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Social media has a way of making the ho-hum seem fresh and novel. Case in point: exfoliation, the process of removing dead cells from the skin’s outer layer. Anyone scrolling through TikTok lately might be convinced this longtime skin care approach can transform something old — let’s say our aging epidermis — into like-new skin.

But a Harvard dermatologist says that’s asking too much.

“I don’t think exfoliation is going to fix anybody’s wrinkles,” says Rachel Reynolds, MD, interim chair of dermatology at Harvard-affiliated Beth Israel Deaconess Medical Center. While exfoliation offers definite benefits, it can also irritate and inflame the skin if you don’t do it carefully, or use tools or chemicals your skin doesn’t tolerate.

How is exfoliation done?

There are two main ways to exfoliate: mechanical and chemical. Each boasts specific advantages.

• Mechanical (or physical) exfoliation uses a tool such as a brush or loofah sponge, or a scrub containing abrasive particles, to physically remove dead skin cells. “Mechanical exfoliation can improve skin luster by taking off a dead layer of skin that can make it look dull,” Dr. Reynolds says. “And it can help unclog pores a bit, which can reduce some types of acne.”
• Chemical exfoliation uses chemicals — often alpha and beta hydroxy acids or salicylic acid — to liquify dead skin cells. “Chemical exfoliants work on a more micro-level to help dissolve excess skin cells and reduce uneven pigmentation sitting at the surface of the skin,” she explains. “They also restore skin glow, improve acne, and give the skin a little more shine.”

Why do skin care products so often promote exfoliation?

Perhaps hundreds of commercially available skin care products — from body washes to cleansers to face masks — are labeled as exfoliating, Dr. Reynolds notes. But she’s skeptical about why such a wide array of items plug this feature so prominently.

“It’s advantageous for a cosmetics company to sell consumers more products in a skin care line,” she says. “But it’s buyer beware, because this is a completely unregulated market, and cosmetic companies can make claims that don’t have to be substantiated in actual clinical trials.”

Do we need to exfoliate our skin?

No. “Nothing happens if you don’t exfoliate — you just walk around with bumpy or slightly dry skin, which is inconsequential except for cosmetic reasons,” Dr. Reynolds says.

“No one has to exfoliate, but it can be helpful to exfoliate the arms and legs,” she adds. “As we age, these areas get more dry than other parts of the body, and people notice they build up a lot more flaking skin and an almost fish-scale appearance.”

That phenomenon may or may not be a sign of keratosis pilaris, a common but harmless skin condition characterized by rough, bumpy “chicken skin” on the upper arms and thighs. Physical exfoliators are a good first choice because keratosis pilaris covers areas that have tougher skin than the face, she says. But it’s fine to use a cleanser or lotion containing a chemical exfoliant instead. Either type can improve skin texture and the skin’s appearance.

Can exfoliation harm our skin?

Yes. Both physical and chemical exfoliation techniques can do more harm than good, depending on several factors. Sensitive skin is more likely to become irritated or inflamed by any exfoliant. And overdoing it — whether by rubbing too hard or using a product with higher concentrations of acid — can trigger irritant contact dermatitis, which can look red, angry, and chapped.

“Physical exfoliation that’s done too harshly can also aggravate inflammatory acne, making it worse,” Dr. Reynolds says. “Also, exfoliating can make you more prone to sunburn.”

What are the safest ways to exfoliate?

Dr. Reynolds recommends chemical exfoliants over physical versions. “Sometimes the abrasives in those apricot scrubs, for example, can go too far, aggravating the skin and creating inflammation,” she says.

She offers these additional tips to exfoliate safely:

• If you haven’t exfoliated before, start with a simple washcloth to determine how well your skin responds to mild attempts at physical exfoliation.
• Then try gentler chemical exfoliants, such as lower concentrations of hydroxy acids or salicylic acid. Work your way up to stronger concentrations only if needed.
• If you’re hoping to eradicate stubborn skin problems such as melasma (brown facial patches) or comedonal acne (small, skin-colored bumps often on the forehead or chin), consider undergoing a chemical peel at a dermatologist’s office.

Don’t exfoliate every day. “At most, do it two or three times a week,” Dr. Reynolds says. “Your skin needs to repair itself in between exfoliation episodes.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

A bird flu strain that began circulating in 2020 continues to evolve globally and locally within the United States. If you’re wondering what this means, understanding the basics — what bird flu is, how it spreads, whether foods are safe, and prevention tips — can help. More information will come in as scientists learn more, so stay tuned.

