Author: books

As the world continues to feel the effects of climate change, research suggests that the severity and frequency of extreme weather events—like unrelenting stretches of heat—will only worsen with time.

“We shouldn’t be worried—we should be terrified,” says Camilo Mora, an associate professor in the department of geography and environment at the University of Hawai‘i at Mānoa. “What we are dealing with here is between something bad and something terrible,” depending on what actions are taken to curb climate change.

For a study published in Nature Climate Change in 2017, Mora and his colleagues analyzed hundreds of extreme heat events around the world and determined that, while about 30% of the population was exposed to a deadly combination of heat and humidity for at least 20 days annually, that percentage would increase to nearly half by the year 2100.

Heat and humidity can be pernicious. In another 2017 study, published in Circulation: Cardiovascular Quality and Outcomes, Mora described 27 ways a heat wave can kill, such as inadequate blood flow to the brain, heart, kidneys, liver, or pancreas. “It’s like a horror movie with 27 endings to choose from,” he says.

However, it’s possible to prepare for a hotter world by building up your heat tolerance, though experts say doing so isn’t necessary for everyone. Here’s what to know about how humans can adapt to rising temperatures, and the ways in which they can’t.

What is heat tolerance?

The Occupational Safety and Health Administration (OSHA) defines heat tolerance as “the physiological ability to endure heat and regulate body temperature at an average or better rate than others.”

Heat tolerance likely has a genetic component, though that connection isn’t yet well-understood. “Our nervous systems don’t all function exactly the same,” says Thomas E. Bernard, a professor in the College of Public Health at the University of South Florida who studies occupational safety and health in the heat. “Just like you have high performers in terms of intelligence, you have high performers in a neurophysiological sense. There’s nothing you can do to change that.”

Age is another contributing factor: very young children and seniors are at particularly high risk of heat illness, Bernard says. Beyond that, drug and alcohol use, the presence of acute or chronic illness, and obesity can negatively affect heat tolerance, while improving cardiovascular fitness will increase it.

Read More: Why Extreme Heat Is So Bad for the Human Body

Hydration status also plays a role in how well someone fares in warm weather. Drinking enough fluids “doesn’t make you superhuman, but it allows you to continue to tolerate the heat,” Bernard says. (Once you’re well-hydrated, however, “more doesn’t help.”)

Other factors that affect a person’s heat tolerance are more situational, like how long a heat wave has lasted. Heat tolerance tends to decline when it’s extremely hot for many days. If you’re working outside on the fourth consecutive day of high temps, for example, you likely won’t do as well as you did on day one.

While no one is immune to the heat, most people have “an inherent ability to tolerate quite a bit,” says Michael F. Bergeron, who advises the Women’s Tennis Association on performance health and has extensively researched heat. “Human beings who are healthy and used to the hot conditions, and who don’t overexpose themselves to undo levels of work or exercise in the sun, can tolerate a lot.”

Can you improve your heat tolerance?

People can do plenty of things to enhance their ability to tolerate or adapt to changes in the environment. The best method is heat acclimatization, which is “the process of the body gearing up all these physiological systems to better handle heat stress,” says W. Larry Kenney, a professor of physiology and kinesiology at Penn State. To get acclimatized, he says, you could go outside on a hot day and engage in mild activity—like taking a walk—for a very short period of time—about 15 minutes—and then repeat the process the following day. It takes the average person between nine and 14 exposures to become acclimatized, Kenney says. “The fitter you are, the shorter that time is.”

Read More: How to Cool Down When It’s Really Hot Outside

Several things happen during the acclimatization process that improve people’s ability to tolerate heat. Most notably, blood volume expands. “That allows the heart to not work as hard, and it provides more fluid for sweating,” Kenney says.

