Jack Esry died alone in his home on July 25, 2019.
As temperatures soared close to 110 degrees, Esry's son Bill, who lived out of state, had worried that his aging father, who had already been injured in a serious fall, would be affected by the extreme heat.
His dad's air conditioning unit had failed and Jack had delayed getting it fixed. He kept his windows closed, fearful his cats would escape. Finally, a friend called Bill to say his dad had missed a weekly chat.
Bill called authorities and asked for a welfare check.
When Scottsdale police arrived, the house was a scorching 99 degrees inside.
Jack Esry had succumbed to the heat.
Esry, 80, was one of a record 197 people in Maricopa County who died from heat-related causes in 2019. That surpassed the previous record of 182 deaths in 2018, which surpassed the record of 179 deaths in 2017.
So far in 2020, the Maricopa County Health Department has confirmed 30 heat-related deaths. The agency is investigating an additional 243.
The death toll rises in a way that would drive dramatic headlines if tied to a single weather event. Hurricane landfalls typically claim far fewer lives.
Instead, heat deaths happen one at a time, over the growing number of weeks and months each year when the weather turns dangerous. They are tied not to a single event but to an ongoing one, the rising temperatures that affect all seasons.
Over the past 30 years, heat has accounted for more fatalities on average than any other weather-related disaster in the U.S., according to the National Weather Service.
And while heat deaths may be more acute in the desert city of Phoenix, the warming climate that helps drive them is not likely to leave any major American city unscathed.
Hot days, hotter nights
Along with longer days, school holidays and the annual departure of the human snowbirds from Phoenix, summer comes with heat and, increasingly, the heat doesn't let up at sundown.
Phoenix area residents accustomed to blazing summer days are also being hammered by rising nighttime temperatures. More than once this summer, the thermometer still read 100 degrees at midnight and for more than seven days in July, the temperature never dropped below 90 degrees, setting a new record.
The region also contends with longer summers as days grow hot earlier, sometimes as soon as April, and stay hot well into October.
And summers won't grow more temperate any time soon. Climate change has increased the average temperature in Phoenix by 4.35 degrees since 1970, according to a 2019 report by Climate Central.
The expanding urban heat island hoards heat in asphalt, concrete and tall buildings during the day and releases it at night, which has resulted in nighttime temperatures soaring as much as 10 degrees above historical records.
These factors helped contribute to Phoenix being named as the fourth fastest-warming city in the U.S. With an average of 169 days per year with temperatures of 90 degrees or higher and an average midsummer high temperature of 106.1 degrees, Phoenix was also ranked as the hottest big city in the U.S.
As if to underscore the trend, the average temperature in Phoenix during July was 99 degrees, which made July the hottest month on record.
But it's not just desert cities like Phoenix and Tucson that are threatened by hotter summer temperatures. Deadly heat is on the rise across the United States. Cities including Burlington, Vermont; Chattanooga, Tennessee; and Helena, Montana, are right behind Phoenix as members in Climate Central's top 10 fast-warming cities list, experiencing temperature rises of more than 4 degrees.
Chattanooga experienced what one meteorologist called a "death ridge" during a May 2019 heat wave. The city and surrounding region experienced record temperatures - Chattanooga's high temperature was more than 10 degrees above normal for late May. The Tennessee Valley city's summer temperatures stretched into fall, reaching 100 degrees in October for the first time since weather records have been kept.
Even Minneapolis, known as the coldest large city in the U.S., has seen a 3.72 degree temperature rise.
"We are seeing more intense and longer heat waves, and while everywhere is used to dealing with seasonal extreme heat events for their given city, many northern areas may not able to adapt fully to extended periods of heat the same way as the south," said Jennifer Vanos, professor of sustainability at Arizona State University.
"When heat combines with humidity over many days, like we see in much of the Great Lakes region," Vanos said, "it can become particularly dangerous."
