ALTERATION IN BODY TEMPERATURE

INTRODUCTION:

Body temperature reflects the balance between the heat produced and the
heat loss from the body. Abnormal body temperature can be slight, such as low
grade fever or life threatening, as in severe cases of hypothermia or hyperthermia.
The nurse is often the person to monitor client‘s temperature, to identify deviations
and to report significant findings to the physician, so that appropriate therapy can be
instituted.

DEFINITION:

Body temperature is the degree of hotness or coldness of a body temperature.

It is the somatic sensitization of heat or cold. It is the degree of or intensity of heat

of a body in relation to external environment.

The body temperature is the difference between the amount of heat produced by the
body processes and the amount of heat loss to the external environment.
Heat produced- Heat lost= Body temperature.

Types:

Core temperature: -
It is the temperature of the interior body tissue below the skin and subcutaneous
tissue. The sites of measurement of core temperature are rectum, tympanic
membrane, esophagus, pulmonary artery, urinary bladder.

Shell temperature: -
It refers to body temperature at the surface that is of the skin and subcutaneous
tissue. The sites of measurement of shell temperature are skin, axillae and oral.

Oral: 37C (98.6F)

Rectal: 37.5C (99.5F)
Tympanic: 37.5C (99.5F)
Axillary: 36.5C (97.6F)
PHYSIOLOGY OF THERMOREGULATION:

Regulation: The balance between the heat lost and heat produced or
thermoregulation is regulated by physiological and behavioral mechanisms.
 Neural control
 Vascular control
 Skin in temperature regulation
 Behavioural control

Factors Affecting The Body Temperature:

Many factors affect the body temperature. Changes in body temperature within an
acceptable within an acceptable range occur when the relationship between the heat
production and the heat loss is altered by physiological or behavioral variables.

1. Age:

Children have a greater body – surface-to-mass ratio, and children also have
metabolic rate. The infant is greatly influenced by temperature of the environment
and must be protected from extreme changes. Children’s body temperature continue
to be more variable than those of adults until puberty. Older adults have a lower
average body temperature. Many older people, particularly those over 75 years, are
at risk of hyperthermia (temperature below 36 C , or 98.6F) for a variety of reasons
such as inadequate diet, loss of subcutaneous fat, lack of activity, and reduced
thermoregulatory efficiency.

2. Exercise:

Muscle activity requires an increased blood supply and an increased fat and
carbohydrate breakdown that causes increases in heat production. Any form of
exercise increase the heat production and thus the body temperature. Prolonged
strenuous exercise, such as long distance running, can temporarily raise body
temperatures up to 41C (105.8F).

3.Hormone level:
Woman usuallly experience greater fluctuations in body temperature than men.
Hormonal variations during the menstrual cycle cause body temperature fluctuations.

Even during menopause, woman experiences intense body heat and sweating
(known as hot flashes) because of instability of vasomotor control

4.Circadian rhythm:

Body temperature normally changes 0.5-1C (0.9-1.8F) during a 24 hour period. The
temperature is usually lowest between 1.00- 4.00 am. During the daytime the body
temperature rises steadily up to 6.00pm and then declines to early morning levels.

5.Stress:

Physical and emotional stress increase body temperature through stimulation of

sympathetic nervous system due to increase in production of epinephrine and nor
epinephrine thereby increasing metabolic activity and heat production. A client who
is anxious could have an elevated body temperature for that reason.

6.Environment:

Extremes of environment can affect a person‘s temperature regulatory systems. If

temperature is assessed in a warm room, a client may be unable to regulate body
temperature by heat loss mechanisms and the body temperature will be elevated.
Similarly, if the client has been outside in extremely cold weather without suitable
clothing the body temperature may be low.
 EQUIPMENT FOR TEMPERATURE RECORDING

 Mercury- in glass thermometer

 Electronic thermometer

 Disposable thermometers

Mercury- in glass thermometers

The mercury in glass thermometer is a glass tube scaled at one end. with a mercury-
filled Bulb at the other end. Exposure of bub to heal causes the mercury la expand
and rise in the enclosed tube. The length of the thermometer is marked with
Fahrenheit or centigrade calibrations.

