When Dr. Jeremy Hess started his shift at Harborview Medical Center Monday, the pace felt frenetic — similar to the beginning of the COVID-19 pandemic here.

Hess, an attending physician, began his shift at 10 p.m. at the hospital in Seattle’s First Hill neighborhood, as temperatures from the historic heat wave tormenting the area had finally begun to drop from that afternoon’s peak of 108 degrees.

Immediately, “we got notified EMS [emergency medical services] was bringing us two patients in heatstroke in rapid succession,” Hess said.

The patients continued to stream in throughout the night. Many had to be put on ventilators; some were suffering from kidney or heart problems. Hess saw one patient who suffered third-degree burns on the soles of his feet from walking barefoot on hot asphalt. On Monday, 223 people made visits to King County emergency departments for heat-related illness.

At least two people died from exposure to the heat, including a 65-year-old Seattle woman and a 68-year-old Enumclaw woman, according to the King County Medical Examiner’s office. The cause of their deaths was hyperthermia, meaning their bodies had became dangerously overheated. A 4-year-old boy drowned Monday.

Experts say those numbers likely represent just a portion of the toll on human health.


“It felt very much like what happened in the initial days of trying to deal with the original outbreak [of the coronavirus] at the Life Care Center in Kirkland,” said Dr. Steve Mitchell, medical director of the emergency department at Harborview. “We got to the point where facilities were struggling with basic equipment, like ventilators.”

Hospitals see hundreds of patients

Some 10% of all emergency room visits Monday were due to heat-related illnesses, according to data supplied by Public Health – Seattle & King County.

During the three-day heat wave, 357 King County residents visited emergency rooms for heat-related complaints. Since January 2018, the one-day high for visits to emergency rooms for such illnesses had been nine.

On Monday, 68 of the 223 residents who visited emergency rooms were admitted. Acute kidney failure, encephalopathy and fever were the most common diagnoses.

Emergency medical workers also responded to 165 heat-related calls.

They only handled 91 calls in all of 2020, according to Gabriel Spitzer, a spokesperson for Public Health – Seattle & King County.

The heat wave, which experts say was driven by climate change, continues east of the Cascades, with temperatures slowly cooling but still above average for this time of year, according to the National Weather Service’s Spokane office. Ephrata, Wenatchee, Yakima and Spokane all surpassed their previous highest recorded temperatures on Tuesday, hitting 116, 114, 113 and 109, respectively.


ER doctor recounts harrowing evening

The experience at Harborview was “intense,” said Hess, who is also the director of the University of Washington Center for Health and the Global Environment.

“It was quite a large volume. They were all very, very sick patients. The system as a whole was strained.”

As soon as Hess got word of his first two heatstroke patients, teams of medical workers rushed to don personal protective gear — the patients’ coronavirus status was unknown.

“It’s already hot. It’s hotter in there,” Hess said of the gear.

The first patient was having a stroke in addition to suffering from the heat, Hess said. The second patient died before reaching the hospital, he soon learned. 

Then, a third patient arrived. The team had to intubate and place her on a ventilator.


Hess said he was surprised by the volume of very ill patients. “Normally in a given shift, I might see a few of those patients over eight hours. In this case, I saw three in about 45 minutes, and that was just me.”

At 11:30 p.m., Mitchell, the emergency department’s director, activated the regional Disaster Medical Coordination Center. The center acts something like air traffic control, spreading patients throughout area hospitals so no one site is overwhelmed.

The center would manage patient flow until 5:30 a.m. Tuesday, Mitchell said.

Hess said he treated mostly older patients who did not have air conditioning and were discovered to be very sick by other people.

People arrived dealing with everything from “classic heatstroke, where people have altered mental status and they are really hot,” to stroke symptoms, cardiovascular problems, respiratory issues and kidney failure.

“This was a formative event for me. It really brought home that climate change is obviously driving these events,” Hess said. “This was the first I’ve helped manage.”


Hess said he is glad it was only heat that affected the area on Monday, and it was not coupled with wildfire smoke or blackouts, which are additional climate concerns.

“In the future, we’re likely to see worse,” Hess said. “That’s a message that’s upsetting to people and scary, but it’s one everyone needs to hear. We need to start planning for those contingencies.”

Excess deaths to be counted

It will take several months to understand the true impact of the heat wave beyond its immediate effects. 

Researchers will evaluate death data and assess it to understand excess deaths — people who would not have otherwise died if not for the heat wave, said Kristie Ebi, a professor in the University of Washington Center for Health and the Global Environment.

But that data can take months to gather, said Ebi, who plans to study this heat wave’s impacts.  

Before researchers can look at the aggregated data, death certificates must be filed, coded with the underlying causes of death and then entered into a national database, Ebi said.


Few people die of heatstroke directly. Instead, they typically die of cardiac events, respiratory problems or kidney disease — underlying conditions exacerbated by heat.

Researchers will analyze the data to tease out the deaths that would not have occurred otherwise by comparing the data to the same time period in previous years, and counting deaths during the heat wave and after.

The results can be surprising, Ebi said. 

After a devastating heat wave struck Europe in 2003, some 15,000 excess deaths were recorded in Paris, including many who were in elder-care facilities, Ebi said. 

The trend was not immediately noticed because such facilities often had one or two additional deaths and it wasn’t uncommon for people to die in those facilities, Ebi said. 

With heat, “It’s pretty much silent, unless somebody does the analysis,” Ebi said. 

A Centers for Disease Control and Prevention study of deaths attributable to heat exposure from 2004-2018 found an average of 702 heat-related deaths in the United States annually. 


But a recent study published in Environmental Epidemiology that examined death records in 297 U.S. counties for excess deaths due to heat, suggests the CDC figure undercounts the yearly impact of heat. 

The study estimated that 5,608 deaths were attributable to heat each year from 1997 to 2006. 

Ebi said it’s difficult to predict how much impact the heat wave had on the Seattle area.

“We were breaking records. Given the low penetration of air conditioning, I expect there were excess deaths,” Ebi said. “It’s very hard to know how many without doing the analyses.” 

A recent study in Nature Climate Change estimates that 37% of heat exposure deaths in 43 countries during warm seasons, and from the years 1991 to 2018, were from human-caused global warming. 

“The numbers of heat-related deaths caused by climate change are large and they’re going to continue to get larger,” Ebi said.

Seattle Times staff reporter Elise Takahama contributed to this report.