The most recent horrific example was Hurricane Ian, the massive storm that in September smashed into Florida’s southwestern coast — a haven for retirees — with winds up to 150 mph and storm surges in some areas. , most of them in Florida. Of those who perished, two-thirds were 60 or older. Many and were found in their homes.

Why didn’t more older adults leave for safer areas, as authorities recommended? Understanding this is critically important as the population of older people expands and natural disasters become more frequent and intense with climate change.

“I think the story of Hurricane Ian that people will remember is the story of people who didn’t evacuate,” said Jeff Johnson, AARP’s Florida state director.

Even before the storm, there were worrisome signs that disaster preparedness was lagging. In an this summer of 1,005 Florida residents 45 and older, 67% reported having a natural disaster emergency plan, compared with 75% in 2019. The declines were most notable among people with low incomes (less than $50,000 a year) and those who owned their homes.

Meanwhile, 61% of Florida residents 45 and older said they planned to shelter in place during the next bad storm. In 2019, the comparable figure was 55%.

Johnson said concerns about the covid-19 pandemic and inflation’s impact on budgets may have contributed to “a lot of people who were just not mentally prepared to leave.” More broadly, he faulted disaster preparation checklists that target seniors.

Mostly, these resources tell older adults to complete a long list of tasks before a crisis occurs. “Coming out of Ian, what’s become clear is that giving seniors materials with lots of steps they need to follow ends up being overwhelming,” Johnson told me. “The checklists aren’t working.”

Among the items that seniors are advised to assemble: enough nonperishable food, water, and medications for several days; cash for 30 days of living expenses; hearing aids and glasses; flashlights and battery-powered lamps; extra batteries; and first-aid supplies.

Beyond that, older adults are encouraged to create a list of people who can help them in an emergency, familiarize themselves with evacuation routes, arrange for transportation, and compile essential documents such as wills, powers of attorney, and lists of their medical providers and medications.

Doing all this is especially challenging for older adults with hearing and vision impairments, cognitive problems, difficulties with mobility, and serious chronic illnesses such as heart disease or diabetes.

Also at heightened risk are seniors without cars, cellphones that broadcast emergency alerts, extra money for lodging, or family members and friends who can help them get organized or take them in, if necessary, according to Lori Peek, director of the Natural Hazards Center and a professor of sociology at the University of Colorado-Boulder.

“It’s not age alone that renders elderly people vulnerable in disasters,” she noted. “It’s the intersection of age with other social forces” that affects people who are poor and represent racial and ethnic minorities.

This lesson has been painfully learned during the covid pandemic, which has killed enormous numbers of vulnerable seniors. But it hasn’t been incorporated into disaster preparedness and response yet.

Sue Anne Bell, an assistant professor at the University of Michigan, who studies the health effects of disasters, said this must change. “We need to focus disaster preparedness on these vulnerable populations,” she said, adding that a one-size-fits-all approach won’t work and that outreach to vulnerable seniors needs to be tailored to their particular circumstances.

Coming up with better strategies to boost older adults’ ability to cope with disasters should be a national priority, not one specific to areas beset by hurricanes, because lack of preparedness is widespread.

In May 2019, Bell’s colleagues at the University of Michigan’s National Poll on Healthy Aging surveyed 2,256 adults ages 50 to 80 for natural or man-made disasters. Although nearly 3 in 4 respondents said they had experienced an event of this kind, just over half had a week’s supply of food and water available, and only 40% said they had talked to family or friends about how they would evacuate if necessary.

Least likely to have prepared for emergencies were seniors who live alone, a growing portion of the older population.

Of enormous concern are older adults with Alzheimer’s disease or other types of cognitive impairment living in their own homes, a larger group than those living in institutions.

When Lindsay Peterson, a research assistant professor at the University of South Florida, interviewed 52 family caregivers in 2021 and 2022, all of them said they would never take a loved one with dementia to a disaster shelter. Although Florida has created “special needs” shelters for people with disabilities or medical concerns, they’re noisy and chaotic and lack privacy.

Even older adults without dementia are loath to go to shelters because of these issues and because they don’t want to identify themselves as needing assistance, Peek noted.

Using feedback from her research, Peterson this year created a in concert with the Alzheimer’s Association that presents information in an easy-to-understand format.

“A lot of caregivers told us, ‘Please help us do this but make it simpler. Every day I wake up and there’s a new crisis,’” Peterson said.

She noted that institutions such as nursing homes have been a focus of disaster planning for older adults in the wake of disasters such as Hurricane Katrina in New Orleans in 2005 and Superstorm Sandy, which hit the New York City metro area and New Jersey especially hard in 2012.

Now, the field needs to do more to address the needs of the vast majority of older adults who live at home, Peterson suggested.

What might that include? published by the Federal Emergency Management Agency and AARP in July calls for bringing together organizations that serve older adults and local, state, and federal agencies responsible for emergency preparedness on a regular basis. Together, they could plan for reducing the impact of disasters on seniors.

Separately, a by the American Red Cross and the American Academy of Nursing recommends that home health agencies and other organizations serving older adults at home develop plans for helping clients through disasters. And more opportunities for older adults to participate in community-based disaster training should be made available.

Think of this as age-friendly disaster planning. Until now, the focus has been on individuals taking responsibility for themselves. This is a more communal approach, focused on building a stronger network of community support for older adults in times of crisis.

“All of us are thinking now that communities can’t be age-friendly or dementia-friendly if they’re not disaster-resilient,” said Johnson of AARP Florida. “And everyone who’s been through Ian, I suspect, will be more vigilant going forward, because people have been scared straight.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit  to submit your requests or tips.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

The lung-irritating particles were blowing in from burning forests in California and settling in Douglas County, Nevada, home to nearly 50,000 people, that air quality had reached hazardous levels.

Those levels meant the air was very unhealthy, bad enough to raise alarms about people’s immediate health care needs and questions about whether worsening pollution could result in long-term health issues. People could increasingly face such risks as climate change makes wildfires, drought, dust storms, and floods more frequent across the U.S. and the world.

Some people simply feel powerless.

“There’s not much we could do about it,” said , chairman of the Washoe Tribe of Nevada and California. The tribe’s land straddles the border between California and Nevada near Lake Tahoe and extends into Douglas County, about 60 miles south of Reno.

Tribe members and other area residents are of people nationwide who this year will experience poor air quality because of wildfires. In September, as smoke settled over Nevada, air quality alerts were dispatched in six other states: California, Idaho, Montana, Oregon, Washington, and Wyoming.

Yet, by one measure, people who live in Douglas County are better off than those in some other hard-hit areas. Douglas County residents must drive 30 minutes, on average, for medical care from lung specialists called pulmonologists. In other parts of the West and Upper Midwest, however, patients must drive an hour or more, according to , a website that tracks prescription drug prices and conducts research.

Specifically, the research found that about 5.5 million Americans live in the 488 counties where drive times to pulmonologists are an hour or more. Much of Nevada and large parts of Montana fall into those gaps between specialists — places that have recently grappled with wildfires that fill the air with smoke and ash, which can cause lung problems or exacerbate existing ones.

Allergies, asthma, and similar issues are often handled by primary care physicians, but patients are when problems escalate — think severe asthma; chronic obstructive pulmonary disease, or COPD; or emphysema.

shows the number of pulmonary disease specialists in the U.S. dropped nearly 11% from 2014 to 2019. The group, which is based in Washington, D.C., and represents the academic medicine community, noted that the decline might not be as high as it appears because some physicians are opting to practice pulmonary critical care rather than just pulmonology. Many of those types of pulmonologists work in hospital intensive care units.

