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epidemic or pandemic, although it only achieves such status in particular years, when the severity of the infection far exceeds normal levels. Other diseases that may result in epidemics or pandemics include Zika virus, Ebola, yellow fever, and cholera. The last major epidemic in the City was the 2009 influenza outbreak, which became a pandemic. Specific impacts in the City are unknown, although the disease did kill 11 people in San Mateo County and sent 19 others to intensive care, more than have been sent in years since. Other past public health emergencies affecting the City include the 1968-1969 "Hong Kong flu" pandemic and the 1918 "Spanish flu" pandemic. Given the past occurrences of public health emergences, it is very likely that such events will continue to occur in the future, although the specific frequency and severity of these events is unknown and unknowable. Climate change may increase the spread of some types of public health emergencies, particularly those carried by mosquitos and other pests, by creating warmer temperature conditions that are more favorable to these organisms. 2.2.7 SEVERE WEATHER (TORNADOES, HIGH WINDS, AND EXTREME HEAT) Severe weather includes a variety of different weather-related events that have the potential to cause injury, death, or property damage, and are not adequately included in other types of hazards. For the purposes of this EOP, severe weather is defined as tornadoes, high winds, and extreme heat. A tornado is a rapidly rotating column of air stretching from the ground to a thunderstorm cloud. They are associated with strong thunderstorms and are harmful due to the high wind speeds of the rotating column (in some cases, in excess of 200 miles per hour). Tornadoes often cause extensive damage to buildings and infrastructure in their path. Severe winds are more generally any type of wind that can cause structural damage (usually in excess of 47 miles per hour). These winds can be associated with storm systems, or they may occur independently. High winds often blow down trees and branches (which can cause further damage when they land), knock down power lines, and in severe instances may damage homes and businesses. Extreme heat refers to days in which the high temperature is significantly above normal levels (in the City, this threshold is approximately 94 to 97 degrees). Extreme heat can cause various illnesses such as heat exhaustion and heatstroke, particularly for senior citizens, who often have a reduced ability to maintain a safe internal body temperature. Extreme heat can also stress power lines and other electrical infrastructure, increasing the likelihood of a power outage. High winds and extreme heat are more common forms of severe weather in the City. There are often at least a few days each year where temperatures rise to extreme levels, an average of four annually. More significant extreme heat events occur on occasion, including in 2017, 2010, and 2006. Notable high wind events occur regularly, usually at least once every few years and sometimes annually. One of the most notable events occurred on October 13, 2009, when an oak tree in the City was toppled and crushed a house. Two other trees hit houses or parked cars, and dozens of other trees were knocked down. Four 13