1. What is bird flu and how does it spread?

Bird flu, or avian flu, is a naturally occurring illness. Just as certain flu viruses spread among humans, Type A influenza viruses often spread among wild birds. The strain of virus circulating now is H5N1, named for two proteins on its surface.

Avian flu infections are highly contagious. Infection often spreads first among wild water birds, such as ducks, geese, and gulls, and shore birds, such as plovers and sandpipers. The viruses are carried in their intestines and respiratory tract and shed in saliva, mucus, and feces. Wild birds can easily infect domestic poultry, such as chickens, turkeys, and ducks.

Some bird species, including ducks, may carry and spread infection without appearing sick. Domestic flocks are more likely to sicken and possibly die from bird flus. However, not all avian flu viruses are equally harmful:

• Low pathogenic avian influenza (LPAI) may cause no signs of illness, or signs of mild illness like fewer eggs or ruffled feathers in domestic poultry.
• Highly pathogenic avian influenza (HPAI) causes more severe illness and high rates of death in infected poultry. The current H5N1 virus is considered an HPAI.

2. Can humans get bird flu?

Yes, though this doesn’t usually happen.

When flu viruses mutate, they may be able to move from their original hosts — birds in this case — to humans and other animals. As of early April 2024, only two cases of bird flu in humans had been reported in the US since 2022. In May, two more cases were reported. Newer case numbers of bird flu will continue to be reported by the CDC, which offers weekly snapshots of influenza in the US.

The virus may be introduced into the body through the eyes, nose, or mouth. For example, a person may inhale viral particles in the air (droplets, tiny aerosolized particles, or possibly in dust). Or they might touch a surface contaminated by the virus, then touch their eyes or nose. Bird flu in humans typically causes symptoms similar to seasonal flu, such as fever, runny nose, and body aches.

3. Which animals have been affected by bird flu?

A surprisingly long list of animals affected by the current H5NI bird flu infection includes:

• wild birds, chickens, ducks, geese, and other domestic and commercial poultry in 48 states and more than 500 countries
• livestock, such as dairy cows in nine states at this writing, and other farm animals
• marine animals, such as seals, sea lions, and even dolphins
• wild animals, such as foxes, skunks, and racoons, and some domestic animals, such as farm cats.

4. Why are experts concerned about this bird flu outbreak?

It might seem odd that there’s been so much concern and news coverage about bird flu lately. After all, bird flu has been around for many years. We’ve long known it sometimes infects nonbird animal species, including humans.

But the current outbreak is unique and worrisome for several reasons:

• Fast, far-reaching spread. The virus has been found throughout the US, Europe, the Middle East, Southeast Asia, multiple sub-Saharan African countries, and even Antarctica.
• Many species have been infected. Previously uninfected species have been affected, including animals in our food supply.
• Economic impact. If large numbers of beef and dairy cows and chickens sicken or must be culled (killed) to contain outbreaks, this could have a major economic impact on farmers, agriculture businesses, and affected countries’ economies. This could also mean higher prices at the grocery store.
• Opportunities for exposure. Though only two human infections were reported in the US in recent years — both in people working with animals — the more exposure humans have to bird flu, the more chances the virus has to develop mutations that allow easier spread to humans.
• Potential for fatalities. Severe strains of bird flu have led to H5N1 infections in nearly 900 people in 23 countries since 2003. More than half of these reported cases were fatal. Keep in mind that the math isn’t straightforward. It’s likely that many more cases of bird flu in humans occurred, yet people experiencing few or no symptoms or those not tested weren’t counted, so lethality is likely overestimated.
• New mutations. It’s rare, but possible: If this H5N1 bird flu develops mutations that enable efficient person-to-person spread, bird flu could become the next human pandemic.

5. Are milk, beef, chicken, and the rest of our food supply safe?

Public health officials emphasize that the food supply is safe.

But concern has understandably run high since the discovery that this outbreak has spread from birds to dairy cows for the first time. More alarming? A study found fragments of bird flu DNA — which is not the same as live virus — in 20% of commercially available milk in the US.

So far, there’s been no indication that bird flu found in pasteurized milk, beef, or other common foods can cause human illness. Even if live bird flu virus got into the milk supply, studies show that routine pasteurization would kill it. Initial tests did not find the virus in ground beef.

