Public Health’s Summer Plan (June 2020 to October 2020)Priorities

1. Provide proactive and reactive messaging to mitigate the impacts of heat and sun.2. Ensure proactive and reactive messaging on hydration to mitigate the impacts of dehydration.3. Provide messaging and support to prevent exacerbations for those living with respiratory conditions and seek to reduce

or minimise air pollution during summer months due to the impacts on respiratory conditions.4. Embed climate change perspective into messaging and utilise opportunities from the heatwave plan to support actions to

respond to the climate change emergency, increasing awareness of the need to adapt to future warmer weather, and wetter weather. And, reduce our environmental impact.

5. Ensure the summer plan considers and supports messaging on the potential impacts of COVID-19.6. Respond to heatwave escalation processes in line with PHE guidance.

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HydrationEffects of Heat & Sun

Respiratory

Air Pollution

and Climate Change

Impacts of Covid-19

AimTo protect the population from heat-related harm to health by preparing for, alerting people to, and protecting from, the major avoidable effects on health during periods of hot weather in Leeds.

The Plan presents a series of actions delivered in partnership with the NHS, Leeds City Council, professionals and voluntary groups supporting vulnerable people and underserved populations.

WhyWe should not forget that the temperature can get too high and become uncomfortably, and for some dangerously, hot.

Evidence about health risks from heatwaves is extensive and consistent from around the world. Excessive exposure to high temperatures can kill.

The three-week heatwave in France in August 2003 resulted in 15,000 excess deaths. The vast majority of these were among older people.

In England that year, there were over 2,000 excess deaths during the 10 day heatwave period from 4 to 13 August 2003, compared to the previous five years over the same period. In 2006 it was estimated that there were about 680 excess deaths and in 2009 there were approximately 300 excess summer deaths.

Excess deaths are not just deaths of those who would have died anyway in the next few weeks or months due to illness or old age. There is strong evidence that these summer deaths are indeed ‘extra’ and the result of heat-related conditions. In contrast to deaths associated with cold snaps in winter, the rise in mortality as a result of very warm weather follows very sharply – within one or two days of the temperature rising. This means that by the time a heatwave starts, the window of opportunity for effective action is very short and therefore advanced planning and preparedness is essential.

Heatwave Plan for England

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This provides guidance on how to prepare for and respond to a heatwave which can affect everybody’s health, but particularly the most vulnerable people in society. The 2020 Heatwave Plan remains largely unchanged, but includes additional information and advice relating to COVID-19.

The National Heatwave Plan for England describes the heat-health watch system which operates in England from 1 June to 15 September each year. During this period, the Met Office may forecast heatwaves, as defined by forecasts of day and night-time temperatures and their duration. This triggers response levels from the NHS, Government and the public health system, and communicates risks.

The heat-health watch system comprises five main levels (Levels 0-4), from long-term planning for severe heat, through summer and heatwave preparedness, to a major national emergency. Each alert level triggers a series of appropriate actions detailed in the Heatwave Plan.

Met Office Weather AlertsThe Leeds and national plans continue to be underpinned by a system of heatwave alerts, developed by the Met Office. The Met Office offers email alerts about specific weather topic areas. When you receive an alert you can follow the hyperlink in the email, taking you to the Met Office's weather warnings page which shows full details of the warning and a map of the areas where the warning applies.https://service.govdelivery.com/accounts/UKMETOFFICE/subscriber/new

Who are we targeting?

The Public Health Summer Plan takes a life course approach and aims to increase the effectiveness of interventions throughout a person’s life. It focuses on a healthy start and targets people at critical periods when they are more vulnerable to the effects of warm weather and heatwaves e.g. pregnancy and older age.

It recognises the work within the city to support whole population health management where a framework has been developed to segment the Leeds population. These segments recognise that at a given point in time the Leeds GP registered population will be in one of these groups, but over their life course may move between groups..

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There are certain factors that increase an individual’s risk during a heatwave identified in the PHE heatwave plan which include:

• Older age: especially over 75 years old, or those living on their own who are socially isolated, or in a care home

• Chronic and severe illness: including heart conditions, diabetes, respiratory or renal insufficiency, Parkinson’s disease or severe mental

illness. Medications that potentially affect renal function, the body’s ability to sweat, thermoregulation (eg psychiatric medications) or

electrolyte balance (diuretics) can make this group more vulnerable to the effects of heat

• Infants are vulnerable to heat due to immature thermoregulation, smaller body mass and blood volume, high dependency level,

dehydration risk in case of diarrhoea

• Homeless people (those who sleep in shelters as well as outdoors) may be at increased risk from heatwaves. Higher rates of chronic

disease (often poorly controlled), smoking, respiratory conditions, substance dependencies and mental illness are more frequent

homeless populations than in the general population. These risk factors increase the risks of heat related morbidity and mortality, on top of

social isolation, lack of air conditioning, cognitive impairment, living alone and being exposed to urban heat islands