After the first few days of acclimatization—which are all about cardiovascular adjustments—“the sweating mechanism starts to gear up, and we produce more sweat,” Kenney says. Plus, the sweat we produce will be more diluted, meaning we lose less salt, and will occur more frequently on the limbs. “When people are unacclimatized, most of their sweating is on the trunk, the face, the back, and the chest,” Kenney says. “But the best way to evaporate sweat is to get it all over the body. So being able to sweat more on the limbs, which are moving through space quite a bit, allows that sweat to evaporate better.”

Heat acclimatization is often a focus for athletes, people who work outside, and those in the military, says Brenda Jacklitsch, a health scientist with the U.S. Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health. For example, some farm workers who spend their days spraying pesticides have to wear protective equipment such as long sleeves, pants, and respirators, all of which increase the odds of a heat-related illness—hence the need to become acclimatized.

Jacklitsch advises people who are trying to build up their heat tolerance to slowly introduce themselves to hot environments over one to two weeks. Those who are new to working outside benefit from easing in, perhaps spending 20% of their first day in the heat and then gradually increasing that time for the rest of the week.

Even when someone is fully acclimatized, she notes, they’re still susceptible to heat stress and could become sick. That’s why it’s important to always be around other people, take breaks in the shade, and stay well-hydrated. Also, heat acclimatization isn’t static: “Once you get better tolerance, you have to maintain it, because if you aren’t in the heat any longer, that resilience can decay,” Bergeron says.

While acclimatization is helpful for those who can’t escape the heat, experts agree it’s not necessary for the average person, and pushing yourself could lead to heat illness. There’s nothing wrong with hunkering down in the air conditioning during heat waves. “You’re not doing yourself a disservice,” Bernard says. “Your tolerance to heat might not be maximized—but it’s uncomfortable [to become acclimatized]. Why would you want to do that unless you have to?”

Will humans adapt to extreme heat?

For years, climatologists described a wet-bulb temperature of 95 degrees Fahrenheit as the upper limit for humans to be able to safely regulate their body temperature. (“Wet-bulb” temperature is a measurement used by researchers that accounts for both heat and humidity. It’s the temperature that would be read by a thermometer that was covered in a water-soaked cloth; at 100% humidity, it’s equal to the air temperature.)

Thinking about the maximum sustainable wet-bulb temperature has evolved, in part thanks to Kenney’s research. He and his colleagues send volunteers of all ages into environmental chambers and adjust the humidity and temperature, while monitoring participants’ core temperature. Participants swallow a pill that allows researchers to monitor their deep body temperature, and while they’re inside the chamber, they move around, perhaps walking on a treadmill as the temperature and humidity fluctuate.

Read More: A Hotter World Means More Disease Outbreaks in Our Future

Kenney’s findings indicate that the “critical upper limits,” even for healthy people, are closer to a wet-bulb temperature of 88 degrees Fahrenheit—which would mean, for example, 88 degrees at 100% humidity or 100 degrees at 60% humidity. At that point, “the sweat you produce doesn’t evaporate,” Kenney says, so the body can no longer cool itself. But that’s not synonymous with instant death. “People would stop the activity, go inside, find shade, and drink more fluids. Nobody would keep going above those limits for long periods of time.”

These conditions aren’t yet widespread on Earth, though some areas approached them during recent heat waves. If the world experiences another 2.5 to 3 degrees Celsius of warming (or 4.5 to 5.4 degrees Fahrenheit), significant parts of the population could start routinely breaking these thresholds, says Matthew Huber, a climate scientist at Purdue University.

Experts agree that, physiologically, humans will not be able to adapt to such extreme heat—even within the next few centuries. As Huber puts it, humans’ internal body temperature is “a shared trait, from 100 million years ago. It’s not something that changes quickly.”

That doesn’t mean, however, that the human species will cease to exist. Rather, we’ll need to depend on behavioral adjustments and other interventions. In some areas of the tropics and subtropics, Huber says, it’s already common for workers to do time-shifting, like working from 4 a.m. to 11 a.m., and then spending the hottest part of the day inside. That could become the norm in other places.

