This short story is a collaboration between The Texas Tribune and Inside Climate News. Schumacher, Foxhall and Martinez reported for La Tribune, and Pskowski and Baddour for the ICN.
AUSTIN, Texas — On a hot day in May 2020, with a high temperature of 95 degrees, Austin resident Jose Mario Calles showed up for his landscaping job.
A lawsuit later filed through Calles’ circle of relatives recounted what happened that day: the 51-year-old man, who financially supported his spouse and children in El Salvador, fainted at work. He rushed to the hospital and spent two nights being treated for heart disease and diabetes, diseases that make people more vulnerable to heat.
The lawsuit claims that his employer failed to report the incident to the Occupational Safety and Health Administration or his painters’ reimbursement insurance company, as required by law. The father of six returned to painting without mandatory medical clearance, according to the lawsuit, lifting 40-pound bags of mulch. Twelve days after his initial collapse, he suffered a central attack on a structure and did not wake up.
The Travis County medical examiner found the cause of death was myocarditis, an inflammation of the central muscle. The autopsy did not mention heat.
Last year was the year recorded in the state. And the heat was particularly deadly: 365 more people died directly from the heat, according to state records, the highest number of heat deaths ever recorded. The figure increases to 562 if the deaths in which heat was one of the causes are added.
Climate change is leading to warmer days and nights, increasing the strain on the human body. Most likely, the challenge will only get worse.
Yet heat-related deaths are largely undercounted in Texas and across the country, experts say. Explaining the role of warmth in a death is notoriously complicated due to the subjectivity and complexity of the process. For example, doctors or local government completing records showing the cause of death would likely not take into account the weather on the day of death or whether a user worked in the heat.
“The effects (of heat) on fitness are a little more subtle,” said Sameed Khatana, an assistant professor of medicine at the University of Pennsylvania and a cardiologist. “They can be delayed. And it is analyzed whether it is a deadly or adverse effect on physical condition. “It’s because the temperature is quite difficult.
During a recent visit to Austin, Douglas Parker, assistant secretary of hard work for occupational health and protection, called warmth “the most damaging weather phenomenon facing staff. “
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Not counting, as it should be, the number of other people dying from heat-related reasons leaves officials unable to master the scale of the challenge and work more directly to solve it, said Andrew Dessler, a professor of atmospheric sciences at Texas A
“A lot of the climate change debate is: why do we care if the temperature rises one degree?” said Dessler. And that’s one of the reasons we care. “
Community organizers, scientists and academics say the lack of public data and heat-related deaths makes it difficult to mount an effective local reaction to what they see as a public health crisis.
“How do you pose a challenge if you don’t know the scale of the challenge, if you don’t perceive the breadth and intensity of the challenge? said Gregory Wellenius, an environmental epidemiologist and professor of environmental fitness at Boston University.
An investigation of the data by the Texas Tribune found that the Texas high likely didn’t account for many heat-related deaths between 2013 and 2019. In those years, the state recorded 777 heat-related deaths. The Tribune’s estimate, calculated by comparing the number of people who died on abnormally hot days to the number of people who deserve to have died in weather conditions more average, found that 998 deaths were heat-related at that time in the 41 most populous regions of Texas.
Texas counties with medical examiners take other approaches to documenting heat-related deaths. For example, Dallas County reports all deaths in which heat is suspected as the cause of death or a contributing factor. In Nueces County, which includes Corpus Christi, one official said it does not track heat-related deaths at all.
“Deaths are investigated differently depending on where people die. We don’t really have a federal death investigation system, every state runs a different death investigation system. And so the whole thing is pretty fragmented,” said Gregory L. Hess, a chief medical examiner at Pima County in Arizona, which includes Tucson.
That means cases like Calles’ may go unnoticed because the medical examiner did not cite heat as something imaginable in his death. It is unclear whether the medical examiner considered anything warm. In Travis County, only deaths caused directly by heat are recorded as heat-related.
