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Getting Ready: Water, Wildfire & Wellness – An Interview with Dr. Irva Hertz-Picciotto and Dr. Linda Rudolph

We’re increasingly concerned with these catastrophic wildfires – the impacts of wildfire smoke on health, the impacts on mental health, and the impacts on water supplies.
~Dr. Linda Rudolph, Public Health Institute  

We’re looking down the barrel of another summer (plus fall/winter/spring) season of devastating wildfires in the American West. And, we’re learning a lot more about what these huge wildfires mean for our communities’ health and for our water supply.

We recently spoke with two experts who share their insights.

Dr. Linda Rudolph with the Public Health Institute summarizes a checklist of what communities can do to get ready.  She also reminds us of who is most at risk – everyone from asthmatic children to wildland firefighters.

Dr. Irva Hertz-Picciotto with the University of California at Davis leads a research project studying the long-term public health effects post- the wildfires last fall in northern California. The research findings will help inform communities and legislators.

It’s easy to get overwhelmed when dealing with a warming climate and catastrophic wildfires.  And, there are so many actions we can take right now to ensure better health for our families and a more resilient western water supply.

Dr. Irva Hertz-Picciotto, Ph.D., M.P.H.
Director, Environmental Health Sciences, UC Davis

Dr. Linda Rudolph, MD., M.P.H.
Director, Center for Climate Change and Health, Public Health Institute


Dr. Rudolph, Public Health Institute

As you look across the West, what are you seeing?
We’re increasingly concerned with these catastrophic wildfires –  the impacts of wildfire smoke on health, the impacts on mental health, and the potential impacts on water supplies.

We know that higher temperatures, earlier snowmelt in the mountains, drier conditions and drought associated with climate change are increasing the frequency, intensity, and duration of these wildfires. And we’re also seeing longer wildfire seasons. Some of the firefighting professionals are concerned that we’re starting to see almost an all year-round fire season in California.

What are the public health impacts you’re seeing?
What wildfires do to health is just one of a complex web of impacts of climate change on human health. The Lancet Commission has published several important reports on climate change and on planetary health, and they say that climate change is potentially catastrophic for human survival – it constitutes a medical emergency. Wildfires gives us a lens that allows us to really see that.

Obviously, wildfires cause a lot of smoke. These smoke plumes travel up to a thousand miles. Smoke from the northern California wildfires last October was detected in Mexico. On the East Coast, cities had elevated levels of particulate matter from wildfires in Northern Canada, which was about 1,000 miles away. These plumes are laden with particulate matter and other substances, but it’s the particulate matter that’s of the greatest concern. Particulate matter exacerbates asthma, cardiovascular disease, chronic obstructive pulmonary disease, and increases adverse birth outcomes and has been associated with increased hospitalizations.

The pollution from wildfire smoke is really significant. During last October’s wildfires in northern California, the air quality index in Napa was the highest pollution level ever recorded. It was twice what is considered a very unhealthy level, meaning that even people that are healthy shouldn’t be going outside. And although we recommend that people stay indoors when smoke levels are high, we now know that wildfire smoke penetrates into homes during wildfire episodes, creating poor air quality indoors as well.

Last year’s fires in northern California put out a quantity of air pollutants and greenhouse gas emissions that was about equivalent to the pollution from all the vehicles in California for a year.

It also puts critical facilities like hospitals and skilled nursing facilities at risk at exactly the moment in time when you most need to have healthcare facilities up and running. We’ve seen evacuations from these critical healthcare facilities as a result of wildfires.

Wildfires damage the soils creating risks of severe erosion and, in the southern California wildfires, that resulted in really horrific mudslides when fires were followed by extreme precipitation, resulting in significant damage to homes, deaths and injuries in Santa Barbara County.

Wildfires burn everything in their way, and that means that they’re burning up a lot of stuff that has toxic chemicals in it – for example, plastics, paints, pesticides – and you then get this toxic ash that requires great care in handling.

Following last year’s northern California fires, there were high levels of benzene in drinking water in some areas of Santa Rosa – presumably (although I don’t think this has been proven) due to the melting of plastic pipes.

We’re seeing increased risk for:

  • People that live in forested areas, which in California includes many Native American communities.
  • The elderly and the young are at particular risk of the impacts of wildfire smoke. And for children particulate matter can impact the development of their respiratory systems, meaning that there’s long-term potential impacts of their exposure to severe smoke.
  • Firefighters and other emergency responders are at increased risk, especially of injuries associated with working on wildfire response.
  • People with disabilities are at risk of not being able to evacuate.

Regarding low-income and the most vulnerable populations:

  • Low-income people usually don’t have disaster insurance and have very few resources to rebound from a wildfire disaster. Undocumented people are also ineligible for FEMA and other disaster recovery assistance, and they have low income to start with, which puts them really at risk of not being able to recover and rebound.
  • People that have preexisting cardiovascular disease and asthma are at greater risk from exposure to wildfire, and African Americans in California tend to have a higher prevalence rate of those illnesses.
  • Undocumented individuals and families are at increased risk because they are more likely to work outdoors, for example, as agricultural workers.
  • Many agricultural workers, even in Napa and Sonoma counties, continued doing very hard physical labor – where they’re breathing hard and breathing in more smoke – because they couldn’t afford to take time off, even while the fires were burning.