The world will also need improved access to air conditioning, as well as cheaper, more energy-efficient forms of cooling, like electric fans. We might see “swamp coolers” more often—devices that use moisture to cool air, Kenney says. “I think what will have to happen is better engineering controls that provide those sorts of cooling devices to more and more people who can’t afford them.”

Plus, Huber stresses, we’ll need to shift our mindset on the heat—and not push ourselves to go for a run when it’s really hot outside, or try to tough it out because “grandma used to live in this house without an air conditioner.”

“There’s going to have to be a change in mindset that people have, where they have to start thinking about hot, humid conditions actually as a threat and not something to be overcome,” he says.

Contact us at [email protected].

Analysis by Dr. Joseph Mercola
Fact Checked

• August 20, 2022Download PDF

  14140

Analysis by Dr. Joseph Mercola
Fact Checked

• August 20, 2022Download PDF

  155875

For the last decade, Precious McCowan’s life has revolved around organ transplants. She’s a PhD candidate studying human behavior from Dallas who’s already survived two kidney transplants. And in the midst of her own end-stage renal disease, her two-year-old son died. She chose to donate his organs in hopes they would save a life.

Now her kidneys are failing again, and she’s facing the possibility of needing a third transplant. Meanwhile, the agency that oversees donations and transplants is under scrutiny for how many organs are going to waste instead of helping patients like her. The agency, the United Network for Organ Sharing, received a bipartisan tongue lashing at a recent Congressional hearing.

“Patients, we’re not looking at that,” McCowan said, referring to the policy debates. “We’re like ‘hey, I need a kidney for me. I need it now. I’m tired of dialysis. I feel like I’m about to die.”

The number of kidney transplants increased last year by 16% under a new policy implemented by UNOS that prioritizes the sicker patients over those who live closer to a transplant center.

Still, nearly 100,000 patients are waiting on kidneys and even more for other organs. Roughly 5,000 a year are dying on the waitlist — even as perfectly good donated organs end up in the trash. A two-year inquiry by the Senate Finance Committee uncovered numerous incidents that were previously undisclosed publicly.

• Charleston, South Carolina: In November 2018, a patient died after receiving an organ with the wrong blood type.
• Las Vegas: In July 2017, two kidney recipients contracted a rare infection. One died days later.
• Kettering, Ohio: In June 2020, a transplant recipient was informed that he had accidentally received an organ from a donor with cancer and would likely develop cancer.

UNOS has held the contract to manage organ distribution since the beginning of the country’s transplant system in 1984, and now U.S. senators — both Democrat and Republican — are questioning whether it’s time for another entity to step in.

“The organ transplant system overall has become a dangerous mess,” Sen. Elizabeth Warren (D-Massachusetts) said during the Aug. 3 hearing. “Right now, UNOS is 15 times more likely to lose or damage an organ in transit as an airline is to lose or damage your luggage. That is a pretty terrible record.”

Outdated technology has no way to track organs in transit

The investigation places blame on antiquated technology. The UNOS computer system can go down for an hour or more at a time, delaying matches when every hour counts. There’s also no standard way to track an organ, even as companies like Amazon can locate any package, anywhere, anytime.

“I can’t even get a kidney that’s 20 miles away from my transplant center, with UNOS thinking it was in Miami,” said Barry Friedman, director of the transplant center at AdventHealth in Orlando. “It was actually in Orlando, 20 miles away.”

In the decade between 2010 and 2020, the congressional report found UNOS received 53 complaints about transportation including numerous missed flights leading to canceled transplants and discarded organs. The report also cites a 2020 KHN investigation that uncovered many more incidents — nearly 170 transportation snafus from 2014 to 2019. Even when organs do arrive, transplant surgeons say the lack of tracking leads to longer periods of “cold time” — when organs are in transit without blood circulation — because often the transplant surgeons can’t start a patient on anesthesia until the organ is physically in hand.

