Northern California health system reports surge in cases as region endures weeks of dangerous air
A month after hundreds of wildfires started spewing toxic smoke along the west coast, doctors are seeing the alarming health effects of air pollution.
In northern California’s Stanford Health Care system, hospital admissions have jumped by 12% in recent weeks, including a stunning 43% increase in cerebrovascular conditions such as strokes. In Oregon, health officials reported nearly one out of 10 people visiting the emergency room had asthma-like conditions due to the smoke. And in San Francisco, doctors had to cancel their clinics for recovering Covid-19 patients, because the air was so unhealthy that just getting to their appointments could make patients more sick.
A growing body of scientific evidence paints a dire picture of the effects of wildfire smoke on the human body. Experts told the Guardian earlier this month that the smoke can have an almost immediate effect on people’s health, causing asthma, heart attacks, kidney problems and even mental health issues to surge.
Now, as the west coast reckons with an unprecedented stretch of hazardous air, scientists and health experts are growing even more concerned about the immediate and longterm consequences of continuous exposure to the harmful pollution.
In the Bay Area, despite firefighters gaining control of the nearest blazes started by lightning strikes in August, smoky conditions have persisted, turning the sky orange and keeping people inside their homes.
“We’re on the 30th consecutive day of our ‘Spare the Air’ alerts,” said Kristina Chu of the Bay Area air quality management district on Wednesday. “That’s an all-time record,” she explained; the previous longest was 14 days.
After a month steeped in orange-brown air filled with dangerous tiny particles emitted by the wildfires, patients with pre-existing lung or heart conditions were at particular risk for hospitalization or even premature death, health officials in California said.
“We’ve now had a month of severe exposure to smoke and the levels have been very high,” said Dr Mary Prunicki, director of research for Stanford’s Sean N Parker Center for Allergy & Asthma Research.
At Stanford’s health centers, doctors told the Guardian they had seen a troubling rise in overall hospitalizations, as well as an increase in specific conditions.
Bibek Paudel, a postdoctoral researcher at Stanford’s asthma clinic, has been following the rise in hospitalizations. In the first two weeks after smoke pollution permeated the Bay Area’s air, he calculated an extra 500 people had been admitted to Stanford’s hospitals compared with what would normally be expected – 12% more than the two weeks before the fires. After three weeks of bad air, he could detect an 14% increase in the number of heart patients hospitalized, an 18% percent increase in kidney conditions and a 17% increase in asthma hospitalizations.
“The smoke and the number of intense fires has gone up and up,” he said, noting that the California fire season has just begun. “I expect it will go up even more.”
The most alarming finding was the 43% increase in strokes and other cerebrovascular hospitalizations, which could be related to inflammation brought on by the pollution, the researchers said.
The research also shows a 15% increase in hospitalizations for substance abuse disorders and a small uptick in other mental health hospital intakes.
“People were already dealing with the stress of Covid-19,” said Prunicki. “And I read that there has been an increase in alcohol use. This just may be a tipping point.”
Prunicki said researchers were just beginning to understand the many detrimental effects that the smoke ingredients, known as particulate matter 2.5, have on the body.
“Fine particles [in the smoke] go to the bottom of your lungs, then can cross over to the bloodstream and go anywhere in your body,” said Prunicki. She co-authored an earlier study that showed even healthy teenagers see an increase in the markers of inflammation in their bloodstreams during periods of wildfire smoke exposure.
“I don’t know that we have it figured out on a cellular level, but we see dysregulation and we know that pollution is causing inflammatory changes throughout your body,” she said.
Scientists are still working to understand the long-term effects of wildfire smoke exposures, but studies of firefighters have shown they face a higher rate of cancer than the general public, despite being otherwise healthier than the average person.
In Oregon, residents were facing air pollution so severe that the air quality index readings were “literally off the charts”, according to Gabriela Goldfarb, a spokesperson for the Oregon health authority, which has been monitoring an increase in people seeking emergency treatment for asthma symptoms. While any air quality index over 300 is considered “hazardous”, numerous communities bordering the wildfires near Salem and the Portland suburbs have experienced readings of over 500, she said.
Goldfarb says the health authority has spent years studying how to combat the health toll of more frequent wildfires, which have been intensified by the climate crisis. Its recommendations have included proposals to distribute air purifiers to low income families and renters. But this year, legislation to do that was put on hold when the Oregon legislature disbanded early due to the pandemic. Now, she said, it is hard to recommend safe alternatives for the public, other than staying home – and people facing evacuation don’t even have that option.
“Traditionally people could go to their public library or a local shopping center to escape the smoke. But those aren’t available this year because of Covid,” she said.
Dr Neeta Thakur, a University of California, San Francisco, pulmonologist who heads both the chest clinic and the clinic for recovering Covid-19 patients at San Francisco general hospital, said the smoke pollution had presented a catch-22 for those concerned about the risks of the coronavirus.
She said one of her lung patients called the hospital complaining of breathing problems and was told to come immediately to the emergency room. But the patient, an older person, waited, fearing exposure to coronavirus. Two days later, the patient’s lung problems became so severe that they had to be brought in by ambulance and intubated in the ICU, she said.
“There was definitely a delay in seeking care because of fear of the pandemic,” said Thakur, noting that the patient was recovering at home.
“We could see more of this,” added Thakur, who has had to cancel recent clinics for people recovering from Covid and asthma patients because of the poor air quality. “Trying to navigate these two health crises and tell people what to do is very difficult.”
She said residents of low income communities bore the brunt of the health risks because of poor-quality housing.
“I can go inside and get clear air,” she said. “But when you live in poor-quality housing, the bad air outside can come inside.”
On Thursday, air quality experts predicted west coast residents would finally get a break as offshore winds blew the clouds of smoke inland, spreading them all the way to the east coast.
Still, “we do not feel we’re in the clear for this fire season yet,” said Goldfarb. She predicted rain storms might bring lightning and the prospect of more fires to Oregon; California air quality officials noted that the state might not see rain until November and smoke pollution could return as early as this weekend.
“If there are people who need to leave the house and get some fresh air, we recommend they do it now,” said Chu, of the Bay Area air quality district. “It’s a new normal that we’re getting used to.”