th; 92.5th; 95th; 97.5th; 99th percentiles), and duration (1-; 2-; 3-days). A time-stratified case-crossover design assessed heat wave impacts on ED visits using infants with a warm season ED visit (May-October) within the first year of life (n = 228,250). Effect modification by preterm birth status, age, sex, race/ethnicity, education, and delivery payment type was also investigated.

RESULTS

Infants demonstrated increased risk of an ED visit with exposure to all heat definitions. The 3-day minimum temperature 99th percentile definition had the highest adjusted odds ratio (AOR: 1.14; 95% CI: 1.05-1.23) for the total population. Term infants were more affected by some heat waves than preterm infants. Effect modification was additionally identified, such as by maternal education.

DISCUSSION

This study provides insight on the heat wave definitions that lead to adverse health outcomes and the identification of the most susceptible infants to these impacts, which has implications on heat-related interventions.

An Improved New YOLOv7 Algorithm for Detecting Building Air Conditioner External Units from Street View Images

Street view images are emerging as new street-level sources of urban environmental information. Accurate detection and quantification of urban air conditioners is crucial for evaluating the resilience of urban residential areas to heat wave disasters and formulating effective disaster prevention policies. Utilizing street view image data to predict the spatial coverage of urban air conditioners offers a simple and effective solution. However, detecting and accurately counting air conditioners in complex street-view environments remains challenging. This study introduced 3D parameter-free attention and coordinate attention modules into the target detection process to enhance the extraction of detailed features of air conditioner external units. It also integrated a small target detection layer to address the challenge of detecting small target objects that are easily missed. As a result, an improved algorithm named SC4-YOLOv7 was developed for detecting and recognizing air conditioner external units in street view images. To validate this new algorithm, we extracted air conditioner external units from street view images of residential buildings in Guilin City, Guangxi Zhuang Autonomous Region, China. The results of the study demonstrated that SC4-YOLOv7 significantly improved the average accuracy of recognizing air conditioner external units in street view images from 87.93% to 91.21% compared to the original YOLOv7 method while maintaining a high speed of image recognition detection. The algorithm has the potential to be extended to various applications requiring small target detection, enabling reliable detection and recognition in real street environments.

Global warming and implications for epithelial barrier disruption and respiratory and dermatologic allergic diseases

Global warming has direct and indirect effects, as well as short- and long-term impacts on the respiratory and skin barriers. Extreme temperature directly affects the airway epithelial barrier by disrupting the structural proteins and by triggering airway inflammation and hyperreactivity. It enhances tidal volume and respiratory rate by affecting the thermoregulatory system, causing specific airway resistance and reflex bronchoconstriction via activation of bronchopulmonary vagal C fibers and upregulation of transient receptor potential vanilloid (TRPV) 1 and TRPV4. Heat shock proteins are activated under heat stress and contribute to both epithelial barrier dysfunction and airway inflammation. Accordingly, the frequency and severity of allergic rhinitis and asthma have been increasing. Heat activates TRPV3 in keratinocytes, causing the secretion of inflammatory mediators and eventually pruritus. Exposure to air pollutants alters the expression of genes that control skin barrier integrity and triggers an immune response, increasing the incidence and prevalence of atopic dermatitis. There is evidence that extreme temperature, heavy rains and floods, air pollution, and wildfires increase atopic dermatitis flares. In this narrative review, focused on the last 3 years of literature, we explore the effects of global warming on respiratory and skin barrier and their clinical consequences.

Exploration of the preterm birth risk-related heat event thresholds for pregnant women: a population-based cohort study in China

Background

Heat events increase the risk of preterm birth (PTB), and identifying the risk-related event thresholds contributes to developing early warning system for pregnant women and guiding their public health response. However, the event thresholds that cause the risk remain unclear. We aimed to investigate the effects of heat events defined with different intensities and durations on PTB throughout pregnancy, and to determine thresholds for the high-risk heat events.