As highs and lows continue their inexorable rise, long-running factors including poverty, homelessness and isolation for the elderly have begun to intersect with new effects of the COVID-19 pandemic, which may limit incomes and shutter the facilities that help some people escape the heat. The combined effects could lead to a higher death toll this year.
How heat kills
As the air temperature rises, so does the body's temperature, said Mona Sarfaty, director of the Program on Climate and Health in the Center for Climate Change Communication. In response, a person begins to sweat.
"The sweat evaporates from the skin as long as the air isn't too humid," Sarfaty said. "So you would expect that sweat to evaporate and cool things. It's the body's way of cooling itself."
Without an opportunity to cool the body down, she said, people begin to feel the first symptoms of heat illness.
"You get headaches," Sarfaty said. "You may just start to feel kind of dizzy or lightheaded. You may have some cramping, either abdominal cramping or muscle cramping."
The longer someone is overheated, the worse the body's response. If a body's core temperature soars to 104 degrees or higher, the heart starts to pound and breathing speeds up. Eventually, the heart, lungs, kidneys, liver and brain will become damaged.
When that occurs, without immediate medical treatment, lifelong damage or death can occur within 24 hours.
Higher nighttime temperatures also make heat-related illnesses and deaths more likely.
"People need time to recover from the heat," said Nancy Selover, Arizona's state climatologist. "If your body has a chance to cool and recover, you're OK to go again the next day. But if you can't get that cooling relief, then it's hard to sleep when it's 85 degrees."
Selover said there are more days when nighttime temperatures never dip below 90 degrees, once a rare phenomenon.
In July, Phoenix broke the record for the most nights with low temperatures of 90 degrees or above and, by late August, there had been more than 25 days when the temperature remained above 90, day and night.
Rising humidity also factors into more dangerous summer days across the nation. The intersection of temperature and humidity can turn deadly with a thermometer reading as low as 100 degrees if the humidity rises to 35% or higher.
Weather and climate experts measure the effects of heat and humidity with what's called a heat index. Excessive heat warnings are issued when the heat index is expected to reach 105 or higher for at least two days, and nighttime temperatures will be 75 degrees or higher.
Colin Raymond, a researcher at the Jet Propulsion Laboratory in California, said adding humidity into a hot day affects the body's ability to cool itself.
"It's like being in a steam room," Raymond said. Days of higher temperatures coupled with higher concentrations of water vapor in the air can cause people to fall ill in large numbers, although he said more research is underway to more fully understand the effects.
A report by the Union of Concerned Scientists said if warming proceeds without any action to reduce heat-trapping emissions, one-third of the nation's 481 urban areas with populations of more than 50,000 people, including Phoenix, will experience an average of 30 or more days per year with a heat index registering more than 105 degrees.
The combination of increased heat and inadequate mitigation can be lethal: The Maricopa County Department of Public Health's statistics indicate that deaths attributed to heat increased 232% from 2006 to 2019.
Many of those victims were homeless or elderly, both considered particularly vulnerable communities. Because the county has focused on more closely evaluating deaths for heat-related causes, their figures capture more cases than do national sources.
The Arizona Republic examined reports from 164 autopsies performed in Maricopa County between Jan. 5 and Sept. 6, 2019. By Dec. 31, the county would add another 33 deaths to that total. Of the reports examined, 141 revealed that death was either heat-caused or heat-related. Others appeared to suggest that heat may be a factor; three deaths were caused by exposure to cold temperatures.
"We know that we are the hottest county in the U.S.," said Vanos, at ASU. "We're also the fastest-growing county in the U.S., so we should have the smartest policies and programs for reducing public health impacts that are associated with heat."
Vanos said existing programs don't seem to be effective at protecting the area's most vulnerable, like people who don't have air conditioning. Seniors and homeless people are also succumbing at increased rates. And transit riders in the metro area are greatly challenged as they deal with little shade and heat radiating off asphalt.
Low-income families struggle
Summer in Phoenix typically starts with stifling heat with low humidity. Once the monsoon sets in, that sense of being dry-roasted gives way to steamy, oppressive heat that is inescapable even at night.
