where there’s wildfire, there’s smoke · • prevention wildfire sonoma-napa wildfires – oct....

WhereThere’sWildfire,There’sSmoke

JohnR.Balmes,MDUniversityofCalifornia,

SanFranciscoandBerkeley

Outline

•  Wildfire•  ClimateChange•  What’sinwildfiresmoke•  Healtheffects•  Publichealthmessaging•  Post-fireissues•  Prevention

Wildfire

Sonoma-NapaWildfires–Oct.2017

SouthernCAWildfires–Dec.2017

Carr,MendocinoComplex,andCampFires-2018

7Source: National Interagency Fire Center

2017and2018wereBadWildfireYears-Why?

•  5yearsofdrought2011-2016;manydeadtrees

•  ElNinowinterof2017broughtlotsofrain,endingthedrought

•  Increasedgrowthofvegetationinspring

•  Normallydryandveryhotsummerweathergeneratinglotsoffuel

•  Lackofraininfall

2017and2018wereBadWildfireYears-Why?

•  5yearsofdrought2011-2016;manydeadtrees•  ElNinowinterof2017broughtlotsofrain,endingthedrought

•  Increasedgrowthofvegetationinspring•  Normallydryandveryhotsummerweathergeneratinglotsoffuel

•  Lackofraininfall

ClimateChangeandIncreaseinWildfires

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Wildfireemissionsandrelatedhealthimpacts

Youssoufetal.AtmosphericEnvironment2014;97:239-251

Emissions from Wildfires Primary air pollutants

– Particulate Matter (PM) – CO – NO2 – Polycyclic aromatic hydrocarbons

(PAHs) – Volatile organic compounds

(VOCs)

Secondary air pollutants – Particulate Matter (PM) – Ozone

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CoffeyParkneighborhoodburning

WhenBuildingsandVehiclesBurn

•  Structuralfiresmokecontainsothertoxicaircontaminants,including– HCN,HCl,phosgene,metals–  toluene,styrene,dioxins

•  TheSonoma-Napa,Thomas,andCampfirescausedmanybuildingsandmotorvehiclestoburn–  Localresidentsexposedtomorethanwoodsmoke

AustralianBushFires•  16millionacreshaveburned(8timeswhatburnedinCaliforniain2018

•  Firesareinpopulatedareaswithmorethan2500homesdestroyed

•  PoorairqualityinSydney,Melbourne,Canberra,andNewZealand

•  Climate-forcingemissions=8monthsfromman-madesources

Acutehealthimpactsofshort-termcommunitywildfiresmokeexposures

16EnvironHealthPerspect2016;124:1334–1343

Clearevidenceofanassociationbetweenwildfiresmokeand

respiratoryhealth•  Asthmaexacerbationssignificantly

associatedwithhigherwildfiresmokeinnearlyeverystudy

•  Exacerbationsofchronicobstructivepulmonarydisease(COPD)significantlyassociatedwithhigherwildfiresmokeinmoststudies

•  Growingevidenceofalinkbetweenwildfiresmokeandrespiratoryinfections(pneumonia,bronchitis)

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Haikerwaletal.2015JAmHeartAssoc

•  Wildfire-PM2.5associatedwithheartattacksandstrokesforalladults,particularlyforthoseover65yearsold

•  Increaseinriskthedayafterexposure:-  Allcardiovascular,12%-  Heartattack,42%-  Heartfailure,16%-  Stroke,22%-  Allrespiratorycauses,18%-  Abnormalheartrhythm,24%(onthesamedayasexposure)

Wildfire-PM2.5 Increases Heart Attack & Stroke

19

AllCardiovascularCauses

1.2

1.1

1.0

0.9Re

lativ

eRisk

AllAdults

Adults18-44Adults45-64Adults65+

Light Medium Heavy

WettsteinZ,HoshikoS,CascioWE,RappoldAGetal.JAHAApril11,2018Slidecredit:WayneCascio

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WettsteinZ,HoshikoS,CascioWE,RappoldAGetal.JAHAApril11,2018

OtherHealthOutcomes•  Adversebirthoutcomes

– Healthofpregnantmothers•  Mentalhealth•  ?ChroniceffectsfromrecurrentexposuresbasedonthePM2.5literature– Metabolicoutcomes–  Cognitivedecline–  Childneurodevelopment– Healthofpregnantmothers

WildlandFirefighterHealthEffects

•  Cross-shiftchangesinlungfunction,urinarybiomarkersofexposure,andbloodbiomarkersofinflammation

•  Pre-postseasonchangesinlungfunction,airwayresponsiveness,andairwayinflammation

•  Dothefireseason-associatedchangespersist?

