New study finds wildﬁre smoke impacts respiratory health more than ﬁne particles from other sources
Choking smoke from record wildfires blanketed Northern California last summer and fall. It turned Bay Area skies an otherworldly orange, raising health concerns over a hazard that is increasing as temperatures continue to climb and poorly managed forests burn out of control each year across the West.
With this winter being extraordinarily dry, the chances of another big wildfire year are high. But the flames may not pose the biggest danger to the most people: A new study published Friday found that tiny particles of soot from wildfires, which millions of Californians are breathing in, are up to 10 times as harmful to human respiratory health as particulate pollution from other sources, such as car exhaust, factories or power plants.
“We’ve been really successful in reducing air pollution across the country by improving standards for automobiles, trucks and power plants,” said Tom Corringham, a research economist who studies climate and atmospheric science at the Scripps Institution of Oceanography at UC-San Diego. “The trend has been a decrease in air pollution. But these wildfires are getting worse.”
Corringham and his fellow researchers studied the number of people admitted to hospitals with respiratory problems daily from 1999 to 2012 in Southern California. They compared it to data from fires, Santa Ana winds and smoke plumes from San Diego to Santa Barbara.
They found that when air pollution of tiny particles called PM 2.5 — for particulate matter 2.5 microns or smaller, so small that 30 of them can line up along the width of a human hair — increased modestly, the number of people admitted to hospitals for respiratory ailments such as asthma increased by 1% on average. But when PM 2.5 levels from wildfire smoke went up by the same amount, or 10 micrograms per cubic meter, there was a 10% increase in those hospital admissions.
The tiny particles can penetrate deep into people’s lungs, enter the bloodstream and increase the risk of heart attacks, strokes and other serious health issues.
Last year, 4.2 million acres — an area 13 times the size of the city of Los Angeles — burned in California, the most in modern times. Fires from the Santa Cruz Mountains to the Southern Sierra sent enormous plumes of smoke over the state’s largest cities and as far away as the East Coast. On Sept. 9, smoke mixed with the marine layer, turning Bay Area skies an apocalyptic orange.
The Bay Area Air Quality Management District called 30 “Spare the Air” days in a row from August 18 to September 16. Soot levels nearly as bad blanketed the Bay Area during the Camp Fire in 2018 and Wine Country fires in 2017. In the Sierra, the Sacramento Valley and parts of Southern California, air quality was even worse last year, reaching 10 to 15 times the federal health standard.
A study by Stanford researchers concluded that the fires last fall caused 1,200 excess deaths and 4,800 extra emergency room visits in California, mostly among people 65 and older with pre-existing conditions such as respiratory problems, diabetes and heart disease.
More is on the way. Wildfire risk is expected to be high this summer due to the unusually dry winter. Last fall, state and federal officials signed an agreement to double the rate of thinning forests that have grown unnaturally thick due to generations of fire suppression. Gov. Gavin Newsom added $1 billion to California’s state budget this year for increased forest management, fuel breaks, fire inspections and fire crews.
But Corringham said that as the climate continues to warm and wildfires increase, government agencies must directly address the health risks of smoke, particularly to the elderly and low-income people. More “clean room” cooling centers, rebates for home air purifiers and better public education campaigns are key, he said.
Other health officials generally agreed.
Dr. John Balmes, a professor of medicine at UC San Francisco and a member of the California Air Resources Board, said some types of particle pollution, such as diesel soot, can be more dangerous than wildfire smoke. But overall, he agreed with the Scripps researchers’ conclusions that wildfire smoke poses a growing threat to the state’s residents as the climate warms.
“There’s no question it’s a huge air quality problem that has major health impacts,” Balmes said.
“There was a ring of fire last year around the Bay Area,” he added. “We are going to have to spend billions of dollars to maintain our forests better. It is going to take years. It can’t be done overnight.”
Scientists don’t know precisely why wildfire smoke is more harmful than most other particulate pollution. One theory is that when buildings burn, everything toxic in them, from heavy metals to plastics to pesticides, is sent airborne in smoke. Another theory is that the carbon nature of the particles causes more inflammation and stress on the lungs than other types of pollution.
“They are saying that wildfire smoke is more toxic. And that’s probably true,” said Dr. Mary Prunicki, director of air pollution and health research at Stanford University’s Sean Parker Center for Allergy and Asthma Research. “Usually direct deaths from wildfires are smaller than the effects from the smoke.”
Vallejo Times-Herald, by Paul Rogers, September 25, 2020
Heavy smoke from wildfires that choked much of California in recent weeks was more than an annoyance.