Of course, if you are particularly concerned, you could avoid foods and beverages that come from animals affected by bird flu. For example, you could switch to oat milk or almond milk, even though there’s no convincing scientific justification to do so now.

6. What if you have pets or work with animals?

Bird flu rarely spreads to pets. While that’s good news, your pets could have exposure to animals infected with bird flu, such as through eating or playing with a dead bird. So, it’s safest to limit your pet’s opportunities to interact with potentially infected animals.

If you work with animals, especially birds or livestock, or hunt, the Centers for Disease Control and Prevention (CDC) recommends precautions to minimize your exposure to bird flu.

7. What else can you do to stay safe?

The CDC recommends everyone take steps to avoid exposure to bird flu, including:

• Avoid contact with sick or dead animals and keep pets away from them.
• Avoid animal feces that may be contaminated by birds or bird droppings, as might be common on a farm.
• Do not prepare or eat raw or undercooked food.
• Do not drink raw (unpasteurized) milk or eat raw milk cheese or raw or undercooked foods from animals suspected of having bird flu infection.
• Wear personal protective equipment (PPE), such as safety goggles, gloves, and an N95 face mask, when working near sick or dead animals or their feces.

Right now, available evidence doesn’t support more dramatic preventive measures, such as switching to an all-plant diet.

8. Is there any good news about bird flu?

Despite all the worrisome news about bird flu, this recent outbreak may wind up posing little threat to human health. Virus strains may mutate to spread less efficiently or to be less deadly. Efforts are underway to contain the spread of bird flu to humans, including removing sick or exposed animals from the food supply and increased testing of dairy cattle before transport across state lines.

And there is other encouraging news:

• Some birds appear to be developing immunity to the virus. This could reduce the chances of continued spread between birds and other animals.
• Developing a vaccine to protect cattle from bird flu may be possible (though it’s unclear if this approach will be successful).
• If spread to humans does occur, genetic tests suggest available antiviral medicines could help treat people.
• So far, human-to-human transmission has not been detected. That makes it less likely that the H5N1 bird flu will become the next pandemic.
• And if human infections with bird flu did become more common, researchers are working on human vaccines against bird flu using virus strains that match well with those causing the current outbreak.

9. How worried should you be about bird flu?

Though there’s much we don’t know, this much seems certain: bird flu will continue to change and pose challenges for farmers and health experts to stay ahead of it. So far, public health experts believe that bird flu poses little health risk to the general public.

So, it’s not time to panic about bird flu. But it is a good idea to take common sense steps to avoid exposure and stay current on related news.

For updated information in the US, check the CDC website .

About the Authors

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Francesca Coltrera, Editor, Harvard Health Blog

Francesca Coltrera is editor of the Harvard Health Blog, and a senior content writer and editor for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast … See Full Bio View all posts by Francesca Coltrera

About the Reviewer

John Ross, MD, FIDSA, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. John Ross is an assistant professor of medicine at Harvard Medical School. He is board certified in internal medicine and infectious diseases, and practices hospital medicine at Brigham and Women’s Hospital. He is the author … See Full Bio View all posts by John Ross, MD, FIDSA

As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.

How does wildfire smoke affect air quality?

Wildfire smoke contributes greatly to poor air quality. Just like fossil fuel pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes (known as particulate matter, or PM10, PM2.5, PM0.1) that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.

The smoke can travel to distant regions, carried by weather patterns and jet streams.

How does wildfire smoke affect our health?

The small particles in wildfire smoke are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.

The health effects of wildfire smoke include eye irritation, coughing, wheezing, and difficulty breathing. The smoke may also increase risk for respiratory infections like COVID-19. Other possible serious health effects include heart failure, heart attacks, and strokes.

Who needs to be especially careful?

Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.

If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.

What can you do to prepare for wildfire emergencies?

If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:

• Create an evacuation plan for your family before a wildfire occurs.
• Make sure that you have several days on hand of medications, water, and food that doesn't need to be cooked. This will help if you need to leave suddenly due to a wildfire or another natural disaster.
• Regularly check this fire and smoke map, which shows current wildfire conditions and has links to state advisories.
• Follow alerts from local officials if you are in the region of an active fire.

What steps can you take to lower health risks during poor air quality days?