Electronic thermometers

The electronic thermometer consists of a rechargeable battery- powered display unit,

a thin wire rod, and a temperature processing probe covered by a disposable plastic
sheath. Separate unbreakable probes are available for oral and rectal use. The oral
probe can be used for axillary temperature measurement. Within 20 to 50 seconds of
insertion, a reading appears on the display unit. A beep sound is heard when the peak
temperature reading has been measured

Disposable thermometers
Disposable single use thermometers are thin strips of plastic with a temperature
sensor at one end. They are used for oral and axillary temperatures, particularly with
children. They are useful when caring for clients on protective isolation lo avoid the
need to take electronic instruments into client rooms. They are inserted the same way
as an oral or axillary thermometer and used only once.
SITES OF TEMPERATURE MEASUREMENT:

 Mouth
 Axilla
 Skin
 Rectum
 Tympanic membrane
THERMOREGULATION MECHANISM

Fever:
Fever is an elevation of body temperature that exceeds normally daily variation and
occurs in conjunction with an increase in the hypothalamic set point for e.g. 37C-
39C.

Causes of fever:
• Hot environment.
• Excessive exercise.
• Neurogenic factors like injury to hypothalamus.
• Dehydration after excessive dieresis.
• As an undesired side effect of a therapeutic drug.
• Chemical substances e.g. caffeine and cocaine directly injected into the
bloodstream.
• Injection of proteins or other products.
• Infectious disease and inflammation.
• Severe hemorrhage.
Symptoms of fever:
 Flushed face
 hot dry skin
 anorexia
 headache
 nausea and sometimes vomiting
 constipation and sometimes diarrhoea6
 body aches
  scant highly coloured urine.

Clinical signs of fever:

Increased heart rate, respiratory rate and depth; shivering; pale cold skin; cyanotic
nail beds; cessation of sweating

Classification or patterns of fever:

1. Intermittent fever: the temperature curve returns to normal during the day and
reaches its peak in the evening. E.g.: in septicemia

2. Remittent fever: the temperature fluctuates but does not return to normal.
E .g: TB, viral diseases, bacterial infections

3. Sustained fever: the temperature remains elevated with little fluctuation.

4. Relapsing fever: periods of fever are interspersed with periods of normal

temperature.
• Tertian- when paroxysm occurs on 1st and 3rd days
• Quatrain- fever associated with paroxysm on first and fourth day. E.g. in
malaria

Pathogenesis of Fever:

PYROXENES

PHYLOGENIC CYTOKINES

ELEVATION OF HYPOTHALAMIC SET POINT BY CYCTOKINES

PRODUCTION OF CYTOKINES IN CENTRAL NERVOUS SYTEM

 Exogenous pyogenes (viruses. bacteria, fungi, pyrogenic steroids) enter the body

Activating Leukocytes to produce interleukin 1 which is released into the

bloodstream

Causing the thermoregulatory center in the brain to reset to higher set point

Activating Physiologic effectors to cold(shivering)

Generating heat and causing fever

Grades of Fever:

1. low grade fever: 37.1-38.2C(98.8-100.6F)

2. high grade fever: 38.2-40.5C(100.6-104.9F)
3. 3. hyperpyrexia: >40.5C(104.9F)

Hyperthermia:

It is elevated body temperature due to failed thermoregulation that occurs when a

body produces or absorbs more heat than it dissipates. Temperature ranges - >37.5-
38.3degree Celsius (99.5- 100.9 degree Fahrenheit).

Causes of Hyperthermia Syndromes:

 Heat stroke: caused by thermoregulatory failure in association with an arm
environment may be categorized as exceptional and non exceptional.

 Drug induced hyperthermia: due to increased use of psychotropic drugs.

