After Historic Winter Storm, Experts Explain Why Cold Kills Even in Moderate Temperatures and Why Coats Aren’t Enough Without Shelter
The winter storm that swept across 35 states this week sent millions of Americans indoors to wait it out.
For people living outside, there was nowhere to go.
And contrary to what many people think, it doesn’t take sub-zero temperatures to become deadly when you don’t have shelter. Some of the worst cases of hypothermia happen when days are in the 40s and nights fall into the 30s.
As reports emerge of power outages, travel disruptions, and emergency responses, there is far less visibility into how people without shelter endured the storm.
Misunderstanding Hypothermia
One of the biggest misconceptions about hypothermia is that it only occurs in extreme cold. While historic winter storms often contribute to cold-related injuries and death, it’s often other weather conditions that make late Fall, Winter, and early Spring especially dangerous.
Wind and precipitation cause the body to lose heat rapidly. Wet clothing can increase heat loss up to 20 times faster. Staying dry and protected from wind is often more important than the actual temperature.
According to Dr. James J. O’Connell from the Boston Health Care for the Homeless Program, “the worst cases arise when the days are warm (between 40–50 degrees Fahrenheit), and the nighttime temperature drops to the mid-30s.”
“The most drastic case ever seen at BHCHP, in which a homeless man was brought in with a body temperature of 57 degrees, occurred when the temperature was greater than 50 degrees during the day and fell to 36 degrees at night,” O’Connell said.
Risk factors include lack of proper clothing, malnutrition, infection, fatigue, inadequate shelter, and pre-existing medical conditions. Elderly people are particularly vulnerable.
Why Coats and Charity Are Not Enough
Across the country, outreach groups distribute coats, boots, socks, hats, and gloves during the winter. These items are vital. But coats alone cannot prevent hypothermia.
Many people living outside cannot change into dry clothing when they become wet. Avoiding exposure to snow, rain, and wind altogether is often the only way to truly prevent hypothermia.
“There were times that I walked all night just to keep from freezing to death,” Tim Bush, who once experienced homelessness in Denver, told Denver 7 News.
Patrick McCosker, currently navigating housing instability, said the coldest hours — between 3 and 4 a.m. — can be unbearable. “My biggest thing is trying not to get frostbite,” he said.
Why Warming Centers and Shelters Matter
This is why 24-hour warming centers and winter shelters are critical during storms and cold snaps.
In Baltimore, where homelessness continues to rise, there are just 562 shelter beds. In 2025, more than 20,000 people called the city’s shelter hotline. Officials confirmed that many were turned away.
Rather than expanding winter shelter capacity, the city has debated implementing a 90-day shelter policy. Advocates warn that without sufficient winter planning, people are left outside during the most dangerous months of the year.
When temperatures drop, the difference between life and death often comes down to whether someone can get indoors and dry.
Signs of Hypothermia
Recognizing the signs of hypothermia can be life-saving. Shivering, slurred speech, drowsiness, confusion, exhaustion, and loss of coordination are warning signs that someone needs immediate shelter and medical attention.
“Hypothermia can cause the heart, brain, and kidneys to malfunction and may be life-threatening,” O’Connell said. “People suffering from hypothermia often have impaired judgment and cannot perceive their own need for shelter or medical care.”
That impaired judgment is part of what makes hypothermia so dangerous for people living outside. Someone in medical distress may not realize they are in danger — or may be physically unable to seek help.
Frostbite is another serious risk. While superficial frostbite affects the skin and nearby tissues, deep frostbite can reach bones, joints, and tendons. Frostbite can occur with any degree of hypothermia.
“Around 90 percent of frostbite cases affect the hands and feet,” O’Connell continued. “Frostbitten areas often develop sensory loss and increased sensitivity to cold that may last for years. After deep frostbite, areas may also develop arthritis and chronic pain.” In severe cases, amputation may be required.
Want to Help?
If you see someone outside who is shivering, disoriented, struggling to speak clearly, or unusually drowsy, seek help immediately and help them get indoors.
Carrying extra gloves, hats, socks, hand warmers, fluids, and food can make a critical difference. Blankets and proper nutrition matter, too. Many people experiencing homelessness are unable to access regular, healthy meals and often suffer from malnutrition, which weakens the body’s ability to regulate heat and increases vulnerability to hypothermia.
Knowing what to look for and acting quickly can save a life.
The Only Way to Prevent Homeless Deaths Is Not Being Homeless
With everything we know about how hypothermia occurs, one truth becomes clear: the only permanent way to prevent deaths from cold is for people not to be homeless.
Every December, communities across the country gather for National Homeless Persons’ Memorial Day to remember people who died from exposure and other preventable causes. The numbers are always an undercount. And January and February — historically the coldest months — are still ahead.
In the immediate term, cities can prevent deaths by keeping warming centers open 24 hours a day, extending winter shelter access between October and March, and ensuring no one is turned away during extreme weather.
“We know that permanent housing, and only permanent housing, is the solution to homelessness,” said Antonia Fasanelli, executive director of the National Homelessness Law Center, who spoke at last month’s HPMD memorial vigil in Baltimore.