About 15,000 pulmonologists are practicing in the U.S., according to the GoodRx report. Yet vast swaths of the country have .

“New Mexico has one pulmonologist for the entire southeastern part of state, not counting Las Cruces, which is closer to El Paso,” said , a pulmonologist at Texas Tech Physicians.

Test, one of 13 pulmonologists in the Lubbock, Texas, region, said that his patients from within Texas sometimes drive four hours for an appointment and that other people travel from “New Mexico, Oklahoma, even far western Kansas.”

Increases in wildfires and their intensity will likely expand the need for pulmonologists.

“Climate change is going to affect lung disease,” said , a professor of pulmonary, critical care, and sleep medicine at the University of California-Davis School of Medicine in California, where he and are tracking the effects of wildfires. At his Sacramento practice, Kenyon said, he sees patients from far northern parts of California, including Eureka, a five-hour drive from the state capital.

The short-term effects of breathing smoke are pretty well known. People show up in emergency rooms with asthma attacks, exacerbation of COPD, bronchitis, and even pneumonia, Kenyon said. Some have chest pain or other cardiac concerns.

“But we have very little understanding of what happens over the longer term,” he said. “If people get two or three weeks of wildfire exposure for two or three years, does that lead to worsening of asthma or COPD? We just don’t know.”

Fires release multiple pollutants, including carbon dioxide, carbon monoxide, and chemicals like benzene. All fires send particles into the air. Health researchers and air quality experts are most concerned about tiny pieces referred to as particulate matter 2.5. Far smaller than a human hair, the particles and have been linked to heart and lung conditions.

Increases in those tiny particles are associated with a greater risk of death from all causes, excluding accidents, homicides, and other non-accidental causes, for up to four days after a population is exposed, according to a 2020 .

The concentration of fine particulate matter is one of five gauges used to calculate the Air Quality Index, a numerical and color-coded index used to let the public know about local air pollution levels. Green denotes good air quality and is given if the total index is 50 or less. When the measurement exceeds 100, the air quality gets an orange label and may be bad for certain groups. Levels over 200 get a red label and are considered unhealthy for everyone.

Government agencies track those levels, as do people who use apps or websites to determine whether it’s safe to go outside.

When the AQI rises above 150, Dr. Farah Madhani-Lovely, a pulmonologist, said Renown Regional Medical Center in Reno shuts its outpatient pulmonary rehabilitation clinic because it doesn’t want to encourage patients to drive in. Some patients from Douglas County opt for care near home, about an hour away. “We don’t want these patients exposed outside because just one minute of exposure to the smoke can trigger an exacerbation of their chronic disease,” Madhani-Lovely said.

Smokey said connecting with pulmonologists can be difficult for Washoe Tribe members, particularly those who live on the California side of the reservation. “We cannot find providers for them,” he said. “We end up referring them out and sending them hundreds of miles out of their way just to get care that we should be able to provide here.”

Recruiting specialists to rural areas or smaller cities has long been difficult. For one thing, a specialist might be the only one for miles around, “so there’s a tremendous burden in terms of coverage and days off,” Test said.

Another concern is that physicians tend to train in larger cities and often want to practice in similar places. Even recruiting pulmonary physicians to Lubbock, a city of 260,000 in West Texas, is a challenge, Test said.

“I love Lubbock,” he said. “But I tell people who have never been here, I say, ‘It’s really flat.’ They don’t understand flat until they get here.”

In Nevada, on days when the air quality is bad, Washoe tribal members try to protect themselves with makeshift air purifiers created from fans, duct tape, and air filters, Smokey said.

Longer term, Smokey and other tribal leaders are pushing the Indian Health Service to establish a specialty care hospital in northern Nevada. The closest specialty care hospital for Washoe tribal members is more than 700 miles away, in Phoenix.

It’s difficult because “there’s a need we should be taking care of,” Smokey said. “But we have to fight for it. And sometimes that fight takes years, years, and years to accomplish.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Hurricane Ian forced at least 16 hospitals from central to southwestern Florida to evacuate patients after it made landfall near the city of Fort Myers on Sept. 28 as a deadly Category 4 storm.

Some moved their patients before the storm while others ordered full or partial evacuations after the hurricane damaged their buildings or knocked out power and running water, said , president of the Florida Hospital Association, which coordinates needs and resources among hospitals statewide during a hurricane.

About 1,000 patients across five Florida counties were evacuated from hospitals for different reasons, Mayhew said, with one hospital moving patients after the storm tore part of its roof and deluged the ground floor. Other hospitals emerged with no structural damage but lost power and running water. Broken bridges, flooded roads, and lack of clean water all added to the challenge for some hospitals, Mayhew said.

And that’s before considering the need to help those injured in the hurricane and its aftermath.

“Climate shocks like hurricanes show us in the most painful way what we need to fix,” said Aaron Bernstein, interim director of the Center for Climate, Health, and the Global Environment, known as C-CHANGE, at the Harvard T.H. Chan School of Public Health.

As climate change of hurricanes, coastal cities threatened by rising sea levels from Miami to Charleston, South Carolina, have considered billion-dollar storm surge protection plans — from elevating homes to creating a network of seawalls, floodgates, and pumps to protect residents and infrastructure against powerful flooding from storms.

Some hospitals are fortifying buildings and elevating campuses. Others are moving inland, as they prepare for a future when even weak storms unleash flooding that can overrun facilities.

“They’re the front lines of climate change, bearing the costs of these increased weather events as well as the increase in injuries and disease that come with them,” said Emily Mediate, U.S. climate and health director for , a nonprofit that works with hospitals to prepare for climate change.

Yet even as hospitals prepare for extreme weather, Bernstein and a team of researchers at Harvard predicted in that many facilities along the Atlantic and Gulf coasts will face a suite of problems, even from milder weather events.

The study analyzed the flood risk to hospitals within 10 miles of the Atlantic and Gulf coastlines. In more than half of the 78 metropolitan areas analyzed, some hospitals are at risk of storm surge flooding from the weakest hurricane, a Category 1. In 25 coastal metro areas, half or more of the hospitals risk flooding from a Category 2 storm, which would pack winds of up to 110 mph. Florida is home to six of the 10 most at-risk metropolitan areas identified in the study, with the Miami-Fort Lauderdale-West Palm Beach region ranked as having the greatest risk of hurricane impact.

Researchers also considered the risk of flooding for roads within 1 mile of coastal hospitals during a Category 2 hurricane. That’s what happened on Florida’s western coast, where Hurricane Ian’s maximum sustained winds of 150 mph contributed to flooded roads and washed-out bridges.

All three hospitals in Charlotte County were closed during the storm. One reopened its emergency room the following day, and two were operational by Oct. 1.

In neighboring Lee County, the public hospital system was forced to partially evacuate three of its four hospitals, potentially affecting about 1,000 patients, after the facilities lost running water. As of Oct. 6, the county remained in a state of emergency and many roads and bridges were closed due to flooding and damage, according to the Florida Department of Transportation’s .

Several Florida hospitals on waterfront property have moved their essential electrical systems and other critical operations above ground level, elevated their parking lots and buildings, and erected water barriers around their campuses, including Tampa General Hospital, which has the only trauma center in west-central Florida.