Monoamine oxidizes inhibitors, tricycle antidepressants, amphetamines,
phencyclidine, lysergic acid diethylamide or cocaine, , selective serotonin uptake
inhibitors(SSRIs), MAO‗s( Serotonin Syndrome), use of narcoleptic agents like
antipsychotic phenothiazine's, haloperidol ( NMS),

 malignant: occur in individuals with inherited abnormality of skeletal muscle

sarcoplasmic reticulum that cause rapid increase in intracellular Ca level in response
to halothane and other inhalation anesthetics or to succinylcholine. In this there is
elevated body temperature, increased muscle metabolism, muscle rigidity,
rhabdomyolysis, acidosis and cardiovascular instability and is often fatal.

 The narcoleptic malignant syndrome (NMS): occur due to use of narcoleptic

agents like antipsychotic phenothiazines, haloperidol, pro chlorprazine, meto
chlopramide or withdrawal of dopaminergic drugs and is characterized by muscle
rigidity (lead pipe), extra pyramidal side effects, autonomic deregulation and
hyperthermia. It is caused by inhibition of central dopamine receptors in
hypothalamus which results in increased heat generation and decreased heat
dissipation

 endocrinopathy: thyrotoxicosis and pheochromocytoma can lead to increased

thermogenesis

 central nervous system damage: cerebral hemorrhage, status epileptics,

hypothalamic injury can cause hyperthermia

DIAGNOSIS:

1. History
2. Physical examination
3. laboratory tests
 Chemistry
 Microbiology
 Radiology

Medical management:
It is important to distinguish between fever and hyperthermia since hyperthermia
can be rapidly fatal and doesn‘t respond to antipyretics. Pharmacological
management:
 1. Acetaminophen: adult: 325-650 mg PO q 4-6 hrs. Children: 10-15mg/kg body
weight q4-6 hrs.
2. Ibuprofen (NSAID) - dosage: adult-200-400mg PO q6hrs; children: 5mg/kg
body wt for temp. <102.5F; 10 mg/kg body wt. for temp 102.5F (not to exceed 40
mg/kg/day).
3. Indomethacine and naproxen (NSAID).
4. Aspirin: adult 325-650 mg PO q6hrs; children 10-20 mg q 6hrs.
5. Glico corticosteroid: potent antipyretic inhibit PGE2 synthesis.
6. Mepridine, morphine sulphate, chlorpromazine.
To manage severe rigors: treatment of underlying cause, nutrition, rest, physical
cooling: tepid bath, hypothermia blankets

Management of hyperthermia:

 Cause of hyperthermia should be treated.

 Dandroline and procainamide should be given for malignant hyperthermia.

 The attempt to lower the already normal hypothalamic set point is of little use.

 Physical cooling with sponging, cooling blankets, cooling mattress or even ice
bags should be initiated immediately in conjunction with appropriate
pharmacological agents and intravenous fluids.

 Internal cooling can be achieved by gastric or peritoneal lavage by iced saline.

In extreme circumstances, hemo dialysis or even CPB with cooling of blood may be
performed.

How to prevent hyperthermia

The first step in preventing hyperthermia is recognizing the risks in working or playing
in extremely hot conditions. Being in the heat means taking the following precautions:

 Take cool-down breaks in the shade or in an air-conditioned environment. If

you don’t need to be outside in extreme heat, stay indoors.
 Stay well hydrated. Drink water or drinks containing electrolytes, such as
Gatorade or Powerade, every 15 to 20 minutes when you’re active in the heat.
 Wear lightweight, light-colored clothing when outdoors.
 If your home isn’t well air-conditioned, consider spending time in an air-
conditioned mall, library, or other cool public place during hot spells
Nursing management of fever and hyperthermia:

• Monitor vital signs.

