• The incidence of asthma and allergic rhinitis is likely to be lower compared to the previous season (JJA) due to less frequent episodes of Saharan dust incursions and lower levels of local dust into the Caribbean in the coming season.
• Increased humidity – at even higher levels than usual for this time of the year – in the Caribbean islands and Belize throughout the period may cause dampness in some poorly ventilated residences and offices resulting in the growth of mould and increased allergic reactions.
• Where episodes of flooding may occur, particularly in the Caribbean islands and Belize, there is an increased risk of ear, nose, and throat infections from contact with contaminated water.

• Where episodes of flooding may occur, cases of gastroenteritis may increase, where persons consume foods contaminated by these waters, especially in the Caribbean Islands and Belize.

• Excessive heat from high temperatures across the region (exacerbated by humid air across the Caribbean Islands) will first be of greater concern through the end of September before becoming less prevalent towards November. Moreover, especially during September and, possibly, in October anywhere further south than the Leeward Islands (or even in early-November in the Guianas), frequent heatwave days can increase the risk of morbidity from heat related illness in vulnerable persons, especially smaller children, the elderly, pregnant women and persons with NCDs. Heat stress may present as a worsening in chronic conditions such as cardiovascular, respiratory, cerebrovascular disease and diabetes-related conditions. Symptoms can include lethargy, general weakness, dizziness, fainting and, in extreme cases, kidney failure. More information can be found at: https://ghhin.org/in-the-body/. For more information on what to do during heatwaves, see: https://www.paho.org/hq/index.php? option=com_content&view=article&id=15130:heatwave& Itemid=4206&lang=en
• During the period, unprotected exposure to dangerous UV radiation may cause skin damage across the population (for more information, see: https://www.epa.gov/sunsafety/uv-index-scale-1).
• There is a possibility of skin infections due to contact with contaminated, stagnant and/or floodwaters, especially in the Caribbean Islands and Belize.

• As the region enters the peak of the Wet Season, increased rainfall, stagnant water in the aftermath of a flood, as well as water accumulating and/or stored in open containers may also potentially create more breeding sites for mosquitoes. These situations would increase the risk of associated mosquito-borne diseases such as Dengue, Chikungunya and Zika. Access useful materials on mosquito control measures here: (https://www.paho.org/hq/index.php? option=com_content&view=article&id=12355:cdemosqui to-awareness-week&Itemid=42087&lang=en)
• Episodes of flooding may occur in any flood-prone area of the Caribbean Islands or Belize during this period. In such cases, there is an increased risk of Leptospirosis due to displaced rodents that could contaminate floodwaters, household items and food containers.

• With the possibility of tropical cyclones and other extreme weather events, health practitioners and administrators should maintain a state of readiness.
• In areas where flooding damages or destroys food crops, food insecurity may be a concern.
• During extreme weather events or disasters, vulnerable populations may have an increased need for medical care as they face a greater risk of poor health and even death. Health care providers and other stakeholders should clearly define various vulnerable populations and develop tailored strategies for assisting them.
• Heat stress associated with heatwaves, can increase mood-affective and stress-related disorders, as well as other mental and behavioural disorders. Persons taking medication for mental health disorders are at increased risk of heat-health effects.

• Water availability is critical to support prevention strategies to combat the COVID-19 pandemic, especially with regards to safe water for hygiene purposes. Flooding after an extreme weather event may affect water quality. Special attention should be paid to communities with interrupted or limited access to safe water over the coming period. Further details on water, sanitation and hygiene practices related to the COVID-19 pandemic can be found here:
• https://www.carpha.org/Portals/0/Documents/Technical Guidance/Water Sanitation Hygiene and Waste Management during the COVID-19 Pandemic.pdf
• https://www.paho.org/en/documents/key-recommendations-water-sanitation-and-hygiene-covid-19

• Any disaster occurring will compound psychosocial impacts related to the COVID-19 pandemic, particularly disasters arising from extreme weather events.
• Extreme weather events or disasters may cause an increased burden on already stressed healthcare services and the rollout of vaccination campaigns. National health systems must factor the above issues into multi-hazard disaster response planning for the upcoming months.
• Prior to or following an extreme weather event, displaced persons may require the use of an evacuation shelter. Shelter management is critical during the COVID-19 pandemic as additional measures must be taken to ensure maintenance of physical distancing, appropriate hygiene and respiratory protection. Further information on shelter management during the COVID-19 pandemic can be found here: https://www.carpha.org/Portals/0/Documents/Technical%20Guidance/Emergency%20Shelter%20Management%20in%20the%20Caribbean%20during%20the%20COVID-19%20Pandemic.pdf

This Bulletin provides a broad overview of climate conditions up to 3 months in advance. It is based on insights drawn from CIMH’s suite of technical climate information products and epidemiological insights from CARPHA and PAHO. The information contained herein is provided with the understanding that the CARPHA, the PAHO and the CIMH make no warranties, either expressed or implied, concerning the accuracy, completeness, reliability or suitability of said information. The Bulletin may be freely used and disseminated by the public with appropriate acknowledgement of its source but shall not be modified in content and then presented as original material.