Hurricane Beryl and the Impact of Climate Change: Lessons Learned and Preparation for Extreme Weather

The climate change scientists were right. Last week, we saw the prediction of extreme weather right on our rooftops, as Hurricane Beryl came a-calling. We extend our condolences to our Bajan fisherfolk in particular, and to many of our neighbours in other Caribbean islands, Venezuela, Mexico and now even the US.

The scientists were quick to point out that Hurricane Beryl was the earliest hurricane, in terms of our annual hurricane seasons, to target the Caribbean islands, and a Category 3 hurricane was the most powerful hurricane to hit the Caribbean this early. At this time of the year we are normally getting ready for the end of the school term, and the start of multiple carnival festivities, not dodging hurricanes.

While hurricane preparedness is a specific area, and the scientists predict that we are likely to have a very active storm season, with multiple powerful hurricanes coming our way, I hope we can learn valuable lessons from Hurricane Beryl, and use these lessons to protect ourselves, our families, and our communities.

One major other prediction is severe hot weather, with 2023 being the hottest year ever recorded, and 2024 predicted to be even hotter. As we prepare for the outdoor activities that we love to do in ‘summer’, efforts to protect yourself, your family and your community must get high-priority consideration.

Heat exposure is associated with an increased risk of medical problems, such as cardiovascular, respiratory, metabolic diseases, pregnancy complications and even mental illnesses. Heat can trigger sudden events like heart attacks or strokes, or worsen existing medical conditions like kidney and respiratory diseases. Extreme heat can affect anybody and everybody. More frequent and severe extreme weather events like heat waves – over 1 300 people died during the annual Muslim pilgrimage in Hajj, Saudi Arabia just two weeks ago due to the extreme heat; severe hurricanes, like the category 3 Hurricane Beryl which battered Venezuela, the Caribbean, Mexico, and has now set its sights on parts of North America, causing severe disruption to fishing, agriculture and people’s lives; bush fires around the world, which destroy millions of acres, destroying hundreds of homes and other buildings. These are all happening in real time, and are affecting real people and real lives, and most predictions suggest that there’s lots more to come.

Heat-related illnesses can be separated into mild, moderate and severe. The mild illnesses include heat rash, heat cramps, heat oedema, and heat syncope (fainting). Heat exhaustion makes up the moderate category, and heat stroke is a severe heat-related illness. Ongoing exposure to heat can move the prognosis from mild to moderate to severe.

Heat cramps are the mildest form of heat-related illness. Symptoms of heat cramps often include heavy sweating, fatigue, thirst and muscle cramps. It is not uncommon for the feet or hands to become swollen when a person sits or stands for a long time in a hot environment. This swelling is called heat oedema. Heat causes the blood vessels to expand (dilate), so body fluid moves into the hands or legs. Heat rash occurs when sweat is trapped in the skin. Symptoms can range from small blisters to deep, inflamed lumps. Some forms of heat rash are very itchy. Heat syncope or fainting is a mild form of heat illness that often results from physical exertion when it is hot. It occurs when your body, in an effort to cool itself, causes the blood vessels to dilate to such an extent that blood flow to the brain is reduced. Inadequate fluid replacement, which leads to dehydration, usually contributes greatly to this illness.

Heat exhaustion, a moderately severe heat illness, is associated with headaches, fatigue, weakness, dizziness and nausea, and may be accompanied by vomiting. The individual loses salt and water and becomes mildly dehydrated. Importantly, and unlike the case of heat stroke, the person’s mental capacity remains intact. Treatment of heat exhaustion entails removal of the individual from the heat (or heat-related activity), encouraging lying down in a cool well-ventilated space (a fan or AC will be useful), spraying a mist of cool fluids would be helpful, and replacing the fluid loss with oral drinks. If the person shows little/no signs of improving in 15-30 minutes, then urgent medical attention is recommended. Intravenous fluid replacement may be needed. Recovering from heat exhaustion usually takes 24 to 48 hours. Depending on the severity of heat exhaustion, you may need to be hospitalised so doctors can monitor your fluid and electrolyte levels to avoid complications.

The most severe category of heat illness is heat stroke, characterised by hyperthermia (high temperature), mental confusion, and exposure to hot weather and/or significant physical exertion. Heat stroke, if not recognised promptly and treated urgently, is a rapidly fatal condition. Frail elderly individuals, those who live alone, and those with pre-existing conditions like obesity, heart disease, diabetes and hypertension, are at increased susceptibility to severe heat illnesses. The very young, pregnant women, and those with disabilities, as well as those with mental illnesses, are also at risk. Unfortunately, some of the medications used in the day-to-day treatment of these conditions may also aggravate an individual’s ability to respond to heat illnesses. The same is true for alcohol, some blood pressure medications, and some cough and cold medications.

A “heat plan” is thus essential, especially for those at high risk for heat illnesses. Drink, drink, drink. Keep well hydrated, but avoid alcohol-based drinks. Wear cool clothing wherever possible), and protection of the head is very important, with umbrellas, hats, caps or other apparel. Avoid outdoors during the hottest parts of the day, but if you must go outdoors consider some sort of sunscreen or sunblock protection. This should be a necessity for people who have to work or play outdoors in very hot conditions.

In classic heat stroke, the skin is hot and dry; on the other hand, in exertional heat stroke, which can affect individuals engaged in strenuous physical activity such as distance running or working outdoors, there is (at least initially) severe sweating. The individual develops a fast heartbeat (tachycardia), fast breathing (tachypnoea), and blood pressure drops (hypotension). Distinguishing heat stroke from less severe forms of heat illness, the individual may be weak, confused, dizzy, (inappropriately) upset and angry, have slurred speech, and vomiting, or may even be unresponsive or have convulsions.

A patient with suspected heat stroke should be removed from the heat as soon as possible, and cooling started. THIS IS A MEDICAL EMERGENCY. Pouring cold water over the individual, misting, and a fan are essential. Urgent medical care is needed, and immediate transfer to a hospital should be organised. It is essential to get the temperature down ASAP, ideally within 30 minutes. This can be accomplished by immersing the individual in an ice bath, where available; by applying ice packs to the neck, armpits and groin, and using a cold intravenous infusion. The mist spraying and the fan are also critical parts of the management. A heat stroke patient requires intensive care.

Global warming and climate change have severe short, immediate and long-term consequences, many life-changing and some life-taking. While we focus on helping our neighbours build back their lives by donating food, clothing, medical supplies and building materials, we must also focus on the need for prevention, to lower greenhouse gas emissions and global warming in the first place. Severe hurricanes, flooding and heat waves threaten to become even more frequent if we don’t attempt to prevent them or reduce their severity. We just don’t have the resources, money or time to replace buildings, fishing boats and lives, not to mention agricultural production as quickly as severe weather occurrences can destroy them. We cannot keep ignoring these phenomena, hoping they will disappear or ‘someone else’ will do something about it. “Mash up and buy back” is not sustainable. We must devote some of our effort to preventing, or at least trying to limit global warming.

Dr Colin V Alert MB BS, DM is a family physician.