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MICHAEL DUNNE: I'm Michael Dunne. When you talk to longtime residents of our region, they often say the same thing, I don't remember it ever being this hot for this long in the summertime when I was younger. And of course, the science and climatology back that up, we are indeed seeing higher temperatures and more sustained heat waves in our communities and in the state as a whole. This increase due to climate change is already impacting our environment. What about us, the people who live here today, on the show, we talk with our frequent guest and public health expert, Dr Patrick Luedke, medical director of Lane County. He'll talk about the direct and indirect public health risks of our hotter environment and how it contributes to bad health for adults and children alike. Dr Patrick Luedke, Lane County's Medical Director. Thanks so much, as always, for coming in and talking with us.
DR. LUEDTKE: Happy to do so. Michael, thank you for the invitation.
MICHAEL DUNNE: We're speaking on a fairly temperate day. It's not too hot, in fact, a little rain. But obviously, you know, this summer has been a pretty hot one. And I just wanted to ask you, from a public health overview, talk about how heat impacts public health.
DR. LUEDTKE: Oh, my, it does. And there are multiple areas we in the public health space divided up into areas. So for example, direct physical weather impacts. Heat Waves affect people, especially those who are working outside, or some people unfortunately live outside. They're houseless, and the heat impacts the risk of wildfires, which unfortunately we know more and more about in this part of Oregon, and that affects air quality, yeah, and then heat does these differential impacts that I think many people don't think about so part of the paradigm of public health response is looking at these different types of impacts and heat impacts animals, including ticks and mosquitoes as well. So that's part of our disease surveillance system. And have you ever heard of a tick drag, Michael?
MICHAEL DUNNE: I don't think I have.
DR. LUEDTKE: Well, ticks are a drag, but yes, we do something in the environmental side of public health, where we go out with a standard size white cloth, okay, we pull it across the ground, typically where grasses are sometimes in the woods for a select distance, and then any ticks or other bugs that are out there will pop onto this bright white cloth, and They're easy to see because it's white, and then we speciate them. So, what are the ticks? And then we have them tested to see what's in them. So, the heat waves and the overall changes in climate don't just impact us, but they impact, you know, the animal kingdom. So, we're seeing different ticks, and those ticks carry different diseases. So we're also looking in that space.
MICHAEL DUNNE: It's always interesting, as our climate is getting warmer and we're talking more about heat, I want you to kind of compare and contrast, from a public health perspective, how we protect people from the cold in winter to the heat in the summertime, because obviously, you know, serious cold happens. We have things like the Eagan Warming Centers and whatnot that provide that kind of thing. But you know with it getting hotter, I'm wondering if public health is has made a bit of a shift to spend more time and resources on Okay, now we got to protect people from, gosh, March until October or something like that?
DR. LUEDTKE: Well, it's interesting. This, I guess, line of inquiry, my first several years in Oregon, the west side of Oregon, okay, we didn't have the need to open cooling centers, or if we did, it was for a very short period of time. In the last 5, 6, 7 years, we've opened them for days because of huge heat spikes. So probably what's most visible with regards to what public health is doing locally, is opening these cooling centers and providing water and spray showers to cool people off, and using the fairgrounds and other sites, it is, unfortunately a fact of life that sometimes these are needed, and we also need to respond to people who may have a home but they don't have air conditioning, a fair number of people on the western side of this state. Don't have air conditioning, and if you have days and days of heat, that's a challenge. Now, one more challenging point, especially with regards to people who are at home most of the time, for example, the elderly. Many elderly people are at home a good deal, and some can't get out because of disability and such, and they may have medications that they need. So public health has been working with the clinical community. Collectively, it's not just our idea. How can we make sure that if a forecasted heat wave is coming that may or may not include bad air quality from a wildfire, that people have the medications they need, the critical medications, their seizure medications, they don't run out of them during seven days of bad air quality or excess heat or their cardiac medication? So, we've done a lot of work in that space, and we've had a lot of collaboration from our CCOs, CCO coordinated care organizations. So, Trillium and Pacific source, okay, great. They have worked really hard to make sure that we can provide extra access and give longer prescriptions for medications during a heat wave. And if the medications are lost because it got too hot in somebody's apartment, we can replace those medications because those organizations have been flexible in this space, okay, probably more than you wanted to hear…
MICHAEL DUNNE: No, that is very instructive. And it gets to a point to that, in addition to public health experts such yourself, you know, helping people and treating people, you also are data collectors, and I wanted to kind of ask in your long and storied career, what are some of the impacts on individuals that you're seeing more of now because of heat related trauma, if you will.