Methods

Using a population-based birth cohort data, we included 210,798 singleton live births in eight provinces in China during 2014-2018. Daily meteorological variables and inverse distance weighted methods were used to estimate exposures at a resolution of 1 km × 1 km. A series of cut off temperature intensities (50th-97.5th percentiles, or 18 °C-35 °C) and durations (at least 1, 2, 3, 4 or 5 consecutive days) were used to define the heat events. Cox regression models were used to estimate the effects of heat events on PTB in various gestational weeks during the entire pregnancy, and event thresholds were determined by calculating population attributable fractions.

Findings

The hazard ratios of heat event exposure on PTB ranged from 1.07 (95% CI: 1.00, 1.13) to 1.43 (1.15, 1.77). Adverse effects of heat event exposure were prominently detected in gestational week 1-4, week 21-32 and the four weeks before delivery. The heat event thresholds were determined to be daily maximum temperature at the 90th percentile of the distribution or 30 °C lasting for at least one day. If pregnant women were able to avoid the heat exposures from the early warning systems triggered by these thresholds, approximately 15% or 17% of the number of total PTB cases could have been avoided.

Interpretation

Exposure to heat event can increase the risk of PTB when thermal event exceeds a specific intensity and duration threshold, particularly in the first four gestational weeks, and between week 21 and the last four weeks. This study provides compelling evidence for the development of heat-health early warning systems for pregnant women that could substantially mitigate the risk of PTB.

Funding

National Key R&D Program of China (No. 2018YFA0606200), National Natural Science Foundation of China (No. 42175183), Sanming Project of Medicine in Shenzhen (No. SZSM202111001).

Association of Temperature Thresholds with Heat Illness- and Cardiorespiratory-Related Emergency Visits during Summer Months in Alaska

BACKGROUND

Recent record-breaking hot temperatures in Alaska have raised concerns about the potential human health implications of heat exposure among this unacclimated population.

OBJECTIVES

We estimated cardiorespiratory morbidity associated with days above summer (June-August) heat index (HI, apparent temperature) thresholds in three major population centers (Anchorage, Fairbanks, and the Matanuska-Susitna Valley) for the years 2015-2019.

METHODS

We implemented time-stratified case-crossover analyses of emergency department (ED) visits for International Classification of Diseases, 10^th Revision codes indicative of heat illness and major cardiorespiratory diagnostic codes using data from the Alaska Health Facilities Data Reporting Program. Using conditional logistic regression models, we tested maximum hourly HI temperature thresholds between 21.1°C (70°F) and 30°C (86°F) for a single day, 2 consecutive days, and the absolute number of previous consecutive days above the threshold, adjusting for the daily average concentration of particulate matter ≤2.5μg.

RESULTS

There were increased odds of ED visits for heat illness above a HI threshold as low as 21.1°C (70°F) [odds ratio (OR)=13.84; 95% confidence interval (CI): 4.05, 47.29], and this increased risk continued for up to 4 d (OR=2.43; 95% CI: 1.15, 5.10). Asthma and pneumonia were the only respiratory outcomes positively associated with the HI: ED visits for both were highest the day after a heat event (Asthma: HI>27°C(80°F) OR=1.18; 95% CI: 1.00, 1.39; Pneumonia: HI>28°C(82°F) OR=1.40; 95% CI: 1.06, 1.84). There was a decreased odds of bronchitis-related ED visits when the HI was above thresholds of 21.1-28°C (70-82°F) across all lag days. We found stronger effects for ischemia and myocardial infarction (MI) than for respiratory outcomes. Multiple days of warm weather were associated with an increased risk of health impacts. For each additional preceding day above a HI of 22°C (72°F), the odds of ED visits related to ischemia increased 6% (95% CI: 1%, 12%); for each additional preceding day above a HI of 21.1°C (70°F), the odds of ED visits related to MI increased 7% (95% CI: 1%, 14%).

DISCUSSION

This study demonstrates the importance of planning for extreme heat events and developing local guidance for heat warnings, even in areas with historically mild summertime climates. https://doi.org/10.1289/EHP11363.