• Assess skin color and temperature.
• Monitor white blood cell count, hematocrit value, and other pertinent
laboratory reports for indication of infection or dehydration.
• Remove excess blankets when the client feels warm, but provide extra warmth
when the client feels chilled.
• Provide adequate nutrition and fluids to meet the increased metabolic demands
and prevent dehydration.
• Measure intake and output.
• Reduce physical activity to limit heat production especially during the flush
stage.
• Administer antibiotics as ordered.
• Provide oral hygiene to keep the mucous membranes moist.
• Provide a tepid sponge bath to increase heat loss through conduction.
• Provide dry clothing and bed linens.

NURSING DIAGNOSIS:

During chill phase:

Risk for altered body temperature as evidenced by shivering and feeling cold

During fever phase:

Altered comfort as evidenced by restlessness.
Altered nutrition related to fever as evidenced by anorexia and lack of food intake.

During flush phase:

Altered fluid and electrolyte balance related to excessive sweating:

FEVER OF UNKNOWN ORIGIN:

Definition:
Fever of unknown origin (FUO) was defined by Peterson and Benson in 1961 as (1)
temperatures of > 38.3 degree Celsius (>101 degree Fahrenheit) in several
occasions; (2) a duration of fever of > 3 weeks and; (3) failure to reach a diagnosis
despite 1 week of inpatient investigation.

Classification of FUO:

Derrick and Street have purposed a new system for classification of FUO:-
 1. Classic FUO: same as above criteria. E.g. infections, malignancy,
inflammatory diseases, drug fever.
2. Nosocomial FUO: a temperature of >= 38.3 C (>=101 F) develops on several
occasions in a hospitalized patient who is receiving acute care and in whom
infection was not present at time of admission. For e.g. septic thrombophlebitis,
sinusitis, drug fever.
3. Neutropenic FUO: a temperature of >= 38.3 C (>=101 F) develops on several
occasions in a patient whose neutrophil count is < 500/micro liter or is expected to
fall to that level in 1-2 days.
4. HIV- associated FUO: a temperature of >= 38.3 C (>=101 F) develops on
several occasions over a period of > 4 weeks for outpatients or > 3 days for
hospitalized patients with HIV infection.

Causes of FUO:
1. Infections:
2. Neoplasm’s
3. Habitual hyperthermia
4. Collagen vascular/ Hypersensitivity diseases
5. Granulomatous Diseases
6. Miscellaneous conditions
7. Inherited and metabolic diseases
8. Thermoregulatory Disorders

Diagnosis of FUO:

 History and physical examination,

 Blood investigations, tumor markers, PPD for TB, serological studies,
peripheral smears, multiple samples for culture and sensitivity,
 X-Ray studies,
 bone marrow biopsy,
 Liver biopsy,
 GI contrast studies,
 CT scan, MRI, ultrasonography.

Treatment:

The patients with classic FUO are

continually observed and examined and not given the empirical therapy.

The antibiotic therapy given to the patient can delineate the ultimate cause of FUO.
 If neutropenia and vital sign instability are present then empirical therapy with
fluroquinolone and piperacillin is given.

If PPD test is positive or granuloma hepatitis is confirmed then isoniazid and

rifampcin for 6 weeks is given. is generally good.

The debilitating symptoms are treated by NSAIDSs and glucocorticoids.

Hypothermia:

Hypothermia is a state in which the core body temperature is lower than 35 degree
Celsius and 95 degree Fahrenheit. At this temperature many of the compensatory
mechanism to conserve heat begin to fall.