John Escamilla, a McAllen attorney who sued Calles’ employer on behalf of his family and who specializes in office injuries and injuries, said more and more people are coming to him for legal assistance in cases involving employees who suffered heat-related injuries. . Landscaping firm BrightView, which bought the company where Calles worked, declined to comment.
“I don’t think employers are consciously putting their staff at risk. I think they’re either ignorant or they don’t care,” Escamilla said. “But those summers are getting more intense over longer periods of time. “
In some deaths, the role heat plays is clear: In June 2023, a 68-year-old man was found dead on the couch in his Fort Worth home. A death investigator discovered that the air conditioning was broken and the internal temperature of the space was 91 degrees.
That same month, a 28-year-old man discovered he was engaging in “seizure-like activity” in the parking lot of a Fort Worth shopping mall. His core body temperature was 108 degrees in the hospital. His muscles collapsed, his brain swelled, and there were symptoms of liver failure, according to the autopsy.
On August 25, 2023, a 48-year-old woman was admitted to a hospital outside Houston with a body temperature of 108. 1 degrees. She had been sitting outdoors for an hour, according to an autopsy.
Heat kills other people when the frame can’t cool down and the user doesn’t act early enough to cool their frame. In hot weather, the frame redistributes warm blood from the skin to the internal organs. Sweat evaporates, cools the skin and reduces temperature. of the blood underneath.
But if it’s too hot, if the user exerts themselves physically, or stays in the heat for too long, the frame can heat up faster than it can handle. The center runs as it accelerates to circulate blood across the frame. Blood pressure drops.
If the user does not drink water and escapes the heat, the next phase is heat exhaustion, characterized by weakness, heavy sweating, headaches, or dizziness. Without proper treatment, the situation can progress to heat stroke, when the body temperature can reach 103. higher and important degrees or organs such as the kidneys, center, and brain lack oxygen, a potentially fatal scenario.
“Often, people aren’t aware that heat is starting to cause [fitness] problems, and by the time they realize it, it may be too late,” said Kristie Ebi, a professor and expert on heat-related fitness risks at the University of Washington’s Center for Global Health and the Environment.
But it’s more complicated to determine the role warmth plays. Experts refer to warmth as a silent killer because the damage it causes is not necessarily transparent or sudden.
Determining the warmth that contributed to a death becomes subjective. Experts who round out the bureaucracy on deaths (adding local doctors, medical examiners, and justices of the peace, all of whom have other degrees of education) have other thresholds when they feel they have enough data to list. Warmth as something direct or that contributes to death.
“People are not aware that the heat is starting to cause [health] problems, and by the time they realize it, it will probably be too late. “
It also takes time and effort to track down data about the cases that led to a user’s death to look for clues that may imply that Heat contributed. Was the user suffering in a greenhouse? Live under a viaduct? Play tennis in the heat?
“It also depends on people’s need for a safe point of accuracy,” said Scott Sheridan, a geography professor at Kent State University in Ohio who has a doctorate in climatology. “And this is where I think heat tends to be one of the most difficult to transmit. . . We all think of the runner who collapses from the heat, or in a very obvious case, but the vast majority of cases simply do not They are so obvious. .
And even with an autopsy, the picture can still be murky, said Bob Anderson, head of the Vital Statistics Division at the United States Centers for Disease Control and Prevention, which assigns codes to the state’s death knowledge so it can be analyzed.
Suppose an elderly user with a central illness who works in the garden is discovered dead outside: did the heat play a role?
“So it can vary depending on the quality of the death investigation conducted and the amount of data collected,” Anderson said. “But even the most productive death investigation won’t tell whether warmth played a role or not. “
Experts say the best place to investigate and count heat deaths is Maricopa County, Arizona, in the Sonoran Desert, home to about 4. 6 million people, including Phoenix, and which reaches temperatures of 110 degrees Celsius in summer. The county medical examiner’s office has worked since 2006 to detect any deaths that may have been heat-related, Chief Medical Examiner Jeff Johnston said.