• People with alcohol dependence and drug dependence often have poorer overall health and increased social isolation which can

increase their risk of heat stress

• Inability to adapt behaviour to keep cool such as having Alzheimer’s, a disability, being bed bound, drug and alcohol dependencies,

babies and the very young

• Environmental factors and overexposure: living in urban areas and south-facing top-floor flats, being homeless, activities or jobs that

are in hot places or outdoors and include high levels of physical exertion, children and adults taking part in organised sports (particularly

children and adolescents)

Hot weather presents an additional risk due to the ongoing Covid-19 pandemic therefor those that are clinically at high risk of Covid-19 including:

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pregnant women people living with frailty people with long term conditions those who are extremely clinically vulnerable (currently shielding)

The actions and messages within the plan, centre on targeting the needs of these high risk groups, to reduce the impact of hot weather and heatwaves. The 2020 plan also includes key messages and actions focussed on the additional risks presented by COVID-19.We have developed the plan with proactive and reactive messages and actions across the above groups, seeking to increase the city’s preparedness for the summer period, whilst maintaining the needs to escalate during a heatwave.

Priority 1. Provide proactive and reactive messaging to mitigate the impacts of heat and sun

Lead Sharon Hughes

Objectives 1.1. Ensure we provide appropriate messages to the general public including specific messaging for vulnerable groups both proactively during June to October, and reactively following Met Office and LCC weather alerts.

ActivityWho, what, where, when and how

Performance MeasureHow will we know we have achieved the

who, what, where, when and how

RAG

1.1 Action:Communications plan with proactive messages developed and shared across key settings.

Communications plan (see appendix 1) developed in preparation for heatwave following PHE guidelines, with localised messaging and information sources produced. Plans and messages adapted to include specific COVID-19 advice in line with PHE guidance.

Communications linked to the 33 volunteer hubs in

Plan produced and distributed with log of areas/organisations contacted.

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Lead: Sharon Hughes/Hannah McGurk

addition to statutory and 3rd sector organisations

1.2 Action:

Key messages shared upon notification of a heatwave and escalation

Lead: Liz Messenger/Sharon Hughes

Messages, as set out in the communications plan (appendix 1) distributed through communication channels including social media.

Easy read information out to LCC accommodation providers, LYPFT and 3rd Sector organisation working with people with LD – e.g. People Matters and People in Action

Have contacted GP clinical lead/Health facilitation lead in LYPFT/Reasonable adjustment lead in LTHT and Primary Care Lead Alert systems• Send ‘vulnerable groups heatwave document’ out to accommodation providers and third sector• Work with service providers more intensively as per ideas in the national heatwave plan i.e. Prevention is key – are houses cool, fridges working, staying cool advice and caution around particular drugs?Levers: LD Strategy and focus on health promotion and technology, also possibly PHE Health Charter

1.3 Action:A notification email to go to all A and H commissioned services upon notification of heatwave and escalation

Text of message

Dear Service Manager,

A Level 3 Heatwave Alert has been Issued for the York’s & Humber region; this has been upgraded from yesterday’s Level 2.

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Lead: Liz Messenger/Sharon Hughes

Although many of us enjoy the sunshine, extreme summer temperatures may harm the health of some vulnerable groups. Groups of people more likely to be at risk of harm include older people, the very young and people with pre-existing medical conditions as well as those whose health, housing or economic circumstances put them at a greater risk of harm from very hot weather.

Please can you ensure, where appropriate:

• You share key public health messages to protect your service users and staff – see attached• You visit/phone high-risk vulnerable people.• You regularly record indoor temperatures during the hottest periods for all areas used by staff and service users.• You activate plans to maintain business continuity.• You help and advise clients including access to cool rooms, close monitoring of vulnerable individuals, reducing internal temperatures through shading, turning off unnecessary lights/equipment, cooling building at night, ensuring discharge planning considers home temperatures and support available.• Your organisation is signed up to receive Met Office alerts.

https://www.metoffice.gov.ukhttps://www.metoffice.gov.uk/about-us/guide-to-emails

For more information please see The Heatwave Plan

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for England, which provides specific guidance for providers including health and social care staff in settings such as community bases, care homes and hospitals.

The message to have the ‘Beat the Heat’ advice sheet from PHE

1.4 Action:Link activities to work and messaging to support prevention of skin cancer

Lead: Louise Cresswell/Sharon Hughes

Ensure that messages include both proactive and reactive messages to prevent skin cancers and raise awareness.

Link to the cancer work programme for the city to broaden reach.

Priority 2 Hydration

Lead Rachel Brighton

Objectives 2.1. Ensuring proactive and reactive messaging and training on hydration to mitigate the impacts of dehydration.

ActivityWho, what, where, when and how

Performance MeasureHow will we know we have achieved the

who, what, where, when and how

RAG

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1.1.1 Action:Training

Lead:Rachel Brighton

Hydration (information and resources) is included in the Improving Nutritional Care (older people) training provided by LCH and Occupational Development for frontline staff to access.