DR. LUEDTKE: Well, I'm going to start with something that's rare so it impacts very, very few people, but the numbers have increased over time. I suspect you and probably listeners have heard of the brain eating amoeba. Its genus and species is the naegleria fowleri. It lives in warm waters, and people who will dive into a warm pond or something, the amoeba can get into your nose. Sometimes you put your head underwater, and then that amoeba tracks up your olfactory nerve, your smelling nerve gets into your brain. Kind of an ugly, nasty thing.
MICHAEL DUNNE: I'm cringing as you're describing it.
DR. LUEDTKE: I'm sorry. So we're seeing more of these cases now. They're distinctly rare. You know, we're talking about a few handfuls a year, but we went, you know, years with zero cases, so we're seeing more of those, and that's an area where we are concerned. We need to do messaging to make sure people know that there was a case in this area. You could be at risk. Please don't go in the water. And if you do, don't put your head underwater. Just enjoy it, or have your dog enjoy it, you know, with limited impacts. Okay, now, second part of your question, what was it?
MICHAEL DUNNE: Well, the second part was just kind of, what are you seeing in terms of, you know, heat impacts on individuals. Because I imagine, like you said, you know, when you first started, it was, it was more about, you know, protecting people from cold weather and stuff. What are some of the, you know, community wide impacts you're seeing because of heat?
DR. LUEDTKE: So, we do see, we do have data, national data. We have fewer great data locally. Our numbers are small, but across the state as well, the heat impacts result in an increase in cardiovascular disease. So, it stresses your cardiovascular system. We see more heart attacks and strokes. Now, people who are at risk of heart attacks and strokes, they may have one anyway, so we're always looking closely at the data, but heat clearly stresses the system, and we see an increase in that space. We also see, especially if the air quality gets worse, whether it's with wildfires or not, we see more asthma attacks and more exacerbations of COPD. I think many people know chronic obstructive pulmonary disease or COPD, and that data, especially urgent care and emergency department data, is really quite good. When the air quality gets bad, whether it's just from a heat event with high ozone or it's a heat event with wildfire smoke, we clearly see more asthma attacks and COPD, and that's miserable for the person, and it's costly for the healthcare system. And it can, you know, impact productivity. If people are working and they're taking care of their family, it's a problem, and we need to watch that too.
MICHAEL DUNNE: There's been in the literature, a strong link between, you know, dark, cold, rainy days and, you know, seasonal affective disorder, depression. But it's funny, I was just with some friends, and we were all happy that, you know, it was cooler. Do these heat waves? Is there any link with mental health problems?
DR. LUEDTKE: So, there are links to mental health, especially when you have physical health suffering as well. Okay? And gosh, think of yourself, Michael, when you've been hot and sticky and you can't get cool. Hmm. And then add to that the worry of a fire coming your way. You know, many of our facilities are such, especially our homes are stick built, you know, they can burn. Some of our larger businesses might be cement and, you know, steel walls and such, but sure, people worry about that as well. Now, do we have data showing directly if the temperature goes up one or two degrees, the percentage of depressed individuals goes up. We don't have that kind of data, I see, but we know that there's a lengthy burden where, if the risk goes on for an extended period of time, the level of burden on people from physical health impacts their mental health. I think that would be wise, perhaps, to, let's bring on a psychiatrist or a psychologist…
MICHAEL DUNNE: Probably, probably a good idea. You talked about, you know, certain, certain bugs that might last longer because of heat. I am also wondering about, I mean, do viruses and other things, do they prefer the hot weather, or does that suppress their ability to infect? Kind of how does the weather and heat impact those kinds of pathogens and what it might mean to the human population?