Miami Beach is a barrier island where roads flood on sunny days during extremely high tides. Building to withstand hurricanes and flooding is a priority for institutions, said Gino Santorio, CEO of , which sits at the edge of Biscayne Bay.

Over the past decade, Mount Sinai has completed nearly $62 million in projects to protect against hurricanes and flooding. The projects were part of funded by the Federal Emergency Management Agency and state and local governments to fortify schools, hospitals, and other institutions.

“It’s really about being the facility of last resort. We’re the only medical center and emergency room on this barrier island,” Santorio said.

But Bernstein said the “Fort Knox model” of spending hundreds of millions of dollars on state-of-the-art hurricane-proof hospital buildings isn’t enough. This strategy doesn’t address flooded roads, transportation for patients ahead of a storm, medically vulnerable people in areas most at risk of flooding, emergency hospital evacuations, or the failure of backup power sources, he said.

Urging hospitals to fortify for more severe hurricanes and rising sea levels can feel overwhelming, especially when many are struggling to recover from pandemic-related financial stress, labor shortages, and fatigue, said Mediate, of the group Health Care Without Harm.

“Lots of things make it hard for them to see this is a problem, of course. But on top of how many other issues?” she said.

As Hurricane Ian approached the South Carolina coastline north of Charleston on Sept. 30, the city’s low-lying hospital district reported about 6 to 12 inches of water. “That’s much less than was expected,” Republican Gov. Henry McMaster said during a news briefing.

Though Hurricane Ian was a relatively minor weather event in South Carolina, it’s not unusual for Charleston’s downtown medical district to flood, making it dangerous and, sometimes, impossible for patients, hospital employees, and city residents to navigate surrounding streets.

In 2017, the Medical University of South Carolina ferried doctors across its large campus on from Hurricane Irma. One year later, the Charleston-based hospital system bought a military truck to navigate any future floodwaters.

Flooding, even after heavy rain and high tide, is one reason — one of three systems in Charleston’s downtown medical district — announced plans to eventually move Roper Hospital off the Charleston peninsula after operating there for more than 150 years.

“It can make it very challenging for people to get in and out of here,” said Dr. Jeffrey DiLisi, CEO of .

The hospital system sustained light flooding in one of its downtown medical office buildings from Ian, but it could have been much worse, said DiLisi. He also said that the downtown district is no longer the geographic center of Charleston and that many patients say it’s inconvenient to get there.

“The further inland, the less likely you’re going to have some of those problems,” he said.

Unlike Roper St. Francis, most coastal nonprofit and public hospitals have chosen to remain in their locations and reinforce their buildings, said , the president of the Safety Net Hospital Alliance of Florida and a former secretary of the state’s Agency for Health Care Administration, which regulates hospitals.

“They’re not going to move,” Senior said. “They’re in a catchment area where they’re trying to catch everyone, not just the affluent but everyone.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

With her cat, Bodhi, in his carrier in the back seat, 80-year-old Diana Dimas, who doesn’t see well at night, kept her eyes glued to the rear lights of her neighbor’s Toyota. She and Magdalena Mulay had met a few years before at a bingo night in their sprawling retirement community on the outskirts of Santa Rosa. Both Libras, each with two marriages behind her, the two women soon became the sort of friends who finish each other’s sentences.

Now, for the second time in three years, they heard the alarms and fled together as fire consumed the golden hills of Northern California’s wine country.

“I thought, where on earth are we going to go?” recalled Dimas. She remembered that when the catastrophic Tubbs Fire hit back in 2017, people had sought refuge outside well-lit supermarkets, which had water and bathrooms. Which is how Dimas and Mulay and dozens of other seniors ended up spending the night of the most recent evacuation in the parking lot of the Sonoma Safeway.

At midnight, Mulay was trying to get comfortable enough to catch a few winks in her driver’s seat when her phone began to chirp. A friend was calling to wish her a happy 74th birthday.

The stories of that Sunday night — as a 20-acre fire started that morning merged with two other fires to become an 11,000-acre conflagration forcing tens of thousands from their homes in two counties — spotlight the challenges of evacuating elderly and infirm residents from the deadly wildfires that have become an annual occurrence in California. This year, the coronavirus, which is especially dangerous to the elderly, has further complicated the problem.

While the 2020 fire season will go down as the state’s biggest on record, rescuers have so far managed to avoid horrors on the scale of three years ago, when the firestorm that raced through California’s wine country killed 45 people. Almost all were over 65 — found in wheelchairs, trapped in their garages, isolated and hard of hearing, or simply too stubborn to leave. The same grim pattern emerged from the Camp Fire, which leveled the Northern California town of Paradise in 2018.

Assisted care homes in particular came under scrutiny after the 2017 fire, when ill-equipped and untrained workers at two Santa Rosa facilities abandoned two dozen frail, elderly residents as the flames closed in, according to state investigators. They concluded the seniors would have died in the flames had emergency workers and relatives not arrived at the last minute to rescue them.

“The problem is we don’t value elders as a society,” said Debbie Toth, CEO of Choice in Aging, an advocacy group. “If children needed to be evacuated, we’d have a freaking Romper Room stood up overnight to entertain them so they wouldn’t be damaged by the experience.”

The destructive effects of climate change in California have dovetailed with a rapidly graying population — which in a decade is projected to include 8.6 million senior citizens. That has fueled a growing demand for senior housing, from assisted care homes to swanky “active adult” facilities complete with golf courses and pools.

Proximity to nature is a major selling point of Oakmont Village, Dimas and Mulay’s upscale community of nearly 5,000 over-55s, which has everything from bridge games to cannabis clubs. But the woodlands and vineyards surrounding this suburban sprawl have put thousands of elderly citizens in hazardous wildfire zones.

“With seniors, there’s mobility issues, hearing issues — even the sense of smell is often gone in the later years,” said Marrianne McBride, who heads Sonoma County’s Council on Aging. Getting out fast in an emergency is especially challenging for those who no longer drive. In Sunday’s evacuation, some residents who followed official advice to call ride services had to wait hours, until 3 or 4 a.m., for the overtaxed vans.

Dimas and Mulay managed to scramble into their cars and get on the road shortly after 10 p.m., when a mandatory evacuation order went out for the thousands of seniors in Oakmont Village. But it was after midnight when residents of two Santa Rosa assisted care homes in the evacuation zone were shuffled onto city buses in their bathrobes, some with the aid of walkers. Off-duty drivers braved thick smoke and falling embers to ferry some of them to safety, only to spend hours being sent from one shelter to another as evacuation sites filled up fast because of social distancing rules designed to prevent the spread of COVID-19.

Other precautions, including masks and temperature checks, were followed. But health officials nonetheless voiced concerns that vulnerable people in their 80s and 90s — especially residents of skilled nursing homes, the source of most of Sonoma County’s coronavirus deaths so far — had been moved among multiple locations, upping their chance for exposure.

In the following days, shelters were fielding frantic calls from out-of-town relatives searching for their loved ones. “We were getting phone calls from Michigan, other places across the country, saying, ‘I’m trying to find my mother!’” said Allison Keaney, CEO of the Sonoma-Marin Fairgrounds, which sheltered several hundred horses, chickens, goats and llamas as well as displaced people.

By Wednesday afternoon, a few dozen evacuees remained at the shelters, mostly seniors without relatives or friends nearby to take them in, like Dimas and Mulay. The two women had left the Safeway lot and were sleeping on folding cots in a gym at the Veterans Memorial Building in Petaluma, an old poultry industry town dotted with upscale subdivisions.

