Welcome to the fifth edition of the Climate and Health Outlook from the Department of Health and Human Services (HHS) Office of Climate Change and Health Equity (OCCHE). The Climate and Health Outlook is an effort to inform health professionals and the public on how our health may be affected in the coming month(s) by climate events and provide resources to take proactive action. This edition provides a seasonal outlook for the climate-related health hazards of wildfire, drought, extreme heat, hurricanes, and Lyme Disease. This webpage includes additional resources and information excluded from the PDF summary.
Download the Climate and Health Outlook for September 2022*
Image source: https://scenarios.globalchange.gov/regions_nca4
U.S. Seasonal Forecast for Health: September 2022
Regional health forecasts for heat, wildfire, drought, and hurricanes
Alaska: Normal wildland fire* potential is expected for Alaska through the rest of the 2022 wildfire season, after a very busy June and first half of July.
Northwest: One county in Idaho is projected to have more than 5 heat exceedance days in September 2022. Drought is favored to persist in parts of southern Idaho, southern and central Oregon, and central Washington. Above normal wildland fire* potential is projected for much of Idaho, southern and central Oregon, and central and southern Washington.
Southwest: Counties in California (10), Arizona (5), and Utah (2) , are projected to have more than 5 heat exceedance days in September 2022. Drought is favored to persist in California, Nevada, and Utah as well as parts of Arizona Colorado, and New Mexico. However, drought removal is favored in southern and central Arizona and much of New Mexico. Above normal wildland fire* potential is projected for northern California and north-western Nevada.
Hawai’i and Pacific Islands: The Central Pacific is projected to have a below-average hurricane season. Drought is favored to persist or develop in Hawai’i. Above normal wildland fire* potential is projected for Hawai’i.
Northern Great Plains: Drought is favored to persist or develop in Nebraska as well as parts of Montana, North Dakota, South Dakota, and Wyoming. Above normal wildland fire* potential is projected for western Montana.
Southern Great Plains: Counties in Texas (2) are projected to have more than 5 heat exceedance days in September 2022. Drought is favored to persist in Kansas, much of Oklahoma and northern Texas. However, drought removal and improvement is favored in most of Texas and eastern Oklahoma. Above normal wildland fire* potential is projected for much of Oklahoma.
Midwest: Drought is favored to persist or develop in parts of Iowa, Illinois, Minnesota, Michigan, Missouri, and Wisconsin.
Southeast: The Atlantic basin is forecasted to have an above-average hurricane season with 14 – 20 named storms with winds of 39 mph or higher, with 6 –10 of those possibly becoming hurricanes with winds of 74 mph or higher, and 3 – 5 possibly becoming major hurricanes with winds of 111 mph or higher. One county in Florida is projected to have more than 5 heat exceedance days in September 2022. Drought is favored to develop in parts of North Carolina and South Carolina. However, drought removal/improvement is favored in parts of Arkansas, Mississippi, and Tennessee.
Northeast: Drought is favored to persist in parts of Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Drought is favored to develop in parts of Delaware. Above normal wildland fire* potential is projected for Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont, as well as eastern New York and the northern tips of New Jersey and Pennsylvania.
Caribbean: The Atlantic basin is forecasted to have an above-average hurricane season with 14 – 20 named storms with winds of 39 mph or higher, with 6 –10 of those possibly becoming hurricanes with winds of 74 mph or higher, and 3 – 5 possibly becoming major hurricanes with winds of 111 mph or higher. Drought removal is favored in parts of Puerto Rico.
*Smoke from wildfires can impact health hundreds of miles from site of the fire.
A "heat exceedance day” is when the daily maximum temperature is above the 95th percentile value of the historical temperature distribution in that county.
For additional information please visit:
- Centers for Disease Control and Prevention Heat and Health Tracker
- National Oceanic and Atmospheric Administration (NOAA) National Hurricane Center and Central Pacific Hurricane Center
- NOAA National Integrated Drought Information System
- NOAA National Weather Service Climate Prediction Center
- National Interagency Fire Center Predictive Services
Wildfire Outlook for September, 2022
Figure: The National Significant Wildland Fire Potential Outlook identifies areas with above, below, and near normal significant fire potential using the most recent weather, climate, and fuels data available. These outlooks are designed to inform decision makers for proactive wildland fire management.
Year-to-date acres burned for the US is approximately 116% of the 10-year average, with over half of the total acres burned in Alaska alone. Above normal significant fire potential is forecast for much of the Northeast September through November due to the ongoing drought. Above normal potential is also forecast for much of Oklahoma in September and October, expanding to include all of Oklahoma and Texas by December. Most of northern California, central and southwest Oregon, southeast Washington, Idaho, and far western Montana will have above normal potential in September. Lee sides of the Hawai’ian Islands will continue to have above normal potential through November before returning to normal potential in December.
Wildfires Affect Health in Many Ways
Wildland fire increases the risk for a diverse range of health outcomes from both the fire itself and smoke. For example :
- Due to the nature of their work, firefighters are at risk of developing severe heat-related illness (such as heat stroke) and rhabdomyolysis (muscle breakdown).
- Wildfire can cause burns through contact with flames and hot surfaces as well as chemical and electrical burns.
- Wildfire smoke can lead to disorders including reduced lung function, bronchitis, exacerbation of asthma, and cardiovascular effects like heart failure.
- For pregnant people, smoke exposure may increase the risk of reduced birth weight and preterm birth.
- Wildfire smoke may affect the immune system, potentially leading to increased vulnerability to lung infections like COVID-19.
- Smoke and ash from wildfires can travel downwind and affect air quality hundreds of miles away from the fire.
Who is at high risk in the counties with above-normal wildland fire potential in September?
Wildland fires are occurring more frequently in the United States and present a health hazard for populations living close to a fire or whose air quality is affected by smoke. For those in the impacted area, wildfires can cause or exacerbate illnesses and injuries, cause property damage and hurt the local economy, and impose financial, physical, and emotional costs associated with evacuation or sheltering in place.
In September, 312 counties across 17 states are projected to have above-normal wildfire potential. In these counties, the total population at risk is 54,742,313 people. Of these counties:
- 68 (22%) have a high number of people aged 65 or over, living alone.
- 81 (26%) have a high number of people without health insurance
- 84 (27%) have a high number of uninsured children.
