SYDNEY — At major events around the world, scenes of extreme heat stress are starting to look familiar. Older men, their shirts loosened, lying with their eyes closed. Aid tents full of unconscious people. And lines of believers – whether seeking religion, music, ballot boxes or sports – sweat under patches of shade.
The consequences have been terrible. At least 1,300 people died during this year’s Hajj, the Muslim pilgrimage in Saudi Arabia, when temperatures rose above 100 degrees Fahrenheit. And in many ways, that heavy toll was just the latest sign that crowd control and heat waves fueled by climate change are on a dangerous collision course.
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During the recent elections in India, dozens of poll workers died on the job. Last summer, troops of Boy Scouts visiting South Korea for an anniversary became ill from the heat, as did others at music festivals in Australia, Europe and North America.
Even as heat kills more people than any other extreme weather event today, there is still a dangerous cultural slowdown. Many organizers and visitors of major events are still behind the climate curve and cannot estimate how much a warming planet has increased the risk to summer crowds.
“As warm seasons lengthen and heat waves come earlier, we will have to adapt,” said Benjamin Zaitchik, a climate scientist at Johns Hopkins University who studies health-damaging climate events. In addition to personal behavior, he added, infrastructure, emergency management and social agendas “must really recognize this new reality.”
Among the many low-tech ways to prevent illness and death are shade, water stations, sidewalks painted white to reflect the heat, and emergency health services to treat severe cases of heat stroke. Some warm and innovative places, like Singapore, have created public spaces that unite the outdoors with the indoors. They have added air conditioning to areas where people may have to wait a long time, such as at bus stops.
The hardest solution of all may be one that is in some ways also the simplest: educating people about the risks of heat, including those who are used to living in hot places. They are often unaware of the early symptoms of heat stress or of the fact that high temperatures are especially dangerous for people with pre-existing health problems, such as kidney disease or high blood pressure. Even medications, such as anticholinergics, that treat allergies or asthma can accelerate problems by restricting sweat.
“Heat is a very, very complex and sneaky killer,” says Tarik Benmarhnia, an environmental researcher and associate professor at the University of California, San Diego. “It is very quiet.”
A religious pilgrimage can be the most difficult of all events. Devotees of many religions – Christians in the Philippines; Hindus in India; Muslims in Saudi Arabia have died of heatstroke during religious rituals in recent years.
But the Hajj may pose the greatest danger.
The entire Arabian Peninsula is hot and warming rapidly, while night temperatures are also rising, losing the hours when the body usually cools down. The hajj lasts five or six days, increasing heat exposure in the holy city of Mecca.
The Hajj calendar is also determined by the lunar cycle, so the times scheduled for the trip can be the hottest, as was the case this year. And because pilgrims are often disproportionately old, they are more vulnerable to the effects of intense heat.
Benmarhnia shuddered when he heard the news of the deaths during this year’s Hajj.
“I thought this could have happened to my grandmother,” he said by phone Monday.
He had paid for her trip to Mecca in 2019. She was 75 years old, but fortunately, he said, she went on a smaller pilgrimage during a cooler time, in April. With the death toll this year, he suggested that heat experts use what had happened to work with religious authorities to quickly devise adaptation strategies.
The Saudi Ministry of Health had introduced information campaigns urging people to stay hydrated and use umbrellas. Officials set up field hospitals and water stations. They deployed thousands of paramedics.
It was not nearly enough for a wave of millions, including many who circumvented national quotas designed to limit crowd size. And Saudi Arabia has faced criticism over the deaths for its handling of the pilgrimage.
This year’s elections in India have shown that even in places where people think they are used to heat, much more awareness is needed about the dangers of extreme heat.
At least 14 people died in Bihar in late May, and at least 10 of them belonged to polling stations, state disaster management officials said. At one point in June, nearly 100 people died in Odisha within 72 hours in cases suspected to be linked to the heat.
Health officials in India had to prepare. In sunstroke units in hospitals in Delhi, patients were immediately immersed in an ice-filled plunge pool to lower their temperatures. In a ward equipped with an ice machine, coolers and fans, critical patients were immediately placed on ice trays and injected with cold fluids.
But in many areas, heat waves and voting peaked around the same time – including in Bihar’s Aurangabad district, home to three million people, where temperatures approached an abysmal 48 degrees Celsius (118 Fahrenheit) in late May.
Ravi Bhushan Srivastava, chief medical officer of a government hospital, was on his way to review the daily post-mortem reports on a particularly bad day, when 60 patients were admitted for heatstroke.
“At least 35 to 40 people were in a bad condition,” he said. “They were unconscious, had altered consciousness, very hot bodies and had difficulty breathing.”
“I have never seen patients with heatstroke symptoms in such large numbers and with such intensity in my entire career,” he added.
Election rallies can be particularly vulnerable because of the large crowds involved. But there are plenty of feasible solutions for that too. Aditya Valiathan Pillai, an adaptation specialist at the Sustainable Futures Collaborative, a research organization in Delhi, said participants should be able to see real-time local temperatures, with color-coded risk levels. Water stations, shade and cooling centers can be set up. Last but not least, government agencies must do their utmost to earn warnings about heat. “We now have heat wave forecasts that are quite accurate five days from now,” Pillai said, “so this kind of advance awareness is possible.”
Sporting events have already adapted to the dangers of extreme heat. Water breaks for players were introduced during the 2014 World Cup in Brazil, when the combination of heat, humidity and sun exposure led to a temperature of 89.6 degrees Fahrenheit. Officials have moved the 2022 World Cup in Qatar from the summer months to November and December, when it is cooler.
The Olympic Games in Paris seem to be seeking some kind of balance. Some events, such as the marathon, start earlier in the day and water stations must be available for patrons.
“Mega events like the Olympic Games and the FIFA World Cup have a duty of care for everyone who attends,” said Madeleine Orr, a professor at the University of Toronto and author of the book “Warming Up: How Climate Change Is Changing Sport.”
“We’re talking about hydration breaks and cooling breaks,” she added, “opportunities for athletes and officials to have access to cooling towels and some shade or misting fans, and medical personnel on standby to intervene if anyone extra needs care.”
That may be enough for now. Many experts say more radical shifts may need to follow. The Summer Olympics should perhaps become the Fall Olympics. Similarly, elections in India, along with international tennis tournaments, could be shifted to cooler months. School holidays may be rescheduled due to weather conditions. Summer jobs like painting houses can become spring jobs.
David Bowman, a climate scientist from Tasmania who wrote an article that attracted widespread attention online during Australia’s 2020 bushfires calling for an end to the summer holidays, said people were already starting to adapt in small ways. Umbrellas are becoming fashionable accessories for shade, shorts are becoming more acceptable at work and road workers are doing more at night.
Climate change could force major events to cause even more change.
“All these disasters are like a cultural price signal for climate change,” he said. “Of course we can be stubborn and carry on regardless of the changing climate – but in the end the climate will win.”
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