This was their first time out and around other people since March, when the two friends had been planning a big night out to see Il Volo, an Italian pop group. Seven months later, the new outfits they bought for the concert still hang unworn in their closets.

“All we do since the shutdown is stay home and talk on the phone,” said Mulay, who spoke to a reporter while sitting next to her friend on a folding chair outside the shelter. “Now, with all these crowds — it’s terrifying.”

Dimas likened the pandemic followed by the fires to “a ball rolling downhill, getting bigger and bigger. And then there we were, with the flashing lights all around us and the cops shouting, ‘Go this way!’ ‘Keep moving!’”

Listos California — an outreach program, for seniors and other vulnerable people, run out of the Governor’s Office of Emergency Services — allotted $50 million to engage dozens of nonprofits and community groups around the state to help warn and locate people during disasters. (Listos means “Ready” in Spanish.)

In Sonoma and Napa counties, where the Glass Fire had destroyed at least 630 structures by late last week, the bolstered threat of wildfires in recent years has promoted new alert systems — including a weather radio that has strobe lights for the deaf or can shake the bed to awaken you.

But while counties are legally responsible for alerting people and providing shelter for them once they’re out, no public agency is responsible for overseeing the evacuation. Practices differ widely from county to county, said Listos co-director Karen Baker.

If Sonoma County has learned anything from the disasters of the past few years, it’s not to depend too much on any system in an emergency. “You’ve got to have a neighborhood network,” McBride said. “As community members, we have to rely on each other when these things happen.”

Early last week, word filtered through the shelters that the fire had consumed a triplex and two single-family homes in the Oakmont neighborhood, but firefighters had battled the blaze through the night with hoses, shovels and chainsaws and miraculously managed to save the rest of the community.

A week later, to their relief, Oakmont’s senior residents were allowed to return home. By then, Mulay had developed severe back pain. Dimas missed her TV.

Back in her apartment with Bodhi, Dimas noted with horror that the blaze had come close enough to her building to incinerate several juniper bushes and scorch a redwood just 2 feet away.

“The whole thing feels surreal, like ‘Oh, my God, did that really happen, or did I dream it?’” she said.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Last week, Hurricane Sally left a trail of watery devastation in Mississippi, Alabama and the Florida Panhandle, even as more storms brewed offshore.

All of that on top of the COVID-19 pandemic, which has .

The timing couldn’t have been better for the opening this month of the at UCLA’s Fielding School of Public Health.

Its mission is to work with policymakers and community groups to help safeguard human health against the ravages of climate change. The center was founded on the premise that the of climate change are already here and must be met with policies not only to slow the warming of the planet but also to help people adapt to its reality.

The center’s co-directors, Dr. Jonathan Fielding and Michael Jerrett, believe the clock is running out and we must quickly reduce the amount of carbon being pumped into the atmosphere to have any hope of preserving a viable planet.

“A lot of the predictions of what could happen with climate change have been wrong. But the predictions have been wrong in that they haven’t been catastrophic enough,” Fielding, a professor of medicine and public health at UCLA and former head of the Los Angeles County Department of Public Health, said in an interview last week.

Jerrett, a professor of environmental health sciences at UCLA’s who also participated in the interview, is the principal investigator on a study hypothesizing that long-term exposure to air pollution elevates the risk of severe COVID-19 outcomes. Other studies have yielded .

The following excerpts of the interview with Fielding and Jerrett were edited for length and clarity:

Q: Could the hazardous air quality from the wildfires burning across much of the West Coast fuel an increase in severe COVID-19 cases and deaths?

Jonathan Fielding: There’s a very good chance of that. There is no doubt the effects of air pollution on the lungs and other organs are substantial and contribute to people with chronic problems being more susceptible to the severe effects of COVID.

Michael Jerrett: When we have wildfire events like this, as people are exposed to these high levels of smoke, we see increases in those indicators of morbidity and mortality. And we’ve seen those effects for several lung diseases that have similarities to COVID, like pneumonia.

Q: How does climate change exacerbate the racial, ethnic and socioeconomic health disparities that are so prevalent in our society?

Fielding: You already have people who have a higher rate and burden of chronic illness. Just look at the rates of obesity, for example, as well as the rate of cardiovascular disease. Those are certainly exacerbated by increased heat and by where people can afford to live. A lot of people can only afford a place that’s going to have a lot of heat islands, it’s not going to be air-conditioned, it might not have much in the way even of public transportation.

Jerrett: If you look through very long periods of time, people who have more resources — whether that’s better social contacts or they’re more highly educated, or have higher incomes, or other factors that put them at a social advantage — have always been able to protect themselves from environmental risks better than people who lack those resources.

Q: Can you explain how wildfires affect mental health?

Jerrett: There’s emerging and increasingly convincing literature that shows air pollution is related to anxiety and depression. It’s thought that the change in the nervous system that seems to be stimulated by air pollution, and perhaps the vascular system changes, can affect brain function and lead people into a more depressive state. … Secondly, the loss of immediate surroundings that people are familiar with: So if you are used to looking out and seeing a beautiful forest, and you walk out and you look in your backyard and you see nothing but smoke, and the whole forest is gone, that can affect mental health.

Q: Can we expect to see pandemics more frequently?

Fielding: What I think most people are missing in discussing this issue is population growth. We’re increasing the interface between humans and other species that have viruses that may not affect them but very severely affect humans. So, that’s one issue. The second issue is that climate change is increasing the area where you have vectors that can thrive. So, for example, we’re going to wind up with mosquitoes that can transmit dengue fever and malaria in the U.S.

Q: You talk about the “health co-benefits” of programs that can help slow climate change while mitigating its impact on public health. What are some examples?

Jerrett: Some of the leading practices in terms of generating benefits involve, say, increasing the green cover. As we increase green cover, we absorb more carbon, so we’re going to reduce the risk of long-term climate change, but you can also have substantial health benefits from that. We know that the introduction of more vegetation generally lowers extreme heat, particularly in disadvantaged neighborhoods where they don’t have a lot of park space or a lot of trees. Another leading practice, where the Europeans are way ahead of us — but we do see signs of improvement across California, in places like Santa Monica — is promoting what’s known as active travel: to get people out of their cars and get them on a bicycle or walking for incidental trips or going to work. We get a benefit in terms of their increased physical activity, and we also reduce the amount of emissions.

Q: Are the climate changes we are already seeing permanent, or can they be halted or even reversed?

Jerrett: We’re already in what I would call a climate crisis. It’s elevating to a climate catastrophe, and that’s going to happen in the next 20 years. We still have a chance to pull back. If we don’t, then we’re going to start seeing massive species die-offs; it’s going to affect the ability of people all over the world to feed themselves. We’re going to have these extraordinary, extreme events like wildfires that are going to dwarf what we’ve seen in the past, and large portions of the planet may become uninhabitable.

Fielding: Here I would draw a parallel to COVID. Even though many of us predicted a pandemic, most people didn’t really believe it, the government didn’t prepare well for it, and we’re learning the same thing with climate change. The difference is we have a way, through vaccination and maybe drugs, to reverse what’s going on with COVID. We don’t know that we have the ability to do that with climate change. You have people politicizing it and calling it a hoax, and that, unfortunately, is very detrimental to what we all want, which is to have a habitable planet.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

As Hoopa’s fire chief and its pandemic team leader, Moon feared the impact of the blaze on the dense coniferous forests of the reservation, near Redwood National and State Parks, where 3,000 tribal members depend on steelhead trout and coho salmon fishing. He was even more terrified of a deadly viral outbreak in his tribe, which closed its land to visitors in March.

