Opinion | None of Your Patients Are Safe From Wildfires

By now, we have all walked through the smoke or seen the pictures. Plumes from over 400 Canadian wildfires engulfed the East Coast last week, shrouding the New York City skyline in thick, orange smoke that made the Statue of Liberty and the World Trade Center vanish in the haze. More dangerously, the fumes put the health of millions of people in the Northeast at risk and prompted 20 states to issue air quality alerts.

It is easy to feel scared — even terrified — by these images, but there is a lot we can do to protect public health, even as wildfires intensify and become more frequent because of climate change.

First, it is crucial that healthcare providers and public health authorities across the country more consistently educate people about the risks wildfires pose to human health. We saw good public health messaging over the past week, but authorities shouldn’t wait until there’s a crisis to begin raising awareness.

Everyone needs to realize that even a distant wildfire can pose a major threat to communities downwind — even hundreds of miles away. Particulate matter and other toxins in the smoke can travel through the air and end up in our lungs and bloodstream, accumulating in our bodies over time and increasing our risk of developing cardiovascular disease and lung cancer.

Some people, however, are more vulnerable than others when exposed to wildfire smoke (even just after a few days). Children, whose lungs are still developing, can develop asthma — and kids who already have asthma can see their asthma attacks double. Pregnant people can have miscarriages or pre-term delivery as well as several other adverse health impacts. The elderly are also more susceptible. Evidence suggests that the risk of cardiovascular events may increase by as much as 40% for people over 65 exposed to wildfire smoke. Individuals experiencing homelessness and outdoor workers who might be unable to take precautionary measures are also more at risk, and so are people of color and members of underserved populations who are already exposed to higher levels of pollution due to decades of discrimination and racist economic, health, and housing policies.

All healthcare providers should make sure their patients, but especially their most vulnerable ones, fully understand the risks associated with wildfire smoke. Clinicians already encourage patients to eat healthy and exercise. They should remind them to keep an eye on the Air Quality Index, encourage them to buy effective air filters that keep indoor air clean, make sure they have enough N95 masks to wear outside when the Air Quality Index is poor, and know the importance of promptly following evacuation orders.

Physicians should also look out for their patients’ mental health as wildfires and other extreme weather events are known to cause stress and long-lasting anxiety. We routinely assess new mothers’ mental health, for example, to screen for postpartum depression. We could use similar questionnaires for patients who have been recently exposed to wildfires, so we can surface any issues and refer patients for treatment.

But healthcare providers are not the only ones who can act to reduce the health burdens of wildfire smoke. Federal and local authorities also need to build better warning systems that can alert and advise the population in case of hazardous air quality. Officials should implement forest management strategies to prevent wildfires in the first place, since research shows that doing so can decrease health effects for nearby communities. We should aim to make air purifiers more affordable so that everyone can buy them. And of course, we must achieve our goals to significantly reduce global greenhouse emissions and protect the population from the most harmful effects of climate change.

More research, too, is needed. For example, we don’t know exactly what medications and health conditions, aside from respiratory problems, make certain patients more susceptible to the adverse effects of wildfire smoke. This prevents clinicians from providing more targeted guidance that could protect vulnerable populations. And we should build databases that allow us to follow patients — especially symptomatic ones — over time so we can find out more about the long-term effects of wildfire exposure.

Nobody is safe from wildfires. As last week has shown, not even borders can protect us. But together we can be part of the solution. We can protect the most vulnerable and care for those exposed to extreme climate events. And we can develop new ways to improve people’s lives and well-being in the face of global warming. The scary skies over the Northeast this past week should galvanize all of us to action.

Kari Nadeau, MD, PhD, is the chair of the Department of Environmental Health at Harvard T.H. Chan School of Public Health and John Rock Professor of Climate and Population Studies. Rachel Nethery, PhD, is assistant professor of Biostatistics at Harvard Chan School.