Climate change is a contributory factor to wildfires in California this year that have engulfed 1.4 million acres of land. Most recently, lightning strikes sparked new fires in Northern California, including the L.N.U. Lightning Complex (currently the third largest fire in California history). Wildfires contribute to poor health outcomes and disrupt care delivery. In addition, the ongoing COVID-19 global pandemic compounds the stress, uncertainty, and health risks associated with the wildfires. 
As a Bay Area resident, I firsthand experienced the suffocating air quality due to increased air pollution as well as uneasiness due potential evacuation notices. As a public health graduate and medical student, I am frightened by the impacts of the wildfires on health and care delivery. Are health care systems and providers ready to address these effects?
Wildfires and human health
Wildfire smoke is a complex mixture of thousands of compounds dependent on the fuel type and temperature of the fire. Wood smoke may contain toxic and carcinogenic substances. The principal air pollutant of health concern for short-term exposure is particulate matter less than 2.5 microns in diameter (PM2.5). PM2.5 is a mixture of both solid particles and liquid droplets known to have a wide range of harmful health effects. Public health messaging on air quality in the U.S. (such as air quality alerts) relies on PM2.5 concentrations to calculate an air quality index. This information is publicly available on the U.S. Environmental Protection Agency’s AirNow website.
Exposure to PM2.5 has many negative health effects. For example, it increases risk for pulmonary, cardiovascular, neurologic, dermatologic, metabolic, and mental health conditions. The breadth of physical and mental health harms of PM2.5 raise concern of exposure to wildfire smoke. Studies have linked exposure to wildfire-associated air pollution with mortality, exacerbations of asthma and chronic obstructive pulmonary disease, cardiovascular morbidity, low birth weights, and poor mental health.
Clinicians must recognize that short-term exposure to wildfire smoke increases patients’ risk for the development, or worsening, of several conditions. They should incorporate this information into their differential diagnosis and clinical decision making. They should be aware too that children and older adults are particularly susceptible to the health impacts of wildfire-associated air pollution. In addition, providers should teach patients with chronic diseases about the importance of reducing wildfire smoke exposure.
Wildfires strain care delivery
The health threats of wildfire smoke consequently increase the demand for health care services. Wildfire smoke exposure increases emergency department visits, inpatient hospitalizations, and outpatient visits for cardiovascular, cerebrovascular, and respiratory diseases. This may strain local hospital resources and spike healthcare expenditures. And some providers may not be available to work if they temporarily evacuated during wildfires.
Wildfires affect care delivery in other ways. In California, hospitals and other health care facilities have recently been evacuated. This results in the dislocation of patients and disruption of services. Even facilities located far away from the origin of wildfires can be affected due to disruptions of supply chains (for food, water, and medications) and power grids. For example, patients dependent on equipment like ventilators or dialysis machines may not receive necessary care during power losses.
Climate-friendly and climate-resilient health care
The frequency and intensity of natural disasters like wildfires will likely increase as climate change progresses. Public health practitioners and clinicians must recognize their direct and indirect effects on human health and health systems. Also, they should note that marginalized communities face disproportionate exposure to air pollution and other risks of climate change.
We need to develop climate resilience in our health care systems to prepare for natural disasters. Hospitals and clinics should prepare plans to reallocate resources to address sudden increases in demand for services. They must prepare reserves of equipment, supplies, and power and have plans to be able to restore essential supply chains.
The health care sector as a whole must also find ways to become more sustainable. Socially-responsible health care systems should aim to reduce waste and emissions to mitigate their contribution to climate change. Opportunities include focusing on energy efficiency, improving environmental design, and building sustainable food partnerships. To educate and empower health care professionals to enact sustainable health care practices, I am collaborating with other students and faculty to organize the first virtual NorCal Symposium on Climate and Pandemic Resilience in Health Care on September 25, 2020, co-hosted by the Stanford School of Medicine and University of California, San Francisco.
COVID-19 already offers many lessons about preparedness and climate change. The wildfires in California further demonstrate why health care systems and providers must act to mitigate and prepare for climate change. The resulting health threats have been here, are here, and will increase here unless we act.
Raj Fadadu