 Normal Range: – 96-100º F

 Mild Hypothermia: – 90-95º F

 SevereHypothermia – < 90º F

Causes:

1. Exposure to cold environment in winter months and colder climates.

2. Occupational exposure or hobbies that entail extensive exposure to cold for e.g.
hunters, skiers, sailors and climbers.
3. Medications like ethanol, phenothiazines, barbiturates, benzodiazepines, cyclic
antidepressants, anesthetics.
4. Endocrine dysfunction
5. Neurologic injury from trauma, Cerebral vascular accident, Subarachnoid
hemorrhage
6. Sepsis

Risk factors for Hypothermia:

1) Age extremes
2) Outdoor exposure
3) Drugs and intoxicants
4) Endocrine related
5) Neurologic related
6) Multisystem
7) Burns and exfoliative dermatologic disorders.
8) Immobility or debilitation.
Clinical presentation:

MILD Hypothermia: – Lethargy – Shivering – Lack of Coordination – Pale,

cold, dry skin ,Decreased cerebral Metabolism, amnesia, Apathy, Dysarthria,
Impaired judgement Tachycardia , vasoconstriction, increase in cardiac output
Tachypnea, bradypnea, decline Oxygen consumption.

MODERATE Hypothermia:- decreased cardiac output, decreased in pulse,

increased atrial & ventricular arrhythmias , prolonged systole.

SEVERE Hypothermia: –No shivering –Heart rhythm problems –Cardiac

arrest –Loss of voluntary muscle control –Low blood pressure –Undetectable pulse
and respirations

Management:
Management consists of continuous monitoring, rewarding, and removal of wet
clothing, insulation, and supportive care.

Monitoring: the ABC‘s of basic life support are a priority. The patient‘s vital signs,
CVP, urine output, arterial blood gas levels, blood chemistry determinations (BUN,
creatinine, glucose, electrolytes), and chest X-Rays are evaluated frequently. Body
temperature is monitored with an esophageal, bladder, or rectal thermostat.
Continuous ECG monitoring is performed because cold induced myocardial
irritability leads to conduction disturbances, esp. ventricular fibrillation. An arterial
line is inserted and maintained to record BP and facilitate blood sampling.

Rewarming: rewarding methods include active core (internal) rewarding, active

external rewarming, and passive or spontaneous rewarding.

Core rewarming: methods include cardiopulmonary by-pass, warm fluid

administration, and warm humidified oxygen by ventilator, and warmed peritoneal
lavage. Core rewarming is recommended for severe hypothermia i.e.
poikilothermia. Monitoring for ventricular fibrillation as the patient passes through
31C-32C (88-90F) is essential.

Passive external rewarding: includes the use of warm blankets or over-the-bed

heaters. Passive rewarming of the extremities increases blood flow to the acidosis,
anaerobic extremities.

Supportive care:
• External cardiac compression (only as directed in very cold patient).
• Defibrillation of ventricular fibrillation. It is ineffective in patients with
temperatures lower than 31C (88F).
• Mechanical ventilation with positive end-expiratory pressure (PEEP) and
heated humidified oxygen to maintain tissue oxygenation.
• Administration of warm intravenous fluids (normal saline) to correct
hypotension and maintain urine output and core rewarding.
• Administration of sodium bicarbonate to correct metabolic acidosis 
Administration of antiarrythmic medications bretylium tosylate is safe.
• Low dose dopamine (2 -5 microgram/kg) to treat hypotension.
• Gastric tube insertion to prevent dilation secondary to decreased bowel
motility.
• Indwelling catheter to facilitate cold induced diuresis.
Nursing management of hypothermia:

Nursing interventions:
• Provide extra covering and monitor temperature.
• Cover head properly.
• Use heat retaining blankets.
• Keep patient‘s linen dry.
• Control environmental temperature.
• Provide extra heat source (heat lamp, radiant warmer, pads, and blankets).
• Carefully assess for hyperthermia or burn.
• Regulate heat source according to physical response.
•
Hypothermia In Newborn Babies:

New born babies are often not able to keep themselves warm with low
environmental temperature resulting in hypothermia. Hypothermia continues to be a
very important cause of neonatal morbidity and mortality due to lack of attention by
the health care providers.

