"Because it's been hot," Rhaney said. "It was hell last week, like 95 with humidity -- Ooh, it was horrible."
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Heat and humidity exacerbate many common conditions, including diabetes, high blood pressure and asthma. For Rhaney, who has Chronic Obstructive Pulmonary Disease (COPD), the heat is suffocating.
"It feels like this," she said, cupping her hands around the bottom half of her face, "like a plastic bag is over your nose."
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Rhaney, who is 74 years old, has lived in Philadelphia for most of her life, but she says the weather wasn't always this hot and humid.
"You could tolerate it, which you can't tolerate too much anymore," she said.
It's not just Rhaney's perception. This July was the hottest month in Earth's recorded history, and possibly in 120,000 years, according to experts at the World Meteorological Organization.
That unprecedented heat was not a one-off event, say researchers who study the Earth's changing climate.
"It's not just that we're having some bad weather this summer," said Dr. John Balbus, acting director of the Department of Health and Human Services' new Office of Climate Change and Health Equity. "This phenomenon that we're seeing this summer is something that is going to be reoccurring, year after year."
Days where the outdoor heat index -- a measure that includes both temperature and humidity -- exceeds 90 degrees Fahrenheit are considered "extreme heat days" by the National Weather Service. If the heat index exceeds 103 degrees, they become "dangerous heat days," where extended time outdoors could lead to serious health impacts.
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Today, Philadelphia sees an average of 14 days with a heat index above 100 degrees each year, according to an ABC Owned Television Stations analysis of data from the First Street Foundation, a nonprofit that studies climate change.
And it's projected to get even worse: In 30 years, Philadelphia will see almost a dozen more days this hot annually, for a total of 25 dangerously hot days per year, the analysis found.
"It's really going to be rough," Rhaney said.
A spectrum of health impacts
Dr. David Manoff is the chief of pulmonary and critical care at Temple University Hospital's Jeanes Campus and an associate professor at the Temple Lung Center. He said the heat brings increases in outpatient and emergency room visits, particularly for people with chronic conditions like Rhaney's.
"We hear a lot of people saying, 'I am having more trouble breathing,'" he said. "People are at an increased risk of both a gradual worsening of their disease and also sort of an acute worsening."
That means a greater need for additional medications, Manoff added, like Rhaney's nebulizer treatments, rescue inhalers or steroid pills, which Rhaney's doctor prescribed her during this summer's heat.
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Manoff sees these worsening heat-related health impacts not in isolation, he explained, but rather "as part of an overall spectrum, which is directly attributable to climate change."
On top of patients with heat-sensitive conditions, people without underlying health issues also can become very sick or even die directly from the heat. Dr. Lara Phillips, an emergency medicine physician at Thomas Jefferson University, says she has seen an increase in visits for heat-related illness in recent years.
Milder symptoms include swollen limbs, fainting, dehydration and heat rashes. More moderate heat-related illness comes in the form of heat exhaustion, with symptoms such as high body temperature and faster breathing. Some people may feel dizzy or have a bad headache, Phillips added.
The deadliest form of heat-related illness is heat stroke when a person's core body temperature rises above 103 degrees. At that point, they may seem confused or incoherent. Their organs will begin to fail, and they will need to be cooled down to a normal body temperature within 30 minutes to prevent irreversible damage. Without treatment, almost 80% of people with heat stroke die from it.
"It can affect people across age, gender and health lines," Phillips said. "And it's a prevalent problem."
Dr. Cecilia Sorensen is the director of Columbia University's Global Consortium on Climate and Health Education and an associate professor at Columbia's Medical Center and School of Public Health. She said during heatwaves, the cumulative health burden of consecutive hot days adds up to more serious illness and exacerbations.
Today, Philadelphia sees three-day stretches of dangerous heat on average, the ABC data analysis found. In 30 years, those heat waves are projected to last four days, further compounding their health impacts.
"If you're going to have a really hot week, towards the end of the week, we're going to start seeing huge, huge numbers of people coming in," Sorensen said. "I always brace myself going into an ER shift when it's hot out."
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Across the U.S., there have been 11,921 heat-related Emergency Medicine Services activations in the last month, for a rate of 3.6 per 100,000 residents, according to data from Balbus' office at HHS. Philadelphia's rate was even higher.
Rhaney winds up in the Emergency Room for COPD flair-ups and complications about three times a year, she said.
"I'm huffing and puffing, can't breathe, so they give me oxygen, give me a nebulizer. I'm usually on there about six, seven hours, then they say we have to admit you," Rhaney said. "And I'm in there about a week because it done got infected."
One time, Rhaney went to see her lung doctor for a regular appointment and it turned out she had sepsis -- an infection had reached her bloodstream.
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"I was so sick," she said. "I didn't even know I was that sick, and they admitted me right there and then."
These dangerous exacerbations and complications are likely to become more common as patients like Rhaney are exposed to rising temperatures and lengthening heat waves.
"Based on the trends, we can only expect that it's going to get worse," Manoff said.