Most people would rely more on their air conditioners, but many low-income families don't have that luxury.
Tucked into a largely Latino neighborhood in south Phoenix, one family has struggled to keep cool yet not run out of money during the torrid summer monsoon.
Blanca Abarca, her husband and 14-year-old daughter, Isabella, lack the means to cool off that many people take for granted: air conditioning. The Abarcas rely on a different technology - two evaporative coolers - in their modest 1950s-era brick home.
The coolers reduce air temperature by blowing water-charged air through the house. But a swamp cooler, as it's often called, becomes ineffective once the dew point, a combination of temperature and moisture in the air, reaches 55. Abarca's husband, a handyman, installed ventilators in the ceiling and floor to circulate more air, but during the monsoon, being indoors can be almost unbearable.
Abarca showed off her outdoor kitchen and dining area in a backyard alive with big shade trees, three dogs, several chickens, a vegetable garden shaded to keep the hot sun off her tender plants. The kitchen is essential when it's too hot to cook indoors, she said through an interpreter.
The family maintains big trees to provide shade over their home. The side yard sports a large aviary, where they keep cockatoos. There's even a turtle enclosure along one wall.
But along another fence sits an air quality monitor, installed by ASU students who are studying the high rates of asthma and other respiratory illnesses in the neighborhood. That pole is overshadowed by a charred electric pole that was struck by lightning several years ago. It looks like it could topple on the garden during the next hard windstorm.
"All the electric company did was put a new (transformer) up," said Abarca.
The Abarcas take at least three showers a day to cool off. And, Abarca said, "We drink about six or seven gallons of water a week just to hydrate."
They purchased two tiny room air conditioners for the bedrooms, but Abarca said they carefully ration their usage to just a few hours at night, so they can sleep.
"During the summers, we pay $200 a month at most," said Abarca, a stay-at-home mom. That's still a lot of money to a family with just one breadwinner.
Abarca said she's investigated solar panels but found the cost would add the equivalent of another house payment to their budget. And, since the Abarcas make barely more than state guidelines for low-income solar grants, she said, they are deemed ineligible for not only solar power but other low-income assistance from their electric provider, Salt River Project.
"It's illogical," she said. "Every year, we pay our taxes. But, by just $1, you're considered rich!"
The Abarca family isn't alone: The U.S. Census Bureau notes that the poverty rate for residents of the Abarcas' ZIP code is 32% higher than for the county as a whole, and per-capita income lags by 13.4%.
Local electricutilities, including SRP and Arizona Public Service, offer some programs to aid low-income customers making at or less than 150% of the federal poverty level. For the Abarcas, that would be just $32,500 annually. Making their home more energy-efficient is out of reach even with a more generous income limit of twice the federal poverty level, since the maximum grant is $6,000.
In the meantime, Abarca said, she sees her neighbors getting AC units, only to be shocked when the first bill arrives.
"Some people pay $400 or $500 a month," she said. "One lady got a $1,500 bill, but even after talking to the company and finding there was a mistake, they still had to pay $600. Oh my gosh, I don't have that kind of money!"
"My husband said that if we put an air conditioner on the house, that he'd have to get another job," she said. "I see other families that finally got AC units, but now both parents have to work just to afford the electric bills."
She said it's grown hotter and more humid over the two decades they have lived in Phoenix.
"it's getting so that you can't be outside anymore," Abarca said. Yet there are still many homes in the neighborhood that have only swamp coolers hanging off walls or mounted on roofs.
A study to assess the cooling needs of homebound people published by the Maricopa County Department of Public Health found that about 19% of homes in the county have swamp coolers. The study also noted that the cost of running air conditioners in homes that have them was listed as the biggest reason for not using them.
"I think that in this 21st century there's so much technology," said Abarca, "but it's illogical that a lot of people pay a high price to have it while others don't pay as much."
