COVID-19 Guidance - Avoiding heatstroke in community settings

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.”

Who is at risk?

Patients who:
  • are over the age of 75
  • live on their own
  • are socially isolated
  • live in a care home environment.
Patients with a chronic condition or severe illness are more at risk of heat exposure. Conditions/illnesses such as:
  • Heart conditions
  • Diabetes
  • Respiratory
  • Renal
  • Parkinson’s and other dementia’s
  • Conditions affect
Patients with an inability to adapt behaviour to keep cool:
  • Having a disability
  • Parkinson’s and other dementia’s
  • Being bed-bound
  • Babies and the very young
Environmental factors and overexposure
  • Living in a top floor flat
  • Homeless
  • Activities that include a high level of physical exertion
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.

 

How to help your service user during a heatwave

How to keep them out of the heat:

  • Keep curtains on windows exposed to the sun closed while the temperature outside is higher than it is inside
  • Once the temperature outside has dropped lower than it is inside, open the windows – this may require late-night visiting and such advice needs to be balanced by any possible security concerns
  • Water external and internal plants and spray the ground outside windows with water (avoid creating slip hazards) to help cool the air
  • Advise the service user to stay out of the sun, especially between the hours of 11 am and 3 pm
  • Advise the service user to stay in the shade and to wear hats, sunscreen, thin scarves and light clothing if going outside.

How to keep their body temperature down:

  • Ensure that the person reduces their levels of physical exertion
  • Suggest they take regular cool showers or baths, or at least an overall body wash
  • Advise them to wear light, loose clothes to absorb sweat and prevent skin irritation
  • Suggest that they sprinkle their clothes with water regularly, and splash cool water on their face and back of the neck
  • Recommend cold food, particularly salads and fruit with a high-water content
  • Advise them to drink regularly (if appropriate), preferably water or fruit juice, but avoid alcohol and caffeine
  • Monitor their daily fluid intake, particularly if the service user is unable to drink unaided.

Be alert! As well as the specific symptoms of heat exhaustion and heatstroke, look out for other signs such as:

  • Difficulty sleeping, drowsiness, faintness and changes in behaviour
  • Increased body temperature
  • Difficulty breathing and increased heart rate
  • Dehydration, nausea or vomiting
  • Worsening health problems, especially of the heart or respiratory system

If you suspect your service user has heatstroke – call 999 and:

  • Take the service user’s temperature
  • If possible, move them somewhere cooler
  • Cool them down – sprinkle them with water or use a fan to create an air current
  • Encourage them to drink fluids (if appropriate)
  • Do not give aspirin or paracetamol

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