- 60 (19%) have a high number of people with frequent mental distress.
- 103 (34%) have a high number of adults with asthma.
- 61 (20%) have a high number of adults with coronary heart disease.
- 48 (16%) have a high number of people living in poverty.
- 114 (37%) have a high number of people with electricity-dependent medical equipment and enrolled in the HHS emPOWER program.
- 42 (14%) have a high number of people in mobile homes.
- 77 (25%) have a high number of people with one or more disabilities.
- 70 (23%) are identified as highly vulnerable by CDC’s Social Vulnerability Index.
*“A high number” indicates that these counties are in the top quartile for this indicator compared to other counties
Real-Time Tracking of Respiratory Outcomes Linked to Wildfire Smoke
Figure. This graph overlays the percentage of Emergency Department (ED) visits due to asthma or reactive airway disease (RAD) in San Mateo County during the 2018 Camp Fire. It uses Morbidity and Mortality Weekly Report weeks, which begin with 1 for the first week of the year. Each red dot indicates an instance where the percent of ED visits due to asthma or RAD is exceptionally high. You can learn more on the CDC’s website.
As wildfires continue to threaten the public’s health across the country, agencies are demonstrating the utility, reliability, and timeliness of syndromic surveillance data for monitoring and characterizing health impacts. During the first two weeks of the 2018 Camp Fire in California, there were higher-than-expected increases in 24-hour particulate matter (PM2.5) concentrations in San Mateo County, which reached unhealthy levels. San Mateo County public health officials monitored for acute respiratory health effects and, in collaboration with the CDC National Syndromic Surveillance Program and the California Department of Public Health, they demonstrated an increase in the weekly percentage of ED visits for asthma or reactive airway disease (RAD) exacerbation, and an increase in the number of visits for smoke exposure or smoke inhalation. Among participating EDs, the county’s safety net hospital had the highest average daily percentage of ED visits for all respiratory syndromes, excluding influenza-like illness and pneumonia.
How does smoke impact firefighter health?
Source: Kathleen M. Navarro, Michael T. Kleinman, Chris E. Mackay, Timothy E. Reinhardt, John R. Balmes, George A. Broyles, Roger D. Ottmar, Luke P. Naher, Joseph W. Domitrovich, Wildland firefighter smoke exposure and risk of lung cancer and cardiovascular disease mortality, Environmental Research, Volume 173, 2019, Pages 462-468, ISSN 0013-9351, https://doi.org/10.1016/j.envres.2019.03.060.
One study funded by the Joint Fire Science Program found that wildland firefighters are at an increased risk for the development of lung cancer (8 percent to 43 percent above the general population) and cardiovascular disease (16 percent to 30 percent above the general population). This risk increases with an increase in career duration and days spent on wildfire incidents (short and long season) each year. The risk of lung cancer steadily rose as career length, while the risk of cardiovascular disease increased sharply for firefighters with 5- to 15-year careers and increased slightly over 20- and 25-year careers. As fire seasons continue to increase in severity and duration, firefighters should reduce exposure to smoke in any way possible.
Wildfire Smoke Can Travel Far Distances
Figure: Example of the AirNow Fire and Smoke Map run by U.S. EPA and the U.S. Forest Service. This screenshot, from September 15, 2020, shows the far distances smoke can travel from the location of wildfires. The map also shows the U.S. Air Quality Index (AQI) from hundreds of air quality monitors and more than 10,000 privately owned air sensors. Green symbols indicate a good AQI; yellow indicates moderate; orange indicates unhealthy for sensitive groups; red indicates unhealthy for everyone; and purple indicates very unhealthy. The flame symbols indicate a large fire incident, and the small yellow spark symbols indicate unverified satellite fire detections.
Wildfire smoke can impact the health of people close to the fire and at distances far from fire impacted areas, depending on meteorological conditions, such as wind speed and direction. As wildfires burn, they generate smoke that is comprised of a mixture of particulate matter (PM) (also referred to as particle pollution) and gaseous pollutants (e.g., carbon monoxide). The pollutant of most concern to public health during a smoke event is fine particulate matter, or PM2.5, because these particles can penetrate deep into your lungs and cause adverse health effects.
Resources to Reduce Health Risks Associated with Wildfire
Exposure to air pollutants in wildfire smoke can irritate the lungs, cause inflammation, alter immune function, and increase susceptibility to respiratory infections, likely including COVID-19.
General Preparedness
The Ready.gov Wildfires site, Centers for Disease Control and Prevention (CDC) Wildfires site, and Environmental Protection Agency (EPA) Smoke-Ready Toolbox for Wildfires include information about how to prepare for wildfires, stay safe during a fire, and return home after a fire.
The AirNow Fire and Smoke Map, a joint project of EPA and the U.S Forest Service, provides information on fire locations, smoke plumes, and air quality, using the color-coding of the Air Quality Index (AQI), along with recommended actions to take to reduce smoke exposure. The AirNow Wildfires site provides additional information on steps to protect your health. The Map is also available in the AirNow app.
Download the Federal Emergency Management Agency (FEMA) App to receive real-time weather and emergency alerts from the National Weather Service. The App can also help you find a nearby shelter if you need to evacuate to a safe space. You can also text SHELTER and your ZIP code to 43362 (e.g. Shelter 12345) to find up to emergency shelters or FEMA Disaster Recovery Centers nearby.
The EPA and CDC continuing education program Wildfire Smoke and Your Patients’ Health can help educate healthcare professionals about the health effects of wildfire smoke and highlights actions that individuals can take to reduce exposure. This printable card contains additional information about the course.
If you do not have health insurance and are in a federally-identified disaster, the Emergency Prescription Assistance Program can help you get the prescription drugs, vaccinations, medical supplies, and equipment that they need.
If you have Medicare and your medical device is damaged or lost due to an emergency or disaster, Medicare may cover the cost to repair or replace your equipment or supplies.
You can locate and access your electronic health records from a variety of sources by using the U.S. Department of Health and Human Services' online tool.
Smoke Sense is a crowdsourcing, participatory science research project developed by EPA researchers focused on increasing public awareness and engagement related to wildfire smoke health risks.
