Wildfire health study – lingering breathing problems after widespread smoke

Repost from REVEAL NEWS, The Center for Investigative Reporting

AMERICA’S RING OF FIRE

The smoke’s gone, but hearts and lungs still may be in danger months after wildfires

By Aaron Glantz and Susie Neilson / November 28, 2018
Pedestrians wear masks while walking through San Francisco’s Financial District on Nov. 9. For two weeks after the Camp Fire ignited, the air in Northern California, stretching as far as 200 miles from the flames, was so full of smoke that it was deemed unhealthy to breathe. Credit: Eric Risberg/Associated Press

Three days after the Camp Fire erupted, incinerating the Northern California town of Paradise and killing 85 people, Katrina Sawa found herself struggling to breathe.

If you or someone you know has had breathing problems or heart problems or had to seek medical care in the wake of the recent fires, we want to hear from you. Text “fire” to 63735 and follow the prompts, or reach out to reporter Aaron Glantz at aglantz@revealnews.org.

But Sawa wasn’t anywhere near Paradise. She lives almost 100 miles away in Roseville, a suburb northeast of Sacramento. Sawa puffed on her emergency asthma inhaler over and over again.

“Usually, I use it once a month,” said Sawa, a 48-year-old businesses coach who has had asthma since she was 13. “After using it four times in one day, I knew it was time to go to urgent care.” There, doctors had her inhale a powerful steroid medication to soothe her inflamed airways.

For two weeks after the fire ignited, the air in Northern California, stretching as far as 200 miles from the flames, was so full of smoke that it was deemed unhealthy to breathe, especially for people with heart and respiratory ailments.

But the health problems Sawa and others experienced while the blaze raged are just the beginning of effects that could plague people from Sacramento to the San Francisco Bay Area long after the smoke clears.

An analysis of hospital data by Reveal from The Center for Investigative Reporting found that emergency room visits surged several months after a previous large wildfire was extinguished.

Three to five months after the 37,000-acre Tubbs Fire in Napa and Sonoma valleys in October 2017, the region’s emergency rooms treated about 20 percent more patients for respiratory and cardiac ailments compared with previous years, according to the analysis, which used state data. At the time, the Tubbs Fire was the most destructive in California history, killing 22 people and destroying nearly 6,000 structures.

Seven of nine hospitals in Napa and Sonoma counties reported either significantly or slightly more cardiovascular and respiratory cases from January through March 2018 compared with the same period in 2016 and 2017. For instance, at Kaiser Permanente Santa Rosa Medical Center in Sonoma County’s largest city, emergency room visits for respiratory problems jumped by 570, or 37 percent, from January through March 2018 compared with the same period in 2017. Twenty miles down Highway 101 at Petaluma Valley Hospital, heart cases increased by 61 patients, or 50 percent.

Medical experts say these findings raise troubling questions about the long-term health effects of wildfires, which, worsened by drought and global warming, are raging across the West.

The life-threatening effects of smoke disproportionately harm the elderly, children and low-income people of color. More than 2.3 million adults and 644,000 children in California have asthma and another 1.7 million suffer from heart disease, according to the Centers for Disease Control and Prevention and California Department of Public Health. Adult asthma rates are highest for multiracial people and African Americans, while heart ailments tend to afflict the state’s poorest and least educated residents across all racial groups.

Reveal’s analysis does not take into account other factors that might have driven up the emergency room visits, such as other pollutants or the weather. But the conclusion is in line with a growing body of research thathas found more people suffer respiratory problems and heart attacks within days of being exposed to wildfire smoke.

“The uptick in ER visits is very consistent” with scientific research about smoke, said Dr. Kari Nadeau, director of Stanford University’s Sean N. Parker Center for Allergy and Asthma Research.

Dr. John Balmes, a pulmonologist and professor at the University of California San Francisco who studies air pollution, is not surprised that emergency room visits increased three months after the wine country fire.

“People with asthma, COPD (chronic obstructive pulmonary disease) and other lung diseases could have persistent exacerbations,” he said, adding that inhaling ash could have longer-term consequences, too. The effects of smoke months or years after a fire are not well understood.