“We’re a high-risk community because we have a lot of diabetes, heart disease and elders that live in multigenerational homes. If a young person gets it, the whole household is going to get it,” Moon said.

Eventually, the three major blazes that burned nearly 100,000 acres around Hoopa were too much for the tribe’s 25-member fire team. Moon had no choice but to request help from federal wildland rangers and other tribal firefighters.

Native American tribes are no strangers to fire. Working with flames to burn away undergrowth and bring nutrients and biodiversity back to lands is an ingrained part of their heritage. But epidemics are also a familiar scourge. With the devastation that pathogens like smallpox and measles brought to Native populations following the arrival of Europeans, tribes are especially wary of COVID-19’s impact.

“When thinking about the potential of COVID-19 repeating history and wiping out entire communities and tribes, there is concern,” said Vernon Stearns, who as the fuels manager for the Spokane Tribe in eastern Washington is responsible for organizing controlled burns.

Some tribes have abandoned traditional fire suppression techniques, watching large swaths of land burn in order to protect a more fragile and essential resource: their people.

“The biggest fear the tribe had was COVID would hit our elders. And they are a very valuable resource of knowledge and connection to our ancestry and teaching of our ways to our children, who we also felt were at risk, and we obviously want to protect them,” said Ron Swaney, fire management officer for the Confederated Salish and Kootenai Tribes in Montana.

“I’ve seen how [the virus] has affected families close to me. I know the grief,” said Don Jones, fire chief of the Yakama Nation reservation in central Washington, where there have been at . “I’m not going to send sick people out to fight the fire. I’m not going to say, ‘Come on, guys, toughen up, go out there.’ Life takes precedence over that.”

Around the country, many tribes have full-time fire crews that traditionally aid one another and federal firefighters, sending out teams to help with blazes. But this year’s COVID-19 pandemic has pushed them to reconsider how much help they can give and receive in the face of encroaching infernos.

A Centers for Disease Control and Prevention found Native Americans and Alaskans were 3.5 times more likely than whites to test positive for the coronavirus. The rapid spread of the virus within tribes early in the pandemic led many reservations to aggressively control outside access. Casinos closed. Entrances to tourist areas such as lakes, hiking trails and fisheries were blocked off. Economically many tribes suffered, but COVID caseloads stabilized or declined.

The ongoing fire season is now threatening that progress.

Tribal families often live in multigenerational housing, sometimes in trailers or other small homes with no running water. Their isolated, tightknit communities can be sequestered from COVID-19 spikes in nearby towns but are ripe for an outbreak if the virus enters. Social distancing is a challenge on small, remote reservations. There may be only a single gas station or supermarket, where visiting fire crews would be likely to interact with the tribal population. Many tribes also lack strong internet connections, forcing fire crews to meet in person rather than stage briefings via Zoom, as federal crews have done elsewhere during the pandemic.

On the Flathead Reservation north of Missoula, Montana, COVID-19 hit the fire crew of the Confederated Salish and Kootenai Tribes before the fires did. A firefighter who came in direct contact with someone who was sick with the virus in early July took the tribe’s entire 12-person aviation team, consisting of an air attack plane and a helicopter crew, out of business for four days. While no fires were burning at the time, it was a worrisome wake-up call for Swaney.

“For a minute there, I really thought we would all be infected with COVID-19 and I was wondering who would be responding to the fires,” he said.

It was enough to convince Swaney that this year the tribe wouldn’t share any of its 60 firefighters with neighbors. It was a tough call because historically “in fire, when our neighbors need help, we go help,” he said.

At the end of July, Swaney had to accept help from nearly outside firefighters when lightning started a blaze in the mountains surrounding the bison-dotted grass valley his tribe calls home.

After the 3,500-acre Magpie Rock Fire was under control, Swaney learned that a federal wildland firefighter involved had tested positive for COVID-19 during his next assignment. He didn’t appear to have infected Swaney’s team, though four members have tested positive this season.

“We’ve had a lot of close calls,” he said.

Other tribes have sought to bolster their fire crews to do without the help of off-reservation teams. The Spokane Tribe in Washington earmarked it received from the CARES Act to hire an additional 10-person seasonal crew. It hoped to aggressively attack any fire and keep it small, thereby avoiding the need for outside firefighters who might also bring in the coronavirus, Stearns said.

The Yakama Nation, near the Oregon border, was still struggling with a coronavirus outbreak that had infected at least 6% of its population when fires started in July. The crews learned quickly that facing wildfire and a pandemic simultaneously would be an exercise in trade-offs.

Early in the effort, five fire crew members were taken off the line when several people got sick, leaving the 20 remaining members to make do. Federal firefighting is stretched thin as megafires consume vast areas of the West Coast — and other tribes were no help because they’ve restricted their fire teams’ movement to prevent COVID spread.

“We had no one else to call on. … It was pretty tough,” said Jones. “The stress level has gone up. You’re worried about exposure all the time.”

Ultimately, eight Yakama crew members tested positive for COVID-19. One of the firefighters who tested positive had already lost two family members to the virus. Another spread COVID-19 to a family member who ended up at the hospital on a ventilator but survived.

“Everyone in my program was affected one way or another,” Jones said. “Everyone lost somebody.”

The West’s brutal fire season is forcing tribes to concentrate on fires that start by lightning or accident, with no resources to give to prescribed burning.

“These fires are just gobbling up the ground,” said Jones. His tribe canceled the carefully controlled fires it normally conducts in September to avoid bringing together the large numbers of people needed to do them.

“Fires are just going to get bigger,” Jones said. “If we can’t do anything about it, we can’t do anything about it. We have to make sure everyone’s healthy first.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

A straight case of COVID-19? Not so fast. This is wildfire country.

Up and down the West Coast, hospitals and health facilities are reporting an influx of patients with problems most likely related to smoke inhalation. As fires rage amid dry heat and high winds, smoke and ash are billowing and settling on coastal areas like and cities and towns hundreds of miles inland as well, turning the sky orange or gray and making even ordinary breathing difficult.

But that, Marshall said, is only part of the challenge. Facilities already strapped for testing supplies and personal protective equipment must first rule out COVID-19 in these patients, because many of the symptoms they present with are the same as those caused by the virus.

“Obviously, there’s overlap in the symptoms,” said Marshall, the CEO of CommuniCare, a collection of six clinics in Yolo County, near Sacramento, that treats mostly underinsured and uninsured patients. “Any time someone comes in with even some of those symptoms, we ask ourselves, ‘Is it COVID?’ At the end of the day, clinically speaking, I still want to rule out the virus.”

The protocol is to treat the symptoms, whatever their cause, while recommending that the patient quarantine until test results for the virus come back, she said.

It is a scene playing out in numerous hospitals. Administrators and physicians, finely attuned to COVID-19’s ability to spread quickly and wreak havoc, simply won’t take a chance when they recognize symptoms that could emanate from the virus.

“We’ve seen an increase in patients presenting to the emergency department with respiratory distress,” said Dr. Nanette Mickiewicz, president and CEO of Dominican Hospital in Santa Cruz. “As this can also be a symptom of COVID-19, we’re treating these patients as we would any person under investigation for coronavirus until we can rule them out through our screening process.” During the workup, symptoms that are more specific to COVID-19, like fever, would become apparent.