Protecting Vulnerable Populations from Wildfire Smoke
Image source: https://ww2.arb.ca.gov/protecting-yourself-wildfire-smoke
Pregnant people should take actions to reduce their exposure to wildfire smoke, which could affect the developing fetus. Other groups like young children, the elderly, those with pre-existing heart and lung disease, and outdoor workers also should take extra care to reduce their exposures to wildfire smoke. Monitor fires and air quality in your area through AirNow and follow instructions about exercise and going outside for "sensitive individuals."
Additional steps you can take to prepare include stocking up on medicine and buying groceries that don’t need to be cooked. In particular, frying or grilling food can make indoor air pollution worse. More information is available on the CDC website for people with chronic conditions, pregnant people, and children.
The California Air Resources Board Air Cleaner Information for Consumers has information about how to select a safe and effective air cleaner. Exercise caution in using air-cleaning devices in the home; some can produce ozone levels that are higher than health-based standards. The Environmental Protection Agency (EPA) also has information on how to Create a Clean Room to Protect Indoor Air Quality During a Wildfire and the California Air Resources Board has information on Protecting Yourself from Wildfire Smoke.
Image source: https://ww2.arb.ca.gov/protecting-yourself-wildfire-smoke
Mental Health
Feelings such as overwhelming anxiety, constant worrying, trouble sleeping, and other depression-like symptoms are common responses before, during, and after wildfires. The Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline and Text Service is available 24/7, free, and staffed by trained crisis counselors. Call or text 1-800-985-5990 to get help and support for any distress that you or someone you care about may be feeling related to any disaster.
Learn more about wildfires and mental health at the SAMHSA’s Wildfires site. SAMHSA also has other disaster behavioral health resources, including resources specifically about wildfires and their impacts on mental health. The CDC also has resources in English and Spanish on Coping with a Disaster or Traumatic Event.
Check out SAMHSA’s newly launched Climate Change and Health Equity site for more information on the behavioral health impacts of climate change, preparing for a disaster, and resources for disaster planning and climate change education.
Best Practices for Emergency Managers
The Office of the Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) has collected lessons learned on Wildfires. An HHS emPOWER Program Story from the Field on Wildfires in Los Angeles County, California briefly explains how HHS emPOWER tools were used to rapidly conduct outreach to nearly 40 durable medical equipment (DME) and oxygen suppliers to provide recovery assistance to more than 600 individuals impacted by the historic 2017 wildfires.
Smoke-Ready Communities is an EPA and U.S. Forest Service Collaboration that is built around a series of interactive workshops and is designed to increase local readiness and improved public health response to wildfire smoke events.
Wildfire Smoke: A Guide for Public Health Officials -- the product of an inter-agency collaboration that includes the California Air Resources Board; California Office of Environmental Health Hazard Assessment; CDC; U.S. Forest Service; and EPA -- is designed to help local public health officials prepare for smoke events, to take measures to protect the public when smoke is present, and communicate with the public about wildfire smoke and health.
The CDC produced a summary for health departments on Evidence on the Use of Indoor Air Filtration as an Intervention for Wildfire Smoke Pollutant Exposure. For commercial buildings, the ASHRAE Planning Framework for Protecting Commercial Building Occupants from Smoke During Wildfire Events provides recommended heating, ventilation, and air conditioning (HVAC) and building measures to minimize occupant exposures and health impacts from smoke.
Workers face hazards even after fires are extinguished. The CDC’s Worker Safety During Fire Cleanup Fact Sheet reviews potential dangers during post-wildfire cleanup.
The HHS emPOWER collects and shares de-identified Medicare data to help response agencies take action to protect the health of Medicare beneficiaries who depend on vulnerable electrical medical equipment.
Resources for Wildland Fire Fighters
Wildland fire presents unique challenges and fire fighters must understand how to best protect their health and safety while fighting fires. Wildland Fire Fighting: Hot Tips to Stay Safe and Healthy reviews some recommended practices for fire fighters and their supervisors. Wildland Firefighter Health: Some Burning Questions offers information on hazards and risks associated with the wildland firefighting job.
Wildland fire fighting involves exposure to heat and prolonged, intense exertion. These factors increase the risk for rhabdomyolysis. The CDC Rhabdomyolysis site has additional information, factsheets, and wallet cards.
Drought Outlook for September, 2022
Figure: The National Weather Service Climate Prediction Center's Monthly Drought Outlook is issued at the end of each calendar month and is valid for the upcoming month. The outlook predicts whether drought will persist, develop, improve, or be removed over the next 30 days or so. For more information, please refer to drought.gov.
For September, drought expansion is favored for portions of the Plains and western Corn Belt. However, above-average rainfall in the southwest is favored, raising the potential for further drought reduction across the southern Four Corners region from the Monsoon. Forecasted heavy rain across Texas and the Gulf Coast states favors further drought improvements and a potential for flooding. Drought persistence remains favored across the Northeast and drought conditions are favored to continue expanding across Hawai’i. Drought conditions are favored to improve across Puerto Rico.
Drought Affects Health in Many Ways
Drought increases the risk for a diverse range of health outcomes. For example:
Low crop yields can result in rising food prices and shortages, potentially leading to malnutrition.
Dry soil can increase the number of particulates like dust and pollen that are suspended in the air, which can irritate the bronchial passages and lungs.
Dust storms can spread the fungus that causes coccidioidomycosis (Valley Fever).
If there isn’t enough water to flow, waterways may become stagnant breeding grounds for disease vectors like mosquitos as well as viruses and bacteria.
Drought's complex economic consequences can increase mood disorders, domestic violence, and suicide.
Long-term droughts can cause poor-quality drinking water and leave inadequate water for hygiene and sanitation.
Who is at high risk in the counties projected to have ‘persistent drought’ in September?
Drought can lead to decreased water quantity and quality that have direct and indirect impacts on health – increasing incidence of illness among the at-risk populations living in the affected area, and worsening mental health outcomes as livelihoods are challenged. These health impacts are moderated by economic and employment factors across rural and urban areas, water infrastructure and local social context.
In September, 1294 counties across 42 states are projected to have persistent/remaining drought or drought development. In these counties, the total population at risk is 157,164,458 people and, of those, 1,612,440 people work in agriculture. Of these counties:
- 368 (29%) have a high number of people aged 65 or over, living alone.
- 362 (28%) have a high number of people living in rural areas.
- 247 (19%) have a high number of people living in poverty.
