Lingering effects

Dr. Matthew Fine recalls the mid-June days of 2008 when the Humboldt Fire spewed smoke into the valley. He “couldn’t believe how bad” the air was then, he told the CN&R last week; a pulmonologist and chief medical officer at Oroville Hospital, Fine treated patients suffering ill effects.

Air quality since the Camp Fire erupted, as anyone anywhere in Northern California knows, is far worse. (“Horrible” was Fine’s description.) With particulate levels exceeding unhealthful levels by magnitudes of 10 or more, North State air has been the worst on Earth.

“The most polluted city in the world is Delhi, [India],” he said. “This is twice as bad as Delhi is when it’s bad.”

He wasn’t exaggerating: Friday afternoon (Nov. 16), parts of Chico measured over 500 microparticles per million as Delhi’s average topped 200.

Coughing, itchy eyes and scratchy throats mark the most obvious effects of smoke inhalation—masks, with appropriate levels of protection, are the most obvious preventative measure. But there’s more in the mix than irritation and N95 filters. Wildfires can trigger an array of health complications.

“People see the haze and say, ‘It’s going to irritate my lungs,’” Fine noted. “It does a lot more than that.”

There’s an increased risk of heart attack and stroke, particularly among current cardiac patients.

There’s greater opportunity for illness to spread, like norovirus has at local shelters.

There’s impaired breathing for children prone to infections, seniors with compromised lungs and adults with conditions such as COPD (chronic obstructive pulmonary disease).

“If you have long-term exposure, like this is the air you lived in, you’d have increased risk of lung cancer, increased risk of emphysema,” Fine said. “Hopefully that’s not going to be the case here, because this should be over [soon].

“Our air in the valley isn’t always so great, anyway—but this is much, much worse than anything else we’re getting exposed to.”

Kent Pinkerton agrees. A professor of pediatrics at the UC Davis School of Medicine, he’s also director of the university’s Center for Health and the Environment. In his 32 years on faculty, he said, never has he seen conditions like this—and he just returned from a teaching trip in China.

“It’s pretty remarkable,” he continued, “but it’s a reflection of what the Air Resources Board and those who were involved with looking at the impact of climate on the state of California were predicting … and drives home that we probably need to look at how we mitigate the effects of wildfires, how we minimize their impacts.”

Microparticles constitute the greatest health concern for people breathing in smoke. Wildfires release myriad compounds (see “Impacts? Stay tuned,” Greenways, page 16)—but particulates under 2.5 microns pose special perils.

At that size, Fine said, particles get into the small air sacs low in the lung, called alveoli, and cross into the blood stream. There they inflame blood vessels, which can trigger a cardiac episode.

“For somebody with a healthy cardiovascular system, it’s not going to cause a heart attack or stroke tomorrow,” Fine said. “But if you’re continually exposed to it, it does increase that likelihood; and for people who already had heart disease or hardening of the arteries, this will definitely increase the risk of an immediate problem.”

Pinkerton also mentioned arrhythmia (irregular heartbeat) and noted the two most vulnerable age groups for ill effects: the very young and the very old. Lungs in children have not fully developed, and because of their size and level of activity, kids get exposed to a greater proportion of microparticles. Elders, meanwhile, may have immune systems weakened by other illnesses or infirmity.

“They may be almost like canaries [in the coal mine], to tell us something is wrong,” Pinkerton said. “They may be the first to feel the effects.

“As a consequence of these wildfires, we clearly will see more emergency room visits with people who are having respiratory problems, but they may soon be coming in due to irregularities with their heart.”

Respiratory problems include exacerbation of asthma, emphysema, COPD and cancer.

“Anybody with a pre-existing medical condition is going to have more problems,” Fine said.

Individuals and families displaced from their homes face an added level of concern. Sheltering in close proximity to others increases the risk of contracting a respiratory infection (e.g., cold or flu) or gastrointestinal illness (e.g., norovirus).

Butte County Public Health put in motion procedures to isolate people with symptoms from others in shelters. Last week’s positive test for norovirus came at Chico’s Neighborhood Church. Fine observed the same thing when volunteering at a shelter in Oroville.

Pinkerton, familiar with the North State because his wife earned her library sciences certification from Chico State, landed at San Francisco airport soon after the Camp Fire sparked Nov. 8. As he rode a train from the Bay Area to Davis, he said, he was struck by the irony of returning to such poor air after two weeks in China, where pollution chokes various areas.

While air quality officials and health professionals focus on 2.5-micron particle concentrations levels (PM 2.5), “we’re beginning to learn that wildfire smoke has hundreds of different compounds,” he said, especially when structures are burned along with trees.

UC Davis researcher Keith Bein is working to identify those components for Pinkerton’s environmental health center. Amid the Camp Fire, and others like it in the wildland-urban interface, “we don’t know how toxic it is,” he said. “So there’s a big concern about a potential increase in the toxicity—and not only that, but an increase in the population that is being exposed for a sustained duration.”