One in four potential donor kidneys, according to the latest UNOS data, now goes to waste. And that number has gotten worse as organs travel farther to reach sicker patients under the new allocation policy.

Organ deliveries arriving damaged or ‘squished’

At the University of Alabama-Birmingham, a kidney arrived frozen solid and unusable in 2014, said Dr. Jayme Locke, who directs the transplant program. In 2017, a package came “squished” with apparent tire marks on it (though, remarkably, the organ was salvaged). And in one week in May of this year, Locke said four kidneys had to be tossed for avoidable errors in transportation and handling.

“Opacity at UNOS means we have no idea how often basic mistakes happen across the country,” she said.

UNOS CEO Brian Shepard has already announced he’s stepping down at the end of September. He defends the organization he’s led for a decade, pointing to the rising rate of transplants.

The new kidney allocation policy, which was challenged in court, is partly responsible for that increased transplant rate. The policy also contributed to equity gains, boosting transplants for Black patients by 23%. Black patients, who are more likely to suffer from kidney failure, have had difficulty getting onto transplant lists.

“While there are things we can improve — and we do every day — I do think it’s a strong organization that has served patients well,” Shepard said.

Another independent government report published this year found that any blame should be shared with the hospital transplant centers and the local organizations that procure organs from donors. The three entities work together but tend to turn into a triangular firing squad when people start asking why so many patients still die waiting for organs.

“[UNOS] is not the only source of problems with efficiency in the system,” said Renée Landers, a law professor who leads the biomedical concentration at Suffolk University. She was on the committee that helped produce the broader report. “Everybody had some work that they needed to do.”

The recent watchdog reports, as well as several ongoing legal battles over revised organ distribution maps, are just noise to Precious McCowan of Dallas, as she faces the prospect of trying to get on yet another waitlist. She said she’s encouraged by the rising transplant rate, especially for Black patients like herself, but also fears she may not get so lucky with a third round on the waitlist.

“I just need a kidney that works for me,” she said. “And I need it now.”

This story comes from NPR’s health reporting partnership with Nashville Public Radio and KHN (Kaiser Health News).

After a bumpy start, the Biden administration is trying to smooth out the vaccination campaign aimed at controlling the country’s growing monkeypox outbreak.

The effort now rests on a new and untested strategy of dividing up what were previously full doses in order to stretch the limited stockpile of vaccines in the U.S.

This comes as monkeypox cases have climbed well above 14,000 in the U.S. – a case count higher than any other country in the world – and yet many local health departments still report not having enough vaccines to reach all those who are considered at heightened risk of contracting the disease.

“We are definitely in what we’re still calling ‘The Hunger Games’ phase of this – where there’s nowhere near enough doses for the demand,” says Dr. Mark Del Beccaro, Assistant Deputy Chief for Public Health – Seattle & King County.

Already facing the expected logistical hurdles of running a vaccine campaign in a public health emergency, health officials now have to tackle another challenge: how to squeeze five doses out of single-dose vials.

“It’s great that we are able to increase the number of people we can vaccinate with the current supply,” says Claire Hannan, head of the Association of Immunization Managers. Still, “when you make a change like that, it’s kind of like turning the barge around in the middle of the sea.”

The change poses challenges with messaging and logistics – training providers and getting the right equipment – and it raises concerns among some over equity as early vaccine data rolls in, showing significant racial disparities.

Stretching a limited supply

The U.S. government’s plan to get the disease under control is largely based on giving out the JYNNEOS vaccine, a two-shot series against monkeypox made by Bavarian Nordic.

But a series of missteps at the start of the response left the U.S. with a major vaccine shortage. The federal government was slow to order vaccines, allowing other countries to jump the queue, and distribution has been chaotic for states and cities.

So far, the U.S. has shipped around 700,000 vials of the monkeypox vaccine to states and territories for distribution. The Centers for Disease Control and Prevention has said the first priority is to vaccinate the 1.7 million people who are considered at highest risk.

