Hospital visits up during wildfires in Clark County

As the climate changes and wildfires are becoming more frequent, data and studies are starting to demonstrate how wildfire smoke can have adverse health effects, even for those who are miles away from the fire.

Clark County Public Health epidemiologist Kathleen Lovgren briefed the Clark County Board of Health at a Wednesday meeting. Public Health’s research shows that emergency department visits spiked in Clark and Multnomah counties during the 2017 Eagle Creek Fire in the Columbia River Gorge.

“Exposure to wildfire smoke can lead to exacerbations of asthma and COPD, especially from people who already suffer from those conditions,” Lovgren said. “There’s a possible association with cardiovascular events such as heart attacks and strokes and a growing body of evidence to show association with pneumonia and bronchitis and other respiratory infections. But there’s a lot more research we still need and lot more questions we have.”

The Eagle Creek Fire was started Sept. 2, 2017, by a Vancouver teenager and lasted into November. The worst air quality days during the fire occurred Sept. 4 through 6, when Lovgren said it seemed like it was raining ash outside, and air quality reached hazardous levels.

There were more than 160 asthma-related emergency department visits in Clark and Multnomah counties Sept. 5, 2017. That is about twice as many visits as there were in the days leading up to the fire.

“During this time we got a lot calls from schools, from sport leagues wondering what they should do,” Lovgren said. “Should kids be outside? Should people be running outside? So we needed to know what the health effects were, who’s most vulnerable and how we should be communicating risk.”

Lovgren said Public Health decided to track PM2.5, an air pollutant, and its correlation to asthma-related visits to the emergency department. PM2.5 can go deep into the lungs when inhaled, and even enter the bloodstream, Lovgren explained.

“We found a significant correlation between PM2.5 and the number of asthma-related visits (to the hospital). In other words, as PM2.5 increases, so do asthma-related visits,” Lovgren said.

While those emergency visits peaked during the smokiest time of the Eagle Creek Fire, Lovgren said Public Health has discovered that there is a correlation between asthma-related emergency department visits and PM2.5 throughout wildfire season.

According to Columbian reporting, during a stretch of hazy days in August 2018, dozens of people were sent to Legacy Salmon Creek Medical Center and PeaceHealth Southwest Medical Center. On Aug. 20, the hospitals had 43 patients being treated for chronic obstructive pulmonary disease and asthma issues, likely tied to poor air quality.

Lovgren said there’s more research needed on how wildfire smoke effects mental health, since people should spend less time outside and less time exercising outdoors during hazy days. She also said there’s more research needed on how vulnerable populations such as the elderly and children are affected, and also whether there are perinatal affects, and if the homeless population and outside workers are harmed from PM2.5.

“This is just one look into the possible effects of wildfire smoke on our communities,” Lovgren said. “Our next steps we want to do are possibly to look at other conditions like cardiovascular events and maybe drill down into vulnerable populations like age groups and the homeless … and then use this knowledge to create the tools and resources for schools and health care facilities to help communicate the risk of wildfire smoke on health.”

Marissa Armstrong, Clark County Public Health’s public information officer, has been working with the Wildfire Smoke Impacts Advisory Group, which was created last year and is spearheaded by the Washington State Department of Health. Local health jurisdictions, the University of Washington, the Department of Ecology and tribal communities are part of the group.

There are three workgroups focusing on different areas such as developing guidance for low-cost air quality sensors that can be used to make health decisions, developing a custom toolkit for local outreach and communication, and developing guidance for school and outdoor event closures, according to a Public Health PowerPoint.

“One thing that state and local jurisdictions realized after last wildfire season is that there is not a lot of consistency and everyone is acting independently and making their own decisions and doing what’s best for their community, but it could vary wildly from one part of the state to the other,” Armstrong said.