Wildland firefighter exposure to smoke and COVID-19: A new risk on the fire line

Respiratory Diseases Associated With Wildfire Exposure in Outdoor Workers

Wildfires, including forest fires, bushfires, and landscape fires, have become increasingly prevalent, fueled by climate change and environmental factors and posing significant challenges to both ecosystems and public health. This review article examines the relationship between wildfires and respiratory diseases in outdoor workers, with a main focus on airway disease. In addition to the expected effects of direct thermal respiratory injuries and possible carbon monoxide poisoning, there are associations between wildfires and upper and lower respiratory effects, including infections as well as exacerbations of asthma and chronic obstructive pulmonary disease. A few studies have also shown an increased risk of new-onset asthma among wildfire firefighters. Outdoor workers are likely to have greater exposure to wildfire smoke with associated increased risks of adverse effects. As wildfires become increasingly prevalent globally, it is crucial to understand the various dimensions of this association. Furthermore, this review addresses preventive measures and potential interventions to alleviate the airway burden on individuals during and after work with wildfires events.

Attitudes and Beliefs of Wildland Firefighters Toward Occupational Health Services

CONTEXT

Wildland firefighters (WLFFs) are at an increased risk of health conditions, injuries, and illnesses related to sustained levels of intense physical activity. The purpose of this study was to identify and explore the current attitudes and beliefs of WLFFs regarding health services. Methods: We used consensual qualitative research design for this study. Participants engaged in an online, semistructured interview. Results: We identified four domains: (1) risk mitigation strategies, (2) culture of fire services, (3) access to health care services, and 4) identification of health care gap. Conclusions: Access to occupational health services for WLFFs is readily available in the form of emergency medical care. However, a lack of regular access to physical medicine and the continuation of care beyond acute treatment was apparent.

Elucidating regulatory processes of intense physical activity by multi-omics analysis

BACKGROUND

Physiological and biochemical processes across tissues of the body are regulated in response to the high demands of intense physical activity in several occupations, such as firefighting, law enforcement, military, and sports. A better understanding of such processes can ultimately help improve human performance and prevent illnesses in the work environment.

METHODS

To study regulatory processes in intense physical activity simulating real-life conditions, we performed a multi-omics analysis of three biofluids (blood plasma, urine, and saliva) collected from 11 wildland firefighters before and after a 45 min, intense exercise regimen. Omics profiles post- versus pre-exercise were compared by Student's t-test followed by pathway analysis and comparison between the different omics modalities.

RESULTS

Our multi-omics analysis identified and quantified 3835 proteins, 730 lipids and 182 metabolites combining the 3 different types of samples. The blood plasma analysis revealed signatures of tissue damage and acute repair response accompanied by enhanced carbon metabolism to meet energy demands. The urine analysis showed a strong, concomitant regulation of 6 out of 8 identified proteins from the renin-angiotensin system supporting increased excretion of catabolites, reabsorption of nutrients and maintenance of fluid balance. In saliva, we observed a decrease in 3 pro-inflammatory cytokines and an increase in 8 antimicrobial peptides. A systematic literature review identified 6 papers that support an altered susceptibility to respiratory infection.

CONCLUSION

This study shows simultaneous regulatory signatures in biofluids indicative of homeostatic maintenance during intense physical activity with possible effects on increased infection susceptibility, suggesting that caution against respiratory diseases could benefit workers on highly physical demanding jobs.

Weight Status and Binge Drinking Among Male and Female Florida Firefighters

OBJECTIVE

The aim of the study is to examine the association between weight status and binge drinking among Florida firefighters.

METHODS

Health survey data collected between 2015 and 2019 among Florida firefighters participating in the Annual Cancer Survey were analyzed for weight class (healthy, overweight, obese) and binge-drinking behaviors. Binary logistic regression models were fit and stratified by sex while controlling for sociodemographic and health characteristics.

