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In CA, Wildfires Accelerate Convergence of Public Health Crises

Unhealthy air quality afflicts large swaths of the state, as coronavirus pandemic rages on.


California Wildfires

Smoky conditions are seen along Highway 154 in Santa Barbara County, California, miles from any active fires when this photo was taken on August 19, 2020. Large fires burning in California have resulted in poor air quality in many places across the state, and the particulates from smoke can exacerbate respiratory health conditions. (Photo by Mike Eliason/Santa Barbara County Fire Department)

California faces a convergence of public health crises as dozens of wildfires unleash hazardous levels of air pollution across the state.

Smoke-laden air has exacerbated conditions, like asthma, while the menace of Covid-19 still looms, mounting a respiratory threat on two fronts. For the more than 650,000 Californians sick with the virus, poor air quality is particularly dangerous. A small increase in air pollution has been shown to significantly increase patients’ risk of severe illness and death.

Meanwhile, sweeping evacuations have forced emergency officials to abandon pre-Covid protocols, filling up hotels to avoid crowded shelters. Nearly 50,000 people have been evacuated across the state.

On this episode of the podcast, we speak with Direct Relief’s head of research and analytics, Andrew Schroeder, about the heightened health risks of California’s wildfires and more on what those affected should know.


RAFANELLI: How does Covid-19 heighten the health risks of these wildfires?

SCHROEDER: I think in a couple of key ways. The first is just that the main route of transmission for COVID is respiratory. And when you have a preexisting respiratory condition that might be exacerbated by wildfire smoke, so you might be an asthmatic that actually has your asthma exacerbated during this time period.

If you also get COVID the likelihood of more severe consequences from COVID, is higher for you because of your preexisting co-morbidity being more intense as a result of the smoke exacerbating it. And you know, the second part of it that I think is important, that is hard to know how to actually advise people effectively is just that ventilation of indoor space is much harder. Right now the air quality in the Bay area, in particular, is absolutely abysmal. But this is true to some degree throughout much of the state right now. So you can’t really keep your windows open. You know, if you are, in your house or in a place of business or in a restaurant, et cetera, you have to be able to close off the space to protect the space where you are breathing from the smoke.

That means people are more likely to spend more time indoors in less well-ventilated spaces. And if we know one thing so far about the likelihood of transmission of COVID it’s that indoors in poorly ventilated spaces is where you’re most at risk. There’s ways to mitigate that risk, but it’s definitely higher under any scenario.

So, the wildfires just make it more likely you’re going to spend that time indoors. And I guess the third is just, with people that are forced to leave their homes there have been some evacuations so far. In previous fire seasons, we’ve seen people spend pretty large amounts of time being displaced from their homes, whether that’s in a shelter or whether that’s in hotels or whether that’s with family and friends, it means that it’s just harder for you to manage health conditions of many kinds, and social distance, while you’re in these kinds of displacement conditions. So the more intense the fires are, the more intense the displacement conditions are. I think that has all kinds of ripple effects and implications for how people manage COVID.

RAFANELLI: With tens of thousands of people evacuated from their homes right now, how are emergency managers navigating this fire response amid COVID?

SCHROEDER: You know, again, a good question. I should start by saying I’m not myself an ermegency manager. I think it’s important to go back through what the managers themselves are putting out, but there have been efforts to reduce the density in shelters and open up additional spaces for shelters.

Maintaining low density is really going to depend on the event. You might have an event comparable to say the paradise fire events or the campfire from last year where the nber of evacuees was straining systems at the time.

Reducing the density in any given shelters can be really hard to do. Making sure people in shelters have access to PPE is one way to deal with that, you know, free access to masks and hand sanitizer and sanitary conditions. Just doing a better job than normal protecting people through their access to equipment in the spaces is probably more important than it ever has been.