These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:

• Stay aware of air quality. AirNow.gov shares real-time air quality risk category for your area accompanied by activity guidance. When recommended, stay indoors, close doors, windows, and any outdoor air intake vents.
• Consider buying an air purifier. This is also important even when there are no regional wildfires if you live in a building that is in poor condition. See my prior post for tips about pollution and air purifiers. The EPA recommends avoiding air cleaners that generate ozone, which is also a pollutant.
• Understand your HVAC system if you have one. The quality and cleanliness of your filters counts, so choose high-efficiency filters if possible, and replace these as needed. It's also important to know if your system has outdoor air intake vents.
• Avoid creating indoor pollution. That means no smoking, no vacuuming, and no burning of products like candles or incense. Avoid frying foods or using gas stoves, especially if your stove is not well ventilated.
• Make a "clean room." Choose a room with fewer doors and windows. Run an air purifier that is the appropriate size for this room, especially if you are not using central AC to keep cool.
• Minimize outdoor time and wear a mask outside. Again, ensuring that you have several days of medications and food that doesn't need to be cooked will help. If you must go outdoors, minimize time and level of activity. A well-fitted N95 or KN95 mask or P100 respirator can help keep you from breathing in small particles floating in smoky air (note: automatic PDF download).

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD

You’ve probably heard the news: Cicadas are coming. Or — wait — they’re already here.

And are they ever! Due to an unusual overlap of the lifecycles of two types (or broods) of cicadas, trillions of cicadas are expected to emerge in the US by the end of June, especially in the Midwest.

If you’d like to see where they’ve already arrived, track them here. And if you’re wondering if this cicada-palooza could help with grocery bills, read on to decide for yourself how appealing and how safe snacking on cicadas is for you. The pros and cons could change your outlook on the impending swarm.

What to know about cicadas

Don’t worry, cicadas are largely harmless to humans. In fact, their appearance is welcome in places where people routinely snack on them as a low-cost source of calories and protein.

Estimates suggest up to two billion people regularly eat insects, especially in South and Central America, Asia, Africa, Australia, and New Zealand. Cicadas, when available, are among the most popular. And if you thought no one in the US eats cicadas, check out this video from a May 2024 baseball game.

Are you tempted to eat cicadas?

For plenty of people, cicadas aren’t the food of choice. Some people can’t get past the idea of eating insects as food. That’s understandable: after all, the culture in which we are raised has a powerful influence on what we consider acceptable in our diets. Something some Americans might find off-putting (such as eating snakes) is common in China and Southeast Asia. Meanwhile, people outside the US find aspects of the typical Western diet unappealing (such as root beer, peanut butter and jelly, and processed cheese).

But some people shouldn’t eat cicadas because it could be dangerous for them.

Why you should — or shouldn’t — eat cicadas

Eating cicadas is common in many parts of the world because they are

• nutritious: cicadas are low in fat and high in protein, including multiple essential amino acids
• inexpensive or free
• tasty (or so I’m told): descriptions of their flavor vary from nutty to citrusy to smoky and slightly crunchy.

In years when cicadas emerge, recipes for dishes containing cicadas emerge as well.

Then again, there are several good reasons to avoid making cicadas a part of your diet, including these:

• You just can’t get past the “ick” factor. Adventurous eaters may be willing to try or even embrace consuming cicadas, while others will be unable to view the idea as anything other than horrifying.
• You find the taste or consistency unappealing.
• You’re “cicada intolerant.” Some people get stomach upset, nausea, or diarrhea if they eat too many cicadas.
• You’re pregnant or breastfeeding, or are a young child. Concerns about even low levels of pesticides or other toxins in cicadas have led to recommendations that these groups not eat them. Doesn’t this suggest the rest of us should also steer clear? Well, thus far, at least, there’s no evidence that toxins in cicadas are causing health problems.

But there is one more very important entry on this list: people with a shellfish allergy should not eat cicadas. Odd, right?

The shellfish-cicada connection

Cicadas are biologically related to lobsters, shrimp, crabs, and other shellfish. So if you’re allergic to shellfish, you might also be allergic to cicadas. A particular protein called tropomyosin is responsible for the allergy. It’s found in shellfish as well as in many insects, including cicadas.

The allergic reaction occurs after eating the cicada. Just being around them or handling them won’t trigger a reaction.

Among people with a shellfish allergy, developing a reaction after eating cicadas could be a bigger problem than it seems: up to 10% of people have shellfish allergies and, as noted, insect consumption is common worldwide.

Is it okay for your dog or cat to eat cicadas?

Walking your dog after the emergence of cicadas can be a new and exciting experience for you and your pet! Dogs may chase after cicadas and eat them. Cats might, too, if given the chance. That can be a problem if your pet eats too many, as some will experience stomach upset or other digestive problems.

