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Wildfire smoke in New York: adapting to a new respiratory reality

Haillie Meek, Centers for Disease Control and Prevention, NY, USA
This summer, unusual wildfire smoke events occurred in New York. To learn more about these events in relation to health issues, and asthma in particular, Medicom talked to Ms Haillie Meek, who is an Epidemic Intelligence Service (EIS) Officer for the CDC.

As a field officer, she is assigned to the New York State Department of Health. Most of her work has been in infectious diseases but being an EIS officer means to respond to any emerging health threats. Ms Meek worked with a team of environmental scientists and asthma experts to understand the health effects of this summer’s wildfire smoke events.
Medicom: Could you describe what the wildfire situation was earlier this summer?

“Wildfires are usually more associated with the western half of the United States, but earlier this summer there were very large and unseasonably early wildfires burning in eastern Canada,” explained Ms Meek. “In early June, the weather pattern brought a considerable amount of smoke down to New York State and affected other states on the East Coast as well. It was apparent at the time; the sky turned red, and the smell was obvious when you went outside. We wanted to understand more about the health effects of these events and our study particularly focused on the first time it happened, from June 6th to 8th.”
Medicom: Could you outline the different elements of the study?

“It was our goal to get a snapshot of the wildfire smoke event and understand the immediate health effects,” answered Ms Meek. “For our outcome, we looked at emergency department (ED) visits associated with asthma. We chose asthma because the effects of wildfires on asthma are immediate and apparent. The purpose was to share our data quickly, so that the public could understand the immediate outcomes. Certainly, there is more work to be done to get a more comprehensive understanding of all the health outcomes.”

“We looked at the study period from June 1st to June 14th of 2023, with this first event really happening from June 6th to June 8th,” Ms Meek outlined the methodology. “New York State is divided up into 8 air quality regions and we observed air monitor data from 1 monitor in each of those regions. The specific pollutant we were looking at is ‘particulate matter with aerodynamic diameter of less than 2.5 microns,’ which is a mouthful; we refer to it as PM 2.5. That was the measure of exposure, whereas the outcome measure was the number of ED visits associated with asthma. This data could be retrieved from the New York State Department of Health Electronic Syndromic Surveillance System. This is a system that looks at ED visits in 134 out of 134 New York State EDs, outside of New York City.”
Medicom: Would you share some of your results?

“Overall, we looked at the daily mean of asthma ED visits for the period of June 1st to 5th, when air quality was normal. We compared this with the ED visits for asthma on June 7th, which was the day of peak wildfire smoke exposure. Across the state, we found that asthma ED visits increased by 82%. The number of visitations at baseline was around 81 daily visits and it increased to 147 daily visits. Moreover, we found that the increase was even larger in specific regions. In 2 of our regions, we observed a 180% increase.”
Medicom: Did the number of visitations go back down immediately following those dates? 

“State-wide they did,” confirmed Ms Meek. “However, for 1 region we saw that the peak of ED visits was 2 days after the peak wildfire smoke exposure. This is not surprising, as previous wildfire smoke data showed a lag in health effects as well. Eventually, the number of ED visits dropped back to baseline levels.”
Medicom: One of the novelties of this study is that these predisposed asthma patients haven't been exposed frequently to wildfire smoke. Can you extrapolate any of the data from the West Coast smoke exposure data?

“This study was meant to be a snapshot in time and there is a lot of work left to do to understand whether this is going to be a typical finding or not,” replied Ms Meek. “There are a lot of factors at play aside from the biological baseline exposure to wildfire smoke. For example, the behavioural aspects of the fact that it was a new and alarming event could have sent more people to the ED. We will look at all the data collected across the summer, because we had multiple additional wildfire smoke events following this first one,” added Ms Meek. “This will help us understand a little bit more what we can expect should this become a regular event.”
Medicom: Can this lead to recommendations for patients during wildfire smoke events; staying indoors or staying in more controlled environments perhaps?

“Absolutely. It's something that we all have to start thinking about, even in places where we didn't think we had to think about wildfire smoke before. Physicians can be a huge part of this, but also patients can look up the air quality at airnow.gov. This website will provide them with the current air quality index for their area. A higher index score means that air quality is worse. Depending on where the index falls, for example, air quality is marked ‘unhealthy for sensitive groups’ or ‘unhealthy for all people,’ there are various recommendations,” Ms Meek clarified.

“Essentially, as air quality gets poorer, we recommend that people try to spend more time inside. In addition, when they are inside, they should be closing windows and doors and run the air conditioning, or ideally an air filter, if they have it. Avoiding strenuous activity outdoors is another one of the recommendations. Individuals can also wear a well-fitted N95 mask. Furthermore, people with a history of respiratory disease and asthma should make sure that they have their acute asthma control medication on hand. Clinicians can discuss this issue with their patients, especially in springtime going into summer, when the chance of wildfire smoke exposure increases.”
Medicom: What are some of the next steps with regard to this dataset?

“As we divided our results into age groups, we noticed that the largest increase was in the 10-to-29-year-olds. In that group we observed a 198% increase in asthma ED visits. This means that we need to be paying special attention to those younger populations when we're seeing these wildfire smoke events.”

“Next to that, we're looking at the whole summer in addition to just this first event to gain a better understanding of other health outcomes,” Ms Meek continued. “There is evidence that exposure to wildfire smoke can exacerbate cardiovascular conditions and lead to an increase in heart attacks and strokes. That is something we will be looking at a little more closely here in New York.”

“We also aim to investigate if there are other groups being disproportionately affected by these events. For example, we will evaluate race and ethnicity data, because we often see that Black populations are most affected by wildfire smoke and other pollutants.

Besides that, occupational data may be interesting, since individuals who have occupations that require them to be outside don't have the option to go inside and protect themselves from the smoke.”
Medicom: Do you have any take-home messages you would like to share with physicians about this research and the value it might bring into daily practice? 

“If you're hearing this message and you think ‘this doesn't apply to me,’ that's what everyone in New York would have said before this summer,” Ms Meek stressed. “We know that wildfires are occurring more frequently, they are becoming larger, and they are burning hotter. When they burn hotter, the smoke can actually travel farther. Even if you haven't experienced wildfire smoke in your area, it's possible that you could in the future. It's important to know the guidelines to be able to help your patients prepare.”

“Finally, it's important to know that there are certain groups that are more sensitive to wildfire smoke events, including younger people and people who have jobs that make them work outside. Paying particular attention to patients who might be at higher risk during a wildfire smoke event is key,” concluded Ms Meek.



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