Increased number of staff (ASAC and third sector) confident in key messages, raising concerns and using resources to promote hydration.

1.1.2 Action:Communications

Lead: Rachel Brighton

Ensure PH links to system resilience and Summer/Winter Comms group. Joined up campaigns through CCG funded activity and NHS E.coli communications campaigns.

Promotion of hydration messages through social media and other appropriate channels as set out in communications plan

1.2.1 Action:Refill and promotion of sites

Lead : Rachel Brighton

Increased access to fresh drinking water across Leeds – increased use of refill stations

Increased number of buildings (businesses, third sector, NHS and LCC buildings) registered as Refill stations.

Increased knowledge of Refill stations within priority groups.

Comments

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Priority 3. Respiratory and air pollution

Lead Carl Mackie

Objectives 3.1 Provide messaging and support to prevent exacerbations for those living with respiratory conditions and seek to reduce or minimise air pollution during summer months.

ActivityWho, what, where, when and how

Performance MeasureHow will we know we have achieved

the who, what, where, when and how

RAG

3.1.1 Action: Communications plan messaging clear and provides information for specific vulnerable groups

Lead: Carl Mackie/Sharon Hughes

Messages shared through key organisations and links made for translation for BAME groups where necessary through existing arrangements.

Links with 3rd sector hubs and BAME organisations to support message sharing and translations.

Plans linked to COVID-19 and coordinated with PH communications group as well as system resilience group and lead is taken in line with other messages

3.1.2 ActionEnsure action links to strategic work on covid-19 recovery and rehabilitation

Lead: Carl Mackie/Sharon Hughes

Align work to the data and information coming out of learning from COVID-19 to build in to messages and link with COVID-19 rehabilitation steering group.

Comments In light of the long-term impact of COVID-19 on people in terms of respiratory issues, this priority needs to link with the city’s wider recovery work. We anticipate that people recovering from COVID-19 may have long-term respiratory conditions.

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Priority 4. Climate Change

Lead Kevin McGready and Dr. Paola Sakai

Objectives 4.1 Provide evidence on the relationship of warm weather/climate change and air pollution and other health risks including COVID-19 in Leeds

4.2 Reduce Urban Heat Islands (UHI) in Leeds in order to reduce the risks of increased pollution

4.3 Embedding climate change into messaging and utilising the opportunities that the heatwave plan provides to support actions in response to the climate change emergency

ActivityWho, what, where, when and how

Performance MeasureHow will we know we have achieved

the who, what, where, when and how

RAG

4.1.1 Action:Provide evidence on the relationship between air quality and climate change and COVID-19.

Lead:Dr. Paola Sakai

Conduct a literature review and produce a paper highlighting the links between heat, air pollution, COVID-19 and vulnerability (socio-economic and health inequalities), and the need of strategic planning.

30th June

4.2.1 Action:Action: identify hotspots in Leeds

Lead:Dr. Paola Sakai

PS will get the heat exposure data for Leeds and other variables (humidity, wind speed) to develop the urban heat island (UHI) map of Leeds.PS will develop maps of vulnerability - considering the social determinants of health (health frailty, unhealthy life-style factors, poor living and working conditions, negative

Produce and present the maps by 30th August

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social and community influence, socio-economic challenges), maps of high air pollutants, and lack of capacitiesPS will get data of COVID-19 in Leeds (positives, recovered, deaths) to produce mapsLocate hotspots in the city with high vulnerability (socio-economic and health inequalities), high UHI, air pollution, and COVID-19. Upload the maps to SHAPE. Investigate if there is a relationship between those hotspots and cases of COVID-19.

Present the analysis and incorporate feedback by September 2020.

Identify possible intervention opportunities that generate the biggest gains in terms of heat-related risks reductions, air quality, long term health and wellbeing of people with COVID-19 and other health conditions

Provide a briefing and incorporate feedback by September 2020.

4.2.2 Action:Identify strategies to reduce UHI

Priority Lead:Dr. Paola Sakai

Organise a workshop to identify strategies to reduce UHI, increase air quality and promote wellbeing of people with long-term respiratory conditions and other citizens of Leeds.

Deliver a workshop to identify the possible interventions (by November 2020).

4.2.3 Action:Identify the strategies that can create the greatest co-benefits to reduce UHI, pollution and increase wellbeing

Priority Lead:Dr. Paola Sakai

Conduct analysis to identify wider benefits to implement the proposed strategies

Provide factsheets of the proposed strategies by February 2021

4.2.4 Action:Identify financing

Organise a workshop to identify the financing mechanisms and deployment pathways for the selected strategies

Delivered the workshop and provide a summary of the proposed pathways to

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mechanisms to implement the selected strategies

Priority Lead:Dr. Paola Sakai

deploy the selected strategies (by March)

Comments

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Key messages and communications plan for summer and heat 2020

This document pulls together national and local key messages that can be used for a variety of audiences to keep people safe and well during heat and summer. We will use it to support communications both internally and by key partners through a variety of channels including social media. Key messages can be adapted to suit different audiences and for differing cultural needs. Priorities:

1. Effects of heat and sun2. Hydration3. Respiratory and air pollution4. Climate change

The Heatwave Plan for England remains unchanged for summer 2020. Additional actions may be needed due to COVID-19 and specific messages are available below. The Public Health Resource Centre provides up-to-date and evidence-based information and support for people working to promote health and wellbeing in Leeds. This includes downloadable and physical resources, training opportunities, lunchtime seminars, etc.

