In a year of wondering what could possibly come next, the next things just keep on coming.
After eight months, they’re starting to add up, say mental health experts. And there’s lots of 2020 left, plenty of time for more next things.
“I’ve been hearing the word ‘apocalyptic’ a lot,” said San Francisco psychiatrist Scott Lauze. “I’m doing a tremendous amount of hand-holding these days. You can’t even rely on the color of the sky anymore.”
Lauze, in private practice for three decades, said he had never seen the call for his services take off like right now.
“In the past two months, there was a significant uptick in demand,” he said. “In the past two weeks, my practice has exploded.”
Pandemic, social unrest, heat waves. Wildfires. Smoke. Mass evacuations. Therapists call them stressors, and there has been no shortage of things to get stressed over.
And this just in: ash raining from the heavens, and darkness at noon.
“I couldn’t fall asleep,” said San Francisco nurse Valieree MacGlaun, who works the night shift and was walking home Friday on Divisadero Street from the VA hospital in her scrubs.
She said she feels overwhelmed, though her job is to help other people overcome feeling overwhelmed.
“This is my calling,” she said. “But you have to take care of yourself.”
Connie and Michael VonDohlen flew from their home in Tennessee to San Francisco on Wednesday to attend their daughter’s wedding, just in time for the dark orange daytime skies that made some locals say it felt like living on Mars. Streets were deserted. The VonDohlens, who don’t seem to shock easily, said they were shocked.
“We thought we had gone into the Twilight Zone,” Michael VonDohlen said. “I was expecting zombies to jump out from every doorway.”
“The fires, added to the pandemic, and the inability to escape — all that adds to the potential for hopelessness,” said emergency room psychiatrist Yener Balan, head of behavioral health services at Kaiser Permanente Northern California.
Calamity and malaise are part of the human condition, he said, and pondering the world wars endured by prior generations can put a virus or a wildfire in perspective.
Coronavirus live updates: SF urges people to stay inside due…
“As a species, we are resilient,” he said. “Many generations have seen this level of calamity.”
Taking care of oneself, living in the moment, checking in with family and friends, getting enough exercise and sleep — those are the keys to coping, Balan said. And turning off the TV and the computer when enough is enough — that helps, too. It also reduces exposure to the added stresses of a national election and its apocalyptic nuances.
“Just when you think you’re beginning to deal with one disaster, another one comes along,” said David Spiegel, a psychiatry professor at Stanford University. “Patients who have been stable are experiencing an exacerbation of depression and anxiety.”
The year 2020, he said, is turning out to be a “remarkable test of everyone’s ability to cope.”
Trying to cope in Alamo Square, while holding three dogs on a leash, was professional dog walker Michael Waddell. He used to wear a plain mask, for the virus. Now he wears a mask with an air filter, for the virus and the smoke. Different disaster, different mask.
Two in 5 U.S. adults say they are “struggling with mental health or substance abuse” since the pandemic hit, according to a report from the Centers for Disease Control and Prevention. And the “prevalence of symptoms of anxiety disorder” were triple those of last year, the report added.
Even if psychiatrists are doing more business these days, Waddell said, dog walkers aren’t. Business has largely fallen off as people staying home can walk their own dogs.
Waddell’s usual complement of dogs is six. Losing half his income, Waddell said, “has added more to my immediate stress than the smoke or the wildfires.”
Dogs, who have no problem living in the moment, help. So do hobbies, said Melissa Smith, who was waiting for 5-McAllister bus. She said her therapy was to try “old lady hobbies.”
“This is the perfect excuse to take up knitting,” she said. “It’s a good outlet for the frustration. You need something to channel your energy.”
Smith was on her way home, where the knitting was waiting.
“What better place to practice peace than the middle of a storm?” she said. “I just think, after this, we are all going to be so resilient.”
To Deer Park residents, fire a reminder of ‘like living on a fault line’
Samantha Ketterer and Emily Foxhall March 18, 2019 Updated: March 18, 2019 4:37 p.m.
Jodie Thompson pulled over on Independence Parkway, less than a mile away from a petrochemical plant that was leaking plumes of black smoke into the sky.
In her 34 years living in Deer Park, she’d seen flares before. But this was different.
“I trust that they actually know what they’re doing, but inside, I have this doubt,” Thompson said Monday afternoon, watching the flames from inside the safety of her car.