A senior succumbs to heat
By most standards, Jack Esry Sr. was set to live out his retirement years in comfort. He graduated top of his class at Stanford in mechanical engineering and parlayed that into a successful career. After retiring from Motorola in 2006, Esry enjoyed a comfortable pension. He owned a spacious home in the suburban area of north Scottsdale, where he lived alone after a divorce.
Esry's son Bill, who lives in Oregon, wasn't initially concerned about residing two states away, since his grandmother had lived to age 107. Grandma had downsized and moved to a nearby senior living facility, and Bill encouraged his dad to do the same.
"Dad made enough money to move to that development," said Bill Esry, "but he was stubborn and wanted to stay."
This scenario is familiar to health care providers who deal with seniors.
"it's a lot easier for the older generation to get into trouble," said Karlene Rood, wellness coordinator for Sun Health at Home, a West Valley program that provides home care for its members. "They don't like to ask for help."
Bill checked in with his dad regularly by text, email and by phone each Sunday. The younger Esry had become concerned enough about Jack's ability to live on his own that he and his wife had begun making plans to move nearby so they could care for him. In addition to ongoing health issues like high blood pressure, kidney disease and COPD, the elder Esry had also become a recluse and a hoarder. Bill learned later that his dad spent all of his money on electronic gadgets and "toys."
Bill Esry had cause to worry: During their weekly phone call on Sunday, July 21, "Dad said his air conditioning had broken a week ago," Bill said.
His father kept saying he would get the AC fixed because he didn't want to pay the estimated $4,000 to get a new unit. He said he had a warranty company that covered repairs, and he was waiting for a technician to come out.
Bill said he advised his dad to open some windows at least, but the elder Esry refused, saying he was afraid his two cats would escape.
It's possible Jack didn't realize he was becoming dangerously overheated. Rood and Sarfaty agree that people over age 65 have a diminished ability to sweat, a function that helps cool the body down and prevent heat exhaustion or potentially life-threatening heat stroke. Seniors also tend to overdress, Rood said. And some prescription and over-the-counter medications for conditions ranging from allergies to high blood pressure and depression increase heat sensitivity.
Two days later, Bill's phone rang, but all he could hear was his dad moving around.
"He 'butt-dialed' me," said Bill. On Thursday, July 25, a friend of Jack's from Prescott called and said Jack had failed to keep his weekly online chat appointment with her.
Bill called Scottsdale police.
"I told them how to get them in the house," said Bill. He later viewed video of the police entering the home and said, "You could tell they were really uncomfortable." The indoor temperature had reached 99 degrees.
Jack Esry was found in his bed, dead.
The cats survived and were adopted by an older couple.
A medical alert device could have saved Jack Esry's life. Rood said Sun Health encourages all of their clients to obtain one.
"They can push it and get help right away," she said. Some devices even link to the person's mobile phone GPS, so responders can easily locate them.
Rood also recommends that seniors have a buddy system in place and check in with each other regularly.
Homeless people are more vulnerable
Nearly half of the autopsies examined by The Republic confirmed that victims of heat-related or heat-caused illness were homeless, with another 14 who likely lacked a place to call home, but whose housing status wasn't clearly stated in the medical examiner's reports.
Some of the victims had burns suffered from lying on hot concrete or asphalt, while first responders reported body temperatures of up to 112 degrees in people who were still alive when they arrived at the scene.
Rebecca Legate counts herself lucky to not be such a statistic. In 2016, Legate was struggling to survive what, at the time, was the third-hottest year in Phoenix. Daytime temperatures reached as high as 118 degrees, and 19 days hit record high temperatures.
More dangerous were the 16 nights during that hellish summer when temperatures never dipped below 89 degrees. To add to her misery, Legate was pregnant.
After a traumatic experience that caused her to flash back to when she was trafficked as a child, Legate said she regressed from a long-term period of sobriety.
"I ended up living in a condemned house with no electricity, no water, in the middle of the summer, pregnant," she said. "I had three of my older kids with me at the time."