High ambient temperatures are associated with urban crime risk in Chicago

Urban crime (UC) seriously affects the security and stability of the communities and society. However, the effects of external temperatures on the risk of UC are still confusing. We quantitatively estimated the effects of high and low temperatures on UC in Chicago. After controlling for the confounding factors, we found that high temperature has a positive promoting effect on UC, for non-domestic crime, the effect occurs at lag day 0 with a maximum risk of 1.40 (95%CI, 1.34-1.46) compared to a risk of 1 at temperature of -12.3 °C, and decreased as the lag day increased. The effect of low temperature is not significant for UC. Heat waves above the 99th percentile with a duration of 4.5-5.5 days exert a significant positive impact on non-domestic crime of UC. Our findings confirm the adverse promotion effect of high temperature on UC risk, and effective individual behavior guidance and administrative intervention are of great significance for reducing the risk of UC under specific high temperature environment.

Comparison of various heat waves definitions and the burden of heat-related mortality in France: Implications for existing early warning systems

INTRODUCTION

In France, a heat warning system (HWS) has been implemented almost two decades ago and rely on some official heat wave (HW) definitions. However, no study has compared the burden associated with a large set of alternative HW definitions to the official definitions. Such comparison could be particularly helpful to identify HW conditions for which effective HWS would minimize the health burden across various geographical contexts and possibly update thresholds to trigger HWS. The aim of this study is to identify (and rank) definitions that drive the highest health burden in terms of mortality to inform future HWS across multiple cities in France.

METHODS

Based on weather data for 16 French cities, we compared the two official definitions used in France to: i) the Excess Heat Factor (EHF) used in Australia, and ii) 18 alternative hypothetical HW definitions based on various combinations of temperature metrics, intensity, and duration. Propensity score matching and Poisson regressions were used to estimate the effect of each HW exposure on non-accidental mortality for the May-September period from 2000 to 2015.

RESULTS

The associations between HW and mortality differed greatly depending on the definition. The greatest burden of heat was 1,055 (95% confidence interval "CI": [856; 1,302]) deaths per summer and was obtained with the EHF. The EHF identified HW with 2.46 (95% CI: [1.92; 3.58]) or 8.18 (95% CI: [6.63; 10.61]) times the global burden at the national level obtained with the climatological indicator of the French national weather service and the HW indicator of the French national HWS, respectively and was the most impactful definition pattern for both temperate oceanic and Mediterranean climate types.

CONCLUSION

Identifying the set of extreme heat conditions that drive the highest health burden in a given geographical context is particularly helpful when designing or updating heat early warning systems.

How can urban parks be planned to maximize cooling effect in hot extremes? Linking maximum and accumulative perspectives

How to maximize the cooling effect of urban parks in hot extremes has been closely linked to well-beings of citizens. Few studies have quantified urban parks' cooling effect in hot extremes from both maximum and accumulative perspectives. Here, we explored 65 urban parks' cooling effect based on spatially continuous cooling curves using multiple satellite images of Greater Xi'an (34°06' ∼34°34' N, 108°33' ∼109°15' E), one of China's metropolises with frequent hot extremes during July and August in 2019 summer. From maximum perspective, the urban parks cool down as far as 151.4 m, and covering 63.62 ha area, circa five times their own area in hot extremes; from accumulative perspective, the average cooling intensity is 0.78 °C along the whole continuous cooling distance spectrum, accumulated as 153.87 °C•m. And the urban parks show stronger accumulative cooling effect in hot extremes than the relative moderate temperatures. The cooling range could be maximized in large parks with dense trees, also in complex-shaped parks with strong interaction with surrounding environment. Small parks such as neighborhood parks located in the densely populated area are with maximum efficiency, cooling down about nine times their own area, which could serve as highly efficient cooling networks. Enhancing vegetation growth and coupling both blue and green infrastructures are always effective to increase accumulative cooling intensity in hot extremes. Our findings provide nature-based solutions (NBS) to counteracting heat stresses from the intense and frequent hot extremes in the future, also helpful for energy saving in the continuing climate change scenario.