- 200 (16%) have a high number of people with frequent mental distress.
- 195 (15%) have a high number of adults with asthma.
- 439 (34%) have a high number of people without health insurance.
- 519 (40%) have a high number of uninsured children.
- 187 (15%) have a high number of Black or African American persons.
- 320 (25%) have a high number of people with severe housing cost burden.
- 246 (19%) have a high numer of people in mobile homes.
- 251 (19%) have a high number of people with one or more disabilities.
- 301 (23%) are identified as highly vulnerable by CDC’s Social Vulnerability Index.
*“A high number” indicates that these counties are in the top quartile for this indicator compared to other counties
Drought and Arsenic in Domestic Wells
Figure: Map showing the probability of having arsenic >10 μg/L (“high arsenic”) in domestic wells during drought. Arsenic occurs in groundwater due to chemical reactions between the rocks and water, lowering of water levels due to drought may cause chemical changes that release more arsenic from the rocks. Less water could also concentrate existing arsenic in the water. Hotspots generally reflect areas in the U.S. with high observed concentrations including New England (predominantly Maine and New Hampshire), a band in the upper Midwest, the southwest (most notably Nevada, southern Arizona, southern and central California, and isolated regions in all western states), and southern Texas.
Drought conditions can lead to elevated levels of naturally occurring arsenic in the water we drink. The risk of contamination increases the longer that a drought persists. In a study done by U.S. Geological Survey and Centers for Disease Control and Prevention in 2021, researchers estimated that over 9% (4.1 million) of the 44.1 million people in the lower 48 states who use private domestic wells were potentially exposed to unsafe levels of arsenic during drought conditions compared to about 6% (2.7 million people) during non-drought conditions. Chronic exposure to arsenic from drinking water is associated with an increased risk of several types of cancers, developmental issues, cardiovascular disease, adverse birth outcomes and impacts on the immune and endocrine systems.
Resources to Reduce Health Risks Associated with Drought
Drought poses many and far-reaching health implications. Some drought-related health effects occur in the short-term and can be directly observed and measured. But the slow rise or chronic nature of drought also can result in longer term, indirect health implications that are not always easy to anticipate or monitor.
General Preparedness
The Centers for Disease Control and Prevention (CDC) Drought and Health site and Ready.gov Drought site have information on the health implications of drought and how to prepare. The U.S. Drought Portal provides data, decision-support products, resources, and information on drought.
Image source: https://www.cdc.gov/nceh/hsb/cwh/docs/CDC_Drought_Resource_Guide-508.pdf
For Farmers
The Department of Agriculture offers programs that can help with drought recovery as well as those that can help farmers manage risk and build resilience. The Department’s Climate Hubs feature regional resources including vulnerability assessments and tools and a Climate, Agriculture, and Forest Science Webinar Series.
The U.S. Drought Monitor is an online, weekly map showing the location, extent, and severity of drought across the United States. The Department of Agriculture uses the Drought Monitor to determine a producer’s eligibility for certain drought assistance programs. You can report drought-related conditions and impacts within the U.S. and associated territories to the Drought Monitor.
The Department of Agriculture’s Natural Resources Conservation Service can help farmers conserve water and build resilience to drought, through conservation practices that improve irrigation efficiency, boost soil health, and manage grazing lands.
Image source: https://www.farmers.gov/blog/making-your-land-more-resilient-drought
Mental Health
Drought is a slow-moving hazardous event, so the psychological effects of living through this type of disaster are more subtle and last longer than with other natural disasters. The Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline and Text Service is available 24/7, free, and staffed by trained crisis counselors. Call or text 1-800-985-5990 to get help and support for any distress that you or someone you care about may be feeling related to any disaster.
Funded by the Federal Office of Rural Health Policy within the Health Resources and Services Administration, the Rural Health Information Hub offers several resources about drought and other stressors farmers face, as well as information and resources about farmers' mental health and prevention of suicide among farmers.
Learn more about drought and mental health at the SAMHSA’s Drought site. SAMHSA also has other disaster behavioral health resources, including newsletters and tip sheets. Check out SAMHSA’s newly launched Climate Change and Health Equity site for more information on the behavioral health impacts of climate change, preparing for a disaster, and resources for disaster planning and climate change education.
Best Practices for Emergency Mangers
The CDC’s When Every Drop Counts: Protecting Public Health During Drought Conditions—A Guide for Public Health Professionals is intended to assist public health officials, practitioners, and other stakeholders in their efforts first to understand and then to prepare for drought in their communities. It provides information about how drought affects public health, recommends steps to help mitigate the health effects of drought, identifies future needs for research and other drought related activities, and provides a list of helpful resources and too.
The CDC’s Preparing for the Health Effects of Drought: A Resource Guide for Public Health Professionals supplements When Every Drop Counts and is based on the results of a qualitative analysis of in-depth interviews with public health professionals, a review of state drought plans, and a literature review.
The Distribution of Lyme Disease
Figure: Lyme disease occurs primarily in the upper midwestern, mid-Atlantic, and northeastern United States. It is transmitted by blacklegged or “deer” ticks, which also transmit the agents of anaplasmosis, babesiosis and Powassan virus disease. The lack of dots in Massachusetts in 2018 is due to a difference in reporting standards, not an absence of Lyme disease.
An estimated 476,000 Americans are diagnosed and treated for Lyme disease each year. It is the most common vector-borne disease in North America. The incidence of Lyme disease in the United States has nearly doubled since 1991, from 3.74 reported cases per 100,000 people to 7.21 reported cases per 100,000 people in 2018. Maine, Vermont, and New Hampshire have experienced the largest increases in reported case rates. Climate is one of several factors that define when and where Lyme and other tickborne diseases are most likely to occur. Mild winters and warmer early spring temperatures are expanding the seasons when ticks are active, resulting in more weeks of the year that Americans are at risk of tick encounters. Expansion of the range of infected ticks puts an increasing number of communities at risk for Lyme and other tickborne diseases.
Which Seasons Are People Most Often Bitten by Blacklegged Ticks?
Figure: Emergency department (ED) visits for tick bites by month for 2020 – 2022. This graph shows 2022 following a similar pattern to previous years, with tick bites spiking in the spring. If this trend continues, there may also be a second, smaller spike in the fall.
