Image by Michael Gaida from Pixabay.

The man who showed up to Dr. Janet Eddy’s mobile clinic was in his 40s. He had diabetes, but it was “well controlled,” she recalled, and he was healthy enough to put in a full day’s work as a landscaper.

He also had a temperature of 105 degrees Fahrenheit — a full degree above the threshold considered to be life-threatening.

Diagnosis was clear: heat stroke. Sent by rescue squad to the hospital, he would take three days in intensive care to recover.

For Eddy, a physician who has worked with uninsured and underinsured patients in Central Virginia since 1990, it was a wakeup call. She was accustomed to treating outdoor workers, many of them migrants doing day laborer jobs in agriculture, construction or landscaping, but “after that,” she said, “I started realizing how high risk this group is.”

As climate change continues to drive peak summer temperatures upward, those risks are only increasing. Between July 16 and 22 this year, when a dangerous heat wave settled over the East Coast and drove heat indexes in Richmond and Hampton Roads as high as 109, more than half of visits to Virginia emergency departments and urgent care centers for heat-related illnesses were made by people between the ages of 20 and 49. About 70 percent of all those visits were made by men.

During a heat wave, “many people just don’t go outside, but there are groups that just don’t have a choice,” said Dr. Samantha Ahdoot, a pediatrician and founder of Virginia Clinicians for Climate Action. “Those groups often bear the brunt of heat illness during extreme heat events.”

Ahdoot is part of a growing group drawing connections between changing climate and health outcomes. Nationwide, the Medical Society Consortium on Climate and Health, which is affiliated with George Mason University, has mobilized practitioners to highlight the health risks associated with climate change and advocate for solutions to them, including greater reliance on clean energy. Since its founding in 2015, the Virginia Clinicians for Climate Action, which Eddy is also involved with, has served as the state voice for the consortium.

“As we’re changing the climate, we’re seeing changes in a host of medical issues,” said Ahdoot. “It’s happening already, but obviously as the climate continues to change, we expect it to become more apparent.”

Temperature shifts are one of the more evident signs of climate change.

“We’re seeing a pattern of a warmer, more extreme heat season here in Virginia,” said Jeremy Hoffman, chief scientist at the Science Museum of Virginia. Not only are daily peak temperatures on the rise, but summer nights are cooling less than they did in the past. According to one study by Hoffman and colleagues, on average, maximum summer temperatures in Virginia were almost 0.6 degrees Fahrenheit higher over the past few decades than they were over the past century, with Northern Virginia’s maximum temperature being more than 0.9 degrees higher. At the same time, the minimum summer temperature, which reflects nighttime heat levels, went up by about 1.1 degree.

Those shifts are affecting virtually all of the commonwealth. During the late July heat wave, Hoffman said, 31 of Virginia’s 35 health districts reported higher incidences of heat-related illness (the four districts spared the most intense effects were found in the more mountainous southwestern and south-central portions of the state).

Multiple groups of people are affected by increasing temperatures, including the elderly and already ill. But outdoor workers are often overlooked, even though they consistently show up as being at high risk in heat exposure studies. One such recent study from North Carolina reported that a third of all heat-related illness visits to emergency rooms between 2008 and 2010 were work-related.

Nor is the problem isolated to certain areas. Agricultural workers — who numbered about 54,000 in Virginia in 2017, with some 13,000 being seasonal or migrant — are some of the most vulnerable due to long hours spent in fields with no shade during the hottest parts of the year.

Yet urban outdoor workers toiling in jobs like construction suffer too because of a phenomenon known as the “urban heat island,” where density, an overabundance of concrete and a lack of shade or heat-absorbing organisms like trees combine to make developed areas hotter.

On July 20, the peak of Virginia’s heat wave, Hoffman and Old Dominion University climate scientist Michael Allen found that urban heat islands in Norfolk had temperatures as much as 16 degrees higher than the city’s coolest parts.

When Hoffman combined ambulance response and temperature data, he found what he called “a very strong correspondence” between heat-related illnesses and urban heat islands that persisted even when he corrected for other factors.

“The hotter zip codes have higher rates of heat-related illnesses,” he said.

As heat exposure risks grow, physicians are increasingly looking toward legislation to protect outdoor workers by instituting standards such as mandated breaks with shade and water once temperatures reach a certain level and required training for supervisors to detect signs of heat-related illness.

“We only expect this to become an increasing problem as temperatures continue to warm, so it’s increasingly necessary that standards are in place that will protect workers in increasingly hazardous conditions,” said Ahdoot.

Currently, there is no federal standard in place to regulate worker exposure to heat, although in 2016, the National Institute for Occupational Safety and Health published recommendations for such a standard. California, Minnesota and Washington have also adopted their own standards on the state level.

In Virginia, workers visiting Eddy’s mobile clinic have generally told her that their employers do regularly offer them rest and shade. But she also cautioned that in different circumstances, “none of my patients would ever whistleblow on their employer because they need the work so bad.”

“Given how bad things are getting with the heat, and the heat combined with pollution, I think they should be stepping up and making some rules,” she said.