Message: COVID-19 and Heat

Message Proactive / Reactive

Vulnerable Groups

COVID-19 amplifies the risks of hot weather.Sign up to the Met Office Heat-Health Watch Service here.

Proactive (before heatwave)

Potential increase in adverse outcomes amongst the same population groups affected by both high temperatures and COVID-19. For example, older people and those with comorbidities such as cardio-respiratory diseases.

Increase in exposure to indoor overheating due to COVID-19 restrictions. For example, people who have been advised to stay at home.

Proactive (before heatwave)

Shielded cohorts

Reduced access to cool public spaces for respite due to COVID-19 restrictions.

Reactive (during heatwave)

EVERYBODY can be affected by high temperatures, but there are certain factors that

Proactive(before

older age: especially those over 75 years old, or those living on their own and who are socially isolated, or those living in a care home

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increase an individual’s risk during a heatwave. heat wave) chronic and severe illness: including heart or lung conditions, diabetes, renal insufficiency, Parkinson’s disease or severe mental illnessinability to adapt behaviour to keep cool: babies and the very young (especially under 4), having a disability, being bed bound, consuming too much alcohol, having Alzheimer’s Diseaseenvironmental factors and overexposure: living in a top floor flat, being homeless, activities or jobs that are in hot places or outdoors and include high levels of physical exertion.People resident in specific institutional settings (e.g. prisons, barracks, inpatient psychiatric units) and some occupations, workplaces and schools - particularly those involving significant manual exertional, heat generation (e.g. cooking, some manufacturing roles) and in buildings prone to overheating and without air conditioning already on this list

Example tweet:Beat the heat this summer and look after yourself and your family’s health by following these very simple steps from @PHE_uk #BeatTheHeat and #HelpUsHelpYou. https://www.leedsccg.nhs.uk/health/healthy-living/stay-well-this-summer/

Proactive

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Priority 1: Effects of heat and sun

Images available here. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/888252/Beat-the-Heat_Leaflet_Coping_with_heat_and_COVID-19.pdf

1.1 Message: Stay cool at home

Message Proactive / Reactive

Vulnerable Groups affected and further support available

Leeds Resources

Some people are particularly at risk from heat and for them a hot home can worsen existing health conditions, or even kill.

Proactive (before heatwave)

People living in their own homes

Care Homes - guidance found here

Home Plus (Leeds)

Many homes are prone to overheating so it may be cooler outside. During sunny periods parks and public spaces may become busy but it is important that everyone continues to follow the rules on social distancing.

Proactive (before heatwave)

Babies and Children: If you have children ensure that they also follow the advice on social distancing.Covid-19: Be respectful of others who may be at high risk from COVID-19 and keep your distance. Follow social distancing guidance when using shared outdoor

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spaces.To reduce the transmission of coronavirus (COVID-19) many people be will work from home. Even during a relatively cool summer, 1 in 5 homes in England are likely to overheat.

Proactive (before heatwave)

Older people / vulnerable groups: getting your home ready for winter

Home Plus (Leeds)

Warm homes discount scheme

Home Hazard assessment

In preparation for warmer weather, use our simple checklist to find out if your home is at risk of overheating and find out what you can do if there is a problem. You can download the checklist here.

Proactive (before heatwave)

Tips: Shade or cover windows exposed to direct sunlight,

external shutters or shades are very effective, while internal blinds or curtains are less effective but cheaper.

Metallic blinds and dark curtains can make a room hotter. Turn off the central heating, and lights and electrical

equipment that aren’t in use. Use electric fans if the temperature is below 35°C, but do

not aim the fan directly at the body and ensure you stay hydrated with regular drinks. Using a fan in temperatures about 35°C can contribute to heat exhaustion.

Check that fridges and freezers are working properly.

Proactive (before heatwave)

Now that the warm weather is here, it might be the time to consider how you will keep warm in winter. If your heating is broken, heating engineers will be less busy now than in the winter and you could also consider some basic energy efficiency improvements such as insulation or draft-proofing. For more information on keeping warm at home, as well as help and advice with fuel bills visit Home Plus Leeds.

Proactive (preparing for winter)

HomePlus

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Are you eligible for the warm homes discount of £140 off of your electricity bill? Households in receipt of the pension guarantee credit should receive this automatically, however other households in receipt of income related benefits might also be able to apply for this from their electricity supplier. Energy supplier’s warm homes discount schemes usually open in early autumn, however some may have a waiting list you can add yourself to. If not, why not make a note in your calendar! More information on the warm homes discount scheme, can be found here.