Their reviews are thorough: When pathologists get a case, they perform an autopsy and the user’s medical history, data on where they died and recent occasions to determine whether heat contributed to the death, Johnston said.
“The devil is in the main points with these,” Johnston said.
Johnston knows that in his workplace he doesn’t stumble upon each and every case; that would require investigating each and every death, even when heat is suspected, which is prohibitively expensive. But he says they have one of the most physically powerful systems in the world. the country for stumbling upon heat-related deaths. In 2018, he even created a category for them: environmental heat exposure.
Maricopa County Department of Public Health Deputy Medical Director Nick Staab said local officials have this knowledge to inform their strategies on how to help Maricopa County citizens stay calm.
Maricopa County used the knowledge to double the county’s network of cooling centers operated through local teams and cities to more than one hundred and expand the hours of operation of some of them to weekends. Arizona 2-1-1 coordinates free transportation to the centers.
They also partnered with network fitness workers or promoters to provide information on how to beat the heat and cooling centers in English and Spanish.
Authorities map where deaths occur and gather demographic and behavioral insights to understand who is dying and why they are at risk.
“We are firmly convinced that all of those deaths are preventable,” Staab said, adding, “We are looking to tell this story. We seek to define excessive heat as a public health emergency so that we can get more funding. “, more resources to bring our high-risk population.
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In Texas, most larger urban areas have medical examiners to investigate deaths. But those offices don’t investigate every death: Texas law requires an investigation in cases such as suspected suicide or homicide, or when a user dies within 24 hours of being admitted to a hospital.
Dr. Jessica Dwyer, Dallas County medical examiner, said tracking heat-related deaths is inherently complex because there is no one-size-fits-all approach. A death from drug ingestion on a hot day would likely be classified at the discretion of the medical examiner. Dwyer said this variability is due to differences in training, work protocols and personal experience.
“Normalization gets a little complicated because all cases are the same,” Dwyer said.
Some people are more vulnerable to heat than others. This includes older residents, children, and others with chronic illnesses. Homeless people and immigrants looking to walk through large expanses of brush also face more heat risks than other people who spend much of their time. his time indoors.
In suburban El Paso, another 12 people died of heat in the summer of 2023 as they sought to migrate through the fiery Chihuahuan desert. Many more died in nearby Sunland Park, New Mexico.
“Every summer we’ve tried to get to 0 deaths,” said Graciela Ortiz, who coordinates the severe weather task force in El Paso. “But I will tell you that last year we broke the water record. I was shocked.
“Before, other people simply had a fan in the window, but nowadays that’s no longer the case. “
Last year in Dallas, Rose Jones, a public fitness professional, said she was surprised to hear friends who worked in an emergency room tell stories of homeless patients coming in with burns on their necks. 3rd grade after falling asleep on the sidewalk. This disturbed her so much that she had to leave her job at an urban forestry company to start a consulting practice focused on protecting people from excessive heat. She knew that other people, like undocumented staff and prisoners, would suffer first.
“These are all marginalized groups, so overall they probably won’t get a lot of attention. People will just move into their air-conditioned homes,” Jones said.
In San Antonio, Lotus Rios saw the danger of the heat grow. The network’s leader, an indigenous activist and mother of two, 45, runs a small food pantry where neighbors in need can eat for free. Over the years, life became more complicated as the city’s treetops gave way to more cement and summer temperatures warmed.
“Before, other people could just put a fan in the window, but that’s not the case anymore,” Rios said. “Enthusiasts are not useful when he is 104 years old. “
She sees a lot of suffering in her work. But there is nothing more difficult to bear than the story of Albert García.
Garcia lost either of his legs to frostbite while living outdoors when Winter Typhoon Uri plunged Texas into freezing weather for a week in February 2021. Rios and others later helped find shelter for Garcia, but he suffered from incontinence. and felt mistreated throughout the year. shelter employees. A year later, he was again under an Interstate 35 overpass.