In areas in the eastern US where Lyme disease cases are common, people are most likely to be bitten by blacklegged ticks at two times of year: from April through July when nymphs are active, and in September through November when adults are active. Nymphal ticks, which feed in late spring and early summer, pose a particularly high risk due to their abundance and small size (about the size of a poppy seed), which makes their detection difficult. However, adult deer ticks can also transmit the infection and may be more likely to be infected themselves. However, owing to their larger size (about the size of sesame seed), adult ticks are often detected and removed from people before disease transmission can occur. Lyme disease can be prevented by avoiding tick bites and prompt removal of ticks on people.
Image source: https://www.cdc.gov/lyme/transmission/index.html
Figure: The different sizes of the blacklegged tick through 4 stages: egg, larvae, nymph, and adult.
How to Prevent Tick Bites and Tickborne Diseases
Tick bite prevention can take place before and after spending time outside. Before you go outdoors, use Environmental Protection Agency (EPA)-registered insect repellents, treat clothing and gear with products containing 0.5% permethrin, and talk to your veterinarian about the best tick prevention products for your dog. If possible, when spending time outside, avoid wooded and brushy areas with high grass and leaf litter where ticks may live. After spending time outdoors, check your body for ticks, take a shower within 2 hours, and check your clothing, gear, and pets for ticks that may have caught a ride into your home. You may also consider using landscaping methods to prevent ticks in the yard.
Resources to Reduce Health Risks Associated with Lyme Disease
The Centers for Disease Control and Prevention (CDC) Lyme Disease site has information on how to avoid Lyme Disease, common symptoms, and treatment. The Tick Bite Bot can assist you in removing attached ticks and seeking health care, if appropriate, after a tick bite. CDC’s Tickborne Diseases of the United States offers information on tick identification, tickborne diseases, and treatment. The CDC has also issued guidance for clinicians on caring for patients after a tick bite. CDC provides maps showing regions where ticks live and the counties where deer ticks and their associated pathogens have been detected in US counties.
The Food and Drug Administration (FDA) has additional information on symptoms, treatment, and prevention for people and pets. The Environmental Protection Agency (EPA) has a tool to help find the repellent that is right for you.
Image source: https://www.cdc.gov/ticks/life_cycle_and_hosts.html
Figure: The life cycle of the blacklegged tick, Ixodes scapularis, generally lasts 2 years, during which it goes through 4 stages: egg, larvae, nymph, and adult.
Updated Outlook for the 2022 Hurricane season
In August, the National Oceanic and Atmospheric Administration (NOAA) Climate Prediction Center slightly decreased the likelihood of an above-normal Atlantic hurricane season to 60% (lowered from the outlook issued in May, which predicted a 65% chance). NOAA’s outlook calls for 14-20 named storms (winds of 39 mph or greater), of which 6-10 could become hurricanes (winds of 74 mph or greater). Of those, 3-5 could become major hurricanes (winds of 111 mph or greater). So far, the season has seen three named storms and no hurricanes in the Atlantic Basin. In past years including 2021, July lulls have sometimes been followed by very active periods in August and September. An average hurricane season produces 14 named storms, of which 7 become hurricanes, including 3 major hurricanes. The Central Pacific, which includes Hawaii, is forecasted to have a below normal season. On average, the Central Pacific experiences about 1.5 hurricanes per year.
Hurricanes Affect Health in Many Ways
Hurricanes increase the risk for a diverse range of health outcomes. For example:
- Flood water poses drowning risks for everyone, including those driving in flood waters. Storm surge historically is the leading cause of hurricane-related deaths in the United States.
- Winds can blow debris—like pieces of broken glass and other objects—at high speeds. Flying debris is the most common cause of injury during a hurricane.
- Open wounds and rashes exposed to flood waters can become infected.
- Using generators improperly can cause carbon monoxide [CO] exposure, which can lead to loss of consciousness and death. Over 400 people die each year from accidental CO poisoning.
- Post-flooding mold presents risks for people with asthma, allergies, or other breathing conditions.
- Power failure during or after hurricanes can harm patients who critically depend on electricity-dependent medical equipment.
Health Impacts From Hurricane Harvey (2017)
This graph shows the observed changes in the population rates of treat-and-release emergency department (ED) visits following Hurricane Harvey in August 2017. Information on ED utilization is based on data from the AHRQ HCUP State Emergency Department Databases (SEDD). Using information from NOAA and the Federal Emergency Management Agency (FEMA), counties that were in the direct path of the hurricane were identified. For these counties, the percent change in the population rate of treat-and-release ED visits during and post-hurricane were compared to the pre-hurricane average utilization rates. Over a 7-week period after the hurricane, the largest increase in population rates of treat-and-release ED visits were observed for respiratory conditions, with relatively smaller increase for infections, injuries and all conditions.
Which parts of the country are at high risk from hurricanes?
Figure: This map of the United States is colored by the relative Risk Index rating for the Hurricane hazard. The characterization of risk across these counties are based on historical records on hurricane paths and intensity.
The Federal Emergency Management Agency (FEMA) provides information on the risk of different climate hazards across the 50 states and Washington DC through the National Risk Index (NRI) platform. The Risk Index leverages available data for natural hazard and community risk factors to develop a baseline relative risk measurement for each United States county and census tract. 291 counties across 16 states are estimated to have “extremely high,” “relatively high,” or “relatively moderate” hurricane risk. In these counties, the total population at risk is 60,095,904 people.
Who is at high risk from hurricanes in the counties estimated to have “extremely high,” “relatively high,” or “relatively moderate” hurricane risk?
Risk factors vary across the 291 counties identified to have “extremely high,” “relatively high,” and “moderately high” hurricane risk. Of these counties:
49 (17%) have a high number of people aged 65 or over, living alone.
153 (53%) have a high number of people without health insurance.
70 (24%) have a high number of uninsured children.
35 (12%) have a high number of people living in rural areas.
235 (81%) have a high number of Black or African American persons.
118 (41%) have a high number of people with frequent mental distress.
154 (53%) have a high number of people living in poverty.
57 (20%) have a high number of people spending a large proportion of their income on home energy.
157 (54%) have a high number of people with severe housing cost burden.
119 (40%) have a high number of people with electricity-dependent medical equipment and enrolled in the HHS emPOWER program.