Tips:• Shade or cover windows exposed to direct sunlight• Open windows when the air feels cooler outside than

inside, eg , at night. Try to get air flowing through your home, if possible.

• Do not use a fan if anyone in the home is unwell with symptoms of coronavirus (COVID-19).

Reactive (during heatwave)

Think about how to sensitively portray these messages: those with smaller homes, etc.

If you have concerns about an uncomfortably hot home that is affecting your health or someone else’s health, seek medical advice.

Reactive (during heatwave)

It is important that if you or someone you live with becomes unwell you get help quickly. Do not delay seeking help if you have concerns.

Your NHS is still here for you campaign.

1.2 Message: Stay cool, keep well

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Message Proactive / Reactive

Vulnerable Groups affected and further support available

Leeds Resources

It is important for your health to avoid getting hot in the first place. If you do get hot, it is important to give your body a break from the heat. It may be cooler outside in the shade than it is inside an overheated building.

Proactive (before heatwave)

Connect with vulnerable neighbours and family members to check if they are coping with the heat, know how to adapt their home and have everything they need.

Babies and ChildrenChildren should not take part in vigorous physical activity on very hot days, such as when temperatures are above 30°C.

Care Homes - guidance found here

Neighbourliness pack from VAL? hyperlink

Sun and UV radiationProtect from the negative effects of the sun (sunburn, skin cancer, effects of UV radiation on the eyes) by using sunscreen of SPF 15 or higher, wear good quality UV protective sunglasses and check the UV warnings.

Example tweet:Even if you’re just out & about in the garden, you need to stay safe in the sun. Drink plenty of water, wear suitable clothing & sunglasses and use at least factor 30 sunscreen #HelpUsHelpYou https://www.leedsccg.nhs.uk/health/healthy-living/stay-well-this-summer/

If you’re spending time outdoors this weekend, make sure you stay safe in the sun – seek out shade, wear suitable clothing and use at least factor 30 sunscreen #HelpUsHelpYou #SummerSignsNHS https://www.leedsccg.nhs.uk/health/healthy-living/stay-

Proactive Choose lightweight, light-coloured, loose-fitting clothing.

Example images:

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well-this-summer/

The only thing burning this summer should be the food on the BBQ. #HelpUsHelpYou by covering up and avoiding sunburn – get summer health info here https://www.leedsccg.nhs.uk/health/healthy-living/stay-well-this-summer/

Skin CancerMost skin cancers are caused by exposure to the sun. This may be long term exposure, or short periods of intense sun exposure and burning. This damage can happen years before a cancer develops.Sunburn does not just happen on holiday. You can burn in the UK even when it is cloudy. Anyone can get sunburnt or develop skin cancer, but there are some characteristics that mean people are likely to have a higher risk and need to take more care in the sun.You should take more care in the sun if you have one or more of the following:

skin that burns easily light or fair coloured skin, hair, or eyes lots of moles or freckles a history of sunburn a personal or family history of skin cancer

Sun safety tips Spend time in the shade when the sun is

strongest. In the UK, this is between 11am and 3pm from March to October

Make sure you never burn Cover up with suitable clothing and sunglasses,

such as wide brimmed hats that shade the face,

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neck and ears, long sleeved tops and trousers or long skirts in close weave fabrics that do not let light through.

Use at least factor 30 sunscreenWhen buying sunscreen, the label should have a high sun protection factor (SPF) of at least 30 and at least 4-star UVA protection. Make sure the sunscreen is not past its expiry date. Most sunscreens have a shelf life of 2 to 3 years and when applying, ensure that all exposed skin is covered, including the face, neck and ears, and head if you have thinning or no hair, but a wide-brimmed hat is better.Knowing the forecast can help you plan ahead and adapt as necessary. Heatwaves may affect other services, such as power and water supplies, and transport.

Proactive (before heatwave)

Listen to the news to be aware of when a heatwave has been forecast and how long it is likely to last.Check the weather forecast and any high temperature health warnings at www.metoffice.gov.uk

Organisations can sign up to receive alerts

Avoid extreme physical exertion. If you cannot avoid strenuous outdoor activity, such as sport, DIY or gardening, keep it for cooler parts of the day – for example, in the early morning or evening.

Heavy activity can make you prone to heat related illnesses, even if you are fit and healthy.

Proactive (before heatwave)

Public Health England provides guidance for physical activity recommendations for different age groups.

Active Leeds

More of us are walking and cycling to support social distancing measures on the transport system; listen to the forecast and take it easy if the weather is hot, especially if you are travelling in the hottest part of the day.

Proactive (before heatwave)

Check the weather forecast and any high temperature health warnings at www.metoffice.gov.uk

Organisations can sign up to receive alerts.

