Countermeasures against the killer heat and that spectre of the summer of 2003 that claimed over 4,000 lives in Italy

Forty-three degrees in Spain (after 46 on Saturday) and southern Portugal. Forty degrees in France and Italy. But it is half of Europe that is in the grip of the African anticyclone that has pushed far beyond our country. 'Right now' a 'scorching heat wave is sweeping across the WHO European region, breaking records, straining health systems and putting countless lives at risk'. Issuing the alert is the World Health Organisation (WHO) regional director for Europe, Hans Kluge who explains in a note why heat waves are a health crisis and how to prepare. Because heat can be an insidious killer, especially for the elderly, as recalled by the record-breaking torrid summer of 2003 when the heat lasted without a break for more than 30 days between July and August, killing more than 20 thousand people in Europe: in France alone, the 'canicule' had claimed 11 thousand victims among the elderly, while in Italy, according to the conservative estimates collected at the time by the Istituto Superiore di Sanità, more than 4 thousand deaths had been recorded.

Extreme heat, the WHO reminds us, 'silently threatens the people who most need protection: the elderly, children, outdoor workers and anyone living with chronic illnesses'. And 'climate change means that heat waves are no longer rare. They are becoming more intense, more frequent and more dangerous. Extreme heat can overwhelm our bodies' ability to cope with high temperatures, causing serious illness and even death. The good news? Most heat-related health impacts can be prevented'. This is why WHO Europe has launched "the annual #KeepCool campaign to remind us of the simple life-saving steps we can all take". Four pillars underpin the campaign. Rule number one: keep the heat away "by staying indoors during the hottest hours of the day, in the shade where possible, and never leave children or pets in parked cars. Point number 2: keep the house as cool as possible by 'airing it at night, closing curtains and blinds during the day and turning off unnecessary lights and devices'. Point number 3: keep your body cool 'by wearing light clothes and drinking plenty of water. And to close point 4: stay in touch with family, friends and neighbours, 'especially those who may need additional help'.

"But we cannot stop there. Every country and every community needs robust health and heat action plans: early warnings, clear communication and support for those most at risk,' the WHO note concludes. 'It's not just about surviving the summer, it's about protecting our health in a changing climate. Let's make sure everyone knows how to stay safe and healthy, no matter how high the temperatures rise'.

But what are the main health risks caused by heat waves? High temperatures combined with high humidity can trigger heat stroke, dehydration, heart failure and respiratory crises in the most vulnerable patients. Attention must therefore be paid to the warning symptoms. "Systemic heat disorders can manifest themselves with more or less severe effects on the entire organism, which is no longer able to dispose of the heat produced internally, for example through sweating, so that the body temperature begins to rise dangerously," warns Mauro Minelli, clinical immunologist and lecturer in Human Nutrition at the LUM University. "The mildest systemic form is sunstroke, also known as sunstroke, which, in terms of symptoms, can manifest itself with erythema extended to the parts most directly exposed to the sun that are also quite hot and, perhaps, covered in blisters. Other typical manifestations of sunstroke can be hyperemia of the conjunctivae with lacrimation and great discomfort in the light, fever, pain in the nape of the neck and a sense of heaviness in the head, sometimes with a vague sense of confusion and dizziness. In these cases,' the doctor warns, 'the treatment, which is usually quickly effective, can simply consist of moving to a cool, airy place, rehydrating with copious amounts of water with added mineral salts, lying on your stomach with your legs slightly raised, loosening belts or ties or tight clothing, and if necessary applying water baths of room temperature water to your forehead, wrists and neck, i.e. not excessively cold, which could have the opposite effect to that expected due to vasoconstriction. It is not necessary for all these symptoms to be present at the same time in the same circumstance. In any case, however, the resolution of sunstroke is usually quick and the clinical picture is not complicated'.

The month of June that has just ended recorded high temperatures well above average and already seems to evoke the nightmare of the summer of 2003, when there was practically uninterrupted high pressure from June to September. A vice that had caused so many deaths in Europe, over 20,000 according to estimates at the time. In France, there was a veritable massacre of the elderly, because the rest homes were not equipped, so much so that the memory of that peak of heat, which caused over 11,000 deaths, at least 80% of which were among the over-75s, is still alive. The figure had been calculated on the increase in deaths over the period compared to the average of previous years. The same calculation had been made in Italy by the Istituto Superiore di Sanità. The survey had been based on an active search for the extra deaths recorded compared with 2002 between 16 July and 15 August, both among residents and among those present, in the registry offices of the 21 main municipalities: compared with the previous year in 2003 there had been an increase of 2222 deaths (from 17493 deaths in 2002 to 19715 in 2003). Finally, an empirical estimate had been made of the excess mortality throughout the country, over the same period, among persons aged 65 and over, and the figure that emerged was as many as 4 175 deaths presumably caused by that anomalous heat wave. After that record summer, Italy began to equip itself with ad hoc plans against heat waves.