RESULTS

Among 4002 firefighter participants, 45.1% binge drink, 50.9% are overweight, and 31.3% are obese. Among male firefighters, being overweight (adjusted odds ratio = 1.34; 95% confidence interval = 1.10-1.64) or obese (1.29; 1.04-1.61) was significantly associated with binge drinking compared with healthy weight counterparts. In female firefighters, being obese (2.25; 1.21-4.22) was significantly associated with binge drinking but being overweight was not.

CONCLUSIONS

Being overweight or obese is selectively associated with binge drinking among male and female firefighters.

Factors Influencing Infection Anxiety in Korean Male Firefighters Due to COVID-19 Infection Status

This paper describes descriptive research to identify the effects of job stress, COVID-19 self-care behavior, and COVID-19 vaccination status according to the infection and non-infection of COVID-19 on anxiety about the COVID-19 infection among firefighters in South Korea. Data from 205 firefighters working at 10 fire stations were collected from 26 January to 16 February 2023. The variables used were job stress, COVID-19 self-care behavior, COVID-19 vaccination status, and COVID-19 infection anxiety. The collected data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation coefficient, and multiple linear regression. In subjects who were infected with COVID-19, the factors that significantly affected infection anxiety were job stress (β = 0.247, p = 0.011) and self-care behavior (β = 0.343, p = 0.011). In subjects who were not infected with COVID-19, the factors that significantly affected infection anxiety were marriage status (unmarried) (β = -0.260, p = 0.005) and self-care behavior (β = 0.374, p = 0.001). These results demonstrate that the infection anxiety of firefighters should be prevented, and their physical and mental health should be promoted by considering job stress, self-care behavior, and personal environment.

Assessment of coarse, fine, and ultrafine particulate matter at different microenvironments of fire stations

The concentrations of respirable particulate matter (PM) and the impact on indoor air quality in occupational settings remains poorly characterized. This study assesses, for the first time, the cumulative and non-cumulative concentrations of 14 fractions of coarse (3.65-9.88 μm), fine (0.156-2.47 μm), and ultrafine (0.015-0.095 μm) PM inside the garage of heavy vehicles, firefighting personal protective equipment' storage room, bar, and a common area of seven Portuguese fire stations. Sampling campaigns were performed during a regular work week at the fire stations. Levels of daily total cumulative PM ranged from 277.4 to 413.2 μg/m³ (maximum values of 811.4 μg/m³), with the bar (370.1 μg/m³) and the PPE' storage room (361.3 μg/m³) presenting slightly increased levels (p > 0.05) than the common area (324.8 μg/m³) and the garage (339.4 μg/m³). The location of the sampling site, the proximity to local industries and commercial activities, the layout of the building, the heating system used, and indoor sources influenced the PM concentrations. Fine (193.8-301.0 μg/m³) and ultrafine (41.3-78.2 μg/m³) particles were predominant in the microenvironments of all fire stations and accounted for 71.5% and 17.8% of daily total cumulative levels, respectively; coarse particles (23.3-47.1 μg/m³) represented 10.7% of total PM. The permissible exposure limit (5.0 mg/m³) defined by the Occupational Safety and Health Organization for respirable dust was not overcome in the evaluated fire stations. Results suggest firefighters' regular exposure to fine and ultrafine PM inside fire stations which will contribute to cardiorespiratory health burden. Further studies are needed to characterize firefighters' exposure to fine and ultrafine PM inside fire stations, identify main emission sources, and evaluate the contribution of exposures at fire stations to firefighters' occupational health risks.

Wildfire Variable Toxicity: Identifying Biomass Smoke Exposure Groupings through Transcriptomic Similarity Scoring

