Construction crews in downtown Raleigh are beginning work earlier and clearing out before the hottest part of the day, a schedule that feels more like July than September.
Among those adjusting is Gavin Manson, a telecommunications specialist who spends an average of 10 to 11 hours a day working outside.
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“When the heat index is 110-plus, it feels like a million degrees,” Manson said.
Manson said knowing the next day’s workload allows him to schedule the most physically demanding tasks before temperatures peak.
“Starting early definitely helps,” he said.
An early September heat wave is pushing temperatures toward daily records across central North Carolina. The National Weather Service said heat index values could reach 108 degrees in parts of the region, with unusually hot conditions expected to persist into Friday.
The timing may feel unusual, but the broader pattern is becoming more familiar.
Raleigh’s average fall temperature has increased by 2.9 degrees since 1970, according to Climate Central. Fall has warmed in 98% of the U.S. cities the organization analyzed.
“Human-caused climate change is the leading reason that sweater weather is turning more into short-sleeve season,” said Shel Winkley, a meteorologist with Climate Central. “And that extra heat means longer allergy seasons, mosquitoes buzzing around and sticking around longer, and fall colors arriving later or just overall looking less vibrant.”
The extended heat also carries a health cost that can be difficult to measure.
Nearly 5,900 heat-related emergency visits since May
North Carolina recorded 5,861 heat-related emergency department visits between May 1 and Sept. 2, according to Autumn Locklear Clark, the climate and health epidemiologist for the North Carolina Division of Public Health.
The state’s forthcoming surveillance report includes 5,720 visits through Aug. 29, the most recent completed reporting period.
North Carolina averaged three heat-related emergency department visits per 100,000 residents each week during that period. That is similar to the rate of 2.9 at the same point in 2025 but 50% higher than the 2020-24 average of two visits per 100,000.
The state’s highest weekly rate this summer was 7.7 visits per 100,000 residents from June 28 through July 4. Northeastern North Carolina has recorded the highest regional average this season, at 4.2 visits per 100,000 each week.
Working-age men between 25 and 44 and men 65 and older consistently experience some of the state’s highest rates, Locklear Clark said.
About 20% of North Carolina’s heat-related emergency department visits are believed to be connected to work. However, the state considers that an underestimate because emergency department records do not always include a patient’s occupation or indicate whether symptoms began on the job.
“The data does not always indicate whether or not someone was at work at the time that they started experiencing heat-related illness,” Locklear Clark said. “And it doesn’t always capture the occupation in the emergency department data.”
The surveillance system searches emergency department records for diagnostic codes and language associated with heat stroke, heat exhaustion, heat cramps, and other effects of excessive heat.
That means it can miss illnesses in which heat worsened an underlying medical condition but was not identified by the provider.
“We absolutely think there is a possibility that providers are not always accurately catching heat-related illness or accurately reporting heat-related illness,” Locklear Clark said. “So it probably is underreported.”
Heat deaths may be substantially undercounted
The same problem extends to deaths.
Federal records show an average of about 1,700 heat-related deaths annually from 2018 through 2025. However, a new NPR and Boston University analysis estimates heat influences approximately 9,000 U.S. deaths each year — more than five times the official average.
Heat is rarely the only cause of death. It can worsen heart disease, kidney problems, and respiratory illnesses or trigger a fatal heart attack. When the resulting death certificate lists only the underlying condition, heat’s role can disappear from official statistics.
The NPR investigation found that identifying heat-related deaths often depends on whether doctors, medical examiners, or death investigators ask about conditions surrounding the death, including whether the person had working air conditioning or had been exposed to extreme temperatures.
The findings suggest that emergency department visits and official death counts represent only part of the public health toll as hot weather stretches later into the year.
How to lower the risk
State health officials recommend reducing strenuous outdoor activity during the hottest part of the day, drinking water regularly, and taking breaks in a cooler location.
Manson said he drinks water throughout the day and keeps electrolytes nearby in case he begins feeling dizzy. When the heat becomes overwhelming, he pours cold water over himself or takes a five-minute break in air conditioning.
“You’re just, you’re melting,” Manson said. “And there’s only so much that you can really do to take precautions as far as staying cool.”
Wetting the skin or clothing can also help the body release heat. A fan can make that evaporation more effective, while immersing the hands and forearms in cool water can help lower body temperature.
Confusion, fainting, or seizures can signal heat stroke, a medical emergency. Call 911 and begin cooling the person immediately.
For Manson, cooler weather cannot arrive soon enough.
“It’ll be great when we’re back down to 60, 70-degree days,” he said.