For the workers at Dominican, the issue moved to the top of the list quickly. Santa Cruz and San Mateo counties have borne the brunt of the CZU Lightning Complex fires, which as of Sept. 10 had more than 86,000 acres, destroying 1,100 structures and threatening more than 7,600 others. Nearly a month after they , the fires were approximately 84% contained, but thousands of people remained evacuated.

Dominican, a Dignity Health hospital, is “open, safe and providing care,” Mickiewicz said. Multiple tents erected outside the building serve as an extension of its ER waiting room. They also are used to perform what has come to be understood as an essential role: separating those with symptoms of COVID-19 from those without.

At the two Solano County hospitals operated by NorthBay Healthcare, the path of some of the wildfires prompted officials to review their evacuation procedures, said spokesperson Steve Huddleston. They ultimately avoided the need to evacuate patients, and new ones arrived with COVID-like symptoms that may actually have been from smoke inhalation.

Huddleston said NorthBay’s intake process “calls for anyone with COVID characteristics to be handled as [a] patient under investigation for COVID, which means they’re separated, screened and managed by staff in special PPE.” At the two hospitals, which have handled nearly 200 COVID cases so far, the protocol is well established.

Hospitals in California, though not under siege in most cases, are dealing with multiple issues they might typically face only sporadically. In Napa County, Adventist Health St. Helena hospital 51 patients on a single August night as a fire approached, moving them to 10 other facilities according to their needs and bed space. After a 10-day closure, the hospital was as evacuation orders were lifted, the fire having been contained some distance away.

The wildfires are also taking a personal toll on health care workers. CommuniCare’s Marshall lost her family’s home in rural Winters, along with 20 acres of olive trees and other plantings that surrounded it, in the that swept through Solano County.

“They called it a ‘firenado,’” Marshall said. An apparent confluence of three fires raged out of control, demolishing thousands of acres. With her family safely accounted for and temporary housing arranged by a friend, she returned to work. “Our clinics interact with a very vulnerable population,” she said, “and this is a critical time for them.”

While she pondered how her family would rebuild, the CEO was faced with another immediate crisis: the clinic’s shortage of supplies. Last month, CommuniCare got down to 19 COVID test kits on hand, and ran so low on swabs “that we were literally turning to our veterinary friends for reinforcements,” the doctor said. The clinic’s COVID test results, meanwhile, were taking nearly two weeks to be returned from an overwhelmed outside lab, rendering contact tracing almost useless.

Those situations have been addressed, at least temporarily, Marshall said. But although the West Coast is in the most dangerous time of year for wildfires, generally , another complication for health providers lies on the horizon: flu season.

The Southern Hemisphere, whose influenza trends during our summer months typically predict what’s to come for the U.S., has had very little of the disease this year, presumably because of restricted travel, social distancing and face masks. But it’s too early to be sure what the U.S. flu season will entail.

“You can start to see some cases of the flu in late October,” said Marshall, “and the reality is that it’s going to carry a number of characteristics that could also be symptomatic of COVID. And nothing changes: You have to rule it out, just to eliminate the risk.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

“Stay home!” another user replies.

The Facebook group called “” has been flooded with pointed, exasperated comments urging travelers to stay away. This is a marked change. Before the pandemic, the exchanges between vacationers and island residents resonated with promises of excitement and fun. Now, tour operators from the mainland who administer the Facebook page quickly try to delete any expressions of anger.

In nearby Puerto Rico, the friction has spilled into real life. have detailed multiple episodes in which tourists, having escaped pandemic restrictions back home, became violent and destroyed store merchandise after being asked to wear a mask.

The COVID-19 pandemic has pitted economic interests against public health guidance all across the United States. Puerto Rico and the Virgin Islands feel this tension acutely, as both U.S. territories rely on tourism to generate revenue and provide jobs. Increasingly, locals have begun to wonder now if welcoming visitors to these islands is worth the risk.

Tourism represents more than half of the Virgin Islands’ gross domestic product. In Puerto Rico, the industry accounts for 80,000 jobs and about 6.5% of the island’s total economy.

But islanders are not only vulnerable to COVID-19’s economic disruptions. Residents of both Puerto Rico and the Virgin Islands are diagnosed with chronic health conditions like diabetes and cardiovascular illness at higher rates than in most U.S. states, which puts them at higher risk for the virus’s complications.

In short, the very industry that represents an economic lifeline for islanders threatens their ability to protect their health.

One Step Forward

When COVID-19 triggered alarms in late winter, Puerto Rico and the USVI adopted strong COVID prevention strategies before most U.S. states did.

In Puerto Rico, Gov. Wanda Vázquez issued an executive order, effectively locking down the island by imposing a curfew, a stay-at-home order and business closures. The first coronavirus cases on the island were reported March 13.

Similarly, Virgin Islands Gov. Albert Bryan Jr. issued prohibiting hotels, villas and other accommodations from accepting leisure guests between March 25 and June 1. The area remained open to business travelers, flight crews, health officials, emergency personnel, government guests and residents. According to a March 20 Department of Health , the territory had — at that time — six confirmed COVID cases and 43 pending test results.

Neither territory, however, was able to close its airports. Local officials do not have the authority to do so because the federal government regulates aviation.

“Part of the challenge of being a U.S. colony, in particular, is that, you know, we don’t have control over our borders,” said Hadiya Sewer, president and co-founder of St. JanCo: the St John Heritage Collective, a cultural heritage preservation and land rights organization on the small island of St. John, U.S. Virgin Islands.

Still, the aggressive measures — while effective — came at a price for residents like Melina Aguilar.

Before the lockdown, the 31-year-old entrepreneur worked as a tour guide for Isla Caribe, a company she founded that offers historical walking tours of Ponce, Puerto Rico. The stay-at-home order in March shut down Aguilar’s business for three months and sequestered her in her house.

Aguilar said the sacrifice would have been worth it if the island could have maintained control of the spread by closing the border and enforcing the 14-day quarantine for travelers. It didn’t work out that way. According to from The New York Times, the seven-day average for cases on May 1 — while Puerto Rico was still in lockdown — was 42 cases per day. On July 1, the seven-day average was 102 cases. By July 15, the average was 233.

“We could’ve basically had the fruits of being locked up for three months,” Aguilar said. “But now we’re stuck.”

Reopening the Gateway

By summer, both territories were itching to get back to business. With many overseas vacation destinations banning U.S. travelers, it seemed like the nearby mainland would be full of beachgoers, who, after living under stay-at-home orders for months, would be ready to travel — no passport required — to the sun and sand.

The U.S. Virgin Islands formally welcomed tourists back to its shores on June 1 — with caveats. Travelers from coronavirus hot spots needed to submit COVID-19 test information through an to receive a negative result “certification code.” Those who didn’t were required to quarantine for 14 days or until they had documentation of a negative test result.

But locals and tourists alike said COVID enforcement measures haven’t been consistent. Capt. Matthias Bitterwolf, owner of Antillean Yacht Charters on St. Thomas, said he delivered a boat to Puerto Rico and was not allowed off the vessel until local police could verify his COVID paperwork. His COVID status was not checked upon returning to St. Thomas.

The Virgin Islands’ case counts soon began ticking up. Between June and mid-July, the case count increased by more than 3,500%, according to one.

Gov. Bryan responded by issuing other to regain control of the outbreak, including prohibiting beach visits after 4 p.m. and not allowing patrons to stand or eat at bars located in restaurants. As of Aug. 24, the USVI had a total of .