Facing a shortage in vaccines, the Food and Drug Administration authorized a new dosing strategy last week: the vaccine can now be administered using an “intradermal injection” – where the vaccine is injected into the skin – rather than the typical method of injecting into the layer of fat underneath the skin.

“This action serves to markedly increase vaccine supply,” said Dr. Rochelle Walensky, director of the CDC, in a video released this week. “Intradermal administration of the JYNNEOS vaccine allows vaccine providers to administer a total of up to five separate doses from an existing one-dose vial.”

Federal officials are adamant that this smaller amount of vaccine should not be considered a “partial dose” because it’s still able to produce a similar level of immunologic response as the original method of administering the vaccine.

However, the evidence for this method is scant, though it has worked for vaccinating against other diseases.

The theory rests on the fact that there are many immune cells embedded in the skin. “When a vaccine is given into this tissue, you can generate a robust immune response using a smaller amount of vaccine,” said Dr. John Brooks, a medical epidemiologist from CDC in the video, citing a 2015 study on the vaccine. Brooks also stressed that the method has been studied on other vaccines including those for flu and rabies.

One vial equals five doses? Not so fast

There’s also a practical problem with the plan to squeeze five doses out of what was once a single dose:

“It’s just mechanically difficult to do,” says Del Beccaro of Seattle & King County. “The federal announcement of five doses per vial was, I think, incredibly optimistic and what we’re seeing in real life is three to four doses per vial.”

Hannan, head of the Association of Immunization Managers, has heard the same concerns.

“Hopefully we will start to see more of the vials yielding five doses, but we’re not really seeing that consistently right now,” she says.

And yet it seems the federal government is assuming five doses per vial as it divvys up the supplies of vaccine and sends those out to health departments, says Del Beccaro.

So far, much of the U.S. vaccine campaign has focused on reaching people who are unvaccinated and at increased risk of contracting monkeypox, but soon health departments will also have to be ready for the influx of people returning for their second doses 28 days later.

In the Seattle area, that could add up to about 4,000 people in the last week of August. And while it continues to be difficult to predict how the federal supply could change, Del Beccaro says currently it looks like they will not be getting enough vaccine to do second shots while also providing first shots at a high rate.

The switch also requires new supplies and training, says Janna Kerins, medical director at the Chicago Department of Public Health. “It means using a different syringe, a different needle,” she says, “So it has taken a bit of time to make sure people have the supplies.”

Plus providers need technical training in how to administer a dose into the skin. And “we also need to educate [providers and the communities they serve] on the data that supports this change,” though there’s not much available, she says.

Distrust and feelings of disrespect

The new dosing strategy is also feeding into a strong sense of inequity among some in the communities most at risk for the disease.

The overwhelming majority of U.S. cases are still being detected among “men who reported recent sexual contact with other men,” CDC director Rochelle Walensky told reporters on Thursday.

Though the data is imperfect, what’s currently available shows another trend: a disproportionately high number of Black and LatinX members of the gay and queer community are getting monkeypox – and they’ve also had a hard time getting access to vaccines.

On August 10, North Carolina’s health department released findings that 70% of the state’s cases have been detected in Black men, but just 24% of monkeypox vaccines have gone to this group.

Chicago is also seeing vaccination gaps in men of color. 30% of the city’s cases have been found among Latino men, but just 15% of vaccines have gone to the Latino population, according to Kerins, in Chicago. “We have some work to do to try to align the doses of vaccine better with those who are [at risk of] becoming cases,” she says.

National data indicates that queer Black and Brown communities are experiencing high rates of monkeypox: 33% of cases are occurring among those who are Hispanic and 28% among those who are Black.

While no national data has been shared on vaccinations, lack of access for these groups is a problem across the board, says Joseph Osmundson, a microbiologist at NYU and a queer community organizer in New York. The new dosing strategy could feed into that.