There was only a slight increase in immediate emergency room visits during the days when last year’s Tubbs Fire burned. That’s because two of the largest hospitals were evacuated and a third was destroyed. As a result, the analysis was based on the period three to five months later, using data from California’s Office of Statewide Health Planning and Development.

Busier ERs in Bay Area, Sacramento

This month’s Camp Fire – the deadliest and largest in California history – was more than four times bigger than the Tubbs Fire. Throughout much of the Bay Area and Sacramento area, the smoke was so intense and widespread that many people wore masks, stayed indoors and bought air purifiers. At least two Northern California hospitals have reported busier ERs due to smoke from the fire, which burned 153,000 acres in the foothills of the Sierra Nevada.

Robin Scott, director of the emergency department at Adventist Health Clear Lake, reported a 43 percent increase in respiratory diagnoses when the smoke hung over the region compared with the two previous weeks.

In Berkeley, 160 miles from the fire, Sutter Health’s Alta Bates Summit Medical Center treated “increasing numbers of patients with chief complaints that appear to be connected to the poor air quality,” including “asthma, eczema, respiratory illness – as well as worsening heart conditions like congestive heart failure and chest pain,” said Dr. Ronn Berrol, medical director of the emergency department.

Other hospitals in the region, however, reported small increases, while some, including Kaiser Permanente in Oakland, reported no increases.

“There has been a slight uptick in terms of patients coming through our ER with respiratory issues. Most have been quickly treated and discharged,” said William Hodges, director of communications at Dignity Health in Sacramento. “I would say the impact has been minimal at most.”

Francesca Dominici, a biostatistics professor at Harvard University’s T.H. Chan School of Public Health, said understanding the health effects is critical because climate change is making fires more frequent, ferocious, erratic and long lasting.

Dominici was on a team of researchers that published a study last year that collected data from wildfires across the West between 2004 and 2009 and compared it with hospitalizations of elderly residents. About 22 percent more African Americans 65 and older were hospitalized for respiratory problems on smoky days than on non-smoky days. For elderly women of all races, respiratory hospitalizations increased more than 10 percent on smoky days, and for elderly men, 4 percent.

Five of the 10 largest wildfires in California history have occurred in the last two years, and many of the state’s largest population centers have been exposed to smoke repeatedly.

Dominici said the impacts are likely cumulative.

“More people are becoming susceptible to air pollution because they have been breathing bad air from previous wildfires,” she said. “For these people, the risk of adverse health effects is going to be even larger than the rest of the population.

U.S. Environmental Protection Agency researchers, in a study published in April, examined more than a million emergency room visits during California’s 2015 fire season and found a 42 percent increase in heart attacks among adults over 65 on days with dense wildfire smoke. They also found increases in strokes and other cardiovascular effects.

The EPA researchers expressed a willingness to speak about their research, but the agency would not grant permission.

Tiny particles harm hearts, lungs

A major health concern is the makeup of the smoke. Fires emit clouds of fine particles known as PM2.5. For decades, researchers have shown that whenever these tiny particles – which largely come from vehicles and other sources of fuel combustion – increase in the air, deaths and hospitalizations from heart attacks and respiratory problems rise. The particles can irritate airways, travel deep into the lungs and disrupt the heart.

In addition, fires can emit toxic gases from a variety of sources, including oil, metals and pesticides.

Among the estimated 19,000 buildings destroyed in the Camp Fire were gas stations, two grocery stores, eight schools and a hotel.

“When you’re breathing smoke from that wildfire,” said Stanford’s Nadeau, “you’re breathing paint thinner, Drano, plastics, heavy metals and burned leaves, which are very similar to tobacco.”

The long-term effects of breathing this cocktail are unknown.

A firefighter searches for human remains in a trailer park destroyed by the Camp Fire in Paradise, Calif.CREDIT: JOHN LOCHER/ASSOCIATED PRESS

In Palo Alto, 200 miles from the Camp Fire, pediatrician Dr. Kellen Glinder said he has seen a marked increase in number of children with breathing problems during each of California’s recent wildfires.

