Da Lat and Sapa: damp cold, hypothermia and chest trouble in the highlands

People arrive in Vietnam dressed for Vietnam, which means dressed for the coast. Then they take a night bus up to Sapa in January, or spend a week in Da Lat in the rainy season, and discover a climate nobody warned them about. Fifteen degrees, persistent fog, everything slightly wet, and a guesthouse with no heating and a tiled floor. It is not cold by European standards. It makes people ill anyway.

Two separate things get confused in this terrain. One is cold exposure, which is a genuine and common problem here. The other is altitude illness, which is mostly not a Vietnamese problem at all, for reasons of simple elevation. This page separates them and covers what actually sends travellers to us from the highlands. It is not a diagnosis of anything you are feeling at the time.

Cold and breathing emergencies up here

Highland emergencies tend to involve either a core temperature that has dropped too far or a chest that has stopped coping. Ring 115 or get to the nearest hospital immediately for:

• Someone who was shivering and has stopped, while still cold — shivering ceasing is a serious sign, not an improvement
• Confusion, slurred speech, stumbling, or odd behaviour such as undressing in the cold
• Drowsiness that is deepening, or someone difficult to wake
• Skin that is cold to the touch over the chest and abdomen, not just at the hands and feet
• Breathlessness at rest, blue or grey lips, or an inhaler that is no longer working
• Chest pain, or a fast irregular pulse in an older traveller after cold exposure
• A newborn or small child who has become cold, floppy or unusually quiet
• A severe headache with vomiting and unsteadiness after a climb, which needs descending and assessing

A cold casualty is handled gently. Rough movement of someone deeply hypothermic can provoke a dangerous heart rhythm. So get them out of the wind and the wet, remove wet clothing, insulate them including the head, and move them carefully rather than briskly. Rubbing cold limbs and giving alcohol both make it worse.

Vietnam is not a high-altitude country

This is worth settling because the question comes up constantly. Da Lat sits at around one and a half thousand metres. Sapa is a little above that, and Kon Tum and the Central Highlands plateaux are lower still. Altitude illness is essentially not a feature at these elevations. A headache in Da Lat is far more likely to be dehydration, too much coffee, a long bus journey or a hangover than anything to do with elevation.

There is one genuine exception. Fansipan is the exception. It rises above three thousand metres, and people do get mild altitude symptoms up there — headache, nausea, breathlessness, poor sleep — particularly when taken from a town to a summit by cable car in a morning, which gives no time to adjust. It resolves on coming down, and coming down is the answer. The warning signs that matter are specific. A headache that worsens despite descending, vomiting, unsteadiness on the feet, confusion, or breathlessness at rest. All of those mean descending and being assessed rather than continuing.

Why damp cold beats dry cold

Fifteen degrees in fog, in wet clothing, with a breeze, draws heat out of a person far faster than the number suggests. Water conducts heat away many times more efficiently than still air. So a soaked shirt is doing continuous work against you, and wind strips away the thin warm layer next to the skin.

Add a highland building to that. Houses and guesthouses in Da Lat and Sapa are mostly built for a tropical climate. No insulation, tiled or concrete floors, large single-glazed windows, gaps around the doors, and heating that consists of a thin blanket. Indoor temperatures track outdoor ones closely, so a cold night is a cold night in bed too.

The people who come to harm are predictable. Older travellers, who feel the cold later and lose heat faster. Small children, with a large surface area for their size. Anyone wet through from rain or a waterfall. Anyone who has been drinking, which widens blood vessels, blunts shivering and removes the judgement that would otherwise send them to find a jumper. And motorcyclists.

The mountain pass problem

A motorbike is how most travellers see the highlands. It combines every cold mechanism at once. Riding at speed produces a windchill well below the air temperature. Rain soaks through anything that is not genuinely waterproof, and the ride over the passes above Da Lat or on the Ha Giang loop can run for hours with nowhere sheltered to stop.

The effect that matters is not discomfort. It is that cold hands lose fine control of a brake lever and a throttle. Cold judgement makes worse decisions on a wet mountain bend in fog. A large share of highland injuries we are called about are road injuries, and the cold is upstream of them.

Charcoal braziers: the risk nobody mentions

This is the most dangerous thing in this guide and the least discussed. Cold rooms in the highlands are sometimes warmed with a charcoal or wood brazier. Homestays, construction camps and long-term rentals all do it. Burning charcoal in an enclosed space produces carbon monoxide. It has no smell and no taste, and it kills people in their sleep across the region every winter.

The early symptoms are indistinguishable from altitude, flu or a hangover: headache, nausea, dizziness, poor concentration, tiredness. That is precisely why it is missed. One detail gives it away. Several people in the same room are affected together, and everyone improves on getting outside into the air.

• Never sleep in a closed room with a charcoal or wood brazier burning, however cold it is, and never use a barbecue or a gas camping stove indoors for warmth
• If a room is heated that way, the fire goes out before anyone sleeps and a window stays open
• Treat a headache shared by everyone in the room as a reason to get out into fresh air first and ask questions afterwards
• Unflued gas water heaters in a small bathroom are the other common source in Vietnam, and the symptom is feeling unwell during a long shower
• Anyone drowsy or confused in that setting goes outside and then to hospital, because carbon monoxide needs oxygen treatment and a blood test, not a lie-down

Chests in cold air

Cold, damp air narrows airways, and the highlands are where asthma that has been quiet all trip announces itself. The pattern is familiar. A cough that starts in the evening, tightness in the early hours, and an inhaler being used far more than usual.

• Bring reliever inhalers into the highlands even if you have not needed one for months, and keep one in a pocket rather than in luggage
• A scarf over the mouth genuinely helps, because it warms and moistens the air before it is breathed
• A cough with a fever and breathlessness in the mountains is worth assessing early, because the options narrow with distance

Being far from a hospital

This is the part that changes decisions rather than treatment. Highland towns have district hospitals that handle ordinary problems competently. The serious cases travel — to Da Lat and onwards for the Central Highlands, to Lao Cai and Hanoi for the far north. Mountain roads in fog are slow, and they are slower at night.

What we can and cannot reach

We would like to be plain about geography, because it is the thing an unwell traveller most needs the truth about. In each place we serve, our own licensed doctors and nurses live and work locally, so nobody has to travel from far away to reach you. In the highlands that includes Da Lat and Kon Tum, where our local team can visit you at your guesthouse or home. Sapa and the far north are not among the places we serve.

So if you fall ill in the far north, the honest answer is usually not a visit from us. It is a local hospital now, with our help in choosing which one, a translated conversation, and a report afterwards that an insurer will accept. Where we do have a local team, we would be glad to come to you, and we will always give you an honest estimate of when we can arrive.

Before you go up

• Pack one warm layer and one waterproof layer, even for a trip that is otherwise entirely tropical
• Assume the room will not be heated and that the floor will be cold, and bring socks for sleeping
• Keep inhalers, regular medicines and a spare dose in hand luggage on a night bus or train
• Do not drink to keep warm. It feels like it works and it is making the problem worse

The last word on this one

The highlands make people ill through wet and wind, not through elevation. The serious events are hypothermia, road injuries after cold hands, chest trouble, and carbon monoxide from a brazier in a closed room. Shivering that stops, confusion, or a whole room with the same headache all mean getting outside and getting to hospital — and 115 if someone cannot be roused.