While the insects are considered harmless to dogs, the American Kennel Club says it’s best to steer them away from cicadas once they’ve eaten a few.

Which other insects trigger allergies?

While insect-related allergic reactions (think bee stings) and infections (like Lyme disease) are well known, the insect-food-allergy connection is a more recent discovery.

One recently recognized condition is the alpha-gal syndrome, in which a person bitten by certain ticks develops an allergy to meat. The name comes from a sugar called galactose-α-1,3-galactose (or alpha-gal) found in many types of meat including beef, lamb, pork, and rabbit. According to the CDC, up to 450,000 people in the US may have developed this condition since 2010.

There aren’t many rigorous studies of the overlap of insects and food allergies, so there are probably others awaiting discovery.

The bottom line

When it comes to eating cicadas, I’ll pass. It’s not because of the risks. I’ve never had a problem with shellfish, and for most people the health risks of eating cicadas seem quite small. It’s just unappealing to me, and I’m not a particularly adventurous eater.

But let’s go easy on those who do enjoy snacking on cicadas. Insects offer a good source of calories and protein. Just because eating them seems unusual in the US doesn’t make it wrong.

So, if you like to eat cicadas and have no shellfish allergy or other reason to avoid them, go for it! This may be a very good summer for you.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Here’s a new fact about spring, summer, fall, and sometimes even winter: now that climate change has blurred seasonal boundaries, sizzling heat may be on the way, or currently blanketing your community.

High temperatures stress the body, leading to thousands of heat-related illnesses and deaths every year in the US. Creating a personal heat plan can help you stay safe when the heat index soars.

Caleb Dresser, MD, MPH, is the health care solutions lead for C-CHANGE, the Center for Climate Health and the Global Environment at the Harvard T.H. Chan School of Public Health, and an emergency medicine doctor at Harvard-affiliated Beth Israel Deaconess Medical Center. Below we interview him about who, how, and why heat harms. Then we’ll help you create your personal heat safety plan.

Interview edited for clarity

Who is especially vulnerable during hot weather?

High temperatures can affect anyone. But some people — children, outdoor workers, people who are pregnant or have health problems or disabilities, and older people — are more likely to experience harm when temperatures rise. For example:

• Young children, especially babies, have less physical capacity to deal with very high temperatures.
• People working outdoors may not have access to shade and could be performing physically intensive labor. They need adequate hydration, adequate breaks, and access to a cool space during break time, as OSHA guidelines spell out.
• People with chronic medical conditions, such as kidney disease or heart disease, may have difficulty adapting physiologically to hot weather, or may be more susceptible to its health impacts.
• And some people living with disabilities or certain neurological conditions may have difficulty with thermoregulation — that is, controlling the temperature of their bodies — or may not be able to take actions that keep them safe, such as taking off layers or moving to a cool area.

Which weather patterns create dangerous levels of heat?

Dangerous heat is the result of both high temperatures and high humidity, which interfere with our ability to cool off by sweating. In dry areas, extremely hot temperatures can be dangerous on their own.

Danger zones vary across the United States and around the world. But hospital use and deaths rise once we get above threshold temperatures. The threshold varies in different places depending on whether bodies, cultures, and architecture are adapted to heat.

For example, here in New England, where some people (particularly those of limited means) may not have access to air conditioning, we see increases in healthcare use and deaths at a lower temperature than in the American South, where people and organizations may be more used to dealing with hot weather.

When does hot weather become dangerous to our health?

Risk goes up the longer hot weather sticks around.

One hot day can put some people at risk. A stretch of several hot days in a row during a heat wave is particularly dangerous because it can overwhelm people’s ability to adapt. Eventually people run out of physiological reserves, leading to greater health harms and greater need for medical care.

Surprisingly, spring and early summer are particularly dangerous times because people and organizations aren’t as prepared for hot weather.

How to create your personal heat safety plan

Five key points to help you create a personal heat plan are below. Americares offers further information through heat tip sheets developed with the Harvard C-CHANGE team that are tailored to people in different health circumstances.

Planning is important because intense heat is occurring more often: a Climate Central analysis found 21 additional risky heat days, on average, for 232 out of 249 locations between 1970 and 2022.