On Friday, after rain cleared much of the wildfire smoke, the waiting room at the Palo Alto Medical Foundation, a clinic where Glinder works, wasn’t as busy as it was in previous days. Several children sat or crawled around as a television played “Toy Story” overhead. But Glinder said he still was treating kids affected by the smoke.

About one-third of the 20 children he treated each day during the fires – six to eight kids per day – had conditions the smoke exacerbated, Glinder said.

“We (saw) a lot of things hidden under the guise of a cold that wouldn’t have gotten worse unless the air quality was so bad,” he said.

In August, when the Mendocino Complex Fire blazed through the state, Glinder treated more patients with asthma and other conditions. And last year, the Santa Rosa fires brought similar health concerns.

“Each forest fire is going to have its own particular combination of chemicals, depending on what’s getting incinerated and blowing our way,” he said. “With this particular fire, I saw a lot more … skin irritation, headaches and nausea than I had seen in prior forest fires.”

The waiting room had a box of miniature paper masks for the kids, decorated with Mickey Mouse heads. Glinder, however, said such flimsy masks are ineffective at protecting people from smoke’s particles and gases; they are designed to contain germs from colds and flu.

Like the elderly, children are particularly sensitive to soot and smoke.

“Children’s lungs are still growing, their nervous systems are still growing,” Glinder said. “That makes them more susceptible to these pollutants.”

This story was edited by Marla Cone and copy edited by Nikki Frick.

Aaron Glantz can be reached at aglantz@revealnews.org, and Susie Neilson can be reached at susancneilson@gmail.com. Follow them on Twitter:@Aaron_Glantz and @susieneilson.

    Attorney General letter may be terminal for ORCEM / Vallejo Marine Terminal

    By Roger Straw, November 30, 2018
    Nov. 7 2018 letter from Deputy Attorney General Erin Ganahl

    Take heart, Vallejoans!  The letter sent to your City by the Attorney General may just do the trick.  (See Times-Herald Nov. 12 coverage.)

    I remember back in Benicia’s crude-by-rail days, when Deputy Attorney General Scott Lichtig of Attorney General Kamala Harris’ staff wrote to the City of Benicia.  He wrote first in 2014 urging revision of an “inadequate”  Draft EIR, and again in 2016, defending the City’s right to deny a land use permit.  Lichtig advised our city leaders, “For Benicia to turn a blind eye to the most serious of the Project’s environmental impacts, merely because they flow from federally-regulated rail operations, would be contrary to both state and federal law.”

    There were a LOT of us who worked long and hard to defeat Valero’s dangerous and dirty oil train proposal.  Local activists and folks from far and wide disagreed with City staff and Valero’s execs and highly paid attorneys.  We criticized, protested and sent volumes of comments over the course of 3 ½ years.  Scientific and environmental experts and friendly attorneys weighed in.  But it was eye-opening for everyone when the Attorney General’s office got involved.

    But… note that the AG letter wasn’t enough.  It’s important here for us to not dwell on the past or get too optimistic.  Stay tuned via Fresh Air Vallejo and keep up the good work.

    …because ORCEM/VMT wants to run 552 trucks a day up and down Lemon Street!  We stand in solidarity with residents, business owners and all of our neighbors in Vallejo.  And it’s important to realize that the truck exhaust will travel by air west to east, settling, surely, in Glen Cove and Benicia.

    Let’s hope the Vallejo City Council has the backbone Benicia had in 2016, to DENY THIS PROPOSED CATASTROPHIC PROJECT!

      Vallejo city manager critical of ORCEM / Marine Terminal’s deceptive paid advertisement

      Repost from the Vallejo Times-Herald
      [Editor –  Good news that Vallejo’s City Manager has raised eyebrows about ORCEM’S paid advertisement masquerading as news in the Times-Herald’s Nov. 22 edition.   View the Attorney General’s scathing 13-page letter.  Let’s hope the Vallejo City Council has the backbone Benicia had in 2016, to DENY THIS PROPOSED CATASTROPHIC PROJECT!  For more critical perspective, see Fresh Air Vallejo.  For official project documents, see Vallejo’s City website.   – R.S.]