DR. LUEDTKE: So, in the public health space, we look at new diseases that may show up, like Dengue, and we'll talk about that in a second, okay, and then impacts on existing diseases. So, we have West Nile virus in Oregon. We don't have a lot of it, but we definitely have it. Mosquitoes typically stop biting around 55 degrees or so. When the nights are persistently warmer, they don't drop down into the 50s. There's more biting. And the mosquitoes that cause West Nile are night biters. So, we are worried that we'll see more West Nile, because there'll be warmer evenings and there'll be more biting opportunities when you're out to see that evening baseball game or something. And so, we have surveillance systems to watch that on the other side of that coin is a new mosquito. So I suspect you've heard that the Aedes aegypti mosquito, which is a nasty mosquito, because it transmits yellow fever and Zika and chicken gun, yeah, lots of yucky things we don't want. Yeah, it showed up for the first time ever in Jackson County last year, and it wasn't just in one mosquito trap. It was in multiple places, 20 plus sites. So now that mosquitoes have entered the state, we potentially could have something like Dengue or yellow fever or etc, and we don't like to fear monger. We don't want to scare people, sure, but here's a paradigm that has actually occurred. In 2013 Los Angeles had its first ADC glyptoxide cases. Fast forward just a handful of years, and they had dengue cases and people who never left Los Angeles. Wow. And you know, dengue is a viral illness spread by mosquito bites. It potentially infects a few 100 million people a year on planet Earth, typically in tropical and subtropical places. But now, LA, if you were to Google la last fall, you'd see multiple outbreaks of dengue in people who never left. So now Oregon is potentially at risk of the same. I don't think we're gonna see yellow fever. That's typically a much warmer kind of Amazon, Brazilian rain forest thing, but once you get the new mosquito that can transmit it, you got to start planning.
MICHAEL DUNNE: Speaking of planning, you know, I always think it's a good opportunity when you're here to remind people, I know we're heading into fall. It is going to get colder, but it's still going to be warm for a while. What are some of the best things that people can do? Obviously, seek out cooler shelter. But what other things, especially people who have to go outside, what are some things that people should be doing to limit the exposure, to limit the potential damage from heat.
DR. LUEDTKE: When I used to be a big runner, I've done my share of marathons, okay, no, 20 some mile races and when I was, hate to say the word addicted, but I really if I didn't run, I was not a nice person. I think that I've given myself a day, and I probably, when I was younger, would have gone out and run, no matter the air quality. And I think what people need to do, if they're outdoor workers or especially recreation, where they have a choice, if you have, if you have a job and work outside, well, you got to pay the bills, right? But they should look at the weather and look at the air quality. We're very lucky to have a good organization like El Rappa. It's on the website, you can look at air quality and look at that first. And do you really have to go out and do that 10 miler today? Can you put it off a day or two or do something indoor? So be thoughtful. Look at the weather. Plan accordingly. Also, you know, people always talk about drinking eight glasses of water today and all these sorts of things that are not necessarily scientifically based, but we want people to be hydrated. Be thoughtful about hydration, and make sure that you have access to it, and if you're going to be working hard, have access to that water and your kids or your animals, same thing, and I think finally, is be proactive. Look ahead. We're so busy. These days, oh my gosh, life is just chock full, and especially if you have kids at home, if you're parenting, you know you're dealing with multiple lives, try to look ahead a little bit and say, Okay, I really want to do A, B or C or D, and it looks like this is a good time to do it, or this is not a good time to do it. And see if you can move your schedule a bit to accommodate health.
MICHAEL DUNNE: To that point, infants, I've always heard that an infant that's cold is going to cry and let you know that they're cold, but I also heard that maybe during heat episodes, they may not provide that direct impact. Is that true? In other words, give some advice to people with infants as well to make sure that they're protected.
DR. LUEDTKE: Yeah, you know infants. You know pediatricians will tell you that infants are not little adults, some of their chemistry is different, sure, and they can become dehydrated much more quickly than you can, okay. You know, if you think about it, you mentioned the fall time it's getting cooler, you go up and breathe on a mirror and it fogges up. Yep. Well, an average adult breathes Oh, 10 to 16 times a minute. An average infant breathes 35 to 45 times a minute, wow. They are therefore breathing out more water vapor, and they can become more dehydrated more quickly. So, you have to be very careful with infants, but it's easy to see most of the time. If you're an attentive guardian or parent, whether or not they're hydrated, is their skin pale? Is it dry? What are their mucous membranes? You know, in their eyes their nose looks like but it's really important to be attentive to that, because kids’ infants can become dehydrated very, very quickly.