• Stay ahead of hot weather. Check apps, websites, TV, or radio for updates on weather today and in coming days. If local weather alerts are available by phone or text, sign up.
• Have a cooling plan. When temperatures soar, you need to spend as much time as possible in cool spaces. Plan options if your home is likely to be too hot and unsafe to stay in. You may be able to stay with a neighbor or family member who has air conditioning until a heat wave passes. Many cities and towns have neighborhood splash pads for children, and open cooling centers or air-conditioned libraries, public buildings, or community centers to everyone — sometimes even overnight. Spending time in air-conditioned businesses or malls, or in a shady green space like a park, may help too.
• Sip plenty of fluids. Water is the best choice. Skip sugary drinks and avoid caffeine or alcohol.
• Use fans correctly. Fans help if surrounding air is relatively cool. If air temperatures are very high, it’s important to dampen your clothes or skin to help keep your body from overheating, and move to a cooler location, if possible.
• Know your personal risks and the signs of heat-related illness. If you have health problems or disabilities, or take certain medicines such as diuretics, talk to your doctor about the best ways for you to cope with heat. It’s also essential to know the signs of heat-related illnesses, which range from heat rash and sunburn to heat cramps, heat exhaustion, and heat stroke. This chart from the Centers for Disease Control and Prevention describes the signs to look for and what you can do, particularly when heat becomes an emergency.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

Francesca Coltrera is editor of the Harvard Health Blog, and a senior content writer and editor for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast … See Full Bio View all posts by Francesca Coltrera

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Before the pandemic, talking to a therapist or psychiatrist on a video call was novel. Now it’s fairly common. One recent analysis, for example, found that video appointments within the massive Veterans Affairs Health Care System jumped from about 2% of all mental health care encounters in January 2019 to 35% of these encounters in August 2023.

What are some advantages and disadvantages of virtual mental health care visits? Does seeing a therapist or psychiatrist by video instead of in person affect your response to treatment? If you haven’t yet used virtual mental health counseling, what do you need to know? Below, Stephanie Collier, MD, MPH, a psychiatrist at Harvard-affiliated McLean Hospital, shares her expertise and insights.

What are some advantages of virtual mental health visits?

Virtual visits are convenient for many people, including those who might have trouble getting to an office or who live in areas where it’s not easy to find mental health care providers.

“You can chat with your mental health care clinician in the setting of your choice, which might make you feel more comfortable,” says Dr. Collier. “You don’t have to worry about getting to and from an appointment. And you can be confident that your outcome will be similar to receiving in-person treatment. For example, in a 2022 study of about 1,500 people, participants being treated for anxiety or depression reported the same level of symptom improvement on standardized scales, whether they received virtual or in-person treatment.”

How do virtual visits work?

A virtual visit with a mental health care clinician works in much the same way as a virtual visit with your doctor.

You make an appointment to speak with an expert, typically a licensed therapist, psychologist, or psychiatrist. They may be in a private practice or work with your insurance plan or a hospital system. Or they might be affiliated with an online mental health care platform. Often, you can read a bit about their professional background, expertise, and other information to help you decide if they are a good fit for your needs.

Shortly before your appointment, you’ll log on to a specified video platform, and then find yourself in a virtual waiting room. When it’s time for your session, the expert will appear on the screen and conduct a 30- to 50-minute session, depending on what you’ve agreed on, just as they would during an office visit.

Will your insurance pay for virtual visits?

Not necessarily. Make sure your sessions will be covered. Medicare and Medicaid cover virtual mental health care visits, but not all private insurers cover the service. Even if you think you’re covered, double-check in advance.

What should you check on ahead of time?

Getting ready for a virtual visit involves prepping for both a mental health appointment and a video meeting.

• Go over the instructions. The mental health care clinician should give you instructions for accessing the platform where the virtual visit will take place. If you don’t have instructions, contact the clinician’s office or the online service to get them.
• Look for compliance. The platform your clinician specifies for your session should clearly state if it’s HIPAA-compliant, ensuring the privacy and security of your information. If you don’t see any evidence of HIPAA compliance, ask your clinician about it or consider choosing another mental health provider.
• Do an equipment inventory. You’ll need a smartphone, tablet, desktop computer, or laptop to take part in a virtual mental health care visit.The device needs a camera, a microphone, and an internet connection.You’ll also need a quiet space (so you and the expert can hear each other) and decent lighting (so the expert will be able to see you).
• Do a practice run. Well before your appointment, log on to the platform your clinician has specified. Check to see if you need to upgrade your software in order to use the platform. You don’t want any surprises just before appointment time. Try out the volume and your camera angle.