A lethal combo — hot days, no power
Last month, more than 24,000 Bay Area residents experienced a power outage when a local fire affected PG&E equipment. As a medical student at Stanford, I was on campus during the blackout, which lasted for days as temperatures soared over 100 degrees. Shortly before the outage, the National Weather Service had released a heat advisory signaling “the onset of extremely dangerous heat conditions.”
These overlapping threats of extreme heat and power outages expose the ways our state is unevenly and inadequately prepared to keep residents safe. My community was fortunate: The university had the resources to mobilize relief quickly. Officials opened respite spaces for students to cool off in and hydrate. People could refrigerate medications, parents could store breast milk and those needing power for their medical devices could request support. But this type of coordinated response is rare — even though it is increasingly essential as California scorches under heat waves that strain our energy infrastructure and create deadly conditions for human health.
At the center of this vicious cycle is climate change, which is tied to the increasing frequency of extreme heat events. On blisteringly hot days, more people are using power for longer periods to keep cool, creating conditions that can overload the system. And heat increases fire hazards, which in turn can lead to more outages.
Without power and proper resources to withstand the heat, residents are vulnerable to heat strokes, fainting, exhaustion, cramps and rash. During a heat wave last year when triple-digit temperatures gripped Sacramento and the Coachella Valley, the number of emergency room visits surged tenfold.
We are only recently beginning to grasp the true scale of the problem. A Los Angeles Times investigation found last year that California underestimates the number of deaths related to extreme heat by as much as sixfold. Its counts are based on death certificates that reference heat, but they don’t factor in deaths during extreme heat periods that might not have heat cited as an underlying cause or contributing factor. The Centers for Disease Control and Prevention has similar gaps in tracking heat-related deaths.
Unsurprisingly, the effects of heat are unequal. Households of color are less likely to have air conditioners, and a 2019 study found they experienced the greatest increase in emergency department visits for heat-related illnesses, deepening existing health disparities.
Low-income neighborhoods, the elderly and young children are also especially vulnerable.
This emerging picture of the human costs, coupled with projections of how climate change will drive up these costs, renders extreme heat nothing short of a health crisis for California. Yet we don’t have a strong, widely available toolkit to tackle it.
For starters, heat advisories that serve as the first warning to the public often suggest avoiding the outdoors. This advice makes little difference when heat-related power outages leave the indoors just as scorching.
Moreover, when wind, heat and dry conditions combine, utilities often preemptively shut off power to avert fire hazards. This can prove especially dangerous for people on electricity-dependent medical devices. When PG&E initiated widespread power shutoffs across northern California in 2019, the decision impacted nearly 30,000 consumers with medical needs such as dialysis machines and ventilators.
Utilities advise people in those situations to buy backup generators, but not everyone can afford that option or find backup supplies even if they try. During the 2019 shutoffs, people needing medical devices or refrigerated medications struggled to survive without power for several days. Patients complained of receiving insufficient notice of the shutoffs.
For a state that touts its climate consciousness, we have a long way to go to develop a vigorous public health response.
Gov. Gavin Newsom’s recently released “Extreme Heat Action Plan” offers a promising start. The plan endorses steps such as funding new cooling centers, improving Californians’ access to air conditioning, engaging healthcare stakeholders to support patients affected by extreme weather and accelerating “readiness and protection of communities most impacted by extreme heat.” To ensure these steps become meaningful strides rather than just promises, the state should release annual progress reports including deadlines for the most urgent recommendations — such as readiness plans for communities that don’t have enough cooling center capacity.
I am beginning my career as California’s summers get hotter and hotter. I want to know that my future patients, regardless of their needs or circumstances, will have the resources to stay safe.