Do not swim in open water (guidance here, page 13) Proactive Stock image:

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Example tweet:Sun’s out, pool’s out. Make sure children and babies are well covered and spend time in the shade particularly when the sun is at its strongest. Find out more on how to #BeatTheHeat https://www.leedsccg.nhs.uk/health/healthy-living/stay-well-this-summer/ #HelpUsHelpYou

(before heatwave)

Take a break from the heat by moving to a cooler part of the house if possible, especially for sleeping.

Reactive (during heatwave)

Consider how to adapt messages to audiences – i.e. those with smaller houses, unable to move to a different part of the house.

Find some shaded green space or have a cool bath or shower.

If you notice someone has signs of heat related illness (guidelines here, page 12)

Reactive (during heatwave)

Consider how to adapt messages to audiences – i.e. those without green spaces or who are shielding.

LCC parks and countryside

1.3 Message: Look out for others safely, follow COVID-19 guidance

Message Proactive / Reactive

Vulnerable Groups affected and further support available

Leeds Resources

The heat can affect anyone, but some people run a greater risk of serious harm many people who are at higher risk of ill health due to heat are also at higher risk of severe illness from coronavirus (COVID-19).

Stay out of the heat, cool yourself down, keep your environment cool or find somewhere else that is cool if

Proactive (before heatwave)

Care Homes - guidance found here

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possible.Have a plan in place in case you become unwell during hot weather, including who to contact.We still have much to learn about how coronavirus (COVID-19) affects the body but both heat and COVID-19 infections put a strain on the heart and lungs, the kidneys and are linked with inflammation in the body.

Proactive (before heatwave)

List of those who may be more at risk from the effects of heat found here (p.5)

Clinical vulnerabilities that have been linked with worse outcomes from COVID-19 that are also risks for heat related harms are listed here (p.5)

COVID helpline: Coronavirus - help for people and communities

COVID-19 may result in more social isolation as vulnerable or anxious people stay at home, people who are socially isolated are at higher risk during hot weather especially those living alone

Proactive (before heatwave)

Look out for neighbours, family or friends who may be isolated and unable to care for themselves; make sure they are able to keep cool during a heatwave.

Community Care volunteers Become a Volunteer | Doing Good Leeds

R U OK service

COVID-19: Those who are less able to adapt to hot weather rely on others to help them to stay cool and well during hot weather, it is important that care continues even if it has to be done in a different way

Reactive (during heatwave)

If you are providing care and / or support to others you will need to do things differently this year keep in touch remotely over the phone or using video technology, if this is not possible and you need to provide direct care to someone at risk from the hot weather, follow the guidance on providing care for others.

Reactive (during heatwave)

COVID-19 guidance:• wash your hands when you arrive at the

home of the person you care for and often thereafter, using soap and water for at least 20 seconds or use hand sanitiser

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Example tweet:Please make sure you and loved ones stay safe and well during the warmer weather this summer- here’s some advice from your local NHS #HelpUsHelpYou #SummerSignsNHS

• cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze

• put used tissues in the bin immediately and wash your hands afterwards

• do not visit if you are unwell and make alternative arrangements for their care

Make sure medicines are stored below 25°C or in the fridge (read the storage instructions on the packaging).

Proactive (before heatwave)

Carry on taking all prescribed medicines unless advised not to by a medical professional.

Get medical advice if you suffer from a chronic medical condition or take multiple medications.

Proactive (before heatwave)

Be alert and if someone is unwell or needs further help, see the resources section in this leaflet. Be on the lookout for signs of heat-related illness. You can find out more, such as common signs and symptoms to look out for, on NHS Choices:

Example tweet:Help us help you this summer, read our health guide and find out how you could pick over-the-counter medicines to keep you well. Why not pick up the essentials on your next weekly shop #HelpUsHelpYou #SummerSignsNHS

Reactive (during heatwave)

If you are worried about heat stroke seek medical advice.

Image:

Priority 2: Hydration

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Images available here.

And here.

2.1 Message: Drink plenty of fluids, monitor hydration

Message Proactive / Reactive

Vulnerable Groups affected and further support available

Leeds Resources

Fluid requirements are higher than normal in hot weather and after strenuous activity, to replace fluids lost through sweating.

Example tweet:As the temperatures rise this summer, remember to keep hydrated aiming for at around 6-8 glasses a day (2 litres) of water a day. Staying hydrated is easy and can be done for free! For more info visit https://www.leedsccg.nhs.uk/health/healthy-living/stay-well-this-summer/ #HelpUsHelpYou #SummerSignsNHS

Proactive (before heatwave)

Everyone is at risk of dehydration in hot temperatures, but babies, children and older people are particularly vulnerable.

Detailed advice on hydration for different groups of people, including older people is available here.

Hydration for older people. https://www.scie.org.uk/almost-there

Care Homes - guidance found here

Improving Nutritional Care (older people) free training available – bookings taken through the Public Health Resource Centre.

Locally produced video available to promote good hydration. Good Hydration video:

Free COVID-19 Malnutrition Helpline available for any professional or resident wanting advice, guidance or support on nutrition and hydration.