It’s critical to remember that because these smoke plumes carry for such long distances that very large populations, not just those right next to the wildfire, are at risk from the impacts of smoke.

And then there are the mental health impacts. Many thousands of people were displaced in the wildfires in southern and northern California and this can lead to anxiety, depression, and PTSD for both residents and emergency responders. People also experience a sense of loss of place because you can’t really go back home after a wildfire.

It’s important to note that all of these mental health impacts are mediated both by financial wellbeing and by having strong family ties and social cohesion. So, we can do something to mitigate the impacts of wildfires on an individual’s health. We can identify where the most vulnerable people and populations are. There’s been some interesting work looking at providing air filters to high-risk people in areas with high wildfire potential so that their indoor homes are more protective.

We can develop land use policies that reduce development of the urban-wildland interface, and enact stronger building codes. One of the things we learned in the California wildfires is how important it is to make sure that our notification systems reach everyone, and evacuation plans are accessible and known to all members of our community. In Southern California, there were populations of very low income, primarily undocumented agricultural workers living in small communities that local governments didn’t even know existed.

What are smart actions communities can take?
There are a number of steps we can take now:

  • All critical communications need to be ready, in advance, in the languages the local populations speak.
  • We can do a better job of monitoring rapid shifts in the direction and levels of wildfire smoke using now available low-cost portable monitors. And, again, make sure we have mechanisms to inform all the members of our communities about smoke exposure levels and appropriate actions to take.
  • We can establish clean air shelters, and make sure that we have respirators available for everyone, including children. Lack of availability of respirators for young children was an issue in some locations.
  • We can start providing mental health services as quickly as possible.
  • It’s really important that we make sure we have in place the means to help all of our residents, but especially those – including undocumented community members – who either aren’t eligible for a lot of assistance or who are concerned about going to government agencies because of the recent changes in immigration policy

Dr. Hertz-Picciotto – UC Davis

Please describe the project you’re working on.

The project I head up at the UC Davis Environmental Health Sciences Center is ‘Wildfires and Health, Assessing the Toll in Northern California’, which abbreviates to an acronym of WHAT-Now California.

Last fall, there were eight counties in northern California affected by these huge wildfires. The total death toll was 44 people. Close to 10,000 structures were destroyed across those counties, and nearly a quarter million acres burned.

Over 100,000 people were evacuated with the gusts from the wind of 80 miles per hour that were carrying burning embers for miles helping to spread the fire very, very rapidly. A lot of residents were awakened in the middle of the night, and there were deaths that occurred in vehicles as people were trying to flee the area and actually got trapped because of the fires.

Our group here at the University of California at Davis decided that this was the type of disaster where some research could help to understand both the acute and short-term impacts, and also long-term impacts on health. Our project goals are to understand the experiences and needs of those who were affected directly.

There’s acute exposure to the first responders and also to the residents. Post-fire, the residents often are trying to sift through the remains of their homes to find what might not have burned, an action that can result in further exposures because people are shaking up the debris and the smallest and most damaging particles become aerosolized.

How did you develop the survey? What data are you collecting?
We worked closely with Napa and Sonoma County Health Departments to design the survey.  One of the goals of the survey was to obtain information that could be helpful in assisting county health departments and communities, medical professionals and NGOs in understanding, and being able to meet, needs – some in the immediate aftermath, but especially the long-term needs that people have, which has not been well- documented or studied.

So, we have questions in the survey addressing those sorts of issues. We’ve also collected ash samples even as some of the fires were still burning at the very end of October. We’re looking at those ash samples with some very state-of-the-art chemical analysis techniques to identify what is in the ash and how does it differ from what is measured and known about ash from typical forest and grassland fires. That’s another component of the project. We also had some air samplers placed a distance away from those wildfires.

And, again, they spread very far, so although a major focus is on the eight counties that had fires, really virtually all of Northern California counties were affected. So, our survey is actually for people anywhere north of the San Francisco Bay Area to complete.

The main goal is to understand the health consequences, and that’s including both physical and mental health. We’re also planning to follow people up long-term, so we have cohorts that we’re putting together from those who complete the survey and agree to be contacted for further follow-up.

What is the methodology?
The components of the project include an online survey, and we will be doing a door to door survey using methods that the CDC uses to sample and obtain a representative sample. We know that people who are most affected were more likely to take the online survey than people for whom the fire had more of a light touch.

We will be describing impact on different neighborhoods with the geographic information that people provide. So, we ask for addresses, but if people do not want to reveal their addresses, we ask them to provide an intersection that is within a five-minute walk of their home. And, we will be looking at the sociodemographic factors that might, in fact, have an impact on how long the recovery is and how long the health effects might be seen. We will characterize how sociodemographic factors influence the long-term impacts of the wild fires and the smoke exposures.