You know, the other thing to bear in mind is just most people that evacuate during a crisis actually don’t go to a shelter. They go to friends and family. How people manage that is going to be an important question for their own protection from COVID. How to effectively manage having additional people that might be in your house for a certain period of time, making sure that you’re vigilant about all of the other protections, procedures that you would go through, even while these kinds of crisis events are ongoing, is going to be more important than ever before and that’s something that individuals kind of have to manage.

RAFANELLI: In terms of protective equipment, what kinds of masks should people be wearing right now? There’s so many, from N-95s to surgical masks, and they are all intended for different purposes. Which ones are best to protect people from both smoke and Covid-19?

SCHROEDER: Yeah. I mean, I think one of the first things that just remember which may get confusing for folks, just given that there’s so many options, as you say, the purpose of wearing a mask from a COVID point of view is actually less about protecting you and more about protecting others.

So, surgical masks are designed to block droplets that tend to come out of your mouth when you just talk or breathe or just normal activity and that’s important because it’s those droplets that are actually transmitting the virus. The surgical mask is not really protecting you from the virus itself.

The surgical mask has two score screens to prevent the virus itself from coming through it and it doesn’t really help you in a wildfire either. So wearing a surgical mask is not a great protection against wildfire smoke, but it’s still important under any scenario, given that you still have to protect other people from the potential spread of COVID.

The one complexity or nuance that’s come up with the N-95s is just that there’s two primary variants that people see. One is a regular N-95 mask designed for stopping 2.5 particulate matter and it doesn’t have any vents on it and for COVID you really need to use an N-95 mask that does not have vents on it because the vents will actually spread droplets. However, in a wildfire scenario, the vents are actually somewhat better. They allow you to breathe better. If you’re blocking what’s coming in and making it possible to breathe more comfortably, then the vented mask is actually somewhat better.

So, if you’re in an outdoor space and you’re not around a lot of people, but you’re in a very smoky environment and you need to protect yourself from the smoke then a vented N-95 mask is actually a pretty good idea. If you’re around a large amount of people, if you’re in an indoor space, and you’re trying to prevent the spread of COVID, you really can’t use the vented N-95 masks.

And you really can’t expect a surgical mask to protect you much, if any, from wildfire smoke.

RAFANELLI: Over the weekend, many in California experienced rolling power outages and there’s potential for more. How do electricity shortages complicate fire response during COVID?

SCHROEDER: In so many ways. The blackouts, I think, have been a little bit of a surprise this time, just given that it doesn’t seem as though they were necessarily needed, or were caused by an unexpected surge in power, but nevertheless, especially coming on the heels of last year is public safety power shutoffs we’re becoming accustomed to this idea that wildfires in California are kind of normally associated with power shut offs. That compounds problems for people that are indoors, so again, going back to the earlier point about needing to shut your windows, needing to be inside, hide away from the smoke for a longer period of time, lack of access to electricity just for everybody, makes life far less convenient. It can produce problems for food storage. It can produce problems for just making it tolerable to be inside for long periods of time.

The people that have the biggest problems are those with power dependent medical devices. This was a huge problem last time for those that had breathing assistance or insulin pumps or other ways that they were self-managing chronic illness with power dependent devices, rolling blackouts become a real problem. Very few people in California have significant battery backup or the ability to move off grid with power, so when these outages happen, there’s really a very large percentage of population losing power altogether. And that’s compounded if you also have to evacuate.

So, developing better plans for how to manage a chronic illness with power dependent devices. It’s still, I think, at early stages. It’s really up to individuals at this point, from the standpoint of the state, to recharge devices, making sure that you have a plan for power backup. These are new features of life for many people and I think as we factor that into vulnerabilities to COVID, these are also people that have chronic illness and are more at risk for hospitalization and other kinds of acute consequences from COVID, so being very mindful of where the power is shut off, the density of population with power dependent devices, the COVID prevalence in the area, bed capacity, hospital capacity in that area–these things are going to converge in new way to increase risks for a lot of people across the state.

This transcript has been edited for clarity.

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