Reporting on a congressional briefing in 2005, I quoted public health experts predicting a pandemic that would overwhelm hospitals and exhaust respirator supplies. “I want to emphasize the certainty that a pandemic will occur,” the Mayo Clinic’s Gregory Poland said.
In 2009, during the swine flu scare, I relayed warnings about “the nation’s patchwork of a public health system” and the need for better “vaccine and public-health infrastructure before a more severe pandemic comes along.”
I repeat these things not to pretend I was prescient but to show that the nation’s top scientists and public health experts were shouting these warnings from the rooftops — deafeningly, unanimously and consistently. In the years after the 2001 terrorist attacks, the Bush and Obama administrations seemed to be listening.
But then came the tea party, the anti-government conservatism that infected the Republican Party in 2010 and triumphed with President Trump’s election. Perhaps the best articulation of its ideology came from the anti-tax activist Grover Norquist, who once said: “I don’t want to abolish government. I simply want to reduce it to the size where I can drag it into the bathroom and drown it in the bathtub.”
They got their wish. What you see today is your government, drowning — a government that couldn’t produce a rudimentary test for coronavirus, that couldn’t contain the pandemic as other countries have done, that couldn’t produce enough ventilators for the sick or even enough face masks and gowns for health-care workers.
Now it is time to drown this disastrous philosophy in the bathtub — and with it the poisonous attitude that the government is a harmful “beast” that must be “starved.” It is not an exaggeration to say that this ideology caused the current debacle with a deliberate strategy to sabotage government.
Overall, entitlement programs continued to grow, and the Pentagon’s many friends protected its budget. And Trump has abandoned responsible budgeting. But in one area, the tea party types, with their sequesters, debt-limit standoffs and other austerity schemes, did all too well. Between 2011 and 2018, nondefense discretionary spending fell by 12 percent — and, with it, the government’s already iffy ability to prevent and ameliorate public health emergencies unraveled.
John Auerbach, president of Trust for America’s Health, described for me the fallout: Over a dozen years, the Public Health Emergency Preparedness grants to state and local public health departments were cut by a third and the Hospital Preparedness Program cut in half, 60,000 jobs were lost at state and local public health departments, and similarly severe cuts were made to laboratories. A $15 billion grant program under the 2010 Affordable Care Act, the Prevention and Public Health Fund, was plundered for other purposes.
Now Americans are paying for this with their lives — and their livelihoods.
If the United States had more public health capacity, it “absolutely” would have been on par with Singapore, South Korea and Taiwan, which have far fewer cases, Auerbach said. South Korea has had 4 deaths per 1 million people, Singapore 1 death per million, and Taiwan 0.2 deaths per million. The United States: 39 per million — and rising fast.
To have mitigated the virus the way Singapore, South Korea and Taiwan did would have required spending about $4.5 billion a year on public health, Auerbach estimates. Instead, we’re spending trillions to rescue the economy.
Democrats aren’t blameless in pandemic preparedness. And some Republicans tried to be responsible — but the starve-the-beast crowd wouldn’t hear of it.
After Sen. Arlen Specter (R-Pa.) voted for the 2009 stimulus bill because he secured $10 billion for the National Institutes of Health, he was essentially forced out of the GOP. Rising in the party were people such as Rep. Jim Jordan (Ohio), whose far-right Republican Study Committee in 2011 proposed a plan, applauded by GOP leadership, to cut NIH funding by 40 percent.
In 2014, NIH chief Francis Collins said there likely would have been a vaccine for the Ebola outbreak if not for a 10 percent cut in NIH funding between 2010 and 2014 that included halving Ebola vaccine research. Republicans jeered.
In 2016, when President Barack Obama requested $1.9 billion to fight the Zika virus, Republicans in Congress sat on the request for seven months and then cut it nearly in half.
Since then, Trump has proposed cuts to the NIH and the Centers for Disease Control and Prevention so severe even congressional Republicans rejected them. And last month they fed the “beast” a $2.2 trillion feast to fight the pandemic.
Now they know: When you drown the government in the bathtub, people die.
“(The) City of Benicia has issued (an) advisory notice for all residents with respiratory issues due to particulate matter from an ongoing incident at the Valero Benicia Refinery,” the city’s statement reads.
City officials are telling local residents with weakened respiratory systems to close all doors, windows and fireplace dampers, urging them to put tape or damp towels around doors and windows to seal them.
The advisory also recommends that healthy people limit their outdoor activity.
“The concentration of particulate matter has become significantly higher over the past day. The emissions contain coke, a by-product of the refining process that is made up primarily of carbon particles,” the city’s statement says.
Benicia officials said testing of the coke dust released so far did not show heavy metals at harmful levels but warned that breathing in air from the releases could worsen underlying respiratory conditions like asthma.
In a statement, the Bay Area Air Quality Management District said inspectors are at the refinery investigating the cause of this heavy smoke. The Air District also deployed a monitoring van to drive throughout Benicia to “gather ground level emissions data.”
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
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 email@example.com.
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.
Mayor’s request for Benicia Industrial Safety Ordinance (ISO)
June 15, 2018
I believe we need to have a seat at the table, the public’s right to know and air monitors to restore the public trust that we are putting health, safety and welfare at the top. I am asking the council to challenge the status quo by submitting a draft Industrial Safety Ordinance. I am asking the council to direct staff to review the draft ordinance with outside third party knowledgeable about industrial safety ordinances and report back to the city within a reasonable time such as 3 months or sooner.
The Industrial Safety Ordinance provides Benicia the where-with-all through proposed fees to review refinery safety, air pollution and public safety reports, update Benicia Emergency Response Plan, improve public alerts system and provide for air monitoring. This is a budget neutral proposal by setting up a fee structure to pay for the cost of the city having a seat at the table and expertise to review the reports. The expertise can be outsourced and does not require additional staff.
This Industrial Safety Ordinance is challenging the status quo. I believe the public has a right to know they can trust us to put them first in safety, air quality and public health.