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      Have health inequities, the COVID-19 pandemic and climate change led to the deadliest heatwave in France since 2003?

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          Abstract

          Objectives

          Between 2015 and 2019, 5700 excess deaths were observed during heatwaves in France. The summer of 2020 combined exceptionally high temperatures with the COVID-19 pandemic. The associated health impacts of this unique situation are described in this study.

          Study design

          This is an observational study based on indicators of the French heat prevention plan.

          Methods

          Mortality and morbidity data during heatwaves were compared between 2020 and previous years, alongside COVID-19 in-hospital mortality.

          Results

          In total, 1921 additional deaths (+18.2%) were observed during the 2020 heatwaves, which is the largest number of deaths observed since 2003. Less than 100 deaths were attributed to COVID-19 during the heatwaves of 2020.

          Conclusions

          Exceptionally high temperatures driven by climate change, combined with health inequities exacerbated by the COVID-19 outbreak, may have increased vulnerability to heat in 2020.

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          The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate

          Nick Watts, Markus Amann, Nigel W Arnell … (2020)
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            France's heat health watch warning system.

            Mathilde Pascal, Karine Laaidi, Martine Ledrans … (2006)
            In 2003, a Heat Health Watch Warning System was developed in France to anticipate heat waves that may result in a large excess of mortality. The system was developed on the basis of a retrospective analysis of mortality and meteorological data in fourteen pilot cities. Several meteorological indicators were tested in relation to levels of excess mortality. Computations of sensibility and specificity were used to choose the meteorological indicators and the cut-offs. An indicator that mixes minimum and maximum temperatures was chosen. The cut-offs were set in order to anticipate events resulting in an excess mortality above 100% in the smallest cities and above 50% in Paris, Lyon, Marseille and Lille. The system was extended nationwide using the 98th percentile of the distribution of minimum and maximum temperatures. A national action plan was set up, using this watch warning system. It was activated on 1st June 2004 on a national scale. The system implies a close cooperation between the French Weather Bureau (Météo France), the National Institute of Health Surveillance (InVS) and the Ministry of Health. The system is supported by a panel of preventive actions, to prevent the sanitary impact of heat waves.
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              A simple indicator to rapidly assess the short-term impact of heat waves on mortality within the French heat warning system.

              Annamaria Antics, Mathilde Pascal, Karine Laaidi … (2013)
              We propose a simple method to provide a rapid and robust estimate of the short-term impacts of heat waves on mortality, to be used for communication within a heat warning system. The excess mortality during a heat wave is defined as the difference between the observed mortality over the period and the observed mortality over the same period during the N preceding years. This method was tested on 19 French cities between 1973 and 2007. In six cities, we compared the excess mortality to that obtained using a modelling of the temperature-mortality relationship. There was a good agreement between the excess mortalities estimated by the simple indicator and by the models. Major differences were observed during the most extreme heat waves, in 1983 and 2003, and after the implementation of the heat prevention plan in 2006. Excluding these events, the mean difference between the estimates obtained by the two methods was of 13 deaths [1:45]. A comparison of mortality with the previous years provides a simple estimate of the mortality impact of heat waves. It can be used to provide early and reliable information to stakeholders of the heat prevention plan, and to select heat waves that should be further investigated.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Public Health
                Journal ID (iso-abbrev): Public Health
                Title: Public Health
                Publisher: The Royal Society for Public Health. Published by Elsevier Ltd.
                ISSN (Print): 0033-3506
                ISSN (Electronic): 1476-5616
                Publication date PMC-release: 21 April 2021
                Publication date (Print): May 2021
                Publication date (Electronic): 21 April 2021
                Volume: 194
                Pages: 143-145
                Affiliations
                [1]Santé Publique France, 12 Rue Du Val D'Osne, 94415, St Maurice, France
                Author notes
                [∗ ]Corresponding author.
                Article
                Publisher Item ID: S0033-3506(21)00070-6
                DOI: 10.1016/j.puhe.2021.02.012
                PMC ID: 8462812
                PubMed ID: 33894555
                SO-VID: a30347ee-7ff5-46d7-83d4-da9d934f99c9
                Copyright © © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 19 November 2020
                Date revision received : 22 January 2021
                Date accepted : 13 February 2021
                Categories
                Subject: Short Communication

                ScienceOpen disciplines: Public health
                Keywords: heatwave,climate change,mortality
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: heatwave, climate change, mortality

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