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To Prepare for California’s 2021 Wildfire Season, Health Officials Begin with Data

A CrisisReady webinar, co-hosted by Direct Relief, focused on how data can be used to increase community resilience during extreme wildfires.


California Wildfires

A wildfire glows at night above hills in California.
Amid ongoing drought conditions, much of the Western U.S. is at risk of extensive wildfires., Experts in health and emergency response are working to determine how to better to respond to health impacts resulting from wildfires, like the Thomas Fire, pictured here in the hills above Santa Barbara, California, in Dec. 2017. (Photo by Donnie Hedden)

As California braces for another extreme wildfire season, data is playing a crucial role in preparation efforts.

“We need to think about more creative ways to respond, [but] the first step…is to use data to get the picture clear,” said Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis.

This week, Schroeder joined a panel of researchers, public health officials, and health care providers to discuss wildfire resilience at a webinar hosted by CrisisReady – a collaborative project between Direct Relief and researchers at Harvard School of Public Health, Harvard Medical School, Stanford University, and a network of researchers in epidemiology, public health and disasters throughout the world.

Using data, “we can get much more specific about the nature of the problem: who’s affected, the frequency of the problem, [and] the ripple effect of health problems,” said Schroeder.

The project aims to provide data on the scope of fire-related health impacts, which could be used by health facilities to better respond during future wildfires. For Dr. Joan Casey, an assistant professor of Environmental Health Sciences at Columbia University and a speaker on Friday’s panel, that’s a major research focus.

Casey examined the rates of respiratory disease-related hospital visits during the 2018 Carr Fire in Shasta County, California. She found a significant rise in people seeking medical care during the times with PM2.5 (a term for tiny particles 2.5 micrometers across or smaller) was higher.

“In weeks that had greater than 5.5 micrograms per cubic meter, we saw a 14.6% increase in respiratory-related ED visits,” she said. “The next two weeks we saw no increase, so it really seemed confined to when those PM2.5 were elevated.”

In addition, Casey’s work has shown that these health impacts disproportionately affect individuals who are medically vulnerable. In studying the effects of the 2019 Getty Fire in Los Angeles County, she found an additional 0.5 visits per day among those with dementia in the months following the fire.

These insights will prove valuable as health officials seek to mitigate the effects of wildfires. “We know the older adult population is going to increase, so to protect them we need to keep thinking about social and environmental determinants of health,” said Casey.

Those who are medically vulnerable are also disproportionately affected by public-safety power shut-offs, which have become a characteristic feature of the California wildfire season. “There were nearly 1,100 eight-hour events in 2019,” said panelist Dr. Mathew Kiang, a professor of Epidemiology and Public Health at Stanford University. “So these are fairly common and they can impact quite a few people,” he explained.

For some, particularly for those that rely on electronic medical equipment, power shut-offs can be deadly. Without backup power, these individuals have no way to keep their devices running. Through his research, Kiang was able to find “the intersection between where these power outages are happening and where medically vulnerable are located.” According to Kiang’s research, the highest-risk counties include San Bernardino, Riverside, and Orange–all in Southern California.

Panelist Dr. Mathew Kiang of Stanford University presents during Friday's CrisisReady webinar.
Panelist Dr. Mathew Kiang of Stanford University presents during Friday’s CrisisReady webinar.

While medically vulnerable people are at higher risk during power shut-offs, Schroeder points out that these events don’t “follow the conventional lines of social vulnerability.” In other words, both high and low-income communities have experienced an equal share of shut-off events. But for those who can afford to invest in backup power systems, the impacts may be less severe. “One issue is if the grid is unstable. The second is who can buy their way out of that problem,” said Schroeder.

Community health centers, which serve low-income and under-insured patients, are among those most at risk of losing power. “As of 2021, we still have very few health centers in California that have what you would call a truly resilient power system and that’s unequally distributed based on location, the relative wealth of the community, and a number of other factors,” he said.

These concerns are only compounded by the Covid-19 pandemic. It’s still necessary to avoid traditional shelter settings in favor of hotel rooms or other “non-congregate” accommodations. But with tourism picking up, “hotel rooms are going to be harder to come by,” explained Schroeder.

And as the Covid-19 vaccine rollout continues, public safety power shut-offs pose a new threat. The challenge is how to “maintain the vaccines to make sure there’s no cold chain interruption during wildfires,” said panelist Michael Witte, the Chief Medical Officer of the California Primary Care Association and a family medicine physician. If a health facility’s refrigerator shuts down, their vaccine supply could spoil.

These heightened risks are prompting providers like Witte to re-examine how they provide care during wildfire season. “One of the things we need to look at as health care providers is how do we get out of the four walls and help people,” said Witte, who serves a predominantly rural patient population in Northern California. “The model for how we take care of people needs to change dramatically,” he said.

A full-length recording of Friday’s webinar can be found on the CrisisReady webpage.

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