Patient Care in the Age of Climate Change


A clinician offers some insights and considerations on clinical care as it pertains to climate.

Certainly, there are different variables where the evolving climate will bring about changes in many aspects of life. One area that is emerging is how it relates to medicine and specifically patient care.

Toby Hillman, MD, consultant in respiratory and internal medicine at University College London, and sustainability fellowat theRoyal College of Physicians, says temperature rise and specifically heat for sustained periods is a consideration for patients who might be at-risk for health-related events.

The sustained rise in temperatures combined with extreme and more frequent weather events has expanded the natural habitats of mosquitos and ticks and increased the possibility of rare vector-borne diseases being discovered in previously unfounded areas.

For example, The CDC recently reported that babesiosis, a zoonotic-tickborne parasitic disease, has increased dramatically in 3 states (Maine, Vermont, and New Hampshire). Over a study period of 2011-2019, Vermont saw an increase of 1,602%, from 2 to 34 cases, Maine saw an increase of 1,422%, from 9 to 138 cases, and New Hampshire 372%, from 13 to 78 cases.

Hillman presented a scientific session, Improving Patient Health During Climate Crises, at last week’s ACP conference being held in San Diego.

Mostly, vector-borne diseases such as dengue and Zika for places like the United Kingdom and the United States are mostly reported in people traveling to areas where these illnesses are endemic. However, Hillman says, this might change.

“Physicians will see more of these diseases in unusual populations, perhaps without a classical travel history, Hillman stated. “It is something we need on the radar and to include it on the differential diagnosis when we are seeing complex cases.”

Hillman says the increase of dengue incidence rates is one particular example seen in northern hemisphere countries that is something not previously thought of but maybe in the near future. One company recently released the results of their report showing that climate change is likely to turn northern hemisphere cities like New York, Toronto, and London into breeding grounds for dengue- and Zika-carrying mosquitoes over the next 10 years. That company and others are working towards mitigating vector-borne diseases.

Contagion spoke to Hillman about the effects of climate including differential diagnosis, and other factors that may drive an increase in climate-related illnesses.

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