•  EstimatedthedailydoseofwildfiresmokePM2.5•  Thedailydoseforfirefightersworking98daysperyearofPM2.5rangedfrom0.30mgto1.49mg

•  Forcareerdurations(5–25years),wildlandfirefightershadanestimatedincreasedriskoflungCA(8percentto43percent)andCVD(16percentto30percent)mortality

EnvironRes2019;173:462-468

PublicHealthResponse

Improved planning and readiness on the part of the public health infrastructure and health care providers are necessary to reduce morbidity and mortality due to wildland fire smoke exposure

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PublicHealthAdvisories Based on the U.S. EPA’s Air Quality Index:

“Good” 0-50 “Moderate” 51-100 “Unhealthy for sensitive groups” 101-150 “Unhealthy” 151-200 “Very Unhealthy” 201-300 “Hazardous” >300

•  Largefireburnedfor2monthswithpoorairquality(highPM10)

•  CDCinvestigatorsdocumentedincreasedhealthcareutilizationforlowerrespiratoryillness

•  Recollectionofpublicserviceannouncementswasassociatedwithareducedoddsofreportingadverserespiratoryhealtheffects

WestJMed2002;176:157-162

JoshuaAMott,PamelaMeyer,DavidMannino,StephenCRedd

•  IncreaseddurationoftheuseofHEPAaircleanerswasassociatedwithareducedoddsofreportingadverserespiratoryhealtheffects

•  Noprotectiveeffectswereobservedforuseofmasksordurationofevacuation

WestJMed2002;176:157-162

JoshuaAMott,PamelaMeyer,DavidMannino,StephenCRedd

CaseStudy–UCBerkeley•  Oct.13,2017–theAQIgoesover200duringtheday–  UCBerkeleyissuesahealth

advisorytostudents,staff,andfaculty(stayindoors,considerwearingN95masksifyouhavetobeoutside);classesnotcancelled

–  BAAQMDasksUCBerkeleytocancelthetelevisedfootballgamewithWashingtonState

–  GamenotcancelledbecauseAQI<200bykickoff

24-hourPM2.5levelsexceeded200μg/m3inNapaand70μg/m3inOaklandonOctober13

CampFire–Nov.9,2018

PoorAirQualityinBayArea

•  Nov.14,2018–PM2.5goesover200µg/m3thatThurs.eveningandisprojectedtostayhighfordays– UCBerkeleycancelsclasses,butdoesnotclosecampus

– UCBerkeleypostponesthe“BigGame”withStanfordscheduledforSat.Nov.16

EvenPoorerAirQualityClosertoFire

Nov.15,2018–PM2.5goesupto250µg/m3inSacramentoandover300µg/m3inYubaCity

Post-WildfireProblems

•  Post-traumaticstress•  Housingshortage,especiallyforlow-income,immigrantrenters

•  Post-firestructuralbuildingclean-up– Muchoftheworkdonebydayworkers

•  Mudslides

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Fire suppression has increased fuel availability

Prevention

•  MostoftheU.S.ForestServicewildfirebudgetgoestosuppressionactivities,leavingpreciouslittlefornecessaryforest-maintenanceactivities.–  The2013RimFirestartedinYosemitebutmostlyburnedintheStanislausNationalForest–why?

•  Deadtreesandexcessiveundergrowthneedtoberemovedfromourforests

•  CommunitiesnearNationalForestsresistprescribedburns

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IncreasedDevelopment-UrbanWildlandInterface

CommunityProtection•  At-riskcommunitiescando

moretoprepareforwildfires–  Bulldozefuelbreaksaroundneighborhoods

–  Installnewsmoke-detectioncamerasandsensors

–  Removevegetationaroundhomes

–  Improveescaperoutesinsubdivisions

–  Trainresidentsininitialfiresuppressionmethods(i.e.,wateringdownroofs)

Summary•  Thedurationofthewildfireseasonislongerandcatastrophicwildfiresareincreasinginfrequencyduetoclimatechange

•  Acuterespiratoryeffectsarewelldocumented,butnewstudiessuggestacutecardiovasculareffectsaswell

•  Post-firehealtheffectsareimpactful•  Long-termeffectsofhighand/orrecurrentexposuresneedfurtherstudy

•  Needtoinvestheavilyinforestmanagementandcommunityresilience

Thankyou