Metro Vancouver saw 15 times more heat wave deaths than estimated during unprecedented alert

Few people outside public health circles knew an extreme heat alert issued by Metro Vancouver health authorities at the start of the heat wave was unprecedented, and even the authorities’ own forecasting dramatically underestimated how many people could die in the record-breaking temperatures.

Internal documents obtained by CTV News Vancouver support the admission that health officials were unprepared for the scope and severity of the heat wave, which saw quadruple the number of deaths the region typically sees during that week. Health officials had expected only a fraction of that number.

“According to the BCCDC historical data, the Extreme Heat Alert criteria is linked to at least a 20 per cent increase in mortality,” wrote Dr. Mark Lysyshun, Vancouver Coastal Health’s deputy chief medical health officer to hospital staff on Friday, June 26.

“These high temperatures over the coming days will likely result in an increase in heat-related illness or death and require closer monitoring of clients, residents and patients.”

A 20 per cent increase in Vancouver Coastal Health would’ve meant 54 deaths, compared to the 5-year average of 45 for the week of June 25 to July 1. There were 193 this year.

In Fraser Health, the forecast would’ve been for 60 deaths compared to the average of 50. There were 344.

Provincially, the latest figures from the BC Coroners Service show 777 people died, when the average is just 198. That means the anticipated death toll was roughly 240.

AN UNPRECEDENTED ALERT, BUT WHO KNEW?

Late in the afternoon on Friday, June 26, Vancouver Coastal Health and Fraser Health issued “Extreme Heat Alerts,” offering extensive advice on how to keep cool and the importance of staying hydrated.

The health authorities did not alert the public nor the media to the fact that that level of warning and danger was unprecedented and being implemented for the first time.

“Once the criteria level has been reached, Vancouver Coastal Health and Fraser Health will issue an Extreme Heat Alert to the public,” reads an internal planning document that provides guidance and criteria on heat response.

It’s based on analysis and recommendations from the last fatal heat wave that slammed the region in 2009, but the terminology has changed: “heat health emergency” was replaced with “extreme heat alert” sometime before 2017.

"I think it could've really made quite a bit of difference if health officials had come out and said, 'This is unprecedented, this is the first time we're putting in this alert, this is why we're putting in this alert,' and making really clear what the potential risks were," said Heidi Tworek, an associate professor at UBC’s School of Public Policy.

While the social media posts and press releases did say the temperatures were “historically associated with an increase in deaths,” they did not provide a sense of urgency or the sense a health emergency was underway.

“I think there were a lot of people who did not even know that basic fact: that this was an unprecedented declaration,” said Tworek. “Certainly, in retrospect, we've seen many politicians and others saying they could've done better on the communications. That, in a way, speaks for itself.”

CTV News asked the province’s top doctor whether anything exceptional was done to respond, or whether a typical response – the establishing of cooling centres and messaging to hydrate, for example – greeted a very atypical situation.

Provincial health officer Dr. Bonnie Henry acknowledged the response was “not sufficient.”

SERIOUS QUESTIONS ABOUT BCEHS RESPONSE

Given that representatives from BCCDC, Vancouver Coastal Health, Fraser Health, Health Emergency Management BC and Environment Canada were involved with the process to enact the “extreme health alert” and spread the word about it to the public, municipal governments and other health agencies on June 25, it’s particularly perplexing that BC Emergency Health Services didn’t escalate its own internal response for ambulance paramedics for another four days.

The organization’s chief operating officer acknowledged that BCEHS didn’t fully activate its Emergency Operations Centre until the heat wave had started waning on June 29, but couldn’t explain why it waited, nor why it offered overtime pay to entice paramedics to work the following weekend when the extreme heat alert was still in effect but considerably lower temperatures were expected.

On Wednesday, Health Minister Adrian Dix announced significant investment in ambulance paramedics, equipment and stations. He also announced the installation of two new board members and a senior executive, but no other changes to the organization’s leadership.

CTV News asked how the public could be expected to have faith in an agency with essentially the same leadership that had a delayed response during the heat dome.

“I just don’t think that that's a correct analysis,” Dix responded. “I appreciate your asking the question to get a response and that there's concern, but across our health system we were responding to the extreme heat emergency that took place I can tell you the work done across the health system was profound, including for ambulance paramedics.”

He went on to point out the call volume for help was unprecedented and the heat dome itself was far outside anyone’s experience in Metro Vancouver.

“The demands of that extreme heat emergency – the heat dome – were profound, and the system was responding, but I think it's fair to say the response wasn't adequate to the massive increase in demand,” said Dix. “It was an exceptional moment in the history of the climate of B.C., of temperatures in B.C., for people in B.C. No one has ever seen anything like that.”