Wildfires are raging in the West, fueled by high temperatures and high winds. I am in my living room, an anxious mother hunkered down with my children sleeping upstairs, privileged to enjoy a safe home with a robust and expensive air filtration system that was very important to me as a lung doctor trying to protect my family from the dangers of particulate matter. However, on my drive home today, I saw multiple tents by the side of the road and could not help thinking about all the people living in them, not only breathing the traffic-related particulate matter on a daily basis, but now also breathing very deadly air from wildfires burning on a nearby mountain, blown into my hometown by deadly and swift winds.
Obviously, the most immediate health concern from fire is of a horrifying death for those unable to escape the path of rapid moving fires and the health and safety of the brave first responders keeping our communities safe. However, the science also tells us that within days, people breathing this smoke-filled air, even those far from the fires, are going to start to suffer health effects, from COPD and asthma exacerbations to heart attacks, strokes and cardiac arrest. People will die, and human psychology will attribute this to random events. Maybe it was just their time. Maybe this was just when their heart attack hit. Or maybe it’s because they were breathing air filled with particulate matter. We know that particulate matter kills. Unfortunately, it has no political or partisan agenda. Whether the particulate matter is coming out the end of a cigarette butt, coming from the exhaust of a diesel engine, or coming from a wildfire due to high temperatures, dry conditions, and wind conditions worsened by climate change, the end result of death and disability is the same.
Multiple studies have demonstrated this association. I simplify it all with the maxim, “Don’t light things on fire and breathe them into your lungs.” I even made a T-shirt, and I say it with each podcast. It’s a brief statement, but it covers a lot of tragedy. My sister recently sent me a selfie of her wearing the shirt while her California home was surrounded by the smoke of wildfires.
TLDR= Don't Light Things on Fire and Breathe them into your Lungs
There are too many studies to cover, but one I’ll focus on today is an analysis done of one of the most dramatic ways of dying: out-of-hospital cardiac arrest. An out-of-hospital cardiac arrest is when suddenly someone just drops dead from their heart being unable to pump correctly. The inflammation in their system has often grown so severe that a blood vessel perfusing their heart has occluded- that means the platelets in their bloodstream have formed into a mass that completely blocks the coronary artery because the levels of inflammation in the blood vessels themselves are so high, the platelets respond by clotting off the vessel. This leads to sudden lack of oxygen in a part of the heart muscle, and the heart frequently responds by going into an arrhythmia, which means it does not pump well and therefore does not perfuse the rest of the heart or body. People just drop dead unless resuscitated promptly by CPR and/or opening the blockage.
These events can be measured, and a group of researchers looked at the levels of particulate matter and air pollution following the wildfires in California from 2015-2017, and they were able to see that as exposure to wildfire particulate matter increased, this most fulminant manifestation of cardiac toxicity from air pollution also increased. One thing we always look for in studies in medicine is a dose-response curve to ensure the effect is likely a real one; if something is toxic, bad health outcomes should happen more when there are higher concentrations or exposures to it. This study found that on days of higher air pollution, these episodes of sudden cardiac death were more common. There was also a trend towards being worse for those who are poorer, though this did not reach statistical significance. Thinking about my ability to sit in an air-filtered home while those suffering from poverty and a lack of quality housing, this is highly plausible to me.
The costs of this are obviously astronomical. The most immediate cost is the loss of life or disability from suffering an out-of-hospital cardiac arrest. If you’re lucky, and you’re able to be resuscitated and taken to a hospital where we can save your life, hopefully you go back to your family…. but not until after significant healthcare expenditures, including the trip to the cardiac cath lab, your new stent and the very expensive medications required to keep it open, your ICU stay, the doctor and hospital fees, the post-hospitalization rehab facility, etc. You may suffer long-term brain damage from the time of poor perfusion and CPR, which may affect your ability to work and enjoy life. If you die from your out-of-hospital cardiac arrest, your family loses a caregiver, a breadwinner, and an essential element of the family sense of identity and safety. Either way, that’s a massive personal and economic loss for a family and a community. One study placed estimated short-term costs of the US wildfires from 2008 to 2012 at between $11 and $20 BILLION dollars (in 2010 dollars), totalling $63 billion dollars in today’s currency (95% confidence intervals $6–$170), and the cost of long-term exposures as between $76 and 130 billion, totalling $450 billion (or between $42 billion to $1200 billion) in today’s dollars.
We have to start understanding these as the real costs of climate change. We are paying these costs now. In my hometown, in my home state, people are going to start dying in the next few days of the wildfire smoke choking the air. When they show up to the hospital with a severe heart attack, or stroke, or respiratory exacerbation, maybe it will be attributed to the wildfires, but probably everyone will just be focusing on getting through their shift, and the context of this one death, this one illness, will be missed. But make no mistake, the wave of hospitalizations, ER visits and deaths that are going to happen in the next couple of days because of the fires consuming the West are not random, they are due to climate change and worsening fires. Think what kind of climate resiliency programs we could fund with $450 billion dollars. Think how much work we could do investing in energy options that did not lead to climate change and worsen human health. We are spending this money now chasing after the ill effects of climate change, and we are getting sicker. What if we invested those billions of dollars into preventing worsening climate change and wildfires? Think of our loved ones who would still be with us. Think of my patients who could stay home rather than meeting me in the ICU. Think of the healthcare dollars we could all keep in our pockets, and the better nights of sleep more reassured that we will leave a habitable planet to our children.
It is up to us when we want to do something about that. I think of my kids sleeping upstairs, and I hope that we all decide to act, so they have better and healthier futures.
Twitchy Airways Club Members–
If you suffer from asthma or COPD, make sure to follow the air quality reports from airnow.gov or other local public health websites and ensure you pay attention to recommendations for sensitive or vulnerable groups. Make sure to carry a rescue inhaler with plenty of doses, and if you have worsening symptoms, talk to your doctor about whether you need increased maintenance medication as well, and what your emergency control plan is. Also consider using an N95 mask outside or if you can’t find good air quality.
Things you can do:
Donate/Invest in Resiliency-
Donate to World Central Kitchen– working to feed firefighters and those on the frontline
Donate to Pacific NW Red Cross– fund organized by KGW news
Donate to California Fire Foundation– supporting families of fallen firefighters, firefighters, and their communities
Donate to the NorCal Wildfire Relief Fund- helps Latino-lead organizations get critical financial assistance, rehousing support, and emergency translation for Latino and immigrant families affected by the fires
Take Action–
1- Demand your elected representatives take climate change seriously and fund programs to decrease carbon emissions and plan for effects of climate change, including catastrophic fires.
2- Thank your firefighters. Donate to organizations above to support them. Ensure they have adequate PPE, health care coverage and support for their families.
3- Recognize that many of those who need to flee fire are climate refugees. Expand your compassion to those around the world who also need to flee drought and heat to find better lives. We are all in this together.
Consider buying a T-shirt (walking billboard approach) advising people not to light things on fire and breathe them into their lungs as a way of starting a conversation about the importance of healthy air and addressing climate change.
Contact your elected representatives about the importance of addressing climate change and funding climate resiliency programs. Thank your fire department, and ensure they have adequate staffing, healthcare, protective equipment and funding. Write an Op-Ed. Plant a tree. Speak out. Climate change is real. It’s causing worsening fires. Help your friends and neighbors get their heads out of the sand and look to the future.
References–
Oregonian article– source of fire images