“We expect the data in New York and elsewhere to be similar,” Osmundson says. “What this [dosing strategy] is doing is using a different dosing regimen for those who get the vaccine late – who are more likely to be working class and more likely to be Black and Brown, who have not had the privilege, the ability to access vaccine yet.”

The disparities in vaccine access have sowed suspicion and distrust in communities of color, says Kenyon Farrow, with the advocacy group Prep4All.

Farrow says public health leaders still have to do more to explain why this new strategy is not necessarily inferior. He says a sentiment he’s seen online, especially from gay men of color, is that “they let White gay men take all the first full doses. And so we’re now supposed to believe that a fifth of that dose is going to do us just as well.”

Federal health officials say they’re working to bridge these disparities.

On Thursday, the White House monkeypox response team announced a pilot program to bring vaccines to Pride festivals and events where they can reach the gay, bisexual and queer communities at highest risk for contracting the virus.

“Many of the events we’re focusing on are events that focus on populations who are overrepresented in this outbreak,” including Black and Latino individuals, Dr. Demetre Daskalakis, deputy coordinator of the national monkeypox response, said on Thursday during a briefing with federal health officials.

“It’s really about positioning messaging and biomedical interventions where people can reach it, and also making sure that we’re going to the right places and talking about the right people.”

The use of telemedicine and telehealth increased dramatically during the COVID-19 pandemic. For the physicians who used the technology more intensely during that period, more time was spent on after-hours EHR-based clinical and administrative work.

These were among the conclusions of a study of 2,129 physicians that was conducted at New York University Langone Health.

The report, published in JMIR in July, found that time spent on work-related tasks outside clinical hours, often referred to as “work outside work” (WOW), increased “significantly” for those physicians who spent a larger proportion of their time providing care via telemedicine.

“Our study found that telemedicine was less efficient than in-person-based care and increased physicians’ WOW burden,” the researchers noted. “A number of factors may be responsible for our findings that telemedicine increased the after-hours work burden of physicians.”

The study noted, however, that multiple challenges uncovered in early-stage deployments of telehealth during the pandemic — including organizational and technological inefficiencies in design and deployment — could be a key factor in the increased after-hours EHR work burden.

“These issues have been highlighted elsewhere in EHR and digital health technology implementation research, particularly regarding usability and user-experience barriers exacerbated by the scale and abruptness of the transition to telemedicine due to the pandemic,” the study noted.

The disruption of work norms, including new methods of providing care and scheduling arrangements, could also have contributed to the WOW burden.

“Overall, our results suggest that telemedicine is not [a] panacea for the work challenges facing clinicians,” the report noted. “In fact, our evidence during the acute pandemic and after the acute pandemic suggests that rather than reducing administrative burden, telemedicine intensity may increase it, shifting the work temporally and spatially to after-hours work and home.”

WHY THIS MATTERS

Healthcare’s ongoing digital transformation is both contributing to and alleviating clinician burnout.

Two in three clinicians now say treating patients in virtual-only or hybrid care settings best fits their lifestyle, despite a significant lack of interest in telehealth before the pandemic.

Some in the industry advise clinicians interested in telehealth to look for opportunities that prioritize and personalize their experience as clinicians.

THE LARGER TREND

Telehealth adoption is highest among the young, educated and wealthy, according to a December 2021 survey by Rock Health, which revealed an increase in live video telemedicine — and a decrease in satisfaction with telehealth compared with in-person care.

Other studies have indicated telemental healthcare is associated with increased outpatient contact and hospitalization follow-ups

However, that study found that greater use of telehealth among patients with severe mental illness did not affect medication adherence.

ON THE RECORD

“Taking physicians’ clinical load into account, physicians who devoted a higher proportion of their clinical time to telemedicine throughout various stages of the pandemic engaged in higher levels of EHR-based after-hours work compared to those who used telemedicine less intensively,” the study concluded. “This suggests that telemedicine, as currently delivered, may be less efficient than in-person-based care and may increase the after-hours work burden of physicians.”