Children at Risk from Wildfires

Weather conditions in southwestern Pennsylvania were as good as they get for early June: temperatures in the mid-70s and sunny with few clouds in the sky. Too bad it was too smokey and dangerous last week to go outside and enjoy it. Smoke from wildfires in Canada extended down the East Coast as far as Georgia and infiltrated the airsheds of major metropolitan areas, including Pittsburgh, making skies milky during the day and glowing-orange at dawn and dusk.

For most of the week, the region’s air quality index ranged from yellow (moderate) to orange (unhealthy for sensitive groups) to red (unhealthy for everyone). Compared to Pittsburgh, the air pollution was even worse in State College and Philadelphia (purple, very unhealthy). On Wednesday morning, Bethlehem, PA had the worst air quality in the world, with a AQI of 410 (maroon, hazardous); by afternoon, New York City snatched that dubious distinction with a AQI of 484 — near the tippy-top of the scale that goes up to 500.

East of the Rockies, it’s pretty difficult to have poorer air quality than Pittsburgh’s. Even on its best days, the Pittsburgh metropolitan area has some of the worst air quality in the nation, according to the American Lung Association’s recently published report, “State of the Air 2023”. Nationwide, 120 million Americans — more than 1 in 3 — live in places that get failing grades for fine particle pollution (PM2.5) and ozone, according to the report. Americans are not alone in breathing dirty air. In fact, 90% of all humans living on the planet today breathe air that exceeds World Health Organization standards for PM2.5.

Wildfire smoke is a complex mixture of gases (carbon monoxide, water vapor, carbon dioxide, volatile organic compounds [VOCs], and other hazardous air pollutants) and small particles suspended in the air. PM2.5 refers to particles that are less than 2.5 micrometers in diameter — too tiny to see. Because they are so small, they easily make it into the deepest parts of the lungs, causing symptoms of tissue damage (cough, shortness of breath, wheezing). Along with the harmful gases associated with wildfire smoke, PM2.5 is also absorbed in the lungs and gets into the bloodstream, where it travels throughout the body, damaging the heart, the brain, and other organ systems along the way, and raising the risks for developing chronic illnesses, cancer, and dementia. Mental health is also impacted by wildfires because of the psychological stress they induce.

Regardless of its source — from wildfires, highways, or industrial sites — PM2.5 worsens underlying medical conditions such as asthma in children, chronic lung disease (COPD) in adults, heart disease, and mental illness. On days when air quality is not good (AQI > 50), medical providers expect to see more patients in their clinics and emergency rooms suffering from respiratory distress, chest pain, and stress.

It shouldn’t surprise anyone that pregnant women and children are most susceptible to the damage caused by air pollution. Other sensitive people include the elderly, people with chronic health conditions, outdoor workers, and people who live in poverty and in marginalized, disadvantaged, and disenfranchised communities. Residents living in environmental justice communities are more likely to be located close to pollution sources.

Because their bodies are still growing and they breathe faster than adults, young children are more vulnerable to the health effects of dirty air. Of course, fine particles and toxic gases put children with asthma and other lung diseases, congenital heart problems, and chronic medical conditions at higher risk for poor health outcomes. But the American Academy of Pediatrics reminds us that “all children are at risk of short-term physical health effects from a wildfire event.”

They may have:

• Chest tightness or pain

• Burning sensation of the nose, throat and eyes

• Breathing trouble, cough, wheezing or pneumonia

• Dizziness, lightheadedness or headaches

Sometimes, children may have physical symptoms linked to their mental health, such as stomachache or headache. Families should watch their children for signs of emotional distress.

By Friday night, smoke from the Canadian wildfires was no longer blowing our way and air quality warnings were lifted. (On Saturday, the AQI was back up in the yellow (moderate) range in the Mon Valley due to the usual industrial emissions that plague our region, and it stayed that way through the otherwise lovely weekend.) But we should remember that the fires are still burning out of control, destroying forests, threatening homes and infrastructure, and killing wildlife. While the smoke is gone from here, now it’s someone else’s turn to deal with it.

We can all take the following steps to protect ourselves and the health of family members, friends, and neighbors from the threat of wildfire smoke and other sources of toxic air pollution:

1. Take air pollution very seriously. “What doesn’t kill you makes you stronger” is a silly phrase that DOES NOT APPLY to damage caused by PM2.5, ozone, VOCs, and other harmful air contaminants. The solution to air pollution caused by wildfires or from other sources is to severely reduce the use of fossil fuels.

2. Take climate change very seriously. Just as climate scientists have been predicting, wildfires have been growing in frequency and intensity in recent years. Last week’s East Coast smoke-out is a reminder that we don’t have to wait for human-caused climate change to affect our health and our quality of life; it’s happening today and will continue to happen with greater frequency and ferocity until humanity stops releasing greenhouse gases into the air or we run out of trees to burn. There are no longer any excuses not to learn, teach, and act about the climate crisis.

3. Stay informed about local weather and air quality forecasts. Sign up for air quality notifications at AirNow.gov. Southwest PA residents can sign up for email and text notifications of changing air quality conditions at Allegheny Alerts.

4. Stay indoors as much as possible when air quality becomes unhealthy. (Read #1 above.) Don’t assume school administrators and child care facilities receive weather forecasts or warnings about poor air quality and when to keep kids indoors. Parents and teachers may have to advocate for their children’s health by educating the people in charge.

5. If you travel outdoors when air quality is poor, wear a mask. As its name indicates, a N95 mask that is fitted and properly worn filters out at least 95% of airborne particles.

6. Keep air pollution outdoors and don’t let it inside your house. During wildfire events or for people who live near sources of air pollution (highways, factories, power plants, oil and gas infrastructure), it is often not advisable to keep windows open at night. When the wind dies down at dusk, it allows air pollution to settle and concentrate close to the ground.

7. Keep indoor air clean. Change air filters periodically on furnaces and air conditioning units. Keep gas stoves well ventilated. Don’t smoke. Test your home for radon. Consider buying a portable, high-efficiency particulate air (HEPA) filter or make your own air purifier by using a box fan and MERV 13 air filter.

Read more about the health risks from wildfire smoke and air pollution from the AAP here, from the EPA here, and from the CDC here. Gain local knowledge about air quality challenges in the Pittsburgh area from the Breathe Project here and Group Against Smog & Pollution (GASP) here. Join a low-cost air monitoring cohort with ROCIS (Reducing Outdoor Contaminants in Indoor Spaces) here. Read last week’s health alert network (HAN) advisory about wildfire smoke from the Pennsylvania Department of Health here.

Dr. Ketyer is a member of the American Academy of Pediatrics Council on Environmental Health and Climate Change.

Originally posted on The Pedia Blog on June 12, 2023.