150 (52%) have a high number of people in mobile homes.
89 (31%) have a high number of people with one or more disabilities.
178 (61%) are identified as highly vulnerable by CDC’s Social Vulnerability Index.
*“A high number” indicates that these counties are in the top quartile for this indicator compared to other counties
Resources to Reduce Health Risks Associated with Hurricanes
Health risks from hurricanes include drowning due to flood water, injuries, carbon monoxide poisoning after a power outage, infection during evacuation or shelter-in-place, post-storm exposure to mold, and psychological distress.
General Preparedness
Image source: https://www.cdc.gov/cpr/infographics/br-hurricanes.htm
- Find more resources on hurricane preparedness from the Office of the Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange’s (ASPR TRACIE’s) Hurricane Resources at Your Fingertips.
- The Ready.gov Hurricanes site includes information on preparing for hurricanes, staying safe during a storm, and returning home. The Ready Business site also includes a hurricane toolkit for business preparedness.
- The CDC’s Hurricanes and Other Tropical Storms site provides resources to help individuals be prepared for hurricanes and be safe after a hurricane as well as for professionals and response workers.
- The U.S. Food and Drug Administration's Hurricanes: Health and Safety site covers multiple topics to help consumers, industry stakeholders and medical providers prepare for hurricanes, including food and drug safety and using medical devices.
- If you do not have health insurance and are in a federally-identified disaster, the Emergency Prescription Assistance Program can help you get the prescription drugs, vaccinations, medical supplies, and equipment that they need.
- If you have Medicare and your medical device is damaged or lost due to an emergency or disaster, Medicare may cover the cost to repair or replace your equipment or supplies.
- You can locate and access your electronic health records from a variety of sources by using the U.S. Department of Health and Human Services' online tool.
- After natural disasters such as hurricanes, tornadoes, and floods, excess moisture and standing water contribute to the growth of mold in homes and other buildings. The Centers for Disease Control and Prevention’s (CDC) Mold After a Disaster includes information about who is at greatest risk from mold, the health effects of mold, and preventing mold growth.
Image source: https://www.cdc.gov/disasters/mold/index.html
Mental Health
It’s normal for hurricanes and other extreme weather events to cause people to experience emotional distress. Feelings such as overwhelming anxiety, constant worrying, trouble sleeping, and other depression-like symptoms are common responses before, during, and after these types of storms. The Substance Abuse and Mental Health Services Administration Helpline and Text Service is available 24/7, free, and staffed by trained crisis counselors. Call or text 1-800-985-5990 to get help and support for any distress that you or someone you care about may be feeling related to any disaster.
Learn more about hurricanes and mental health at the SAMHSA’s Hurricanes and Tropical Storms site. SAMHSA also has other disaster behavioral health resources, including newsletters and tip sheets. ASPR TRACIE’s Disaster Behavioral Health Resources includes information about services for at-risk populations following a disaster.
Check out SAMHSA’s newly launched Climate Change and Health Equity site for more information on the behavioral health impacts of climate change, preparing for a disaster, and resources for disaster planning and climate change education.
Best Practices for Emergency Managers
- ASPR TRACIE’s Major Hurricanes: Potential Health and Medical Implications provides a short overview of the potential significant health and medical response and recovery needs facing hurricane- and severe storm-affected areas, based on past experience and lessons learned from Hurricanes Katrina, Sandy, Harvey, Maria, and others. The HHS emPOWER collects and shares de-identified Medicare data to help response agencies take action to protect the health of Medicare beneficiaries who depend on vulnerable electrical medical equipment.
- The CDC’s Emergency Responder Health Monitoring and Surveillance™ (ERHMSTM) framework provides recommendations for protecting emergency responders during small and large emergencies in any setting.
Image source: https://www.cdc.gov/niosh/erhms/default.html
- The SAMHSA Disaster Technical Assistance Center Supplemental Research Bulletin, Greater Impact: How Disasters Affect People of Low Socioeconomic Status, is designed to help disaster behavioral health professionals inform their disaster behavioral health planning for low socioeconomic status populations. SAMHSA also has developed a handbook to support disaster planning by behavioral health programs.
- The Agency for Healthcare Research and Quality’s Hospital Evacuation Decision Guidefocuses on post-event evacuations.
- ASPR TRACIE’s After the Flood: Mold-Specific Resources collects public messages, fact sheets, checklists, guidance documents, and other educational resources related to mold. They include pre-scripted (and, in some cases, already recorded) PSAs, as they are tangible and ready to implement examples of risk communication materials that can essentially be used immediately.
- The Department of Education offers tools and resources for schools and educational institutions as they manage safety, security, and emergency management programs.
Additional Resources for Public Health Safety During Hurricanes
Hurricanes can cause power outages that make it impossible to cool your home and refrigerate food. Hurricane Ida caused at least 1.2 million electricity customers to lose power. In addition, disasters like hurricanes that strike during the COVID-19 pandemic can further stress the health and medical system and threaten vulnerable residents and infrastructure.
Image source: https://www.cdc.gov/co/pdfs/Flyer_Danger.pdf
- The CDC has information about What You Need to Know When the Power Goes Out Unexpectedly. To prevent carbon monoxide poisoning, use generators, pressure washers, grills, and similar items outdoors only. Generators should be used at least 20 feet away from your home.
- The CDC’s Going to a Public Disaster Shelter During the COVID-19 Pandemic provides guidance on measures to reduce the possible spread of COVID-19 among people who seek safety in a disaster shelter during severe weather events.
- Considerations for healthcare and emergency management professionals when planning for all-hazard secondary disasters during a public health emergency are available from ASPR TRACIE.
- The Federal Emergency Management Agency’s (FEMA) Exercise Starter Kit for Preparedness in a Pandemic offers ready-to-use materials and templates to your own planning workshop on preparedness in a pandemic. FEMA also offers Mass Care/Emergency Assistance Pandemic Planning Considerations For State, Local, Tribal, Territorial and Non-Government Organizational Planners, Providers and Support Agencies.
- See the Extreme Heat resources section for information on preventing heat-related illness.
Where are extremely hot days expected to be most frequent in September?
