Gianna is an associate editor of The American Journal of Managed Care® (AJMC®). She has been working on AJMC® since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey.
As smoke from West Coast wildfires threatens to worsen outdoor air quality across the country, concerns of indoor air quality are mounting following reports on how insufficient ventilation systems facilitate aerosol spread of COVID-19.
In California alone, wildfires have consumed over 3.2 million acres, an area larger than all of Connecticut, while flare-ups continue to spread across Montana, Oregon, Washington, Idaho, and other western states.
Apart from the physical damage caused by the flames—charred communities, fields, and forests; 27 lives lost; dozens missing—"choking air" travelling via jet streams has plunged most of the continental United States into a hazy fog.
Skies as far east as Baltimore, Maryland, appear blurred while temperatures drop due to smog blocking the sun’s rays. On the East Coast, the thin layer of smoke drifts about 30,000 feet above the earth, but in those areas most affected, the smoke can seep into homes, businesses, and cars. Some measurements even quantified this week’s air in Oregon, Washington, and parts of California as the most unhealthy air on the planet, The Associated Press reported.
“The air was so thick that on Monday Alaska Airlines announced it was suspending service to Portland and Spokane, Washington, until Tuesday afternoon,” the article reads. “Hazy, smoky skies fouled Washington state and experts said some parts of California might not see relief until next month.”
As the smoke threatens to worsen outdoor air quality across the country, concerns of indoor air quality are mounting due to reports detailing how insufficient ventilation systems facilitate aerosol spread of coronavirus disease 2019 (COVID-19). The combined hazards put residents in a challenging position as they weigh exposure risks.
Previous studies have found that air pollution contributes to high rates of chronic diseases such as Parkinson disease, Alzheimer disease, multiple sclerosis, diabetes, and obesity. Pollution can also exacerbate preexisting respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD).
In Oregon, 10% of all emergency department visits are for asthma-like symptoms, The Washington Post reported. To stem further complications, state officials plan to send more than 200,000 N95 respirator masks to agricultural workers and Native American tribes.
However, a report released by the American Lung Association (ALA) in April, prior to the start of wildfire season, showed that nearly 5 in 10 individuals in the United States—150 million Americans—live in areas where pollution levels are already often too dangerous to breathe. The ALA compiled a checklist of respective warning signs to help individuals differentiate between COVID-19 symptoms and smoke irritation.
Prolonged isolation due to social distancing measures put in place to stem COVID-19 transmission, compounded by the inability of some residents to leave their homes to exercise or socialize, and the potential of seasonal affective disorder have led to an increase in patient-reported headaches and signs of depression, one doctor of clinical psychology told ABC7 San Francisco.
Relief from the dangerous air is not expected until later this week for some western states, but meteorologists warn areas of central California, already plagued by a heat wave, may not see relief until October.
While weather patterns with winds are needed to push smoke out, gusts cannot be too strong as they may strengthen flames. Meanwhile, residents are left to deal with the physical and mental ramifications of 2 historic concurrent calamities.
Throughout the COVID-19 pandemic, young adults, racial and ethnic minorities, essential workers, and unpaid adult caregivers reported disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation compared with the general population. In a survey that was conducted in June 2020, respondents’ anxiety and depression symptoms increased by 31% compared with the 30 days prior to the survey, and trauma and stressor-related disorder symptoms increased by 26%.
According to The Atlantic, data show between 10% and 30% of wildfire survivors develop diagnosable mental-health conditions, including posttraumatic stress disorder (PTSD) and depression. Although another 50% may suffer from serious subclinical effects that fade with time, investigations found rates of substance abuse and domestic violence both increase after natural disasters.
“When a whole neighborhood or town feels these effects at the same time, the result is what one psychologist and fire survivor calls ‘community-wide trauma’…The trauma is sustained and amplified by a distinctive characteristic of California’s wildfires: They recur, often in quick succession.” When instances of trauma accumulate over time, they can lead to more severe and complex psychological reactions.
Apart from community-wide trauma, firefighters in particular experience PTSD at rates comparable to combat veterans. Firefighters are also about 40% more likely to commit suicide compared with the general population.
Conditions exacerbated by climate change, such as drying forests due to rising heat, increase the potential for future, more frequent fires to burn across the American West.
Studies consistently show climate change will lead to excess deaths and pronounced health disparities in the United States. According to one study published in 2018, scientists predict increases of 4.8% and 8.7% for particulate- and ozone-associated deaths, respectively. The study forecasts an additional 13,000 human deaths annually caused by higher summer levels of fine particulate matter and 3000 deaths caused by ozone in the eastern United States by mid-century.
Premature cardiovascular and respiratory death rates, in addition to detrimental pregnancy outcomes such as preterm birth, low birth weight, and stillbirth are all associated with exposure to air pollution. Infants born to women exposed to high levels of air pollution in the week before birth are also more likely to be admitted to newborn intensive care units.
As for wildfires, one 2016 study published in Proceedings of the National Academy of Sciences concluded that “as long as there remains fuel to burn, ‘anthropogenic climate change will continue to chronically enhance the potential for western US forest fire activity,’” according to The Atlantic.
In an open letter addressed to President Donald Trump, Washington Governor Jay Inslee (D) implored the president to acknowledge the role climate change plays in the ongoing fires—a notion President Trump has not accepted, as he continues to blame poor forest management for the infernos.
“Wildfires are not new in the western states, yet the 21st century is quickly laying claim to the worst levels of devastation we have ever seen,” Inslee wrote. “It took five days for 2020 to become our state’s second-worst fire season on record with more than 600,000 acres burned, eclipsed only by the 1.1 million acres burned in 2015.”
Current levels of fire containment vary across western states. In the California Bay Area, air quality readings show improvement, while officials in Oregon recently extended an air quality alert until noon on Thursday, as anticipated winds did not materialize.