MICHAEL DUNNE: Okay, let's switch gears really quick. Just want to take the take, take the opportunity to talk to you, because you're here about vaccines, and I'm, I'm not going to ask you to get into the politics of it, but I am just from, from, from your job and what you do for the county, you know, how you, how concerned are you about the confusion that seems to be right now with regard to guidance on vaccines, who can get them, who cannot, especially with regard to the big ones, covid and seasonal flu.
DR. LUEDTKE: So, I am concerned about the uncertainty and in the best of times, which don't happen very often these days, in the best of times, it's still hard to get access to vaccines for many people, and it's hard to get messaging to many people about what is the best thing for you and your family. So here we are now, in significantly less than the best of times, we have multiple different communications out there about what's good, bad and what's indifferent. And we don't have a single harmonized source of truth, so to speak. And that continues to cascade down into the payers, the insurance companies. We are asking insurance companies, what are you going to pay for this year? The FDA says one thing, and the CDC has not said enough, because of the changes to that advisory committee. We are, I think, in a better space that some of the western states and Hawaii just joined. So now it's the three Coast states and Hawaii are joining this Western, you know, Health Alliance. Hopefully we will have clarity this month. There'll be clarity in the state, okay, about what will be recommended and paid for. Okay? I believe that's going to happen within the next two weeks. Now, am I certain? No, that's run by the state health department, sure, but it's coming. In the meantime, we have years of data on flu vaccines. We're fortunate that last week, the Advisory Committee on Immunization Practices, that CDC Advisory Committee, we call an ACIP for short, they did come out and recommend continuation of flu vaccine for everyone six months and older. So that's what it's been for several years. I think some people were surprised that it happened, but it did. So, we can continue to say everybody should get a flu vaccine if you're six months and older, unless you have an anaphylactic reaction to it, don't get that product, but that's tiny, tiny percent of people. Yeah, Covid is harder. It's gonna be harder. We need clarity, and I'm nervous until we get it okay.
MICHAEL DUNNE: If somebody is thinking, Okay, I know that I'm under 65 but I've got some preexisting health conditions that I really want to mitigate for, something like covid. What is there any general advice that you might want to try and give them? Because I know there's a lot of uncertainty, but you know, if I'm I don't know what type two diabetes or something like that, is it talk to their doctor? Is that kind of the advice it is if they are under 65?
DR. LUEDTKE: it is if, if they're under 60, to 64 in adults, and they have a risk factor that's on the list, they should be able to get vaccinated, and it should be paid for by their payer, whoever their insurance company is. We struggle in the governmental world. You can't write a policy. That includes everything. It's just hard. So, one of the problems right now is people who are clearly at risk for getting exposed to covid health care workers, they're not on the list of people at risk, so we have to change that. If a health care worker wants the vaccine, he or she should get it, and it should be paid for by their insurance. And hopefully the CDC, or maybe this Western States Alliance will say healthcare workers are on the list too, even if they don't have an additional risk factor. I've had multiple clinics and one of the hospital groups call me and say, what's going on with this? Recommendations for healthcare workers? We're working with OHA, the state health department, to try to get clarity in that space. Again, I'm hopeful, within about two weeks, that we will have clarity.
MICHAEL DUNNE: All right. Well, we'll keep our fingers crossed too. Dr Patrick Luedtke, the medical director for Lane County, always, always appreciate you coming in, talking with us and the council that you provide.
DR. LUEDTKE: Thank you, Michael.
MICHAEL DUNNE: That's the show for today. All episodes of Oregon On The Record are available as a podcast at KLCC.org. Tomorrow, on the show, we'll bring you a special conversation with KLCC’s Love Cross, who will tell us the emotional story of one resident’s loss and recovery from the terrible fires that swept across our community five years ago. I'm Michael Dunne, and this has been Oregon On The Record from KLCC. Thanks for listening.
