COVID-19 Guidance - Avoiding heatstroke in nursing homes

Many people who are at risk of harm from heat can also be a risk of severe illness due to COVID-19. These people will often be ‘shielding’ or self-isolating from others and will spend more time at home.

“Severe heat is dangerous to everyone. During a heatwave, when temperatures remain abnormally high over more than a couple of days, it can prove fatal” (Public Health England 2015)

Increasing temperatures in excess of 23 degrees are associated with excess summer deaths. It is estimated that for each degree Celsius rise above 21.5 degrees, mortality increases by 3.34% (www.cymru.gov.uk)

Public Health England state: “It is especially important that you know what actions to take to keep yourself and others safe from high temperatures…we still have much to learn about how COVID-19 affects the body but both heat and COVID-19 infections put a strain on the heart, lungs and the kidneys, and are linked with inflammation in the body.”

It is well known that people in residential/nursing homes are at high risk of illness and death during heatwaves.

How the body normally cools itself

The body normally cools itself using the below four mechanisms:

  1. Radiation – The transfer of heat via infrared rays which emanate from a hot body and are absorbed by something cooler
  2. Convection – The transfer of heat of the air surrounding the skin via water or air crossing the skin
  3. Conduction – The transfer of heat by two objects that are in direct contact with each other. By a cooler object being in contact with the skin
  4. Evaporation – The transfer of heat by the evaporation of water through sweat.
Heat-related illnesses

The main causes of illness and death during a heatwave are respiratory and cardiovascular diseases. The list below highlights specific heat-related illnesses:

  • Heat Cramps – Caused by dehydration and loss of electrolytes, often following exercise
  • Heat Rash – Small, red, itchy papules
  • Heat Oedema – Mainly in the ankles, due to vasodilation and retention of fluid
  • Heat Syncope – Dizziness and fainting, due to dehydration, vasodilation, cardiovascular disease and certain medications
  • Heat Exhaustion – The most common illness. It occurs as a result of water or sodium depletion, with non-specific features of malaise, vomiting and circulatory collapse, and is present when the core temperature is between 37-40 degrees – left untreated, heat exhaustion may evolve into heatstroke.
  • Heatstroke – Can become a point of no return whereby the body’s thermoregulation mechanism fails. This leads to a medical emergency, with symptoms of confusion, disorientation, convulsions, unconsciousness, hot dry skin, and core body temperature exceeding 40 degrees for between 45 minutes and eight hours. It can result in cell death, organ failure, brain damage or death. Heatstroke can be either classical or exertional.
Residents at highest risk

It is important that you identify which residents at the highest risk of developing heat-related illnesses. These residents are also at risk of severe illness if infected with COVID-19. Ensure that you:

  • Identify those at highest risk and ensure all staff are aware of these residents
  • Ensure you know what the residential/nursing homes policy is on heatwaves
  • Monitor temperatures in all rooms frequently as per the residential/nursing homes policy
Keep residents cool

It is so important that residents are kept as cool as possible in hot weather, ensure that you:

  • Recognise heat-related illness (as documented above)
  • Monitor hydration and fluid intake – encourage increased fluid intake as possible
  • Fans: fans are only to be used in single rooms with COVID-19 free residents to reduce transmission of illnesses.
Keep the building cool

It is important the building is kept as cool as possible to ensure that the residents remain as comfortable as possible, you can do this by:

  • Opening windows (if safe to do so) at night to allow for cooling
  • Use blinds to reduce heat gain and create cross-ventilation if possible
  • Turn heating systems off
  • Unplug any electrical equipment that is not being used
    You can use the checklist here for further guidance.

Resources:

  • Heatwave Plan for England: Supporting vulnerable people before and during a heatwave. NHS England (2015) www.gov.uk/phe
  • Heatwave plan for Wales: A framework or preparedness and response. Welsh Government (2012) www.cymru.gov.uk
  • Heatwave leaflet