Handicaps of newborn in temperature regulation:

A newborn is more prone to develop hypothermia because of a large surface area

per unit of body weight. A low birth weight baby has decreased thermal insulation
due to less subcutaneous fat and reduced amount of brown fat.
Brown fat is a site of heat production. It is localized around the adrenal glands,
kidneys, nape of neck, inter scapular and axillary region. Metabolism of brown fat
results in heat production. Blood flowing through the brown fat becomes warm and
through circulation transfers heat to other body parts of the body. This mechanism
of heat production is called as non-shivering thermo genesis. LBW babies lack this
effective mechanism of heat production.
 Mechanism of heat loss:

Newborn looses heat by evaporation (particularly soon after birth due to evaporation
of amniotic fluid from skin surface), conduction (by coming in contact with cold
objects – cloth, tray etc), convection ( by air currents in which cold air from open
windows replaces warm air around babies), and radiation(to cooler solid objects in
vicinity walls). The process of heat gain is by conduction, convection and radiation
in addition to nonshivering thermo genesis.

Why newborns are prone to develop hypothermia?

• Large surface area.
• Decreased thermal insulation due to lack of subcutaneous fat.
• Reduced amount of brown fat.

Nursing responsibility in preventing the heat loss in newborns and infants:

Evaporation: keep the child dry, remove wet nappies, and minimize exposure
during baths.
Conduction: e.g. weighing a baby. Put the baby on prewar med sheet and cover
scales and X-Ray diapers with warm diaper or blanket.
Radiation: keep the babies cots and incubators away from outside walls, air
conditioners; cover the baby if stable.
Convection: avoid currents of air, manage babies inside incubator, and organize
work to minimize opening portholes, provide warm humidified oxygen.

FROST BITE

Frost bite is the condition in which the tissue temperature drops below 0 degree
Celsius.It results in cellular and vascular damage. Body parts more frequently
affected by frostbite include the digits of feet and hands, tip of nose, and earlobes.

Predisposing factors:

 Contact with thermal conductors such as metal or volatile solutions

 immobility

 careless application of cold packs

 vasoconstrictive medications
 Symptoms:

 The injured area is white or mottled blue white,

 waxy and firm to the touch.
 There is tingling and redness followed by pallor and numbness of the affected
area.
 There are three degrees: transitory hyperemia following numbness, formation
of vesicles and gangrene.
 The affected area is insensitive to touch.

Diagnosis:
 Angiography and MRI to assess the potency of large vessels. Ultrasonography
 plethismography,
 thermography to evaluate perfusion after rewarming.
 Technetium scientigraphy to assess perfusion.

Management of frost bite:

 Before thawing: remove client from cold environment, stabilize core

temperature, treat hypothermia, protect the frozen part and do not apply friction or
massage.

 During thawing: provide parental analgesia e.g. keratolac & Provide ibuprofen
40 mg PO.

 Immerse part in 37-40 C circulating water containing an antiseptic soap for 10-
45 minutes.

 Encourage patient to gently move the part.

 After thawing: i) gently dry and elevate it. ii) Apply pledges between toes; if
macerated. iii) If clear vesicles are intact aspirate the fluid or the fluid will reabsorb
in days; if broken then debride and dress with antibiotic.

 Continue analgesics Ibuprofen 400mg 8-12 hourly. Provide tetanus prophylaxis

and hydrotherapy at 37C. v) The patient should be stimulated with orally
administered hot fluids such as tea and coffee. vi) The patient should not be allowed
to smoke. vii)Artificial respiration should be administered if the patient is
unconscious.
BIBLIOGRAPHY:

• Koziar Barbaro, Glenora Erb, Andray Berman, Karen Burbe‘s ―Fundamentals

of Nursing‖; Edition 7th; Published by Darling Kindereley Pvt.Limited, pp.523-536
• Potter A Patrica, Anne Griffen Perry‘s ―Fundamental Of Nursing‖, Edition 6 th;
Published By: Elsevier India Private Limited, Pp 257-258
• Saunder‘s Manual Of Nursing Practice, Edition Ist ; Published By W.B.
Saunder

• Smeltzer c. suzzane & brade bare’s Medical surgical nursing, 10th edition
published by Lippincott pg no:481-489.