Evaluating the Sensitivity of Heat Wave Definitions among North Carolina Physiographic Regions

Exposure to extreme heat is a known risk factor that is associated with increased heat-related illness (HRI) outcomes. The relevance of heat wave definitions (HWDs) could change across health conditions and geographies due to the heterogenous climate profile. This study compared the sensitivity of 28 HWDs associated with HRI emergency department visits over five summer seasons (2011−2016), stratified by two physiographic regions (Coastal and Piedmont) in North Carolina. The HRI rate ratios associated with heat waves were estimated using the generalized linear regression framework assuming a negative binomial distribution. We compared the Akaike Information Criterion (AIC) values across the HWDs to identify an optimal HWD. In the Coastal region, HWDs based on daily maximum temperature with a threshold > 90th percentile for two or more consecutive days had the optimal model fit. In the Piedmont region, HWD based on the daily minimum temperature with a threshold value > 90th percentile for two or more consecutive days was optimal. The HWDs with optimal model performance included in this study captured moderate and frequent heat episodes compared to the National Weather Service (NWS) heat products. This study compared the HRI morbidity risk associated with epidemiologic-based HWDs and with NWS heat products. Our findings could be used for public health education and suggest recalibrating NWS heat products.

Recent Climatology (1991-2020) and Trends in Local Warm and Cold Season Extreme Temperature Days and Nights in Arabia

The Arabian Peninsula (Arabia) is among the places to have experienced the greatest amount of warming during recent decades, and this trend is projected to continue. Specifics related to the characteristics (frequency, duration, and intensity) of extreme temperature events (ETEs) over Arabia as a whole are either largely outdated or limited only to specific areas. The seasonal ETE definitions commonly used in local studies are neither climatological- nor phenomenon-based. Using a novel and straightforward framework, the seasons of four extreme temperature types (extreme warm days/nights (EWDs/EWNs) and extreme cold days/nights (ECDs/ECNs)) were identified on the simultaneous basis of event occurrence and impact times. Assessments of ETE frequency, duration, and intensity and their recent changes were then provided based on the most recent climate data (1991–2020). Results showed that the use of traditional seasonal definitions (e.g., meteorological seasons) tends to assume a spatiotemporal homogeneity in the seasonality of ETEs and their potential risk levels throughout the year. The developed framework distinguished months with events that have larger potential impacts together with their local seasons. ETE seasons were found to vary at the regional and local scales and are better defined at both the local and phenomenon levels. Early extreme warm events were hotter, and those at locations with longer local warm seasons demonstrated higher intensities. ECDs tended to be more frequent at coastal locations, whereas ECNs were more frequent over southwestern Arabia. Early and late extreme cold events were much colder than those occurring mid-season. Trend analyses revealed generally increasing regional trends in the frequency of extreme warm events, whereas extreme cold events have declined. The duration (i.e., consecutive occurrences) and intensity of EWNs have been increasing at more locations, suggesting that urgent attention is needed within such an arid and hot climate type in which nighttime stress relief is already very limited.

Extreme heat, preterm birth, and stillbirth: A global analysis across 14 lower-middle income countries

Stillbirths and complications from preterm birth are two of the leading causes of neonatal deaths across the globe. Lower- to middle-income countries (LMICs) are experiencing some of the highest rates of these adverse birth outcomes. Research has suggested that environmental determinants, such as extreme heat, can increase the risk of preterm birth and stillbirth. Under climate change, extreme heat events have become more severe and frequent and are occurring in differential seasonal patterns. Little is known about how extreme heat affects the risk of preterm birth and stillbirth in LMICs. Thus, it is imperative to examine how exposure to extreme heat affects adverse birth outcomes in regions with some of the highest rates of preterm and stillbirths. Most of the evidence linking extreme heat and adverse birth outcomes has been generated from high-income countries (HICs) notably because measuring temperature in LMICs has proven challenging due to the scarcity of ground monitors. The paucity of health data has been an additional obstacle to study this relationship in LMICs. In this study, globally gridded meteorological data was linked with spatially and temporally resolved Demographic and Health Surveys (DHS) data on adverse birth outcomes. A global analysis of 14 LMICs was conducted per a pooled time-stratified case-crossover design with distributed-lag nonlinear models to ascertain the relationship between acute exposure to extreme heat and PTB and stillbirths. We notably found that experiencing higher maximum temperatures and smaller diurnal temperature range during the last week before birth increased the risk of preterm birth and stillbirth. This study is the first global assessment of extreme heat events and adverse birth outcomes and builds the evidence base for LMICs.