"The biggest problem with the heat and homelessness is mental illness, housing and drug addiction," said Nathan Smith, director of community engagement at the Phoenix Rescue Mission. "The reason that they're out there on the streets suffering from the heat is because they don't consistently have access to the services to keep them off the streets."
Smith points to unaffordable housing, mental illnesses that prevent people from staying on track to meet life's demands and drug addiction, which drives people to hunt drugs instead of being healthy, as the root causes of homelessness. Medications that treat mental illnesses also make people more vulnerable to becoming overheated as well.
Smith said an alarming factor in homelessness is the explosion of unsheltered people in metro Phoenix. From 2014 to 2018, he said, the percentage of homeless people who live outdoors increased from 18% to 48%, which greatly raises the specter of more heat-related illnesses and deaths. They are also the hardest for agencies like Phoenix Rescue Mission to serve, Smith said.
Summers were always hot, Legate said, but 2016 was especially scorching, with nearly 30 days of high temperatures soaring above 110 degrees.
"It was rough," she said. She and her boyfriend would ride bikes to fill 5-gallon water containers to lug back to the house. They scrounged money to feed the on-demand box to keep electric service flowing. They kept an ice chest for food due to the sporadic power situation.
"We were always having to get ice for the ice chest and hoping it would last," Legate said.
After the older kids fled to a relative's home, Legate continued her downward spiral. She hit bottom after being arrested on drug charges and sent to prison, where at least there was air conditioning and regular meals.
With the help of a sympathetic attorney and a social worker, Legate transitioned to the Phoenix Rescue Mission, where she completed a faith-based recovery program. She regained custody of her youngest daughter, now 3, and works at the mission.
Transit riders challenged to stay cool
Rosetta Walker has to prepare carefully for her next bus trip.
"I pack a hat, sunscreen, water, an umbrella and sunglasses," said Walker. "The umbrella is an absolute necessity."
That's because Walker, 60, faces up to a 20-minute walk to a bus stop, depending on which direction she's heading that day. There's very little shade along the nine-block route she travels in her south Tempe neighborhood to protect her from blazing hot summer days.
Walker also needs the umbrella while she waits for the bus, as neither of the stops has a shade structure. One stop has some trees on the west-facing side. The other, located on a corner next to an empty lot, has no shade at all.
Walker has been using public transit for the past eight years as she pursues her post-retirement passion of volunteerism. She's unable to drive because diabetes-related glaucoma left her legally blind. She takes the bus and light rail to the federal courthouse every Friday to register newly minted voters after the weekly naturalization ceremony.
Then there are the days she travels downtown to train as a poll worker. A citizen of the Rosebud Sioux Tribe, Walker also lends support to many Native events and initiatives, ranging from the Pueblo Grande Indian Market to traveling to the Arizona Legislature, where she advocates for more services to fight the epidemic of missing and murdered Indigenous women.
In just one week, Walker rides the bus to no less than five such appointments, along with lectures and concerts, community events and trips to the nearby Walmart. Walker's husband, Jim, a firefighter, and daughter, Cheyenne, help by driving her whenever they can, but more often, Walker simply takes the bus.
And, like the other transit users in the Valley, Walker deals with grueling heat in the summer. In January 2020 alone, Valley Metro reported more than 5.3 million boardings on their system and 64,380,334 boardings in fiscal year 2010. That includes bus, light rail service and neighborhood circulator buses.
Having diabetes makes Walker even more cognizant of the need to be heat-savvy, since diabetics are especially susceptible to dehydration. Their insulin uptake can be disrupted when the thermometer registers high temperatures.
But even with all of the precautions she takes, Walker confesses that some days she feels like she might pass out on the street. That's when she ducks into a McDonald's or a Circle K to cool off for a bit.
Governments, nonprofits address heat crisis
Over the past several years, public and private agencies have begun to take a more coordinated approach to addressing what has become an invisible, slow-moving public health crisis.
