This is the disaster scenario the Bay Area has been dreading since March. Wildfires, awful air quality and the coronavirus pandemic are combining to strain public health resources stretched impossibly thin.
The potential for respiratory catastrophe looms large on two fronts. Fires are ringing the nine counties and thick smoke blankets the region. The coronavirus still is circulating widely, with more than 1,000 new cases reported most days. The added air pollution could make matters worse, experts said.
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Meanwhile fire-related evacuations in nearly every Bay Area county are creating additional public health difficulties, from how to keep people socially distant in shelters to finding hotel rooms and other safe spaces to house those who need them.
And there are other challenges. Firefighters may face increased risk of contracting the coronavirus while living and working in close quarters on the front lines. In hospitals and evacuation shelters across the region, people suffering smoke exposure may have symptoms that could be confused for COVID-19, complicating care and draining resources.
“These are all cascading catastrophes. We’re looking at the consequences of these overlapping emergencies,” said Dr. Matt Willis, the Marin County health officer. “We had been concerned there might be a fire here or there. And now we’re dealing with fires everywhere. And while we’re still seeing all this viral transmission.”
And on top of it all, everyone’s exhausted.
“We’re at that point of time where you’re just numb dealing with crises,” said Dr. Bela Matyas, the health officer in Solano County, where thousands have been evacuated this week due to several large, threatening fires. “But it’s an emergency. You don’t really think, you just do. And people are stepping up.”
For many health experts, the most pressing issue is whether the poor air quality from wildfire smoke will exacerbate symptoms of COVID-19, or lead to more coronavirus infections, potentially driving up transmission and sending more people to hospitals even as the Bay Area struggles to quash a summer surge in cases.
Even if the air pollution doesn’t directly cause more severe illness, infectious disease experts said the increased coughing, sneezing and other reactions to smoke exposure could make it easier for the coronavirus to spread.
There is evidence that air pollution is tied to increased risk of coronavirus infection and more serious illness, but those studies are preliminary and more research is needed, infectious disease experts said. Other studies have found that exposure to wildfire smoke can lead to excess cases of influenza and other respiratory infections weeks later.
“There’s a model that showed a moderate wildfire smoke episode, which this is more than moderate, could increase the number of COVID-19 cases and deaths by about 10%,” said Dr. Mary Prunicki, director of Air Pollution and Health Research at Stanford’s Parker Center for Allergy and Asthma Research, referring to a disease model developed by Canadian scientists.
Prunicki noted that models, like weather forecasts and other predictive tools, can be unreliable. Still, she said, “there’s good reason to worry that these wildfires are going to impact how people are susceptible to COVID, and the severity if they do get it.”
Previous studies of wildfire smoke exposure have found that the small particulates people inhale can damage not just the lungs, but the body’s immune response, which can then have further negative effects, said Dr. John Balmes, who studies the health effects of air pollutants at the Human Exposure Laboratory at UCSF.
“We’re very worried about wildfire smoke exposure and a raging viral pandemic,” Balmes said during a news briefing Thursday. “My advice to the public is that people should be sheltering in place as much as possible.”
That advice is consistent across current crises. But in other ways, the messages for how people should behave in a fire compared to a pandemic are conflicting, and that can make the jobs of health officials more difficult.
In a pandemic, people are told that outdoor activities are better than inside. But with smoke choking the region, everyone’s being told to stay inside now. People evacuated from their homes often are urged to stay with friends or relatives if they can. But that’s not necessarily a wise choice now, either, when the pandemic message is to avoid others.
Masks, too, are a confusing topic: Across the state people have been told to wear face coverings outside to protect themselves and others from the coronavirus, but those masks do little or nothing to protect people from the smoke. N95 masks, which are effective at stopping tiny particulates found in smoke, would help, but those need to be saved for doctors and nurses at the front lines of the pandemic.
“The truth is that the normal reactions for this wildfire scenario are unfortunately contrary to what we need to do for COVID,” said Matyas. “So we have to find more elaborate solutions.”
In Solano County, Matyas said he’s suggested that evacuees live out of their vehicles for a night or two if they have a place to park and feel safe. Another solution has been to open more shelters — seven at the moment, when normally they would have only two — so that conditions aren’t so crowded. But that requires more staff.
“That’s a lot more impact on our bandwidth when we’re already thin,” he said. “Plus, many of the people who show up at shelters are coughing and feeling poorly from the smoke, which mimics COVID symptoms, so you have to distinguish between COVID and smoke and do more screening. And that utilizes even more personnel,” he said.
Counties also are running out of hotel rooms for evacuees, due to pandemic- and fire-related factors. Matyas said Solano County hotels already were full of Napa County residents fleeing fires before Vacaville was evacuated. Willis in Marin County said his hotels are close to full, as well, in part because of people who are in quarantine due to COVID-19. On Thursday, Santa Cruz County ordered all tourists to leave to help free up hotel rooms for local evacuees.
And at the back of everyone’s minds is the recognition that it’s only August. Three or more months of fire season still lie ahead, plus whatever the fall brings for the pandemic. Even before these fires, public health officials have been concerned about a new wave of infection later this year.
“We are in this perfect storm of a lot of uncertainty with not a ton of reassurance that things are going to get substantially better in the next few months,” said Dr. Jahan Fahimi, medical director of UCSF’s emergency room.
Dr. John Swartzberg, an infectious disease expert with UC Berkeley, said he worries about the collective resilience of the region, and how well people will cope with increasing stress, isolation and public health demands.
“It feels like we’re being visited by a variety of plagues right now,” Swartzberg said. “And your response can be overwhelmed, and you throw up your arms and say, ‘I can’t deal with this.’ Or the response can be the other extreme, that this is just further argument to hunker down right now.
“But, either way, on either side of the bell curve of response, this is really depressing,” he said. “It was hard enough to cope with just COVID.”
Erin Allday is a San Francisco Chronicle staff writer. Email: firstname.lastname@example.org Twitter: @erinallday ___
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