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A woman shields herself from the blazing sun on West 34th Street, July 27, 2021.
A woman shields herself from the blazing sun on West 34th Street, July 27, 2021.
Ben Fractenberg/THE CITY

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Extreme Heat Sends New Yorkers to Emergency Rooms as Climate Toll Grows

The city is on pace to match 2018, when more than 700 people headed to the hospital due to hot weather, data shows. As the planet is warming, New York is feeling the heat: It recently placed as the nation’s third most intense “urban heat island.”

As the planet is warming, New York City is feeling the heat — and it’s making us sick.

More than 425 New Yorkers have gone to the ER for heat-related illnesses since May 1 — putting the city on pace to match 2018, when extremely hot weather sent more than 700 people to the hospital, the most over the last five summers, data shows.

Some 64 people went to the ER alone on June 30 due to the heat — the third-highest number on a single day in the last five years.

A recent study from the research organization Climate Central ranked the city as the nation’s third most intense “urban heat island” — meaning it’s built to contain heat, spelling increasing dangers for some of the city’s most vulnerable residents.

With temperatures reaching 90 degrees for a second consecutive day Tuesday, the city seeing haze from wildfires out West and the summer less than half over, emergency medicine doctors are on alert for what’s become an all-too-common rush amid climate change.

“We open up our hospitals to receive patients or just for people to come in, [and] we issue community advisories,” said Dr. Rejesh Verma, chief of the emergency department at the city-run Kings County Hospital. “When we know that we’re dealing with hot months, like July and August, we raise the awareness with our residents, staff and our physicians … and we just give them a little bit of a refresher.”

When Heat Meets Humidity

Doctors around the city got a lot of practice at the end of last month, when Mayor Bill de Blasio declared a heat emergency. No one died, according to the Office of the Chief Medical Examiner, but from June 28 through the first of July, 142 New Yorkers went to the emergency room with suspected heat-related maladies.

On June 30, when the heat index — what it feels like when the temperature is combined with humidity — hit 103 degrees, some 64 people headed to the ER, according to data from the city Department of Health and Mental Hygiene.

The only days in the last five years in which more New Yorkers went to the ER due to heat were July 20 and 21, 2019, when a total 215 hospital visits were made. Tens of thousands of residents lost power that weekend, which may have contributed to heat-related ailments.

With 426 total ER visits from May 1, 2021, through July 24, New York had already nearly matched the total for last year when 427 total heat-related ER visits were recorded between May 1 and Sept. 30, an analysis by THE CITY shows.

COVID-19 caused New Yorkers to avoid emergency rooms in 2020, which may have affected the city’s count, according to a health department spokesperson. And considering 91% of city households have air conditioning, the stay-at-home orders may have afforded some people added safety.

The highest total ER visits over the last five years came in 2018, when 739 New Yorkers went to the hospital for heat-related illnesses between May 1 and Sept. 30 — an average of just under five emergency room visits per day.

That’s about the same as this year’s average so far. Whether this year’s visits will catch up with or exceed those from 2018 largely depends on the intensity of the heat through Sept. 30, a health department spokesperson noted.

‘A Vulnerable Population’

While much of the globe is experiencing prolonged periods of extreme heat — the subject of a Congressional committee hearing held last week — cities tend to be hotter than their surrounding areas due to what’s called the urban heat island effect.

Buildings and impervious surfaces like pavement trap heat, and the activity stemming from lots of people in a packed area results in more emissions, creating the sweltering city environment.

New York City suffers from this effect at a particularly high intensity — third only to New Orleans and Newark, according to a recent report from the research organization Climate Central. The study found New York City is on average 7.62 degrees warmer than its less-densely built neighbors.

But there’s another dimension to the effect: the phenomenon of “micro urban heat islands,” as Juan Declet-Barreto, a climate vulnerability scientist with the Union of Concerned Scientists’ Climate and Energy Program, calls them.

A woman uses a fan to cool herself off on a sweltering summer day in Midtown, July 27, 2021.
A woman uses a fan to cool off during a sweltering summer day in Midtown, July 27, 2021.
Ben Fractenberg/THE CITY

They are essentially heat islands within the larger heat island: Much of the South Bronx, Harlem, Central Brooklyn and parts of eastern Queens are among the areas most vulnerable to extreme heat, health department data indicates.

Dr. Rajesh Verma, chief of emergency department at NYC Health + Hospitals/ Kings County
Dr. Rajesh Verma
Photo Courtesy NYC Health + Hospitals/ Kings County

Communities of color and low-income people are at higher risk of extreme heat-tied health woes. They tend to shoulder disproportionate pollution burdens, live in neighborhoods with fewer trees and less open green space — characteristics of micro heat islands — and deal with underlying health conditions that heat can exacerbate.

Verma, whose hospital is in East Flatbush, one of the neighborhoods with the highest vulnerability to heat, said he’s seen patients with body temperatures of 104 degrees or higher in severe cases.

“This is a vulnerable population that may not have cooling at home,” he said.

‘Heat Is a Risk-Multiplier’

City data shows that over 89% of households in East Flatbush have AC, just under the citywide average, although the neighborhood has less green space and higher than average summer surface temperatures compared to citywide figures.

With prolonged heat, Verma has seen patients with heart conditions get edema, or swelling, of their legs, dehydrated patients with headaches and kids with prickly skin rashes. The heat is especially worrisome for those with asthma and psoriasis, he said.

On average, 10 New Yorkers died annually between 2010 and 2019 directly from heat, with Black and senior New Yorkers more likely to die.