The COVID-19 malnutrition

Keeping hydrated will be especially important for people who are unwell with coronavirus (COVID-19) infection and managing their symptoms at home.

Example tweet:

Proactive (before heatwave)

Those who have been unwell with coronavirus (COVID-19) and are recovering, particularly those who have been discharged from hospital, are likely to be more vulnerable to risks from heat stress and dehydration due to complications, for example, damage to their kidneys.

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There’s some lovely weather forecast for the next few days. Don’t forget to drink plenty of water, especially if you’re exercising, and try to limit caffeine & alcohol #HelpUsHelpYou #SummerSignsNHS

Drinking Enough (LCC advicehelpline is a dedicated phone line which puts you in touch with the community dietetic team who can provideimpartial advice and simple ideas to help with your eating and drinking. Monday to Friday 9am – 4pm or email 24 hours a day on lch.malnutrition@nhs.net0113 843 0905

Drink plenty of fluids: water, lower fat milks and tea and coffee are good options for adults.

Fruit juice, smoothies and soft drinks do count towards your fluid intake, but can be high in sugar. Limit fruit juice or smoothies to a combined total of 150ml a day and swap sugary soft drinks for diet, sugar-free or no added sugar varieties.

Keep a bottle of water handy at all times and get it refilled for free.

Have plenty of cold drinks, and avoid excess alcohol, caffeine and hot drinks

Eat cold foods, particularly salads and fruit with high water content. Avoid heavy meals.

Proactive Babies and Young Children From 0 to 6 months: Fully breastfed babies do

not need any water until they start to eat solid foods. During hot weather they may want to breastfeed more than usual. If you bottle feed, as well as their usual milk feeds, you can give your baby a little cooled boiled water. If your baby wakes at night, they will probably want milk. If they have had their usual milk feeds, try cooled boiled water as well.

From around 6 months: Once you have started to introduce solid foods, you should offer your baby sips of water from a cup or beaker with meals. Remember that breastmilk or infant formula should be their main drinks during the first year. In hot weather, you may need to offer some additional water outside of mealtimes.

From 12 months: Water, breast milk or whole cows' milk should be your baby's main drinks. In hot weather, you can try giving them frozen lollies made from plain water or from very diluted fruit juice to help keep them hydrated. Lollies made from diluted fruit juice should only be given at mealtimes because they can cause tooth decay.

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For older children, give them plenty of fruit and salad to help keep their fluid levels up.

Look out for signs of dehydration such as increased thirst, a dry mouth, dark urine, and urinating infrequently or small amounts. Serious dehydration needs urgent medical attention, more information is available here.

It is important that if you or someone you live with becomes unwell you get help quickly. Do not delay seeking help if you have concerns.

Your NHS is still here for you campaign.

Reactive (during heatwave)

Drink plenty of fluids: water, lower fat milks and tea and coffee are good options.

Fruit juice, smoothies and soft drinks do count towards your fluid intake, but can be high in sugar. Limit fruit juice or smoothies to a combined total of 150ml a day and swap sugary soft drinks for diet, sugar-free or no added sugar varieties.

Babies and Children• It is quite common for young children to

become dehydrated. It can be serious if not dealt with quickly. Specific advice for babies and young children can be found here.

Take your baby or child to the GP urgently or go to A&E if they:• seem drowsy• breathe fast• have a dry mouth• have few or no tears when they cry• have a soft spot on their head that sinks

inwards (sunken fontanelle)• have dark yellow pee or have not had a pee in

last 12 hours• have cold and blotchy-looking hands and feet

Once the dehydration has been treated, your child will need to maintain their fluid levels.

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GPs usually advise:• carry on breastfeeding or using formula – try to

give small amounts more often than usual• for babies on formula or solid foods – give them

small sips of extra water• give small children their usual diet• give regular small sips of rehydration solution to

replace lost fluids, salts and sugars – ask your pharmacist to recommend one

• do not make formula weaker• do not give young children fruit juice or fizzy

drinks – it makes things like diarrhoea or vomiting worse

Priority 3: Respiratory and Air Pollution

3.1 Message:

Message Proactive / Reactive

Vulnerable Groups affected and further support available Leeds Resources

Air pollution can become worse during periods of hot weather. Local air pollution (i.e. particulate matter) may exacerbate the health impacts of heat.

Proactive (before heatwave)

Health advice for the general population and those who may be particularly sensitive to air pollution is available from UK AIR by calling 0800 55 66 77 (recorded information) or visiting https://uk-air.defra.gov.uk

There is a link between air pollution, COPD and incident childhood asthma. Therefore, heatwaves exacerbating air pollution can bring negative health effects on people with these conditions.

Black Spot Mould can exacerbate respiratory illness. If you have black spot

Proactive (before

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mould in your home, now might be the time to treat it with an anti-mould cleaner. You can prevent it from returning by regularly ventilating your home, particularly when undertaking activities that cause steam and condensation.

heatwave)

Avoid having garden fires or burning rubbish.Avoid using disposable BBQ’s in open spaces, and if you do use them, ensure you do so safely including making sure that the hot ashes do not ignite grass fires.