Hotspots of exposure and sensitivity
The impacts of a hotter climate will not land on everyone equally. In Rhaney's zip code, 19141, there are currently 50 extremely hot days -- feeling like 90 degrees or more -- per year on average. In 30 years, Fist Street Foundation data projects there will be 68 days that hot annually.
In several North Philadelphia zip codes near Rhaney's, these estimates are even worse, with current counts of 53 extreme heat days projected to jump to 70 days each year. Center City will continue to see the highest counts, with 54 extremely hot days today growing to 71 days in 30 years, while parts of far Northeast and Northwest see roughly a week less than that at extreme temperatures.
Dr. James Rory Tucker is the head team physician at Temple University, practicing both sports medicine and family medicine and treating the health impacts of increasing heat exposure. He said in an urban environment like North Philadelphia, the heat "impacts the sidewalk, the blacktop, the asphalt, the buildings, and it's being absorbed, but it's also being reflected back. So it's amplifying that temperature, and so people are being exposed to that."
These areas, with lots of concrete, little tree canopy and few green spaces, are called urban heat islands, and they can be many degrees hotter than other parts of the city, experts say. When accounting for the types of surfaces and amount of vegetation present, neighborhoods like Rhaney's have much great heat exposure than Center City and other more affluent parts of town.
Residents of urban heat islands are often low-income communities of color, and in addition to their increased heat exposure, these groups also tend to be more sensitive to the heat, whether due to underlying health conditions or external factors.
"The people who are most likely to suffer in the heat are the people who, for example, can't afford to pay their electric bills and have cooling," Balbus said. "Or the people who are experiencing homelessness or who are experiencing severe mental health disorders. They are dying disproportionately and suffering disproportionately in these heat waves."
These gaps are likely to widen as cooling off becomes more costly. In 30 years, Philadelphia properties will spend an extra $21.8 million on air conditioning each year, using an additional 190 million kilowatt hours of energy annually, according to data from the First Street Foundation.
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Tucker has already seen an increase in patients struggling to maintain a cool home environment due to rising costs and strained power grids, which has resulted in greater health impacts, he said.
Luckily, Rhaney says, she has air conditioning in her apartment and is able to stay cool inside when the weather is hot and humid. But that isolation also comes at a cost.
When someone is forced to stay inside because of the heat, "they're losing that sense of connection to their community or their friends or family, which is so vital to their mental health and even physical health," Tucker said.
Building a heat-resilient Philadelphia
Doctors and officials seeing the effects of extreme heat agree that finding equitable, sustainable solutions is urgent.
"This is both an immediate problem -- we have it right now, people are dying right now," Balbus noted, "but we know that this is going to recur -- it's going to be with us next year and the year after -- and that because of climate change, the temperatures are going to trend upwards over the years and decades."
In the short term, doctors say individuals can reduce their chances of heat-related illness by wearing light clothing and sunscreen, staying inside during the hottest times of day and drinking plenty of fluids. They should also know their specific risk factors, like whether their age, underlying health conditions, or medications make them more sensitive to the heat.
On a community level, Sorensen says, building climate resilience starts with vulnerability mapping: "identifying these pockets where you have overlapping vulnerable populations, so, high percentages of elderly patients or patients who have chronic comorbidities, with, for example, urban heat islands."
The Philadelphia Department of Public Health has done this kind of mapping, creating a heat vulnerability index that includes both heat exposure, based on geographic and environmental factors, and sensitivity, based on demographic and health factors. They identified Rhaney's neighborhood as one of the top 75 most vulnerable Census Tracts out of 372 citywide.
Once these neighborhoods have been identified, the next step is determining which interventions to employ there, Sorensen said.
"Oftentimes, this involves asking community members what would be helpful," she said. "Do you want more trees? Do you want public water fountains?"
The City of Philadelphia has expanded access to cool water by recruiting more lifeguards to open public pools across the area, Tucker noted. It also offers spraygrounds, free libraries and air-conditioned recreation centers.
In the long term, infrastructure changes can help cities like Philadelphia become more resilient to a warming climate.
"We have to be thinking about the cool surfaces, the cool roofs and streets," Balbus said. "We have to be thinking about the tree planting and the green spaces that can help provide some respite from hot indoor environments."
These changes need to be targeted toward the most vulnerable areas to close gaps in health outcomes, Sorensen added.
Ultimately, experts say, individuals and communities need to reduce their carbon footprint to curb global warming and all of the health impacts that come along with it.
"We are approaching -- if not at -- a tipping point," Tucker said.
If people don't act quickly to control climate change, he added, the trend of worsening health outcomes he's already seeing will accelerate.
For now, Rhaney tries to adapt. She stays inside in the summer and makes necessary trips, like to the grocery store down the street, early in the morning when the temperatures are lower.
"When it's hot, pay attention to your body," Rhaney advises. "Your body will let you know."
'Weathering Tomorrow' is a new ABC OTV series of data-driven localized reports about how climate change impacts people's quality of life, their property and their family's health, now and over the next 30 years. Every month this year and next, the data journalism team will provide custom, extremely local data that reveals measures like the increased frequency of flooding, the number of dangerously hot days, or the risk of major wildfires across our communities and down to the neighborhood level. See more at 6abc.com/weatheringtomorrow.