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Where There’s Wildfire, There’s Smoke John R. Balmes, MD University of California, San Francisco and Berkeley

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Page 1: Where There’s Wildfire, There’s Smoke · • Prevention Wildfire Sonoma-Napa Wildfires – Oct. 2017 Southern CA Wildfires – Dec. 2017 ... Emissions from Wildfires Primary air

WhereThere’sWildfire,There’sSmoke

JohnR.Balmes,MDUniversityofCalifornia,

SanFranciscoandBerkeley

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Outline

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

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Wildfire

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Sonoma-NapaWildfires–Oct.2017

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SouthernCAWildfires–Dec.2017

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Carr,MendocinoComplex,andCampFires-2018

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7Source: National Interagency Fire Center

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2017and2018wereBadWildfireYears-Why?

•  5yearsofdrought2011-2016;manydeadtrees

•  ElNinowinterof2017broughtlotsofrain,endingthedrought

•  Increasedgrowthofvegetationinspring

•  Normallydryandveryhotsummerweathergeneratinglotsoffuel

•  Lackofraininfall

Page 9: Where There’s Wildfire, There’s Smoke · • Prevention Wildfire Sonoma-Napa Wildfires – Oct. 2017 Southern CA Wildfires – Dec. 2017 ... Emissions from Wildfires Primary air

2017and2018wereBadWildfireYears-Why?

•  5yearsofdrought2011-2016;manydeadtrees•  ElNinowinterof2017broughtlotsofrain,endingthedrought

•  Increasedgrowthofvegetationinspring•  Normallydryandveryhotsummerweathergeneratinglotsoffuel

•  Lackofraininfall

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ClimateChangeandIncreaseinWildfires

10

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Wildfireemissionsandrelatedhealthimpacts

Youssoufetal.AtmosphericEnvironment2014;97:239-251

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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

12

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CoffeyParkneighborhoodburning

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WhenBuildingsandVehiclesBurn

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

•  TheSonoma-Napa,Thomas,andCampfirescausedmanybuildingsandmotorvehiclestoburn–  Localresidentsexposedtomorethanwoodsmoke

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AustralianBushFires•  16millionacreshaveburned(8timeswhatburnedinCaliforniain2018

•  Firesareinpopulatedareaswithmorethan2500homesdestroyed

•  PoorairqualityinSydney,Melbourne,Canberra,andNewZealand

•  Climate-forcingemissions=8monthsfromman-madesources

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Acutehealthimpactsofshort-termcommunitywildfiresmokeexposures

16EnvironHealthPerspect2016;124:1334–1343

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Clearevidenceofanassociationbetweenwildfiresmokeand

respiratoryhealth•  Asthmaexacerbationssignificantly

associatedwithhigherwildfiresmokeinnearlyeverystudy

•  Exacerbationsofchronicobstructivepulmonarydisease(COPD)significantlyassociatedwithhigherwildfiresmokeinmoststudies

•  Growingevidenceofalinkbetweenwildfiresmokeandrespiratoryinfections(pneumonia,bronchitis)

17

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Haikerwaletal.2015JAmHeartAssoc

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•  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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24

WettsteinZ,HoshikoS,CascioWE,RappoldAGetal.JAHAApril11,2018

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OtherHealthOutcomes•  Adversebirthoutcomes

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

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WildlandFirefighterHealthEffects

•  Cross-shiftchangesinlungfunction,urinarybiomarkersofexposure,andbloodbiomarkersofinflammation

•  Pre-postseasonchangesinlungfunction,airwayresponsiveness,andairwayinflammation

•  Dothefireseason-associatedchangespersist?

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

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

EnvironRes2019;173:462-468

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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

24

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25

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

Page 26: Where There’s Wildfire, There’s Smoke · • Prevention Wildfire Sonoma-Napa Wildfires – Oct. 2017 Southern CA Wildfires – Dec. 2017 ... Emissions from Wildfires Primary air

•  Largefireburnedfor2monthswithpoorairquality(highPM10)

•  CDCinvestigatorsdocumentedincreasedhealthcareutilizationforlowerrespiratoryillness

•  Recollectionofpublicserviceannouncementswasassociatedwithareducedoddsofreportingadverserespiratoryhealtheffects

WestJMed2002;176:157-162

JoshuaAMott,PamelaMeyer,DavidMannino,StephenCRedd

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•  IncreaseddurationoftheuseofHEPAaircleanerswasassociatedwithareducedoddsofreportingadverserespiratoryhealtheffects

•  Noprotectiveeffectswereobservedforuseofmasksordurationofevacuation

WestJMed2002;176:157-162

JoshuaAMott,PamelaMeyer,DavidMannino,StephenCRedd

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

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

–  BAAQMDasksUCBerkeleytocancelthetelevisedfootballgamewithWashingtonState

–  GamenotcancelledbecauseAQI<200bykickoff

24-hourPM2.5levelsexceeded200μg/m3inNapaand70μg/m3inOaklandonOctober13

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CampFire–Nov.9,2018

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PoorAirQualityinBayArea

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

– UCBerkeleypostponesthe“BigGame”withStanfordscheduledforSat.Nov.16

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EvenPoorerAirQualityClosertoFire

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

Page 32: Where There’s Wildfire, There’s Smoke · • Prevention Wildfire Sonoma-Napa Wildfires – Oct. 2017 Southern CA Wildfires – Dec. 2017 ... Emissions from Wildfires Primary air

Post-WildfireProblems

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

•  Post-firestructuralbuildingclean-up– Muchoftheworkdonebydayworkers

•  Mudslides

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Fire suppression has increased fuel availability

Page 35: Where There’s Wildfire, There’s Smoke · • Prevention Wildfire Sonoma-Napa Wildfires – Oct. 2017 Southern CA Wildfires – Dec. 2017 ... Emissions from Wildfires Primary air

Prevention

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

•  Deadtreesandexcessiveundergrowthneedtoberemovedfromourforests

•  CommunitiesnearNationalForestsresistprescribedburns

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IncreasedDevelopment-UrbanWildlandInterface

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CommunityProtection•  At-riskcommunitiescando

moretoprepareforwildfires–  Bulldozefuelbreaksaroundneighborhoods

–  Installnewsmoke-detectioncamerasandsensors

–  Removevegetationaroundhomes

–  Improveescaperoutesinsubdivisions

–  Trainresidentsininitialfiresuppressionmethods(i.e.,wateringdownroofs)

Page 38: Where There’s Wildfire, There’s Smoke · • Prevention Wildfire Sonoma-Napa Wildfires – Oct. 2017 Southern CA Wildfires – Dec. 2017 ... Emissions from Wildfires Primary air

Summary•  Thedurationofthewildfireseasonislongerandcatastrophicwildfiresareincreasinginfrequencyduetoclimatechange

•  Acuterespiratoryeffectsarewelldocumented,butnewstudiessuggestacutecardiovasculareffectsaswell

•  Post-firehealtheffectsareimpactful•  Long-termeffectsofhighand/orrecurrentexposuresneedfurtherstudy

•  Needtoinvestheavilyinforestmanagementandcommunityresilience

Page 39: Where There’s Wildfire, There’s Smoke · • Prevention Wildfire Sonoma-Napa Wildfires – Oct. 2017 Southern CA Wildfires – Dec. 2017 ... Emissions from Wildfires Primary air

Thankyou


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