Health Risks to the Russian Population from Temperature Extremes at the Beginning of the XXI Century

Climate change and climate-sensitive disasters caused by climatic hazards have a significant and increasing direct and indirect impact on human health. Due to its vast area, complex geographical environment and various climatic conditions, Russia is one of the countries that suffers significantly from frequent climate hazards. This paper provides information about temperature extremes in Russia in the beginning of the 21st century, and their impact on human health. A literature search was conducted using the electronic databases Web of Science, Science Direct, Scopus, and e-Library, focusing on peer-reviewed journal articles published in English and in Russian from 2000 to 2021. The results are summarized in 16 studies, which are divided into location-based groups, including Moscow, Saint Petersburg and other large cities located in various climatic zones: in the Arctic, in Siberia and in the southern regions, in ultra-continental and monsoon climate. Heat waves in cities with a temperate continental climate lead to a significant increase in all-cause mortality than cold waves, compared with cities in other climatic zones. At the same time, in northern cities, in contrast to the southern regions and central Siberia, the influence of cold waves is more pronounced on mortality than heat waves. To adequately protect the population from the effects of temperature waves and to carry out preventive measures, it is necessary to know specific threshold values of air temperature in each city.

Evolving heat waves characteristics challenge heat warning systems and prevention plans

This paper analyses how recent trends in heat waves impact heat warning systems. We performed a retrospective analysis of the challenges faced by the French heat prevention plan since 2004. We described trends based on the environmental and health data collected each summer by the French heat warning system and prevention plan. Major evolutions of the system were tracked based on the evaluations organized each autumn with the stakeholders of the prevention plan. Excess deaths numbering 8000 were observed during heat waves between 2004 and 2019, 71% of these between 2015 and 2019. We observed major changes in the characteristics, frequency and the geographical spread of heat waves since 2015. Feedbacks led to several updates of the warning system such as the extension of the surveillance period. They also revealed that risk perception remained limited among the population and the stakeholders. The sharp increase in the number of heat warnings issued per year since 2015 challenges the acceptability of the heat warnings. Recent heat waves without historical equivalent interfere with the development of evidence-based prevention strategies. The growing public health impacts heat waves emphasize the urgent need to act to adapt the population, at different levels of intervention, from individual comportments to structural modifications. A specific attention should be given to increase the resources allocated to the evaluation and the management of heat-related risks, especially considering the needs to catch with the rapid rhythm of the changing climate.

Air quality and meteorological patterns of an early spring heatwave event in an industrialized area of Attica, Greece

Heatwaves-excessively hot ambient conditions that are considered a serious threat to human health-are often associated with poor air quality. The aim of this study was to examine the impact of an early heatwave episode in an industrialized plain in the eastern Mediterranean region (Thriasio, Greece) on human thermal discomfort and urban air quality. The heatwave occurred in mid (15-20) May 2020, shortly after some of the restrictions that were improsed to halt the spread of coronavirus disease 2019 (COVID-19) in Greece were lifted (on 4 May). The discomfort index (DI) and the daily air quality index (DAQI) were calculated on an hourly basis throughout spring 2020 (March, April, May) using data from two stations that measure meteorological parameters and air pollutant concentrations in the Thriasio Plain. The analysis showed that the air temperature increased during 7-17 May to levels that were more than 10 °C above the monthly average value (25.8 °C). The maximum measured air temperature was 38 °C (on 17 May). The results showed a high level of thermal discomfort. The DI exceeded the threshold of 24 °C for several hours during 13-20 May. Increased air pollution levels were also identified. The average DAQI was estimated as 0.83 ± 0.1 and 1.14 ± 0.2 at two monitoring stations in the region of interest during the heatwave. Particulate matter (diameter < 10 μm) appeared to contribute significantly to the poor air quality. Significant correlations between the air temperature, DI, and AQSI were also identified.