June 8, 2023 – While millions of Americans in the Midwest and on the Eastern Seaboard got some relief from the wildfire smoke from Canada, with more relief expected over the weekend, health experts warned that for at-risk people, some hazardous health effects may persist.
People with moderate to severe asthma, chronic obstructive pulmonary disease, or COPD, and other risk factors are used to checking air quality warnings before heading outside. But this situation is anything but typical.
Even people not normally at risk can have burning eyes, a runny nose, and a hard time breathing. These are among the symptoms to watch for as health effects of wildfire smoke. Special considerations should be made for people with heart disease, lung disease, and other conditions that put them at increased risk. Those affected can also have trouble sleeping, anxiety, and ongoing mental health issues.
The smoke will stick around the next few days, possibly clearing out early next week when the winds change direction, Weather Channel meteorologist Ari Sarsalari predicted on Thursday. But that doesn’t mean any physical or mental health effects will clear up as quickly.
“We are seeing dramatic increases in air pollution, and we are seeing increases in patients coming to the ED and the hospital. We expect that this will increase in the days ahead,” said Meredith McCormack, MD, MHS, a volunteer medical spokesperson for the American Lung Association.
“The air quality in our area – Baltimore – and other surrounding areas is not healthy for anyone,” said McCormack, who specializes in pulmonary and critical care medicine at Johns Hopkins University.
How Serious Are the Health Warnings?
Residents of California might be more familiar with the hazards of wildfire smoke, but this is a novel experience for many people along the East Coast. Air quality advisories are popping up on cellphones for people living in Boston, New York City, and as far south as Northern Virginia. What should the estimated 75 million to 128 million affected Americans do?
We asked experts to weigh in on when it’s safe or not safe to spend time outside, when to seek medical help, and the best ways for people to protect themselves.
“It’s important to stay indoors and close all windows to reduce exposure to smoke from wildfires. It’s also essential to stay away from any windows that may not have a good seal, in order to minimize any potential exposure to smoke,” said Robert Glatter, MD, editor-at-large for Medscape Emergency Medicine and an emergency medicine doctor at Lenox Hill Hospital/Northwell Health in New York City. (Medscape Medical News is affiliated with WebMD.)
Glatter noted that placing moist towels under doors and sealing leaking windows can help.
Monitor your symptoms, and contact your doctor or go to urgent care, McCormack advised, if you see any increase in concerning symptoms. These include shortness of breath, coughing, chest tightness, or wheezing. Also make sure you take recommended medications and have enough on hand, she said.
Fine Particles, Big Concerns
The weather is warming in many parts of the country, and that can mean air conditioning. Adding a MERV 13 filter to a central air conditioning system could reduce exposure to wildfire smoke. Using a portable indoor air purifier with a HEPA filter also can help people without central air conditioning. The filter can help remove small particles in the air but must be replaced regularly.
Smoke from wildfires contains multiple toxins, including heavy metals, carcinogens, and fine particulate matter (PM) under 2.5 microns. Glatter explained that these particles are about 100 times thinner than a human hair. Because of their size, they can embed deeper into the airways in the lungs and trigger chronic inflammation.
“This has also been linked to increased rates of lung cancer and brain tumors,” he said, based on a 2022 study in Canada.
The effects of smoke from wildfires can continue for many years. After the 2014 Hazelwood coal mine fire, emergency department visits for respiratory conditions and cardiovascular complaints remained higher for up to 2 to 5 years later, Glatter said. Again, large quantities of fine particulate matter in the smoke, less than 2.5 microns (PM 2.5), was to blame.
Exposure to smoke from wildfires during pregnancy has also been linked to abnormal fetal growth, preterm birth, as well as low birth weight, a January 2023 preprint on MedRxiv suggested.
Time to Wear a Mask Again?
A properly fitted N95 mask will be the best approach to lessen exposure to smoke from wildfires, “but by itself cannot eliminate all of the risk,” Glatter said. Surgical masks can add minimal protection, and cloth masks will not provide any significant protection against the damaging effects of smoke from wildfires.
KN95 masks tend to be more comfortable to wear than N95s. But leakage often occurs that can make this type of protection less effective, Glatter said.
“Masks are important if you need to go outdoors,” McCormack said. Also, if you’re traveling by car, set the air conditioning system to recirculate to filter the air inside the vehicle, she recommended.
What Does That Number Mean?
The federal government monitors air quality nationwide. In case you’re unfamiliar, the U.S. Air Quality Index includes a color-coded scale for ozone levels and particle pollution, the main concern from wildfire smoke. The lowest risk is the Green or satisfactory air quality category, where air pollution poses little or no risk, with an Index number from 0 to 50.
The index gets progressively more serious, from Yellow for moderate risk (51 to 100) up to a Maroon category, a hazardous range of 300 or higher on the index. When a Maroon advisory is issued, it means an emergency health warning where “everyone is more likely to be affected.”
New York City is under an air quality alert until midnight Friday with a current “unhealthy” Index report of 200. The city recorded its worst-ever air quality on Wednesday. The New York State Department of Environmental Conservation warns that fine particulate levels – small particles that can enter a person’s lungs – are the biggest concern.
AirNow.gov warns that western New England down to Washington, DC, has air quality in the three worst categories – ranging from unhealthy to very unhealthy and hazardous. The ten worst locations on the U.S. Air Quality Index as of 10 a.m. ET on June 8 include the Wilmington, DE, area with an Index of 241, or “very unhealthy.”
Other “very unhealthy” locations have the following Index readings:
- 244: Suburban Washington, DC/Maryland
- 252: Southern coastal New Jersey
- 252: Kent County, DE
- 270: Philadelphia
- 291: Greater New Castle County, DE
- 293: Northern Virginia
- 293: Metropolitan Washington, DC
These two locations are in the “hazardous” or health emergency warning category:
- 309: Lehigh Valley, PA
- 399: Susquehanna Valley, PA
To check an air quality advisory in your area, enter your ZIP code at AirNow.gov.