One such approach is the Maricopa Coalition on Climate Change and Public Health. Since 2015, the coalition has labored to break down operational silos, share information, develop effective means to track heat-related and heat-caused illness and deaths, and build a strategic plan to address the ever-growing issue of hotter summers and how to support those who are most vulnerable to deadlier days and nights.
The coalition includes the Heat Relief Regional Network, a county-wide system of emergency cooling centers and water distribution sites managed by the Maricopa Association of Governments. The cooling centers, which include community centers, libraries and churches, operate during extreme heat events. Many are located along bus routes, but some can only be accessed by walking several blocks.
But the cooling centers have their limits. They close when the facility does, usually during the hottest part of the day.
Rebecca Sunenshine, medical director and administrator of the Maricopa County Public Health Department's disease control division, said the county is working to get more centers open later in the day. She said the number of centers has tripled. Sunenshine and Vanos both emphasized that data collection has greatly improved.
Mark Hartman, chief sustainability officer for the city of Phoenix, is also looking at how to improve the cooling centers.
"We want to ensure that our cooling centers are actually in places that people will want to go," said Hartman. One tactic is to offer more activities, such as what's available in libraries.
In December 2019, the Institute for Sustainable Communities, an organization that helps build resiliency and economic sustainability, received an environmental community action grant that it will use to help facilitate the coalition's implementation of its strategic plan.
"Maricopa County is more advanced compared to other regions in dealing with extreme heat," said Steve Adams, director of urban resilience at the institute. Adams also noted that many programs to address climate change tend to operate at local jurisdictional levels; he likened such programs to how local governments respond to citizen calls to fix potholes in a pragmatic fashion.
One such public-private partnership is beginning to bear fruit, or, rather, mesquite beans. Tucked in the shadow of glittering new development in downtown Phoenix, the Edison-Eastlake neighborhood swelters during the summer.
Arizona State University partnered with the Nature Conservancy, county and city agencies and local residents to develop a plan to make this working-class neighborhood more walkable and less hazardous to health.
"Phoenix is one of the hottest areas around the world," said Diana Bermudez, director of special projects for the Nature Conservancy. "But this is one of the hottest areas in terms of temperature in Phoenix."
After holding workshops with local residents, the coalition identified 12 "hot spots" that needed to be addressed. One such corner recently was the site of the first installation to relieve the heat: planting mesquite trees and other indigenous plants at the Trans Queer Pueblo on a corner across from the Phoenix Ranch Market.
Jonathan Beebe Giudice with the Pueblo said not only will the trees and cactuses provide needed shade for pedestrians, they also symbolize a return to ancestral foods and to show people in the community how they can continue to self-develop on their own terms.
"I think one of the things that is very important is that people feel that there is not much that they can do when it comes to heat," said Bermudez. "But the truth of the matter is that there are things that can be done, and that nature can play a very important role in that."
Tribes in the area are also taking steps to keep their citizens safe. In Guadalupe, the Pascua Yaqui Tribe has a home safety program to help elders and other fixed-income tribal members repair and maintain their air conditioners.
Alma Iris Valenzuela works with elders in the 3,000-member community that's part of the larger 11,000-member tribe based in Tucson. Valenzuela said she normally deals with about 600 elders, including 45 who participate in the tribe's elder activities, and with other tribal citizens who need assistance. The tribe even offers interest-free loans to replace broken or outdated units, with elders receiving a 50% discount.
"Most elders already know about our program," she said.
Cliff Puckett with the Salt River Pima-Maricopa Indian Community's emergency management department said the tribal government has a plan to aid elders and other people in need of assistance for fixing their cooling systems.
"Seniors can call our maintenance line to get their ACs up and running," said Puckett. "We also have two cooling stations set up for power outages, and we'll evaluate people who come in if they need additional assistance."
In case of extended outages, the tribe will house them free of charge. And the Salt River community can mobilize a mass care center for long-term outages.
But Laura Dent has a different take. Dent is executive director of Chispa AZ, the Hispanic division of the League of Conservation Voters. She said much needs to be done to ensure that all neighborhoods are equally served with heat relief and mitigation.