      Vallejo city manager addresses Orcem, VMT insert

      By John Glidden, November 29, 2018 at 2:05 pm
      Vallejo City Manager Greg Nyhoff

      Vallejo City Manager Greg Nyhoff reiterated Tuesday night that a Final Environmental Impact Report (FEIR) being completed for a controversial south Vallejo project won’t be released until early next year.

      Toward the end of the Vallejo City Council meeting, Nyhoff addressed the contents of a four-page advertising insert paid for by the project applicants and published in the Times-Herald on Nov. 22.

      He took issue with a statement printed on top of the insert asserting that the FEIR being prepared for the Vallejo Marine Terminal, Orcem Americas project would be released “within a matter of days.”

      “I just want to clarify — it looks like it’s official news. That’s not the case,” Nyhoff said to the councilors. “No — this report won’t be coming out within a matter of days.”

      VMT and Orcem representative Sue Vaccaro said via email on Wednesday that the Times-Herald’s deadline to submit artwork for the insert was Nov. 9, several days prior to Nyhoff’s original announcement during the Nov. 13 council meeting that release of the FEIR would be delayed.

      “By that time, due to the two weeks of lead time required in accordance with the newspaper’s specifications, there was not an opportunity to update that two-line reference,” Vaccaro wrote. “In short, we were acting in good faith based on the City Manager’s comments at the time the artwork was submitted for print … obviously, had we known what was coming out from the Attorney General’s Office and subsequent delay ordered by the City Manager, we wouldn’t have made that reference.”

      However, in a phone interview on Thursday, Nyhoff disagreed, noting that despite previously saying in September that the FEIR would be released toward the end of November, both the city and applicants knew the report wouldn’t be released in November — even before the DOJ letter was sent to the city.

      “Everyone still knew we weren’t going to meet that deadline,” Nyhoff explained. He said the city and consultants are still waiting to hear back from the Bay Area Air Quality Management District (BAAQMD), which is still reviewing information about the project.

      Nyhoff said during the council meeting, and again on Thursday, that City Hall will also be looking into additional claims made in the insert, including the $1 million benefits program, and the Lemon Street maintenance program being offered by the applicants.

      He said it’s important to make sure Lemon Street is going to be taken care of, due to the large volume of trucks trips — about 552 — expected daily. Nyhoff said analyzing truck traffic and its impact to surrounding streets near Lemon is also needed.

      Earlier this month, the California Department of Justice sent city officials a 13-page letter warning that environmental documents, a draft final environmental impact report (DFEIR), an Environmental Justice Analysis (EJA), and Revised Air Analysis prepared for project are misleading and violate state law.

      “The environmental documents for the project fail to provide adequate legal support for the City of Vallejo to approve the project,” Erin Ganahl, deputy attorney general for the State of California, wrote on behalf of state Attorney General Xavier Becerra. “The DFEIR fails to adequately disclose, analyze, and mitigate the significant environmental impacts of the project; the EJA improperly concludes that the project would not disproportionately impact low-income communities of color, and thus misleads decision makers and the public by minimizing the projects significant environmental justice concerns.”

      The Vallejo Planning Commission voted 6-1 in 2017 to reject the VMT/Orcem project, agreeing with City Hall that the project would have a negative effect on the neighborhood, that it would impact traffic around the area and the proposed project was inconsistent with the city’s waterfront development policy. The project also has a degrading visual appearance of the waterfront, City Hall said at the time.

      City officials argued in 2017 that since a rejection was being recommended, an FEIR was not required.

      Orcem and VMT appealed the Planning Commission decision, and in June 2017, when reviewing the appeal, a majority of the council — Jess Malgapo, Rozzana Verder-Aliga, Hermie Suna, and Pippin Dew-Costa — directed City Hall to complete the impact report.

      Once the FEIR is completed, Nyhoff previously said the report will be circulated for at least 60 days prior to the council taking up the appeal again.

        For safe and healthy communities…