We’ll be collecting blood samples from a subset of people and assessing women who are pregnant and we’ll be able to follow those children. We’re looking at both ash and the air samples, looking at the chemical composition. One of our Center members has been working with some local food producers, and people with home gardens to see whether, for instance, the chicken eggs are contaminated with any of the chemicals that would be uniquely generated by this kind of wildfire.

The survey covers the basic information about the households, adults, and children in the household. For the people who were evacuated, how far did they go from where the fires were? What was the quality of the shelters that they were in if they were in shelters? We ask about their needs, their most important needs, about three weeks after the fire.

We ask about handling debris. We ask about employment status, whether they lost their job or lost income as a result of the fire. And their health status before, during, and since..

We have so far over 1,600 respondents from 16 counties, which includes all 8 of those with the severe wildfires. Some of the preliminary results:

  • Of the evacuees, 15% relocated to more than three locations in the first six weeks. About two-thirds have returned to their home at the time that they took the survey, which means close to a third had not.
  • Sixty-two percent said that their homes were not damaged, but for 12%, their home was completely destroyed.
  • Twenty-three percent lost cellphone service coverage for two or more days.
  • Ten-percent were without safe drinking water for two or more days.

We asked about concerns, and this list of concerns was cited by quite a few people: air quality, contamination, health concerns, questions about the safety of their locally grown produce, contamination of the soils, water quality, and what people can do to protect themselves and their families from the long-term fire related exposures.

Many respondents discussed a variety of different kinds of health effects, both respiratory and mental health, and quite clearly the populations in these counties experienced a lot of anxiety, increased depression, and respiratory problems. We are now planning to go back for further follow-up. Our pulmonologist is quite interested to see how many people who never had any prior respiratory conditions may be having symptoms that are lingering, and are there new onset cases, for example, of asthma.

We are intending to follow the survey participants for at least five years to see what are the long-term health effects, and how they differ across different communities.

Recently I made a trip up to Butte County, one of the further North counties. Located in the foothills of the Sierras, they have had more fires than typical counties, and they have a whole community project working on building fire brakes around schools and neighborhoods and throughout the whole region as preparation and prevention for future fires, to reduce the impact.

Dr. Hertz-Picciotto, M.P.H, Ph.D, Professor at the University of California Davis MIND Institute and Director of the NIH-funded UC Davis Environmental Health Sciences Center, is an environmental epidemiologist with over 300 scientific publications addressing environmental exposures, including metals, pesticides, air contaminants and endocrine disrupting compounds; their interactions with nutrition, genes or social factors; and their effects on pregnancy, the newborn, and child development. She designed and directs CHARGE (Childhood Autism Risk from Genes and Environment), the first large, comprehensive population-based study of environmental factors in autism, and MARBLES (Markers of Autism Risk in Babies – Learning Early Signs) to search for early markers that will predict autism, starting in pregnancy. Hertz-Picciotto has also led several cohort studies of toxic chemicals and both pregnancy outcomes and early child development in Mexico, Chile, and eastern Europe. She has served on scientific advisory panels for the U.S. Environmental Protection Agency, the NIH National Toxicology Program, and the California Governor’s Proposition 65 committee. She was elected President of two major professional epidemiology societies, and chaired four National Academy of Sciences/Institute of Medicine Panels on: Agent Orange and Vietnam Veterans, and Breast Cancer and the Environment. Dr. Hertz-Picciotto has taught epidemiologic methods on four continents and mentored over 75 graduate students and postdoctoral scholars. In 2011, she received the Goldsmith Lifetime Achievement Award from the International Society for Environmental Epidemiology. Recently she co-founded (with the Learning Disabilities Association) Project TENDR (Targeting Environment and Neuro-Developmental Risks), a collaborative effort of scientists, clinicians, policy-makers and advocates that aims to decrease the incidence of neurodevelopmental disorders by reducing neurotoxicant exposures that contribute to them.

Dr. Rudolph, MD, MPH, is the Director of the Center for Climate Change and Health at PHI. She also provides consultation to local jurisdictions to advance implementation of Health in All Policies, and participates internationally in training and consultation related to HiAP and climate change and health. Previously, Rudolph served as the deputy director for Chronic Disease Prevention and Public Health in the California Department of Public Health, and the health officer and public health director for the City of Berkeley, CA. While at CDPH, Rudolph served as founding chair of the Strategic Growth Council’s Health in All Policies Task Force and the California Climate Action Team’s Public Health Work Group. Rudolph has also served as chief medical officer for Medi-Cal Managed Care, medical director for the California Division of Workers’ Compensation, and a physician for the Oil, Chemical, and Atomic Workers’ International Union. Rudolph received her MD from the University of California, San Francisco, and MPH (Epidemiology) from UC Berkeley. She is board certified in Occupational Medicine.

6/25/18

Photo Credit: Mark Ralston, AFP/Getty Images

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