"Latinos are more affected by heat," she said. For example, families in Hispanic neighborhoods are challenged to make their homes energy efficient. Parks and streets lack the robust tree canopies seen in more upscale neighborhoods. People who are forced into on-demand electric service end up paying far more over the long run. Latinos also tend to work in the construction and agriculture sectors and thus are exposed to extreme heat in great numbers.
Dent's solution: Help Hispanic people to become more politically aware and active so they can advocate for environmental justice.
"We need to hold utilities accountable," she said. "And information on heat and other environmental issues needs to be culturally relevant and in a variety of languages."
Isabella Abarca, who's a promotore, or advocate, with Chispa, said some meetings held by the city of Phoenix didn't have translators, and others were held during working hours, when the people most affected by what was being discussed weren't present to share their concerns.
Dent also called for a more equitable distribution of tree canopies and enhanced parks. And, she said, Hispanics need to be more welcomed into environmental groups.
What does Walker believe is needed for transit customers to withstand hotter days and nights?
"More shade at the stops," she said. Driving east on Guadalupe Road, Walker points out an example: This stop has a metal-roofed shade with solar panels that power a night light.
"I like those because the light makes the stop safer at night," she said. "And the shade is welcome when it's 110 degrees out."
Hartman said the city is looking at creating "walksheds," shaded walkways to keep pedestrians out of the sun. Phoenix is also exploring "cool" paving to reduce nighttime radiation from dark paving materials.
"We're thinking of a light gray material instead of the white that Los Angeles tried," he said.
David Hondula, assistant professor at ASU's School of Geographical Sciences and Urban Planning, agrees that shade structures can make a difference to pedestrians in the summer. Hondula also notes that quality of life issues could be more closely explored to develop heat mitigation and adaptation.
"Is our ice cream not melting as we're walking home from the grocery store? Can people choose active modes of transportation like public transportation?" he said.
Utilities are also beefing up programs to aid customers. Both power providers offer payment assistance, special discounted rates for low-income clients and grants for making homes more energy efficient. SRP works closely with social service agencies to serve customers needing services beyond paying their bill; APS representatives said they have retrained their customer service staff to be more responsive to calls for help.
Valley Metro, the region's transit agency, has been preparing for hotter temperatures.
"Our buses and light rail cars are designed for summer heat," said Valley Metro spokesperson Susan Tierney.
Special paint helps deflect heat, and light rail cars have greater air conditioning capacity. Also, Tierney said, Valley Metro maintains solar facilities at its light rail operations center in Phoenix, as well as at the bus operations and maintenance facility in Tempe. At the Mesa facility, solar panels were recently installed on new canopies, further sheltering buses from the sweltering heat while being serviced before embarking on their routes.
Landscaping is also important to the system, Tierney said. It provides both psychological and cooling effects, she said.
Cities manage their own bus stops. Tempe plans to add more shelters to its 800 bus stops, said city spokesperson TaiAnna Yee.
"Maximizing shade was one of the biggest things people suggested," she said. Also, she said, the city plans to replace neighborhood circulator vehicles with larger buses that will also have greater cooling capacity.
Heat in the time of COVID-19
Nathan Smith says the Rescue Mission and other agencies across metro Phoenix respond to another scorching season by seeing red - Code Red. That's the mission's heat relief campaign.
"We ask the community to give us about 1 million water bottles from May through August," said Smith. "We put them on ice and we take it out to the streets, so we can at the very least make ensure people have consistent access to cold water."
The rescue mission also shares its bounty with hydration stations and cities so the need for water can be slaked.
Smith is also exploring how the Phoenix Rescue Mission can expand its summer heat response to reach out to homebound people and seniors becoming ill and dying in their homes due to heat.
"The biggest problem we face in relation to heat is the same we face in general: the difficulty of getting people into permanent, stable living situations," he said.
A murkier question looms over all of the cities and agencies: What does the COVID-19 pandemic mean for efforts to deal with extreme heat? Many residents may not have the cooling center lifeline if libraries, schools and churches remain closed.