Reactive (during heatwave)

Smoke from bonfires can cause people with respiratory and other health conditions to suffer. This is particularly relevant at the current time where people are likely to be spending more time at home and in their gardens due to the COVID-19 restrictions and self-isolations. Some households may even experience the symptoms of the virus and could be adversely affected by smoke.

WY Fire Service

Air pollutant tends to peak during the hottest period of the day and drop to lower levels at night, so advice is to restrict going outside particularly during the hottest period of the day.High pollen count – ways to ease symptoms: put Vaseline around your nostrils and

wear wraparound sunglasses to stop pollen getting into your nose and eyes

shower and change your clothes after you’ve been outside to wash pollen off

stay indoors whenever possible and keep windows and doors shut as much as possible

vacuum regularly and dust with a damp cloth

Example tweet:If you’re not sure whether you have hay

If you know you are prone to symptoms resulting from high pollen, start taking (medication) earlier. Asthma UK advice on hayfever.

Look for pollen count as part of weather alerts. Keep an eye on the news.

You can buy treatments over the counter. See your GP if you experience wheezing, breathlessness, or tightness in your chest, if you are pregnant or breastfeeding, if your symptoms are not relieved by over-the-counter treatments in combination with measures to reduce your exposure to pollen.

Example tweet:No fun at the fair if you forget your inhaler. With thanks to local school children for this entertaining reminder on why you should

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fever or coronavirus, learn more about the different symptoms before you go out & about https://www.leedsccg.nhs.uk/news/dont-confuse-hay-fever-with-coronavirus-warns-leeds-gp/ #HelpUsHelpYou

Stay well this summer! You can find lots of tips, advice and guidance here including managing hayfever, staying safe in the sun and keeping hydrated https://www.leedsccg.nhs.uk/health/healthy-living/stay-well-this-summer/ #HelpUsHelpYou

If you’re spending more time outdoors this summer, don’t forget your inhaler and make sure children always have theirs too here’s some advice for parents and carers https://www.leedsccg.nhs.uk/health/healthy-living/children/asthma/ #HelpUsHelpYou #SummerSignsNHS

keep your inhaler with you at all times #HelpUsHelpYouhttps://www.youtube.com/watch?v=wu9otZtOY_4&feature=emb_logo

Oh no the ice cream van is here but you’ve run out of puff! With thanks to local school children for this entertaining reminder on why you should keep your inhaler with you at all times #HelpUsHelpYouhttps://www.youtube.com/watch?v=39Mn-KJiF8E&feature=emb_logo

Example images

Priority 4: Climate Change

4.1 Message:

Message Proactive /

Vulnerable Groups Leeds Resources

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ReactiveClimate change is happening. The last three decades have recorded the hottest temperatures, and, the Met Office points at a future increase in heat stress. We need to start adapting our homes, infrastructure and behaviour to a new climate now.

Proactive (before heatwave)

Urban heat islands are created across the city as a result of pavements, concrete, and other solid surfaces increasing the heat in parts of the city.

Save water as there will be drier summers with likelihood of droughts.

Use active transport (cycling/walking) where possible instead of driving

Proactive Be aware of COVID-19 guidelines on social distancing and wearing a mask if appropriate

Active Leeds or Active Travel

Use locally sourced / seasonal produce to reduce food miles – grow own where possible

Proactive Encourage any cooking classes / communal eating activities to be plant based

Gardening groups – grow herbs and vegetables and share produce

Make your home as energy efficient as possible by installing insulation and choosing energy efficient appliances. Use renewable energy providers, when buying new equipment buy energy efficient, change to energy efficient lightbulbs, always turn electrical equipment fully off – don’t leave on standby.

Avoid turning on or buying air conditioning as it will increase CO2 emissions

Proactive Care HomesLaundry – use low temperature, economy saving settings.Encourage residents to minimise use of water / energy e.g. don’t leave taps running.

Home Plus

Use recyclable and re-useable products rather than disposable ones.

Proactive Avoid single-use plastics

Plant and retain trees and hedges in your garden to enhance your environment.

Proactive

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Additional national resources

Heatwave Plan for England (published 28th May 2020)Beat the Heat: Coping with heat and COVID-19 (poster) and leaflet and checklist Beat the Heat: Keep residents safe and well during COVID-19 (poster and checklist)Heatwave Plan for England: easy read versionMaking the case: the impact of heat on health – now and in the futureAdvice for health and social care professionals: supporting vulnerable people before and during a heatwaveAdvice for care home managers and staff: supporting vulnerable people before and during a heatwaveLooking after children and those in early years settings during heatwaves: guidance for teachers and professionalsLeeds Clinical Commissioning Group (CCG) Summer PlanNHS: How can I keep my baby safe during hot weather?

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