García used drugs. He liked to preach the Bible and tell jokes. He made Rios laugh.
In August 2023, after more than 50 consecutive days of triple-digit weather, Garcia died under the viaduct where he was sleeping. Local news site Deceleration told his story in a series of articles.
When journalist Greg Harman, founder of Deceleration, visited Garcia’s place a few days later, he measured the temperature at 114 degrees.
Garcia’s post-mortem report, received through Deceleration, states that he died of a drug overdose. He had heroin in his system. But he also noted that the last known use of it was on the morning of August 11, about a day before he died, and overdose deaths occur some time after a user uses drugs.
“He’s somebody,” he said, Ríos. No had to die the way he did. “
Last week, Harman and 500 signatories filed a petition with the San Antonio City Council, asking it to submit a count of heat-related deaths in the area.
On Monday, after repeated correspondence with the Texas Tribune, Bexar County’s public data officer did a tally of hyperthermia deaths. It reported 12 deaths in 2023, five times the annual average of the past 10 years (not adding heat-related occasions in 2017). and 2022, when dozens of migrants died locked in hot semi-trailers).
Angela Voit contributed to this story.
We conducted our research on excess mortality largely following similar research published through the Los Angeles Times in 2021, with the recommendation of Ariel Karlinsky, an economist and statistician at Hebrew University. The strategies have been reviewed by other experts, including an epidemiologist and climatologist.
We developed a model that predicted the number of people most likely to die in general cases and used it to estimate the number of excess deaths on summer days, when generally higher heat rates were recorded. For this study, we looked at the 41 most populous counties in Texas, which cover about 85% of the state’s population. We saw 998 excess deaths on generally hot days between 2013 and 2019. We excluded the years 2020, 2021, and 2022 from this research due to the higher number of excess deaths caused by the COVID-19 pandemic. At the time of this research, mortality data for 2023 was not yet available.
This research allowed us to calculate the number of deaths attributable to heat, but it also has its limits. First, the mortality knowledge we use includes deaths from all causes except firearm deaths. We subtracted them after seeing rare spikes in deaths in the county on days when a mass shooting occurred. But it is difficult to control each of the factors, which can lead to overestimations in our estimates. Additionally, the model only takes into account deaths on days when the heat index was abnormally high, although in some cases heat sufferers die days or weeks after heat exposure. This would contribute to underestimates in our estimates.
To calculate abnormally hot days, we looked at the maximum daily heat indices recorded in each county between 1981 and 2010. We classify days as abnormally warm if the heat index is in the 10% most sensitive for that day at that location during the 30-period of the year.
Since the number of deaths from excessive heat is small compared to the total number of deaths, the estimates have a wide margin of error, Karlinsky said.
Mortality knowledge was received from the Texas Department of State Health Services. Official heat-related counts were updated as of July 16. Knowledge about the weather comes from the Heat.
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Martha Pskowski covers climate and environment updates in Texas from her base in El Paso. She was previously an environmental reporter at the El Paso Times. She began her career as a freelance journalist in Mexico, applying for media outlets such as The Guardian and Yale E360. Martha has a B. A. She has a PhD in Environmental Studies from Hampshire College and a master’s degree in Journalism and Latin American Studies from New York University. She is a former Fulbright scholar in Mexico.
Dylan Baddour covers the energy sector and environmental justice in Texas. Born in Houston, he worked in the business bureau of the Houston Chronicle, covered the US-Mexico border for foreign media and reported for several years from Colombia for outlets such as the Washington Post, BBC News and The Atlantic. He also spent two years investigating armed teams in Latin America for Facebook’s Global Security Department before returning to journalism in Texas. Baddour has a bachelor’s degree in journalism and Latin American studies from the University of Texas. in Austin. He has lived in Argentina, Kazakhstan and Colombia and speaks fluent Spanish.
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