The frequency of extreme heat events, such as the summer of 2003 in Europe, and their corresponding consequences for human beings are expected to increase under a warmer climate. The joint collaboration of institutional agencies and multidisciplinary approaches is essential for a successful development of heat-health warning systems and action plans which can reduce the impacts of extreme heat on the population. The present work constitutes a state-of-the-art review of 16 European heat-health warning systems and heat-health action plans, based on the existing literature, web search (over the National Meteorological Services websites) and questionnaires. The aim of this study is to pave the way for future heat-health warning systems, such as the one currently under development in the framework of the Horizon 2020 HEAT-SHIELD project. Some aspects are highlighted among the variety of examined European warning systems. The meteorological variables that trigger the warnings should present a clear link with the impact under consideration and should be chosen depending on the purpose and target of the warnings. Setting long-term planning actions as well as pre-alert levels might prevent and reduce damages due to heat. Finally, education and communication are key elements of the success of a warning system.

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Background Growing evidence indicates that the exposure to high heat levels in the workplace results in health problems in workers. A meta‐analysis was carried out to summarize the epidemiological evidence of the effects of heat exposure on the risk of occupational injuries. Methods A search strategy was conducted to retrieve studies on the effects of climate change on occupational injury risk. Among the 406 identified, 5 time‐series and 3 case‐crossover studies were selected for meta‐analysis. Results Pooled risk estimates for time‐series and case‐crossover studies combined, and then separated, were 1.005 (95%CI: 1.001‐1009), 1.002 (95%CI: 0.998‐1.005), and 1.014 (95%CI: 1.012‐1.017), respectively. Subgroup analyses found increased risks (not statistically significant) for male gender, age <25 years and agriculture. Conclusions The present findings can orient further research to assess the effects of heat at workplace and consequently to establish better health policies for managing such exposure in at‐risk regions.

Heatwaves (HWs) are one of the "natural" hazards with the greatest impact worldwide in terms of mortality and economic losses, and their effects may be exacerbated in large urban areas. For these reasons, more detailed analyses of urban HW trends represent a priority that cannot be neglected. In this study, HW trends were investigated during the warmest period of the year (May-September) by using a slightly improved version of the EuroHEAT HW definition applied on long meteorological time-series (36-year period, 1980-2015) collected by weather stations located in the capitals of the 28 European Union member countries. Comparisons between two 18-year sub-periods (1980-1997 vs. 1998-2015) were carried out and a city-specific HW hazard index (HWHI), accounting for the main HW characteristics, was proposed. Most of the capitals revealed significant positive trends of the majority of HW hazard characteristics and substantial HWHI increases were observed during the sub-period 1998-2015, especially in the central-eastern and southeastern cities. Conversely, minor HWHI increases were observed in most of the northern capitals and opposite situations were even observed in several northern and especially southwestern cities. The results of this study represent a support for planning urban HW-related mitigation and adaptation strategies with the priority given to the southeastern cities.

Existing heat–health warning systems focus on warning vulnerable groups in order to reduce mortality. However, human health and performance are affected at much lower environmental heat strain levels than those directly associated with higher mortality. Moreover, workers are at elevated health risks when exposed to prolonged heat. This study describes the multilingual “HEAT-SHIELD occupational warning system” platform (https://heatshield.zonalab.it/) operating for Europe and developed within the framework of the HEAT-SHIELD project. This system is based on probabilistic medium-range forecasts calibrated on approximately 1800 meteorological stations in Europe and provides the ensemble forecast of the daily maximum heat stress. The platform provides a non-customized output represented by a map showing the weekly maximum probability of exceeding a specific heat stress condition, for each of the four upcoming weeks. Customized output allows the forecast of the personalized local heat-stress-risk based on workers’ physical, clothing and behavioral characteristics and the work environment (outdoors in the sun or shade), also taking into account heat acclimatization. Personal daily heat stress risk levels and behavioral suggestions (hydration and work breaks recommended) to be taken into consideration in the short term (5 days) are provided together with long-term heat risk forecasts (up to 46 days), all which are useful for planning work activities. The HEAT-SHIELD platform provides adaptation strategies for “managing” the impact of global warming.

The aim of this study is to identify the most effective thermal predictor of heat-related very-elderly mortality in two cities located in different geographical contexts of central Italy. We tested the hypothesis that use of the state-of-the-art rational thermal indices, the Universal Thermal Climate Index (UTCI), might provide an improvement in predicting heat-related mortality with respect to other predictors. Data regarding very elderly people (≥75 years) who died in inland and coastal cities from 2006 to 2008 (May–October) and meteorological and air pollution were obtained from the regional mortality and environmental archives. Rational (UTCI) and direct thermal indices represented by a set of bivariate/multivariate apparent temperature indices were assessed. Correlation analyses and generalized additive models were applied. The Akaike weights were used for the best model selection. Direct multivariate indices showed the highest correlations with UTCI and were also selected as the best thermal predictors of heat-related mortality for both inland and coastal cities. Conversely, the UTCI was never identified as the best thermal predictor. The use of direct multivariate indices, which also account for the extra effect of wind speed and/or solar radiation, revealed the best fitting with all-cause, very-elderly mortality attributable to heat stress.

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WHO produced guidelines about the use of PPE to reduce the transmission of SARS-CoV-2. • The synergistic effect between heat and anti-COVID-19 measures must be studied. • Researchers must study how PPE behave when used in outdoor warm condition. • A PPE-inclusive customized heatwarning system is useful at the time of COVID-19. • Interventions to review HHWSs in the context of COVID-19 are strongly required.