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 July 27, 2020
How extreme heat makes COVID-19 more deadly

 On a sweltering Sunday afternoon in North Miami, Carmen Arocho, 54, has taken her four grandchildren to a nearby supermarket --- not to get groceries but to escape the oppressive heat that's been baking South Florida. She doesn't like to do this often, as each trip increases the risks of them contracting the coronavirus. Miami-Dade County is currently the epicenter of the pandemic in the U.S., with local health officials reporting upwards of 2,000 new cases daily since July 1.

But with the heat index planted over 100 degrees, Arocho says she can't keep the kids at home in the two-bedroom apartment they share with her partner and their three adult children. Their air conditioning unit is old and often freezes if it's kept on for too long. When that happens, Arocho usually packs the family into their car with the engine idling and the AC running --- sometimes even during bedtime to help the kids fall asleep. But her gas costs have been racking up. She says she hasn't complained to her landlords about the faulty unit for fear of getting evicted.

The grocery store is her last resort. "We go in there and walk around to try to get some air because there's nowhere else to go," she says. Libraries and community pools are closed, and restaurants in North Miami are restricted to outdoor dining. Neither the city nor the county currently operates cooling centers in the area.

This year is already set to be the hottest one on record. A persistent July heat wave across much U.S. has been pushing temperatures to dangerous levels, complicating pandemic-fighting efforts in several cities that have become infection hotspots, like Miami, Houston and Phoenix. Residents in several cities reported waiting hours in the unrelenting heat to get tested, for example, and some sites were shut down as conditions became hazardous for staff. And as groups of residents flee to air-conditioned indoor spaces, they expose themselves to greater infection risk. It's a convergence of crises that public health experts saw coming months ago, when President Donald Trump floated the myth that the coronavirus would simply "go away" in the summer heat.

Seasonal spikes in heat-related illnesses may not only exacerbate symptoms in Covid patients, but also put further strain on hospitals already operating near or beyond capacity, says Ankush Bansal, a physician based in Palm Springs, Florida, who co-chairs the Florida Clinicians for Climate Action coalition. Heat waves kill more Americans that any other kind of extreme weather, and the communities most affected are low-income elderly adults, households that live in poor neighborhoods, and the homeless --- the same populations that are disproportionately vulnerable to Covid-19. As with so many other inequalities in the U.S., the pandemic exposes how some communities bear the brunt of climate change, and the divide between who gets to shelter indoors and who doesn't.

A third of all American households already struggle to pay their utilities bills or keep their heating and cooling systems on at home, according to the latest national residential energy consumption survey, done in 2015. More than 6 million households, or 5% of the national population, reported losing their air conditioning that year. The issue was more likely to affect minority and low-income households, as well as families with at least one child, according to the report.

Many live in homes with a high energy burden, says Michelle Kirwan, a pediatrician who serves low-income families like Arocho's at a community health center in Miami Gardens. "Their bills are higher because of the quality of their homes --- insulation, sealings around their door and things like that --- are less than standard," she says. "So I've had a lot of patients who've had electricity turned off."

The perils of cooling centers

Ever since a catastrophic 1995 heat wave killed more than 700 people in Chicago, many of whom were elderly apartment-dwellers who lacked air conditioning, urban health departments have focused on opening cooling centers --- large, air-conditioned public spaces --- for those who don't have AC at home, or don't have a home. But the coronavirus presents new challenges to such heat-relief efforts. "The problem is if you put in a bunch of people in an enclosed indoor space, then you're not maintaining social distance," says Bansal. "So you're increasing the risk of spreading the virus, particularly to those who are homeless and of low income."

Some cities are keeping cooling centers closed this year, while others have scaled back their capacity and put strict social distancing protocols in place. In Baltimore, where more than a dozen facilities opened up on Monday after temperatures crested 100 degrees for two consecutive days, staff and visitors go through health screenings and temperature checks at the door, and are required to wear masks. Tape on the ground helps maintain six feet distance between people, and each seat is immediately sanitized after use. Activities are kept to a minimum; instead, they're handing out magazines that visitors can take with them.

Each center is limited to only 25% of its normal capacity, but Molly Martin, deputy commissioner of the Baltimore Health Department, says the past few days have seen little attendance. She expects more people to come as word gets out and as the heat persists, though she's hoping a new program will keep most people at home. The city is handing out 1,200 window AC units and 25,000 box fans to low-income seniors, with some given to younger families and homeless shelters. "We had free box fans at one of our cooling sites on Tuesday, with curbside delivery, and people got there early," she says.

