Left in the Dust: Wildfire Smoke a Growing Hazard for Vulnerable Demographics

Faculty from Villanova University's M. Louise Fitzpatrick College of Nursing discuss its health impact and the heightened risk to certain members of the population

The hazy smoke from the raging wildfires in Canada wafted down the eastern United States in early June, bringing with it historically poor air quality that caused an uptick in acute medical issues and brought on inconveniences such as the grounding of flights and cancellation of outdoor activities.

Many Americans had reprieve in their homes, offices or cars while it dissipated over the course of a week, with the event amounting to little more than a nuisance. Other members of the population were not so fortunate.

Ruth McDermott-Levy, PhD, MPH, RN, FAAN, professor and co-director of the Mid-Atlantic Center for Children’s Health and the Environment, and Daniel Jackson Smith, PhD, AGPCNP-BC, CNE, Weingarten Endowed Assistant Professor and co-chair of the Global Nurses Climate Change committee, both with the Villanova University M. Louise Fitzpatrick College of Nursing, specialize in environmental and climate change-related health. They believe that as wildfires, in addition to other climate change-related events, happen with more frequency and ubiquity, certain parts of the population will be among the most vulnerable.

Children, older adults with chronic health conditions, pregnant women, outdoor workers and people living in poverty, they say, are at the highest risk for serious health issues stemming from wildfire smoke and the poor air quality that comes with it. It is not difficult to see that represents a significant portion of the general population.

“It is unfortunately a reminder that climate change is now and there are health impacts, because we are seeing it,” Dr. McDermott-Levy said. “I didn't think we'd experience [wildfires] here [in the eastern United States] but we are seeing more wildfires in Europe, Australia and everywhere.”

“What could have been a once or twice-in-a-lifetime experience for some, now is going to be, with pretty good certainty, something they experience repeatedly over a lifetime,” Dr. Smith said.

That repeated exposure to wildfire smoke can lead to worsening and potentially life-threatening medical issues. Wildfire smoke contains fine particulates, described as PM2.5, that consist of numerous pollutants and toxins. When a fire burns a forest, it also burns buildings, cars and other material. That toxic smoke can travel long distances, often through one or many major metropolitan areas.

“What has the smoke been exposed to along the way?” posed Dr. McDermott-Levy.  “What else is burning that could be toxic and going deep into the lungs and even into the bloodstream?”

Short-term exposure brings shorter-lasting, acute problems like coughing, wheezing, shortness of breath and fatigue. But, per Dr. McDermott-Levy, longer exposure to these particles can “tip the scale for an exacerbation of chronic obstructive pulmonary disease (COPD) or a heart attack and stroke.”

Though the scientific research on such long-term effects of wildfire smoke is in its infancy, mostly because they used to be so rare it was seldom studied, “we can kind of extrapolate that it's the same you may see with people living in a big city, like higher instances of lung cancer and long-term comorbidities of the aforementioned conditions,” Dr. Smith said.

Now, wildfires are no longer rare, and they are no longer contained to the historically susceptible regions, such as the West Coast. When they do occur, the smoke can travel up to 12,000 miles from its original source, posing a hazard to an incredibly vast number of people. As the smoke spreads into areas not used to such events, there is also a naivety component at play. As an example, think of how many traffic accidents occur in a place like North Carolina when there is a minor snow event that, if it were in a place like Boston, people would have little issue driving through.

“If you are not used to living and working in poor air quality conditions you don't know the measures to take to protect yourself,” Dr. Smith said. “Think on a global scale: Stereotypically those in, say, East Asia, have lived with poor air quality for so long that masks are common. Here, individuals might not necessarily know the poor air is going to affect them.”

With these groups of high-risk individuals, there are multiple additional factors at play that can either cause more exposure, cause worse effects from exposure, or limit options for medical treatment for symptoms. Age, existing health conditions, socioeconomic status, and possible lack of education on preventative measures given the region, all would contribute to increased exposure to the smoke in that area, or increased risk of complications stemming from it. Many individuals check several of those risk factor boxes.

Dr. McDermott-Levy used Philadelphia, which saw some if its worst air quality on record in early June due to wildfires in Canada and New Jersey, to illustrate some of these risk factors and their overlap.

“Kids, for example, are developing beings and so their lungs too are still developing,” she said. “If the lungs get hit with something toxic like air pollution, that can cause long term health problems. Well, 21 percent of our children in Philadelphia have asthma [according to Philadelphia Regional Center for Children’s Environmental Health] … There are also children that have issues with health access or may not have air conditioning and need to have their windows open. In addition to the exposure from being outdoors they are physically active, so they are breathing more deeply. They are definitely breathing this in.