It was deadly. And it almost certainly killed more people than the flames from the massive fires themselves, health experts say.
Between Aug. 1 and Sept. 10, the historically bad concentrations of wildfire smoke were responsible for at least 1,200 and possibly up to 3,000 deaths in California that otherwise would not have occurred, according to an estimate by researchers at Stanford University. Those fatalities were among people 65 and older, most of whom were living with pre-existing medical conditions such as heart disease, diabetes and respiratory ailments.
By comparison, through Wednesday, 26 people have died directly in wildfires this year statewide.
“Clean air is much more important than we realize,” said Marshall Burke, an associate professor of earth system science at Stanford who calculated the impacts. “When you look at it on a population level, you can see very clearly that breathing clean air has huge public health benefits, and breathing dirty air has disastrous consequences.”
Decades of medical research has shown that soot is among the most dangerous types of air pollution. Known as “PM 2.5,” for particulate matter that is smaller than 2.5 microns, the microscopic soot particles are so small that it would take 30 or more to span the width of a human hair.
Generated by diesel trucks, power plants, fireplaces and other sources, the tiny particles can travel deep into the lungs, even entering the bloodstream, when people breathe them in high concentrations.
In mild levels they cause itchy eyes and sore throats, coughing and a tight feeling in the chest. In more severe instances, they can trigger asthma attacks, heart attacks, strokes or respiratory failure, particularly in the elderly, infants and people with heart and lung problems.
Smoke levels broke all-time records in California. The Bay Area Air Quality Management District called 30 “Spare the Air” days in a row from Aug. 18 to Sept. 16. Soot levels exceeded federal health standards for 19 days. Air quality was even worse in the Sierra, the Sacramento Valley and parts of Southern California, where it reached 10 to 15 times the federal health standard. On Sept. 9, smoke turned the air across Northern California an apocalyptic orange.
Burke and Sam Heft-Neal, a research scholar at Stanford’s Center on Food Security and the Environment, looked at a study published last year that used Medicare data to show that when levels of particulate pollution increased around the United States, the death rate of people 65 and older also increased, as did emergency room visits.
That study, by researchers at the University of Illinois and Georgia State University, found that for each day particulate air pollution increased by about 10% over typical levels — or 1 microgram per cubic meter — there was an increase in deaths and emergency room visits among people over 65 during the next three days.
California has roughly 6 million people older than 65. The Stanford researchers compared air pollution readings during California’s fires with increased death rates and emergency room rates from the previous study. They concluded at least 1,200 “excess deaths” occurred from Aug. 1 to Sept. 10 in California, along with about 4,800 extra emergency room visits.
“These are hidden deaths,” Burke said. “These are people who were probably already sick but for whom air pollution made them even sicker.”
Burke noted Stanford’s analysis doesn’t include young children or people under 65 with serious respiratory or heart conditions.
Other researchers say they generally support Stanford’s conclusions.
“It makes total sense,” said Dr. John Balmes, a professor of medicine at UC San Francisco and a member of the California Air Resources Board. “It should give us pause.”
In recent days, Bay Area air has cleared. But there is still at least another month of fire season.
Balmes and other experts say it’s important when people can smell smoke outdoors that they go inside and close doors and windows. On very smoky days, towels, masking tape or painter’s tape can block leaks. Air purifiers and wearing N95 or KN95 masks also can help.
“I don’t want to panic people who are healthy and without pre-existing disease, but we should reduce exposure as much as possible,” Balmes said. “You should stay indoors and not be outside any more than you have to be. Exercising outdoors when the air quality is bad is particularly problematic.”
The big unanswered question is whether exposure to thick wildfire smoke has long-term effects on healthy people. A study published this summer by the University of Montana found that of 95 people who lived in the small town of Seeley Lake near Missoula — where wildfire smoke choked the area for 49 days in 2017 — roughly one-third had compromised lung function two years later.
Other studies of wildland firefighters are ongoing. But the public and media often pay more attention to flames than smoke, because we’ve evolved that way, said Dr. Anthony Harris, medical director at WorkCare, a health care company based in Anaheim.
“Those things that are immediate we see and are alarmed by,” he said of the flames. “But studies show that fear only lasts for about two weeks in terms of behavior modification. So the notion that I might have a poor outcome in 15 years because of the smoke I am inhaling today just doesn’t cause a rise in the awareness of people.”
Mental health professional: “In the past two weeks, my practice has exploded.”San Francisco Chronicle, by Steve Rubenstein and Nora Mishanec, Sep. 11, 2020
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.”