Combating heatwave deaths
As per the Intergovernmental Panel on Climate Change (IPCC), the average temperature is going to rise by 2-6 degree C over next 80-100 years. Increasing levels of heat is being experienced by the common man every day in India. Winters in Ahmedabad and rest of India have become much milder and summers much warmer.
Unfortunately, the public health impact of increasing heat and heatwaves in terms of mortality and morbidity have not been well studied in India so far. Occasional reports of some deaths due to heatwaves have been there, for example, in Orissa in the 1998 heatwave, 2042 deaths were recorded.
Systematic studies of heatwave-related mortality have not been done till we recently did a study to show that there was substantial additional mortality in Ahmedabad city during the May, 2010 heatwave when the temperature reached 47 degree C. Ahmedabad had about 100-125 deaths every day in May during those years, and 310 deaths were recorded on a single day of the heatwave in 2010.
Based on these observations and learning from other cities and states in the world, the Indian Institute of Public Health, Gandhinagar, with its international partners – Natural Resources Defence Council, Emory University, Mt Sinai Hospital, and Georgia Institute of Technology (all based in the USA) worked with the Ahmedabad Municipal Corporation (AMC) to prepare a Heat Action Plan (HAP). This HAP was piloted in 2013 and then revised version was implanted in 2014 in Ahmedabad.
The Ahmedabad HAP has five simple elements – first is early warning system based on predictions of maximum temperatures for next seven days obtained from Climate Forecast Applications Network (CFAN) at Georgia Tech.
Second element is a system to issues alerts to various AMC departments and the community when a heatwave is predicted. This involves appointing a nodal officer and a communication network.
Third is community awareness of dangers of heat, how to avoid them, how to recognise early symptoms, and how and where to seek primary and preventive care for heat stroke. This was done via posters, bill boards, and electronic and print media.
Next element is to orient the healthcare providers to treat patients with heat related illnesses rapidly in a correct way. Heat kills by two ways – first is heat stroke in which the body temperature becomes very high, leading to damage in the brain resulting in high mortality.
The other and more common danger of heatwave is circulatory failure in old people with pre-existing severe heart, lung, kidney, or other chronic diseases. Our groups showed that newborns are also very vulnerable to heatwaves.
Final element of the HAP is to evaluate its effect on mortality and morbidity using scientific statistical methods and to revise it going forward using this information. During the 2014 heatwave in June 3-5, the HAP got its first test. Preliminary analysis of data from the city showed much less mortality during this heatwave of 2014 than the heatwave of 2010 when there was no HAP in the city.
Based on the Ahmedabad experience, we strongly recommend that other cities and districts develop such HAP during this summer season. Each city and district can put in place an alert system using IMD temperature predictions which are available for five days in advance on their website.
Nodal officers need to be identified, who will alert other departments and citizens via mass media, social media and cell phone with SMSs of impending heatwaves and what actions they need to take.
Actions needed are simple: avoid exposure to high temperatures, drink plenty of water and liquids to avoid dehydration, and if unwell, visit the doctor and get proper treatment. Health authorities should prepare health institutions for rapid treatment of heat related cases rapidly. Finally all city, village, and town authorities should keep a daily tab on number of deaths due to all causes.
If key elements of Ahmedabad HAP are adapted and implemented in the whole of India, there could be saving of thousands, if not lakhs of lives during heatwaves.
(The writer is Director, Indian Institute of Public Health, Gandhinagar)