“Long term, especially if people aren't following precautions, we could have more children with asthma, or earlier diagnoses of asthma. The same is true with adult issues, and depending on what is in the particles and length of exposure, some of these particles are associated with cancer. In older adults that may have chronic health conditions, like respiratory problems or cardiovascular disease, [wildfire smoke exposure] can exacerbate those issues. With cardiovascular disease, they may also have problems with circulation in the brain and there can be risk for strokes as well as heart attacks.”

Occupation also plays a major factor. Outdoor workers (in this case, anybody whose job requires them to be outdoors) have perhaps the most consistent, long exposure to smoke from wildfires, and some of those workers may have pre-existing medical conditions or no ability for reprieve at home. There is potential, in those cases, for some degree of exposure the entire day and night.

Migrant workers, specifically, also often have little or no access to health care and are disproportionately impacted by all of climate change, per Dr. Smith. Even professional athletes who play outside (and the fans and workers who attend the games) are at greater risk.

As scary as it sounds – and it is – there are proven ways to limit exposure to wildfire smoke during such events and lessen the chances of subsequent medical issues.

“Stay indoors with the windows and doors shut as much as you can,” Dr. McDermott-Levy said. “Use the air conditioner if you have one. If you have to go out in the car keep the windows shut and the car fans on recirculate. Masking is not recommended for children under two years old, so they should be kept inside with windows closed as much as possible. People over two years old should wear a mask, ideally a N-95 that is well fitted, when you are outside and limit being outdoors. Take it easy, listen to your body... Take a break if you need it and monitor the air quality. There is even an app from Environmental Protection Agency you can download to keep an eye on it.”

She also suggests cancelling outdoor events and sports during instances of poor air quality due to wildfire smoke – something that did indeed occur, to a degree, from the professional level all the way down to youth sports during the most recent episode.

“This is the time to say to your children, ‘Okay, it's alright to stay inside and play video games today,’” McDermott-Levy said.

For outdoor workers, including migrant workers, the “Two Es” are paramount: Education and the Employer.

“We need to really target and focus our prevention and education efforts,” Dr. Smith said. “Maybe when it comes to wildfires, we educate both our workers and employers. “We could potentially see increased use of health protective behaviors for acute events that are going to happen repeatedly.

“If we think about getting people interested in climate action and working to mitigate climate change, wildfire smoke is something very easy we can point to because you can see it. We can say, ‘This smoke in the air, whenever we hit the purple air quality range, is equivalent to smoking a half pack of cigarettes. People inherently know smoking tobacco is bad so we can point to it and say, ‘Air quality is very similar.’”

An enormous amount of that responsibility for worker safety now and in the future is on the employer. Employers should be actively monitoring events such as wildfire smoke that could impact workers’ health and have an action plan to limit exposure.

“Employers should say, ‘Wait a minute, at a certain air quality level, you need to come inside,’” Dr. McDermott-Levy said. “Or workers should be given that autonomy to take that time to do their inside work, documentation, etc., if possible.”

“Employers should be obligated to take care of their employees,” added Dr. Smith. “But due to the many pieces of power and privilege that come into play – the exploitation of workers that is – until we have broad, systemic changes, that's not going to happen.”

Migrant workers have an additional layer of difficulty when it comes to protection. Often their entire job is outside, with nowhere safe to go during instances of poor air quality while they are on the clock. Trying to properly mitigate exposure to wildfire smoke or remain safe in other weather and climate-related events by choosing to not work in the dangerous environment could lead to pay-related punishments, job loss and even potential deportation.

For workers, much of it boils down to the willingness of the employer do their part to keep them safe in a world full of increasing environmental hazards. Responsible employers already plan for events like heat waves and manage worker hours accordingly, giving them breaks at the hottest part of the day. The same concept can be applied to instances of poor air quality, whether that be changing the work site, changing the hours, dealing with potential indoor work that day or, if none of that is possible, simply cancelling work altogether while the air quality threat remains high. That’s another important area in which experts like Dr. McDermott-Levy, Dr. Smith and others can make a difference.

“Whether you’re a researcher, clinician or doing advocacy or policy work in this space, you really have to engage the employers, get them to the table and say, ‘This is why this is important. These are the benefits of keeping the work force healthy and why as a business you should care about it,’” Dr. Smith said. “We really need to make sure we are doing that outreach and not leaving those workers in the dust, literally and figuratively.”



“It is unfortunately a reminder that climate change is now and there are health impacts, because we are seeing it. I didn't think we'd experience [wildfires] here [in the eastern United States] but we are seeing more wildfires in Europe, Australia and everywhere.”

Ruth McDermott-Levy, PhD, MPH, RN, FAAN