"We currently have 42 collection locations across the region that accept donations of water and other resources," said Brande Mead, human services director for the Maricopa Association of Governments. "We also currently have 64 heat relief stations across the region that offer hydration and/or refuge."
Mead acknowledged that the number of relief facilities is lower, and MAG believes it's due to the pandemic. Mead said that as locations begin to reopen, the network will add them to the list.
"The CDC has issued guidance for cooling centers and COVID-19 and we have shared that guidance with our partners and have encouraged them to follow the guidance as they are able to," Mead said.
Solveig Muus, who manages the heat relief station at Grace Lutheran Church in downtown Phoenix, said the staff was handing out water during the day and food from 9 a.m. to noon, but was only allowing people with doctor's appointments inside the doors to prevent virus spread. She said the church wouldn't open its doors again until COVID-19 cases were on the decline for at least 14 days.
"That's about the only way we can be certain that our clients will stay safe," she said.
In the meantime, Phoenix Rescue Mission has geared up to offer services tounsheltered homeless people who not only suffer from the heat but may show COVID-19 symptoms.
"I notice when the weather changes that our clients are sicker," said Rich Heitz, a street outreach case manager. "We're lucky when we get them to go in for help."
Both Heitz and his colleague Sarah Snead said homeless people can have trust issues, and building that trust will be essential to persuade any person living without a home to obtain health care if they become ill. And, they said, if the cooling centers remain closed, they will deal with that, too.
"We'll hand out water and hygiene packs and advise them to get out of the sun," said Heitz. "We'll get them to water so they can get cleaned up."
Snead said the Rescue Mission is handing out lunches to their clients.
Another factor is that respiratory illnesses tend to be worse in summer, said Kathleen Winston, dean of the College of Nursing, University of Phoenix. Winston, an RN with 40 years of experience and a Ph.D. in nursing science, said she's familiar with summer heat issues and how to avoid heat-related illnesses.
"The body doesn't have the same metabolic rate; there's greater stress on your body," she said.
Winston said researchers are beginning to study the effects of heat on coronaviruses to learn more about their tie to summer illnesses.
The American Lung Association notes that people with chronic lung diseases like COPD and asthma fare worse in summer because of air pollution and ozone.
Sarfaty said the Center for Climate Change Communication provides a clearinghouse for health care providers that they can use to educate their patients and communities about the dangers of heat, and how to deal with hot summer days and nights. Also, she said, "we need to stop the emission of these carbon dioxide and methane fossil fuel emissions from going into the atmosphere" to mitigate the heat.
Abarca believes one solution to make that happen is to make solar panels and other forms of sustainable energy available to all residents, not just those who can afford them.
She also extended an invitation to policy makers to stay at her home over a weekend during the monsoon.
Maybe then, she said, "they would understand what it's like to live with no air conditioning."
Environmental coverage on azcentral.com and in The Arizona Republic is supported by a grant from the Nina Mason Pulliam Charitable Trust. Follow The Republic environmental reporting team at environment.azcentral.com and @azcenvironment on Facebook, Twitter and Instagram.
Climate collision: Loss and survival in a changing world
Across America, the jobs and traditions, cultural touchstones and ways of living that have defined our communities are changing fast.
A warming planet is reordering how we live and how we see ourselves. It's putting our homelands and historic sites underwater, disrupting how we harvest crops, catch fish and raise livestock. It's raising our risks of diseases and disrupting how we run our businesses and cities.
As the planet changes, Americans are changing with it. Some will reinvent old ways to survive in a new world. Others won't have time, or space, to adapt. Their livelihoods, histories and homes will become the climate's casualties.
All year, the USA TODAY Network explores America, from its inundated coasts to its peaks of melting snow, to reveal these stories of change. These are the climate's casualties - and its survivors.
This article originally appeared on Arizona Republic: Heat is killing more people as cities sizzle in hotter temperatures