JOURNALS
Elevated body temperature contributes to
the increased heart rate response during
eccentric compared to concentric cycling
when matched for oxygen consumption
Tor Eiken,Amelia J. Harrison,Catriona A. Burdon,Herbert Groeller &Gregory E. Peoples 
Pages 30-38 | Received 13 Jun 2020, Accepted 10 Aug 2020, Published online: 16 Sep 2020
ABSTRACT
ABSTRACT:

A cardiovascular requirement to facilitate thermal homeostasis may partly

contribute to the elevated heart rate during eccentric cycling. This study compared
the body temperature response to a bout of eccentric (ECC) and concentric (CON)
cycling to account for the difference in heart rate. Eight (N = 8) aerobically trained
males (age 35 y [SD 8], peak oxygen consumption 3.82 L.min−1 [SD 0.79])
completed an ECC cycling trial (60% PPO) followed by an oxygen
consumption/duration matched CON trial (30 ∘C ∘C, 35% RH) on a separate day.
Trial termination was determined as an elevation in aural temperature, a surrogate of
deep body temperature, by +0.5 ∘C ∘C during ECC. Mean skin (8-sites) and body
temperature (weighting of 80:20 for auditory canal and mean skin temperature) were
calculated. Matching the oxygen consumption between the trials increased external
work during ECC cycling (CON: 71 [SD 14] ECC: 194 [SD 38] W, p < 0.05) and
elevated aural temperature (+0.5 ∘C ∘C) by 20 min 32 s [SD 9 min 19 s] in that trial.
The peak rate of rise in aural temperature was significantly greater in ECC (CON:
0.012 [SD 0.007] ECC: 0.031 [SD 0.002] oC.s−1, p < 0.05). Aural, mean skin and
body temperature were significantly higher during the ECC trial (p < 0.05) and this
was accompanied by elevated mean heart rate (CON: 103 [SD 14] ECC: 118 [SD
12] b.min−1, p < 0.05) and thermal discomfort (p < 0.05). Moderate load eccentric
cycling imposes an elevated thermal strain when compared to concentric cycling.
This requirement for dissipating heat, in part, explains the elevated heart rate during
eccentric cycling.

COVID-19 and thermoregulation-related

problems: Practical recommendations
Hein Daanen  ,Stephan Bose-O’Reilly ,Matt Brearley ,D. Andreas Flouris ,Nicola M. Gerrett
,Maud Huynen , show all
Pages 1-11 | Received 03 Jun 2020, Accepted 30 Jun 2020, Published online: 06 Aug 2020

ABSTRACT
The COVID-19 pandemic started in the cold months of the year 2020 in the Northern
hemisphere. Concerns were raised that the hot season may lead to additional
problems as some typical interventions to prevent heat-related illness could
potentially conflict with precautions to reduce coronavirus transmission. Therefore,
an international research team organized by the Global Health Heat Information
Network generated an inventory of the specific concerns about this nexus and began
to address the issues. Three key thermal and covid-19 related topics were
highlighted: 1) For the general public, going to public cool areas in the hot season
interferes with the recommendation to stay at home to reduce the spread of the virus.
Conflicting advice makes it necessary to revise national heat plans and alert
policymakers of this forecasted issue. 2) For medical personnel working in hot
conditions, heat strain is exacerbated due to a reduction in heat loss from wearing
personal protective equipment to prevent contamination. To avoid heat-related
injuries, medical personnel are recommended to precool and to minimize the increase
in body core temperature using adopted work/rest schedules, specific clothing
systems, and by drinking cold fluids. 3) Fever, one of the main symptoms of
COVID-19, may be difficult to distinguish from heat-induced hyperthermia and a
resting period may be necessary prior to measurement to avoid misinterpretation. In
summary, heat in combination with the COVID-19 pandemic leads to additional
problems; the impact of which can be reduced by revising heat plans and
implementing special measures attentive to these compound risks.