Puerto Rico formally welcomed tourists on July 15 while still imposing some COVID-related restrictions. As in the Virgin Islands, officials required travelers to present documentation of a negative COVID test result upon arrival.

Dr. Victor Ramos, president of the island’s medical association who is involved with the, said these decisions tended to expose the rift “between the medical task force that favors closing things and the economic task force that wants to leave everything open.”

By July, the local economy was in shambles. The Department of Labor reported over 21% of the island’s workforce was receiving unemployment assistance related to the pandemic in the .

But rising case counts attributed to travel prompted local officials to encourage that only essential travel be allowed. As of Aug. 24, had recorded over 30,700 COVID cases and at least 395 deaths, according to the New York Times database.

Government data, though, indicated Puerto Rico’s climbing case numbers were not being triggered by tourists. They are not the culprits, insisted Leah Chandler, chief marketing officer of Discover Puerto Rico, the island’s official tourism website. Rather, the spread was linked to island residents coming home after visiting COVID hot spots like Texas and Florida.

Life on the Ground

Despite the global pandemic and the restrictions, both territories have experienced no shortage of vacationers. “We would have expected this to be a slow moment for us in terms of tourism,” said Sewer. “It’s very busy.”

Still, the trend lines for COVID case counts weren’t moving in the right direction for either territory, so it was no surprise when Puerto Rico closed days after reopening and the USVI followed suit on Aug. 19.

The underlying socioeconomic and health issues put residents in both places at high risk. It’s not just the prevalence of chronic health conditions like diabetes and cardiovascular disease. The high number of multigenerational households in both areas complicates a family’s ability to socially distance from its most vulnerable members. Roughly of the population in Puerto Rico and the Virgin Islands is age 65 or older, and poverty is widespread.

At the same time, both territories have limited health care infrastructure — making it difficult to envision that they can care for their own populations in an emergency let alone visitors who could become ill and island-bound if the virus were to surge.

Currently, the USVI has two main hospitals — one in St. Thomas and one in St. Croix — and a health clinic in St. John. The territory has 20 intensive care unit beds and about 100 one-time-use ventilators for its residents, said Justa Encarnacion, the USVI’s health commissioner. Each island has about 30 full-capacity ventilators.

In Puerto Rico, about of the island’s ventilators for adults were available as of Aug. 24. However, ICU beds are harder to come by, said Ramos. They are filled with COVID patients and those whose conditions worsened after avoiding care out of fear of catching the virus, he said.

The string of problems that have besieged these islands magnifies the effects of the pandemic. That includes debt crises and infrastructure damage from hurricanes and earthquakes. Island residents also fear the possibility of battling a hurricane and a coronavirus outbreak at the same time — a reality that they’ve already confronted when COVID hampered the USVI’s emergency management agency’s ability to distribute sandbags ahead of a storm in .

Colorado State University hurricane researchers predict an 2020 Atlantic hurricane season.

“At this point, we literally have disasters layered on top of disasters,” said Sewer, of the St. John’s Collective.

Still, Joseph Boschulte, tourism commissioner for the Virgin Islands, is cautiously optimistic about finding a balance between health and economic interests.

“We appreciate the concerns of our tourism partners and stakeholders,” he said. But with the spike in cases, he said, “we must reset, take stock, safeguard human life and prepare for restarting our tourism economy at a later date.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

The wildfire evacuation zone, at the time, ended a few blocks from her house. But she worried about what the air quality — which had reached the second-highest warning level, purple for “very unhealthy” — would do to her children’s lungs. Her 4-year-old twins had spent time in the neonatal intensive care unit; one was later diagnosed with asthma, and last year was hospitalized with pneumonia.

By Tuesday, said Smith, “we all had headaches, the kids were coughing a little bit, and it was raining ash.” The family had been conscientiously isolating at home because of the COVID pandemic, and leaving meant potential exposures. But on Wednesday, Smith said, “I looked at my partner and said, maybe we should leave.”

She called a friend in Orange County, about 380 miles south, who offered her parents’ empty condo. But the next day, the friend’s child spiked a fever — a possible case of COVID-19 — and the plan fell through amid the distraction.

So Smith looked on Airbnb, careful to seek out hosts who detailed their COVID precautions, and found an apartment in San Bruno, about an hour’s drive north. She stuffed photos and documents into a suitcase, grabbed the go-bags, and her family headed out.

“It’s coming out of our savings to stay here,” Smith said from the safety of her apartment rental, which runs about $1,150 a week. “It was a really fraught decision to leave, but as soon as we got over the hill and the sky was blue, I took a big sigh of relief and knew that it had been a good decision.”

As the twin disasters of COVID-19 and fire season sweep through California, thousands of residents like Smith are weighing difficult options, pitting risk against risk as they decide where to evacuate, whether from imminent flames or the toxic air. Amid a virulent pandemic, which is safest? Doubling up at a friend’s home? A hotel? An evacuation center? And when do the risks of smoke inhalation outweigh the risk of a deadly infection?

“Obviously the most important thing is for people to do what they can to protect their lives, not only from the fire, but also from COVID,” said Detective Rosemerry Blankswade, public information officer for the San Mateo County Sheriff’s Office, which is helping coordinate response to the massive CZU Lightning Complex fires.

“You have to evaluate the big picture here. If fire is your most imminent danger, maybe take the COVID risk. But if you can avoid both of them, that’s obviously going to be the best option. It’s kind of a little bit of triage that we’re asking for people to do in their own lives right now.”

In San Mateo, one of two counties where the CZU Lightning Complex fires are blazing, officials are advising people to head to an evacuation center, where county workers will assist them in finding a hotel room. Meanwhile, in neighboring Santa Cruz, where tens of thousands of residents have evacuated and shelters have limited space, officials are asking those under orders to leave to stay with family and friends whenever possible.

What’s the right choice when all options pose additional risks? We spoke with several experts to help guide your thought process.

You have to evacuate: Where should you go?

If your region is under an evacuation order, do not hesitate. Leave immediately. If you can afford it, booking a room at a hotel or motel outside the evacuation zones may be the best option, said Dr. Michael Wilkes, a professor at the University of California-Davis School of Medicine. They almost always have air-conditioning units, which help filter the air from both smoke and virus. Many hotels are implementing new cleaning processes; ask staffers to detail what they’re doing to sanitize rooms, and consider skipping the daily cleaning service during your stay. You might also check review sites such as TripAdvisor to see what other guests report. When possible, avoid the lobby and other shared spaces, and opt for contactless check-in.

With so many people in Northern California fleeing the fires, many hotels are already full, especially in more remote areas. So what about staying with family or friends? After months of being shut in and avoiding close contact beyond immediate family, moving into someone else’s home means a host of potential exposures. Consider whether you or anyone else in the home is at high risk from COVID-19 because of age or a preexisting condition.

“If so, that’s a reason to think twice before going to someone’s home,” said Dr. Gina Solomon, a program director at the Oakland-based Public Health Institute.

Consider, too, what precautions your friends or family have been taking. Sheltering with someone whose job brings them into frequent contact with other people may not be as safe as sheltering with people who largely have been staying home. Another question is how crowded the home is: If you have your own room and, preferably, your own bathroom, that makes staying with friends a better option. If a separate bedroom is not available and smoky skies are not a problem, you might consider pitching a tent in their backyard.

For those with an RV or tent, camping can present another good option — although, with hundreds of wildfires burning across California, it may be challenging to drive far enough away to avoid fire and smoke. If you do camp, try to find a site away from wooded areas. And think twice before using group bathrooms.

