The Pacific Northwest heat wave’s cruel impacts came into clearer view Wednesday as officials continued with a grim accounting of those killed by extreme heat.

An additional 11 people in King County were reported dead from hyperthermia, or dangerous overheating, according to information released by the county medical examiner’s office Wednesday. The news — two days after the temperature rose to 108 degrees in Seattle — brought the county’s known death toll from the historic heat wave to 13 people.

The victims, from every corner of King County, were between 61 and 97 years of age.

In all, the heat wave — which experts say was spurred by climate change — could be responsible for hundreds of deaths in the Pacific Northwest.

In Oregon, officials said more than 60 deaths in the state have been tied to the heat. British Columbia’s chief coroner, Lisa Lapointe, said her office received reports of at least 486 “sudden and unexpected deaths” between Friday and Wednesday. Normally, she said about 165 people die in the Canadian province over a five-day period.

The deaths illustrate the profound impacts the unprecedented heat wave had on human health and how poorly adapted Washington state is to extreme heat. Experts say the early deaths attributed to heat waves often represent a small portion of the mortality caused by the extreme weather.

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Few people die of heatstroke directly. Instead, many die of cardiac events, respiratory problems or kidney disease — underlying conditions exacerbated by heat. The heat’s role in many of their deaths might not be examined for months.

In Snohomish County, at least three people have died from heatstroke this week, the county medical examiner’s office said Wednesday: a 51-year-old man from Everett, a 75-year-old man from Granite Falls and a 77-year-old man from Marysville. The causes of two other deaths are pending further testing, but are “very likely” to be heat-related, too, said office spokesperson Nicole Daugherty.

The Spokane Fire Department on Wednesday found two people dead, who had been suffering symptoms of heat-related stress, in an apartment building, TV station KREM reported.

Other counties are still trying to piece together their losses after the historic heat wave.

The Pierce County Medical Examiner’s Office was working to determine if a “small number of deaths” from Friday to Monday were heat related, according to county spokesperson Libby Catalinich. The investigation could take several days, Catalinich added.

Among those killed in the heat wave were Debra Moore, 68, who died Monday after falling on an Enumclaw sidewalk. She was in town visiting someone at the time, said Enumclaw police Cmdr. Tim Floyd. Moore had “pretty significant, pre-existing medical conditions” and usually walked with a cane or walker, though it was still in her car when she slipped and fell, he said.

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Normally, Floyd added, neighbors might have had their blinds open and spotted her quickly, but had closed them on Monday to keep the sun out. “She wasn’t discovered there for quite a while, so she was laying there in the heat,” Floyd said.

Another woman, Juliana Leon, 65, died in an overheated vehicle in Seattle’s Maple Leaf neighborhood on Monday, according to Seattle police. Medics attempted life-saving measures “for some time,” but the woman was declared dead at the scene, Detective Valerie Carson wrote in an email.

Hospitals still dealing with the COVID-19 pandemic and the traumatic injuries common in summer were further stressed by huge volumes of people, according to the Washington State Hospital Association.

“With the surge of patients across the state, hospitals are adjusting to maintain capacity for urgent health care needs. For some hospitals, this means transferring patients, for others it may be delaying some planned procedures for a day or two,” the organization said in a statement. “While the highest temperatures have passed, the impact will be felt by area hospitals for several days to come.”

Doctors at Harborview Medical Center in Seattle told The Seattle Times that the wave of patients they saw flowing into the hospital Monday night was reminiscent of the COVID-19 pandemic’s earliest days.

“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.”

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Dr. Jeremy Hess, a physician in the emergency department, said Tuesday he treated mostly older patients who did not have air conditioning and who were discovered by other people.

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

Beginning last Friday, people made at least 1,648 visits to Washington hospitals’ emergency rooms for suspected heat-related illness, according to the Washington State Department of Health as of Wednesday evening. Of those, 22% were admitted. During that time period, the state also saw 35 drownings, the health department reported.

Material from The Associated Press is included in this report.