“A lot of these inequities in the urban heat island disparities are the consequence of decisions that were not made with the needs of low-income people of color in mind,” Declet-Barreto said.

Staff at Kings County Hospital Center watched a protest over proposed cuts to gynecologic oncology services, June 29, 2020.
Staff at the city-run Kings County Hospital
Ben Fractenberg/THE CITY

He worked on a recent report with WE ACT for Environmental Justice and the Natural Resources Defense Council that examined the risks associated with urban heat islands, focusing on northern Manhattan.

The organizations found residents of Inwood had particularly high-heat sensitivity, combined with high exposure to heat, resulting in the highest risk of heat-related health issues.

“It has to do with the built environment and the ability to stay safe in those heat emergencies,” said Sonal Jessel, director of policy at WE ACT.

“We know hardships are bundled and cumulative,” Jessel added. “People dealing with energy insecurity and are also experiencing rent concerns, food insecurity and medical issues…. Extreme heat is a risk-multiplier.”

Hard to ‘Stay Safe’

The researchers analyzed heat vulnerability, examining both geographic and population-based factors.

During the summer of 2014 and 2015, they also surveyed nearly 500 residents of Harlem, Washington Heights and Inwood, which boast robust Black and Latino populations. The goal: to understand the effects of — and coping mechanisms used to deal with — extreme heat.

But tacked onto those results — largely based on the 2010 census and land surface temperature data from 2007 to 2011 — are more summers characterized by an increasingly changing climate. Related health concerns have grown with the pandemic, which killed a greater percent of Black and Latino New Yorkers than other populations.

“Climate change has gotten worse, we had a pandemic, people have gotten sick and are unemployed. We don’t know exactly, but I wonder what that’s done to people’s ability to stay safe,” Jessel said.

The Empire State building was blurred on a hot and hazy summer day, July 27, 2021.
Haze eveloped the Empire State Building a hot summer day, July 27, 2021.
Ben Fractenberg/THE CITY

The recent, unprecedented heatwaves in the Pacific Northwest that killed nearly 200 people and counting demonstrate the danger of extreme heat, especially for those without air conditioning. The CDC found 1,038 people in the region visited the ER on a single day during that heatwave.

AC’s Mixed Impact

The city’s cooling centers are one solution for providing equitable access to temperature-regulated spaces.

But air conditioning also creates problems: It can add 20% more heat to the environment, according to the Climate Central report. And blasting the AC strains the energy grid, which can lead to blackouts and brownouts — and cause more fossil fuels to burn.

De Blasio called on New Yorkers to limit electricity use during the late June heatwave to prevent “energy disruptions,” and demand subsequently dropped after the city fired off an emergency text alert.

Relying on electricity powered mainly with fossil fuels also creates carbon emissions, which exacerbates the climate change that leads to intensified heat.

“City policies that encourage white roofs and green roofs are a step in the right direction,” said Julie Tighe, president of the New York League of Conservation Voters. “However, mitigating climate change and prioritizing neighborhoods most affected by climate pollution — and less likely to have air conditioning — is the key to combating the urban heat island effect.”

Weatherizing buildings to increase energy efficiency, installing green infrastructure, electrifying vehicle fleets and investing in low-carbon transit options can help slash greenhouse gases from the city’s two largest sectors: buildings and transportation.

Mayor Bill de Blasio shows the expected economic benefit of congestion pricing during a news conference at City Hall, July 20, 2021.
Mayor Bill de Blasio shows the expected economic benefit of congestion pricing during a recent City Hall news conference.
Ed Reed/Mayoral Photography Office

Experts say implementing a long-stalled congestion pricing scheme that promises to reduce traffic in Manhattan south of 60th Street will help, too.

Transforming heat-trapping surfaces with increased trees and greenery can play a huge role in helping to mitigate the heat island effect and provide respite. The city earmarked $82 million to plant trees on streets out of the $106 million “Cool Neighborhoods” program the de Blasio administration launched in 2017.

A Climate Equity Gap

Surfaces in shady areas can significantly lower surface and air temperatures, according to the EPA, reducing the heat island effect. And while New York City boasts several extensive, lush parks, access isn’t equitable — a problem underscored during the height of the pandemic. Trees and other plants evaporate water using heat from the air, which cools the surrounding areas.

“We can’t get to our climate goals, we can’t be a more equitable city, we can’t be a more affordable city — we can’t be a city that’s resilient for climate change — if we’re basically taking one of the greatest assets we have, which is the asphalt, and not reimagining it and giving it back to people,” said Danny Harris, executive director of Transportation Alternatives.

Cyclists enjoy the view on a sultry summer evening in Williamsburg’s Domino Park, July 16, 2021.
Cyclists soak in the view on a sultry summer evening in Williamsburg’s Domino Park, July 16, 2021.
Hiram Alejandro Durán/THE CITY

Transportation Alternatives, which estimates that 75% of streets are devoted to cars and parking, is calling for the city to repurpose 25% of that space for parks or other people-centric uses by 2025.

Democratic mayoral nominee Eric Adams, an avid biker, endorsed that plan. The Brooklyn borough president also wants to add new parks, green 100 asphalt playgrounds, “scale back” highways and build bike and pedestrian infrastructure to connect neighborhoods to open spaces.

“Cities have the capacity now to become deadlier,” Declet-Barreto said. “We need to develop solutions for climate change and urban heat island mitigation and adaptation that take into account the most vulnerable members of the population.”

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