Is an evacuation center safe?

Many counties have implemented new precautions at emergency shelters to prevent the spread of the coronavirus. In Santa Cruz, for example, officials are scaling back the capacity in each shelter to allow for social distancing, providing tents for people to use as shielding inside and allowing camping in the parking lots.

Still, staying in a shelter should probably not be your first choice. In terms of COVID risk, deciding between a hotel and a friend’s house is “nipping at the edges,” said Dr. John Swartzberg, a clinical professor emeritus at the UC-Berkeley School of Public Health, while “being in a congregate setting is only better than being completely exposed to the elements.”

If an evacuation shelter is your best immediate option, again, do not hesitate. “You have these standards you want to practice for yourselves,” Swartzberg said, “but when something worse comes along, it trumps how careful we can be with COVID because the need for shelter is greater.” You can lower your risk of infection by wearing a mask, washing hands frequently and sanitizing surfaces.

If you aren’t in a fire zone, should you invite friends and family to stay with you?

Deciding whether to open your home to friends who are evacuating is an intensely personal decision and may depend on whether anyone in your family has a preexisting condition.

“I guess it depends on how good a friend they are and how desperate they are,” said Swartzberg. It may also depend on how much space you have; if your guests can have their own bedroom and bathroom, it might be safer.

If you do offer your home, experts advise against simply considering yourself a new pod with your guests. Instead, take steps to lower your chances of infection.

“It might not be pleasant, but wearing a mask anytime you’re not in your own bedroom is the safest way to go,” said Solomon. Stay outside as much as possible, she added, and consider eating meals outdoors or eating in shifts to avoid being maskless with those outside your family unit. Sanitize surfaces and wash hands frequently. If air quality permits, keep the windows open to improve airflow.

If you’re in a region with hazardous smoke conditions, should you leave?

If your area has dense smoke but no imminent fire risk, the thought of heading somewhere else may be appealing, especially if you have respiratory issues. But in most cases, Wilkes said, it would be safer not to leave your COVID bubble. And given the expanse of California’s fires, anywhere you flee could end up having lousy air quality by the time you arrive.

“The better part of rationality,” Wilkes said, “would be to stay at home, not exercise [outdoors], stay inside as much as you can, turn on the air conditioning.”

California Healthline senior correspondent Anna Maria Barry-Jester contributed to this report.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

But you are going to have to think a little more about what kind of mask is best.

The fires have spewed toxic substances far and wide, raining ash across the region and leaving an acrid brownish-gray haze. Air quality in much of the Bay Area was the for a few days last week. And fire season is only just beginning.

The biggest health risk: tiny particles, less than 2.5 microns in diameter, that make up 80% of wildfire smoke. They can enter the bloodstream through the lungs, damaging the airways and the heart. The risks are greatest for the old and very young, and those with preexisting heart and lung conditions.

The best defense against the smoke is simply to stay inside. “If you don’t have to go out, don’t go out,” says Dr. Mary Prunicki, director of air pollution and health research at Stanford University’s Sean N. Parker Center for Asthma and Allergy Research. She advises keeping doors and windows shut and using an air purification device to filter out the smoke particles.

And refrain from strenuous exercise. “You have permission to be a couch potato,” says Anthony Wexler, director of the Air Quality Research Center at the University of California-Davis.

If you must be outside for any extended period, — and that’s where the convergence of COVID-19 and wildfires poses challenges, though not insurmountable ones.

The relatively loose-fitting cloth face coverings and blue surgical-style masks that many of us wear in public to prevent spreading the coronavirus are not particularly useful against smoke, though they can provide some protection, has shown. Cloth masks reduced airborne particles by 57%, according to one study. Another study showed that surgical and homemade masks reduced particle concentrations fourfold and threefold, respectively.

That compares with a hundredfold reduction by N95 filtering facepiece respirators, commonly known as N95s. The number 95 signifies that they filter out 95% of particles.

“The N95s are great, if you can get your hands on one,” says Wexler.

And therein lies the rub. Huge demand for N95 masks among health care workers on the front lines of COVID-19 led to supply constraints in the spring that continue this summer.

“We are extremely concerned about the availability of N95 masks,” says Gail Blanchard-Saiger, vice president of labor and employment at the California Hospital Association. Administrators at one hospital recently told her they had not received a single shipment of N95s since March. Another said their hospital had 350,000 N95s on back order and were lucky to get 200 a month.

I conducted a (very unscientific) survey of my own, calling four hardware stores and five medical supply stores in Southern California, where I live, to ask if they carried N95s. None of the hardware stores and only two of the medical supply stores did.

If you do get hold of some N95s, be aware that they work properly only with a tight fit against your skin, providing a seal that minimizes leakage. They will likely be too big for children, and if you have facial hair it will interfere with the fit.

The tight fit of a properly functioning N95 means it is uncomfortable, “so you’re not going to wear it a really long time, because it’s going to be really annoying,” Wexler says.

If you have a chronic respiratory condition such as asthma or COPD, check with your doctor before wearing a mask.

Gina Spadafori, a West Sacramento resident who’s had asthma all her life, bought a box of N95s during the Camp Fire in late 2018 and had one left this month when her neighborhood was engulfed by smoke from a multitude of wildfires burning in the region.

She put it on before she went out to check on her goats and chickens one recent morning. “I still immediately got tightness in my chest and some problems breathing,” says Spadafori, 62. “So I can imagine that going out to the barn without it would have been a pretty bad mistake.”

Given the importance of conserving masks during the pandemic, it’s OK to reuse N95s, says Dr. Nicholas Kenyon, division chief of pulmonary, critical care, and sleep medicine at UC Davis Health. “If they are not soiled and wet, and they are still intact, you can use them for several days, hopefully to get through this.”

If you can’t get hold of N95s, don’t fret. You have other options. One is a kind of alternative N95, known as the KN95, which is abundantly available. Eight of the nine stores I called had them in stock.

The KN95s, produced mainly by Chinese manufacturers, are meant to filter out 95% of airborne particles, like the N95s. But beware: They do not always perform as advertised. The Food and Drug Administration rescinded its emergency authorization for some KN95 brands after a study this year found they the 95% target.

The Centers for Disease Control and Prevention website provides on a large number of N95 and KN95 respirators.

You might also consider insertable PM2.5 filters, designed to fit inside cloth or surgical masks. You can ; they are abundant and inexpensive. The downside is that it may be difficult to get a tight fit, so there could be leakage.

They are “not as good as the real thing, but way better than nothing,” says Wexler.

If you want to go Darth Vader, and a bit more upscale, check out — tight-fitting rubber or silicone masks that come with filtration cartridges and offer protection at least equivalent to an N95 and, in some cases, better.

They also have exhalation valves, which makes it easier to breathe. But here’s the problem with that: You expel respiratory droplets. Great for coping with smoke, but potentially risky for those you encounter in the midst of a pandemic. Like the N95s, their tight fit can make them hard to wear for long periods of time — especially in high heat.

Whatever you decide, one thing seems inescapable: With a society rendered germophobic by the pandemic and with wildfires an ever-increasing threat, masks are fast becoming an indispensable part of our wardrobe.

“I think this is the new normal for the 21st century,” says Dr. Richard Jackson, a professor emeritus at UCLA’s Fielding School of Public Health and former head of California’s Department of Public Health under Gov. Arnold Schwarzenegger. “You keep flashlight batteries in your house, and you keep good quality masks.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .