The first thing Alison Block noticed the morning after giving birth to her third child was the smell of wildfire smoke coming through the supposedly sealed hospital windows. It was Aug. 27, 2020, and Block, a family-care physician, was at the Mission Bay medical campus of the University of California, San Francisco — “a brand-new hospital, as pristine as a hospital can be,” she says. “It smelled like something was burning. It smelled like something was on fire.” She and her husband looked outside, “and it was just this wall of smoky ash,” she says.
It was the latest in a string of extraordinary fire seasons in the state, and every morning, the first thing Block did was to reach over in bed to check her phone’s air-quality app. That morning, she says, “it was something horrible.” She says she felt an overwhelming postpartum lack of control. “In a drafty old house, you certainly can’t escape the smoke, but if you can’t even escape it in a hospital room where you just had your baby, there really is no getting away from it.” When it was time to take their daughter home from the hospital, she and her husband made a quick plan: He would pull around, and she would “cover her with one of those little car seat covers and run her as quickly as possible to the car.”
The precautions felt hopeless, even as she also knew they were irrational, Block says. “A five-minute walk to the car wasn’t going to make the difference between her having a chronic lung disease or not, but it felt like we had to at least try something to protect her tiny little newborn lungs.” On that walk, “with ash falling from the sky directly onto her, I felt I was failing her — letting her breathe that air in the first few days of life and not being able to do anything about it,” she says. “This was the exposure she was going to have because this was the day and the week and the month and the year and the place that she was born.”
At home, the whir of fans and air purifiers that the family rushed to purchase on Amazon became the baby’s first white-noise machine. They returned in the midst of the city’s Covid pandemic lockdown; now they didn’t feel safe going outside for more than a few minutes at a time.
On Sept. 9, with the baby less than 2 weeks old, the sky above San Francisco was an eerie dark amber. “‘The day that the sun didn’t rise’ is how we refer to it in our family,” Block says. “Why is it still nighttime?” her 3-year-old asked at the breakfast table.
Block turned to her husband. “We can’t live here anymore,” she said.
Two years later, they don’t. They left the Bay Area for the East Coast, where even the most neurotic among us can comfort ourselves, most days, by scrolling past the temperature and precipitation to see air-quality indexes in the low double digits. But even here, on a handful of days each fall, the air fills with particulate matter from wildfires in the West, the smoke carried thousands of miles but still dense enough to produce air-quality warnings in New York City, in Boston, in Philadelphia.
Ten years ago, Californians often feared fire, even as they lived in some uneasy accommodation to it. Now, increasingly, they fear smoke — each pyrocumulus cloud or fire tornado an airborne toxic event expanding outward from the flames. Ten years ago, coastal residents might have taken comfort in the hundreds of miles between the inland fires and their homes; now they wonder about wind patterns that might bring the particle pollution to their doors.
Then, they might have looked around their practically treeless neighborhoods and confidently told themselves, “This place doesn’t burn”; now, they know that there is no quarantining smoke, and they may also know about the degradation of health that smoke brings. Then, they might have cleared brush in the backyard, memorized evacuation routes and kept a go bag by the door; now, they follow smoke-tracking apps, install air monitors and purifiers and maybe even secure a clean air room, perhaps with the help of duct tape and fans, as was advised last year in wealthy Santa Barbara. Unlike flooding or drought or heat, the menace of smoke in the American West is not compartmentalized along class lines; in fact, as Stanford’s Marshall Burke and his research partners have documented, U.S. smoke exposure is largely uncorrelated with income.
When the Camp fire torched Paradise in 2018, burning through the entire town in just hours, it seemed hard to imagine fires producing more haunting imagery anytime soon. But just two years later, the dark orange panoramas of the 2020 season displaced it to become the ready picture of the burning West, the color almost matching the towers of the Golden Gate Bridge and the shades of flickering fires in the distance but held aloft above America’s city of the future, as though the sky itself were in flames and ready to be breathed — indeed, as though there were nothing else to breathe.
Over the past decade, smoke exposure has doubled or tripled across the American West, “just a remarkable increase,” Burke says. If you narrow the standard to extreme exposure days, with particulate concentrations at 100 micrograms per cubic meter or above, the increase is even more striking: According to his forthcoming research, there are now 27 times as many such days as there were just a decade ago. The wildfire pollution is enough to threaten the gains of the Clean Air Act, according to him — which, though it was passed five decades ago, is still saving an estimated 370,000 American lives each year. Already, he says, about 30 percent of the air quality gains of the landmark law have been undone by wildfire smoke. In 2020 such smoke accounted for roughly half of the air pollution in the Western United States, which means that, on that side of the Rockies, as much toxic smog was coming from wildfires as from all human activity combined.
That smoke is the focus of a growing subfield of research into the damage of air pollution, especially a level of particulate matter called PM2.5, which is the main component of wildfire smoke. Unlike other forms of air pollution, smoke can kill you immediately if you inhale it. While rare among average residents, death from smoke inhalation is common among wildland firefighters, who also suffer significantly higher rates of death from lung cancer and cardiovascular disease. For residents, even short-term exposure to wildfire smoke can worsen bronchitis, asthma, chronic obstructive pulmonary disease and other respiratory diseases, as well as trigger heart attacks, heart failure and strokes. In an enormous longitudinal study published this May in The Lancet, those living within 30 miles or so of even a single wildfire were, over 20 years, nearly 5 percent more likely to develop lung cancer and 10 percent more likely to develop brain tumors.
As research into the health effects of wildfire smoke expands and deepens, it would not be surprising to see it linked to nearly all the negative outcomes to which PM2.5 pollution has already been linked: cuts to cognitive performance and economic productivity; increases in rates of Alzheimer’s, Parkinson’s and dementia; worse memory, attention and vocabulary; episodes of mental illness, depression, suicide and self-harm; miscarriage, premature birth and low birth weight; pediatric leukemia, kidney cancer, eye tumors and even degenerating eyesight.
These effects aren’t enormous, and the level of absolute risk to any individual means it is somewhat innumerate to think of wildfire smoke as a manifestation of death itself at the door. But the distributed nature of the damage also illustrates what I’ve started to think of as the rule of little numbers in a big world. Perhaps a novel disease kills fewer than 1 percent of those infected, but when billions get sick, the death toll becomes world historical. Perhaps you are breathing air layered with wildfire smoke only several weeks each year, and perhaps the risks to your health are only on the margins — 10 percent here, 5 percent there. But when the same is true for 78 million Americans living across the West (not to mention tens of millions more in Canada, Australia, Siberia and, increasingly, the Mediterranean), the damage mounts. In the years to come, more land will burn in more places, sending off more smoke. Almost all of us, almost everywhere, will be breathing more of it and dealing with the consequences.
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Your home may feel like a fortress, and staying indoors forms the basis of public health guidance about managing them. But just how safe you are inside is not so easy to predict. In a recent paper on the social response to smoke, Burke found a 20-fold variation in levels of infiltration among the homes they studied — mostly expensive places in the Bay Area outfitted with air monitors — but also discovered that almost none of that variation could be reduced to income, home price or neighborhood demographics. Living in a nice new build wasn’t enough, in other words. Closing doors and windows helps, of course, but even in houses designed to be almost leakless for reasons of energy efficiency, smoke can come in through dryer vents, oven hoods and HVAC systems.
“In very wealthy parts of the Bay Area peninsula,” Burke says, “we see some houses that are very good at protecting their indoor environment — the indoor air stays quite clean. And we see others, just like my house before we added extra filtration, that spike way above 100 micrograms or even 200 micrograms on days when smoke exposure is really bad.” For reference, the World Health Organization’s 24-hour exposure standard is just 15 micrograms; registering 100 or 200 indoors is a major problem. “These are some of the wealthiest people in the country,” Burke says. “We can tell because we can see their home price. And their indoor air quality is absolutely atrocious.”
All this may make you feel quite powerless as you watch smoke from the next fire complex approach. But Burke is more hopeful: Since indoor exposure isn’t just a reflection of the quality of housing stock, he says, common-sense measures can bring many more California homes up to the infiltration standards of the best-performing ones. One is simply lowering the bar for precaution. People are often better at limiting infiltration on days when smoke exposure is highest but appear to do much less when the air quality is still unhealthy but not off the charts. Keeping a couple of air purifiers running on even moderate smoke days can help enormously and will surely soon be close to universal among California’s well-off and climate conscious. Over the long run, he says, the goal should be to reduce the draftiness of all newly built houses and make sure that all people, no matter their income, have access to indoor filtration.
But of course, the long run is also a harrowing timeline for fire in the West, which is projected, even by conservative estimates, to grow substantially in the decades ahead. The 15 largest fires in modern California history have burned since 2003, and six of the seven largest since 2020. Last year was a relatively quiet season in the state, and this year has been so far, too, though the scariest period is arriving only now. But across the broader West, nearly six million acres burned this year through July — the third most on record.
Just a few years ago, fire scientists thought that the burn scars of all these megafires and gigafires might help check future spread, theorizing that it would take a while for the landscape to recover and that what would grow back could prove less flammable than what burned originally. But that impact appears to be quite small. Patches of forest that burned just in the past decade are now burning again already and sending off smoke.
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David Wallace-Wells (@dwallacewells), a writer for Opinion and a columnist for The New York Times Magazine, is the author of “The Uninhabitable Earth.”
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