New York City is running a similar combination of programs, opening cooling centers while aiming to install 74,000 portable AC units in low-income homes and public housing units occupied by at-risk older people. Houston is distributing at least 250 machines mostly to seniors with heat emergencies, but will only open cooling sites if there is a large number of people seeking shelter at once. Right now, the city gets about 50 calls a day for heat-relief assistance, and those who don't qualify for a unit get help with finding somewhere else to cool off --- be it a neighbor's house or some sort of public space --- with the city providing transportation if necessary, according to emergency management coordinator Nickea Bradley.

Other municipalities have come up with different solutions: San Antonio, Texas, and Montgomery County, Maryland, turned buses into mobile cooling stations stocked with water bottles, Chicago has reopened some splash pads, and Maricopa County in Arizona recently turned a vacant courthouse in downtown Phoenix into an overnight shelter for the homeless.

Miami-Dade County hasn't announced any plans to open cooling centers, but even if they were to, Kirwan says she wouldn't feel comfortable recommending them to her patients at this time. Yet coming up with alternative suggestions to escape the heat is just as challenging: "It's hard to make recommendations when your families don't have money, or AC. I rack my brain trying to come up with things and I get roadblock," she says, adding that she's frustrated the local government hasn't done more to provide relief.

The high cost of staying cool

Cooling centers and the alternatives to them are, at the end of the day, just a temporary stopgap fix to a long-standing issue that will only worsen as climate change leads to more extreme weather. "What cities should do is not have policies that basically force low-income people to have no other means except to go to cooling centers," Bansal says. That means ensuring low-income households have access to efficient cooling and affordable energy at home and that landlords be required to provide air conditioning to renters. Florida, for one, ranks among the lowest of all states in energy efficiency, and has no such cooling protections for renters.

On July 21, the Miami-Dade County announced that it would provide crisis assistance for families affected by Covid-19 through the federal Low-Income Home Energy Assistance Program, with funding from the CARES Act. Residents can receive up to $2,000 in utilities assistance within a 12-month period if they meet the qualifications --- which say, among other things, that recipients cannot earn above 150% of federal poverty income guidelines. It's a good start, says Mayra Cruz, climate resilience program manager at the nonprofit Catalyst Miami. She's concerned that the people who need it most aren't aware of the program, or lack computer and internet access to submit an application online since government offices are closed. "There's more we can do to ensure that the burden doesn't fall on impacted community members to get relief at this time," she says.

For local advocates like her, it's a small win in a larger battle over climate justice and energy conservation across Florida. Consumers are at the whim of the dominant utilities company Florida Power & Light (FPL), which in 2019 sought state approval to slash energy efficiency goals to zero or near zero, and scale back energy and cost-saving programs for low-income families, says Cruz. Her nonprofit is part of the Miami Climate Alliance, which is urging FPL to extend its current moratorium on electricity shut-off to at least the end of the year, and to reduce utility costs.

In a statement to CityLab, FPL spokesperson Chris McGrath says the company is "continuing to suspend disconnections for nonpayment," and have not made a decision on when to resume them. He also said they will continue "to waive late fees and offer customers additional payment extensions" to those struggling to pay their bill.

All the while, as the temperatures climb, monthly bills get higher. "We've heard community members talk about how they've been struggling to keep up with electricity, especially during the summer," Cruz says. "Now that we're all stuck at home, bills have gone up by $50 over the last few months. You can't expect those families to keep up."

One such hard-up Miami resident is Lynn, who asked CityLab not to publish her last name to maintain her privacy and because she worries about the stigma she might face for seeking public assistance. She says she's 60 and fell behind on her monthly electricity payments after losing her job at a local nursery school because of the pandemic. Catalyst Miami helped her pay some of those bills, but she still owes the company more than $360. She avoids turning on her AC, which would cost some $300 a month, even as temperatures inside her older home exceed temperatures outside. Instead, two fans she bought from Walmart whirred in the background as we spoke.

"I worked my way through society and I accomplished getting a home," Lynn says. "When I got it I was in good shape, working two or three jobs, but now as I get older, it's hard for me to maintain it and I don't have extra income coming in to pay for electricity." The Covid pandemic and her mobility challenges has made it difficult to find a new job, and she doesn't qualify for assistance aimed at families below the poverty line or at renters. She's frustrated, she says, because she's just going through a "rough patch" but isn't finding help to get back on her feet. And it's taking a toll on her mental health.

Her story isn't exceptional in Miami-Dade, where roughly a third of households are so-called ALICE households (Asset Limited, Income Constrained, Employed). They live above the poverty line but don't earn enough to afford basic household necessities. Often, they are only one emergency away from financial instability, Cruz says.

"We see Covid cases continuously rising and it's not stopping --- we're hitting record numbers each day," says Mackenzie Marcelin, climate justice organizer for the political nonprofit New Florida Majority, which is also part of the Miami Climate Alliance. "We need to say, 'Hey, we can't keep putting these residents in anxiety each month.'"