This map shows the expected number of extremely hot days in September in each county in the contiguous U.S. The forecast is based on the NOAA Climate Prediction Center’s probabilistic outlook of temperatures being above, below, or near normal in September. A county’s ‘normal’ temperature is based on the 30-year average from 1991–2020. An ‘extremely hot day’ is when the daily maximum temperature is above the 95th percentile value of the historical temperature distribution in that county. For more information on your county, please refer to the Centers for Disease Control and Prevention (CDC) Heat and Health Tracker.
Who is at high risk from heat in the counties with the most extreme heat days?
Some communities face greater health risks from extreme heat given various risk factors they face. These communities include people who: are elderly and live alone, have existing health conditions, have poor access to healthcare, live in rural areas, work outdoors, make a low income, face difficulty paying utility bills, live in poor housing, and live in urban areas without adequate tree cover. These risk factors vary across the 21 counties estimated to have more than 5 expected extreme hot days in September. Of these counties:
- 5 (24%) have a high number of people aged 65 or over, living alone.
- 3 (14%) have a high number of people without health insurance.
- 7 (33%) have a high number of uninsured children.
- 1 (5%) have a high number of people living in rural areas.
- 2 (10%) have a high number of people with frequent mental distress.
- 2 (10%) have a higher number of people with diabetes.
- 6 (30%) have a high number of people employed in construction.
- 5 (24%) have a high number of people living in poverty.
- 3 (14%) have a high number of people spending a large proportion of their income on home energy.
- 12 (57%) have a high number of people with severe housing cost burden.
- 12 (57%) have a high number of people with electricity-dependent medical equipment and enrolled in the HHS emPOWER program.
- 8 (38%) have a high number of people in mobile homes.
- 12 (57%) have a high number of people living in areas without adequate tree cover.
- 12 (57%) are identified as highly vulnerable by CDC’s Social Vulnerability Index.
*“A high number” indicates that these counties are in the top quartile for this indicator compared to other counties
How hot will it be, and where, over the next 3 months?
Image source: https://www.cpc.ncep.noaa.gov/products/NMME/current/images/NMME_ensemble_tmp2m_us_season1.png
Figure: The North American Multi-Model Ensemble (NMME) predicts that average temperature over the next 3 months (September – November) will be 1.8–3.6°F (1–2°C) hotter than average across parts of the contiguous U.S. For more information about this model or prediction, please refer to the NMME website.
For September – November, the North American Multi-Model Ensemble (NMME) predicts that the average temperature will be 1.8 to 3.6°F (1 to 2°C) above-normal for most of the continental United States. However, parts of the southeast, southwest, and northwest regions may experience a 90-day average that is 0.9 to 1.8 °F (0.5 - 1 °C) above the normal average temperature for this time period. The NMME integrates multiple forecasts of the next 90 days to build the best estimate of temperatures and precipitation over that time frame. Note that although many regions may expect a warmer 90-day average temperature, this is not the same as your local weather forecast, in which large fluctuations in temperature may be predicted from day to day.
Is heat related illness worse in 2022 compared to last three years?
The graphic above compares the rate of heat related illness (HRI) per 100,000 emergency department (ED) visits from May to June in 2022 with the rate observed in 2019-2021 for the same months. The CDC National Syndromic Surveillance Program provides daily rates of HRI by HHS regions. The average rate of HRI was calculated by HHS regions for May 1–June 30 for 2022 and 2019-2021 separately. 6 out of the 10 HHS regions show higher HRI rates in May-June for 2022 compared to the average rate in 2019-2021. HRI rates have been particularly high in regions 4, 5, 6 and 7 in 2022, the same places that experienced the heatwave in the middle of June.
Health Impacts During the Heat Dome of 2021
During June–July 2021, the western U.S. experienced a record-breaking heat wave that lasted for several days. Estimated heat-related deaths and illnesses demonstrate the tragic toll of the heat wave on public health. Comparing the health records from June 26–July 10 between 2021 and 2020, heat-related deaths increased from 2 to 145 in Washington, 0 to 119 in Oregon, and 12 to 25 in California. These estimates were provided by the California Department of Public Health, Oregon Health Authority, and Washington State Department of Health. For context, the CDC estimates an average of 702 heat-related deaths per year for the entire U.S. (based on 2004–2018 data).
Heat Affects Health in Many Ways
Warmer temperatures increase the risk for a diverse range of health risks. For example:
- An increased risk of hospitalization for heart disease.
- Heat exhaustion, which can lead to heat stroke if not treated, can cause critical illness, brain injury,
and even death. - Worsening asthma and chronic obstructive pulmonary disease (COPD) as heat increases the production of ground-level ozone.
- Dehydration, which can lead to kidney injury and blood pressure problems. Some kidney damage can become irreversible with repeated or untreated injury.
- Violence, crime, and suicide may increase with temperature, adding to the rates of depression and anxiety already associated with climate change
- Some medications increase the risk of heat-related illness. These include diuretic medicines (sometimes called “water pills”), antihistamine medicines (including many allergy medicines), and many antipsychotic medicines used to treat a variety of psychiatric and neurologic illnesses. Please review this list of common psychiatric medications that can impair the body’s normal ability to cool itself.
Spotlight on Health Equity: Health Impacts in Rural Areas
![Emergency Department Visits with a Diagnosis Directly Indicating Heat Exposure per 100,000 Population, 2016-2019. Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), State Emergency Department Databases (SEDD) and State Inpatient Databases (SID), 2016-2019.]](/sites/default/files/nonsupp-heat-stcofips-2016-2019-alled.png)
In April 2022, Agency for Healthcare Research and Quality used the Healthcare Cost and Utilization Project (HCUP) 2016–2019 to estimate county-level population rates of emergency department (ED) visits with a diagnosis directly indicating heat exposure. The analysis was limited to records of ED visits, regardless of hospital admission, at community hospitals, excluding rehabilitation and long-term acute care facilities, with any-listed diagnosis directly indicating heat exposure. This analysis includes ED data from 2,550 counties in 39 States and the District of Columbia, representing 85 percent of the population and 81 percent of all counties in the United States in 2019. Among the 1,122 rural counties, 152 (13.5%) had heat-related ED visit population rates of 85 or more per 100,000 population (i.e., 90th percentile of population rates). In contrast, among the 344 large metropolitan counties, 8 (2.3%) had heat-related ED visit population rates in the 90th percentile. The report highlights that a larger proportion of rural than large metropolitan counties experience a high rate of heat-related illness, although there are more heat-related ED visits in large metropolitan areas (n=135,585 ED visits) than in rural areas (n=30,115 ED visits).