The fire had raged at Intercontinental Terminals Company for more than 26 hours by the early afternoon and spread to eight holding tanks. Even after a shelter-in-place was lifted Monday morning, the fire was still expected to burn for two more days.
The ordeal, in some ways, was part of life in Deer Park, an east Harris County city of more than 33,000 people. Residents said they were familiar with the risks that come with living by the refineries and chemical plants. At a certain point, you have to stop worrying, they said.
“You can’t fret about it,” said Thompson, who is 60. “What are you going to do? You choose to live here.”
Holly Ball, 47, is a newer resident to Deer Park, having lived in the city for just a year. She’s noticed the puffing smoke stacks at the refineries, of course, but wasn’t aware of a threat like this, she said.
Like Thompson and many other residents on Monday, Ball parked her car to take photos of the smoke spreading miles west into Houston. She planned to send them to her friends in Louisiana.
“It’s scary,” she said. Her dog barked in the seat next to her. “It’s scary.”
On Facebook, people responded to official updates with more questions. They wanted to know more about what exactly was happening and what the risks were to their health.
Would the city of Deer Park be evacuated? Was it possible the plant would explode? The shelter-in-place had been in Deer Park, but what about people in the close-by city of Pasadena? And in La Porte?
Some people wrote of alarm sirens that should have gone off but haven’t worked for some time. Even with the shelter-in-place lifted, looking up at the sky, it was hard for many to believe air quality was fine. Some wrote of symptoms they were experiencing.
One person said she had trouble breathing overnight. Two others wrote of burning sensations in their eyes. Another person decided to leave the area because their child was having trouble breathing. Some said they were simply nervous to sleep.
Bernice Oehrlein, 78, pushed a cart in the morning through the Food Town grocery store in Deer Park, about 5 miles southwest of the plant. She recently had a bad bout with pneumonia, so the fire is concerning for health reasons, she said.
“I have a hard time breathing anyways,” Oehrlein said.
At a Starbucks just down the road, Cindy Richards and her daughter drank coffee instead of going on their normal Monday walk.
Richards, a 67-year-old who lives in Pasadena, recalled the drive to Deer Park, before she realized a fire had clouded up the sky.
“I was like, ‘It’s a little overcast,'” she said. But then, “I come a little closer – ‘That’s smoke.'”
Richards doesn’t pay too much attention to the factories anymore, although she said they used to be more top-of-mind when she lived off of Sims Bayou, closer to some of the refineries.
Her daughter, 35-year-old Robyn French, lives close to the plant in Deer Park with her husband and two children. Flares, smoke and a gassy smell have become a normal occurrence, and she knows what to do in the case of an explosion.
But French knew better than to ignore the smoke on Monday, even though she said she felt fairly safe.
She made sure Sunday and Monday that her son wasn’t outside on his bike, breathing in anything possibly dangerous. And the unknown is still concerning.
“Am I still able to eat the Swiss chard and kale I’m growing in my garden?” she asked. “That’s a valid question to me. Will my oranges be full of chemicals when they’re full grown?”
Heather Trevino, 42, grew up in Deer Park and lives there now with her 9-year-old daughter. She said she had taken shelter before, but didn’t recall an incident as long and intense as this one.
Trevino saw the smoke rising above her neighbor’s roof Sunday. Her eyes and throat itched. When she got the alert to shelter-in-place, she knew to bring in her two dogs and shut off the A/C.
Trevino faintly heard the sound of the alarms that she said are tested every Saturday at noon. She put on some movies for her daughter, who also learned in school what to do when a shelter-in-place was ordered.
“We kind of get it ingrained in us,” Trevino said. “Living here, it’s just kind of part of what you accept, that there’s something that could possibly happen.”
Thompson likened it to an earthquake-prone area.
“It’s probably like living on a fault line,” she said. “It doesn’t happen very often, but the possibility is always there. In the back of your mind, you push it back. It’s out of your control.”
Anthony, a 36-year-old who works at a nearby plant, said he had to take the day off because of his workplace’s proximity to ITC. He declined to give his last name because of his employer.
While Anthony said he didn’t believe the air quality in the area is particularly bad because of the incident, he’s still concerned of the possibility of an explosion.
“It’s not anything that can really be taken lightly,” he said. “There is a flash point.”
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 firstname.lastname@example.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.