Resources for People at High Risk of Heat-Related Health Problems
Certain populations with limited resources may have restricted access to information on heat illness prevention, cool indoor environments, and government programs that provide critical support. Find more resources on heat illness prevention from Heat.gov and CDC websites.
Worker Health
Occupations that require strenuous work outdoors pose a high risk for heat-related illness. This includes construction workers, farmers, agricultural workers, delivery workers, athletes, landscapers, and others. Learn more about the dangers of working in heat. Employer responsibilities and resources for safety are also available through the Occupational Safety and Health Administration (OSHA) Heat Illness Prevention campaign.
- The Heat Safety Tool provides real-time heat index and hourly forecasts, specific to your location, as well as occupational safety and health recommendations from OSHA and the National Institute for Occupational Safety and Health (NIOSH).
- The National Institute of Environmental Health Sciences (NIEHS) Worker Training Program has heat safety and health training for at-risk workers.
- The Health Resource Services Administration (HRSA) funds National Training and Technical Assistance Partners — Farmworker Justice and Migrant Clinicians Network that helps clinicians prevent and treat heat-related illness among agricultural workers.
Image source: https://www.osha.gov/heat
Staying Safe Indoors
- The Low Income Home Energy Assistance Program (LIHEAP) and the Weatherization Assistance Program (WAP) help keep families safe and healthy through initiatives that assist families with energy costs. To inquire about LIHEAP assistance, call the National Energy Assistance Referral (NEAR) hotline at
1-866-674-6327. - HHS has issued guidance that for the first time expands how LIHEAP can promote the delivery of efficient air conditioning equipment, community cooling centers, and more.
- The National Institute on Aging resource Hot Weather Safety for Older Adults offers background information on heat stroke, who is at risk, lowering your risk, and best practices.
- Medicare Advantage (MA) plans may provide Special Supplemental Benefits for the Chronically Ill (SSBCI) with equipment and services that improve indoor air temperatures and quality (such as portable air conditioners) to chronically ill patients.
Image sources: https://www.acf.hhs.gov/sites/default/files/documents/ocs/COMM_LIHEAP_Earth%20Day_FY2022.pdf, https://liheappm.acf.hhs.gov/datawarehouse
Best Practices for Emergency Managers
This CDC report on Heat Response Plans reviews steps emergency managers and health officials can take to develop and implement measures to protect their communities. Spikes in energy demand should be expected during summer months as air conditioning use increases. The combination of sagging power lines (copper expands as it heats up, thus increasing impedance and reducing throughput) and increased energy demands can cause power failures that make certain populations more vulnerable when the risk is highest. The HHS emPOWER pcollects and shares de-identified Medicare data to help response agencies take action to protect the health of Medicare beneficiaries who depend on vulnerable electrical medical equipment.
Real-time information on health impacts from extreme heat can also help decision-makers implement strategies to reduce risk. CDC’s Heat and Health Tracker provides regular updates on the rate of heat-related Emergency Department visits (organized by HHS regions) and observed temperature.
If you are a local organization planning to open a cooling shelter, consider referring to CDC guidance on how to maintain a safe shelter during a heat wave.
Check out SAMHSA’s newly launched Climate Change and Health Equity site for more information on the behavioral health impacts of climate change, preparing for a disaster, and resources for disaster planning and climate change education.
Clinical Best Practices
A heat stroke is a medical emergency, and rapid recognition and aggressive early treatment are essential to reduce morbidity and mortality (as illustrated below).
See https://pubmed.ncbi.nlm.nih.gov/33856299/ for the full algorithm.
Thank you to the partners who provide invaluable information, expertise, and data for the Climate and Health Outlook series, including the Administration for Children and Families; Centers for Disease Control and Prevention and National Institute for Occupational Safety & Health; Department of Agriculture; Environmental Protection Agency; National Oceanic and Atmospheric Administration and the Climate Prediction Center, National Centers for Environmental Information, National Hurricane Center and Central Pacific Hurricane Center, National Integrated Drought Information System, and National Integrated Heat Health Information System; National Interagency Fire Center; Bureau of Land Management; Substance Abuse and Mental Health Services Administration; United States Geological Survey; the California Air Resources Board; and the San Mateo County Health Department.
Climate and Health Outlook | August 2022
Welcome to the fourth edition of the Climate and Health Outlook from the Department of Health and Human Services (HHS) Office of Climate Change and Health Equity (OCCHE). The Climate and Health Outlook is an effort to inform health professionals and the public on how our health may be affected in the coming month(s) by climate events and provide resources to take proactive action. This edition explores the climate-related health hazards of wildfire, drought, extreme heat, and hurricanes. This webpage includes additional resources and information excluded from the PDF summary.
Download the Climate and Health Outlook for August 2022*
Climate and Health Outlook | July 2022
Welcome to the third edition of the Climate and Health Outlook from the Department of Health and Human Services (HHS) Office of Climate Change and Health Equity (OCCHE). The Climate and Health Outlook is an effort to inform health professionals and the public on how our health may be affected in the coming month(s) by climate events and provide resources to take proactive action. This edition expands beyond extreme heat to include additional climate-related health hazards.
Download the Climate and Health Outlook for July 2022
Climate and Health Outlook: Extreme Heat | June 2022
This edition focuses on the months of June-August, 2022 and uses the most current long-term temperature forecasts that come from the National Oceanic and Atmospheric Administration (NOAA) to illustrate how extreme heat poses a health risk for all Americans.
Download the Climate and Health Outlook for June 2022
Climate and Health Outlook: Extreme Heat | May 2022
As our climate changes, extreme heat events will become more frequent, longer lasting, and more severe. Using temperature projections from NOAA and other partners, this outlook draws attention to the parts of the country and populations at higher health risk from extreme heat exposure. It also provides actionable information and resources from the Department of Health and Human Services for individuals, healthcare professionals, and public health officials to take proactive action that can reduce risk.
Download the Climate and Health Outlook for May 2022*
* This content is in the process of Section 508 review. If you need immediate assistance accessing this content, please submit a request to OCCHE@HHS.gov. Content will be updated pending the outcome of the Section 508 review.