The prevalence of wildfires continues to grow globally with exposures resulting in increased disease risk. Characterizing these health risks remains difficult due to the wide landscape of exposures that can result from different burn conditions and fuel types. This study tested the hypothesis that biomass smoke exposures from variable fuels and combustion conditions group together based on similar transcriptional response profiles, informing which wildfire-relevant exposures may be considered as a group for health risk evaluations. Mice (female CD-1) were exposed via oropharyngeal aspiration to equal mass biomass smoke condensates produced from flaming or smoldering burns of eucalyptus, peat, pine, pine needles, or red oak species. Lung transcriptomic signatures were used to calculate transcriptomic similarity scores across exposures, which informed exposure groupings. Exposures from flaming peat, flaming eucalyptus, and smoldering eucalyptus induced the greatest responses, with flaming peat grouping with the pro-inflammatory agent lipopolysaccharide. Smoldering red oak and smoldering peat induced the least transcriptomic response. Groupings paralleled pulmonary toxicity markers, though they were better substantiated by higher data dimensionality and resolution provided through -omic-based evaluation. Interestingly, groupings based on smoke chemistry signatures differed from transcriptomic/toxicity-based groupings. Wildfire-relevant exposure groupings yield insights into risk assessment strategies to ultimately protect public health.

Evaluation of Mass Spectrometric Methods for Screening Polycyclic Aromatic Hydrocarbons in the Particulate Phase of Wildfire/Biomass Smoke

Polycyclic aromatic hydrocarbons (PAHs) are a class of compounds containing multiple aromatic rings formed during incomplete combustion. Since many of them are known mutagens and carcinogens, PAHs found in the particulate matter (PM) from the wildfire smoke may pose significant health risks to the wildland firefighters. It is pivotal to determine the levels of PAHs in the PM to evaluate the health effects of their inhalation exposure. However, the determination of PAHs using the conventional chromatographic approaches is often time-consuming and laborious. Herein, we describe a novel method for screening nonpolar and polar PAHs in the PM of smoke by direct analysis in real-time mass spectrometry (DART-MS). PM2.5 and PM10 samples were collected on the quartz filters with a sampling system consisting of a cascade impactor with a portable sampling pump. Various indoor and outdoor experiments from biomass burns were conducted to evaluate the PM sampling systems. PAHs were analyzed by DART-MS and gas chromatography-mass spectrometry (GC-MS) methods. The PM samples were collected in California during the wildfire season of fall 2020, and significant levels of multiple nonpolar PAHs and polar PAHs were detected. Overall, the DART-MS method has shown promising ability for high-throughput screening of PAHs in the PM of smoke. Further studies are currently under way to apply this method to study the particulate phase PAH exposures of wildland firefighters during their firefighting activities.

Lifestyle and environmental factors may induce airway and systemic inflammation in firefighters

Health status depends on multiple genetic and non-genetic factors. Nonheritable factors (such as lifestyle and environmental factors) have stronger impact on immune responses than genetic factors. Firefighters work is associated with exposure to air pollution and heat stress, as well as: extreme physical effort, mental stress, or a changed circadian rhythm, among others. All these factors can contribute to both, short-term and long-term impairment of the physical and mental health of firefighters. Increased levels of some inflammatory markers, such as pro-inflammatory cytokines or C-reactive protein (CRP) have been observed in firefighters, which can lead to local, acute inflammation that promotes a systemic inflammatory response. It is worth emphasizing that inflammation is one of the main hallmarks of cancer and also plays a key role in the development of cardiovascular and respiratory diseases. This article presents possible causes of the development of an inflammatory reaction in firefighters, with particular emphasis on airway inflammation caused by smoke exposure.

Wildfire, Smoke Exposure, Human Health, and Environmental Justice Need to be Integrated into Forest Restoration and Management

PURPOSE OF REVIEW

Increasing wildfire size and severity across the western United States has created an environmental and social crisis that must be approached from a transdisciplinary perspective. Climate change and more than a century of fire exclusion and wildfire suppression have led to contemporary wildfires with more severe environmental impacts and human smoke exposure. Wildfires increase smoke exposure for broad swaths of the US population, though outdoor workers and socially disadvantaged groups with limited adaptive capacity can be disproportionally exposed. Exposure to wildfire smoke is associated with a range of health impacts in children and adults, including exacerbation of existing respiratory diseases such as asthma and chronic obstructive pulmonary disease, worse birth outcomes, and cardiovascular events. Seasonally dry forests in Washington, Oregon, and California can benefit from ecological restoration as a way to adapt forests to climate change and reduce smoke impacts on affected communities.

RECENT FINDINGS

Each wildfire season, large smoke events, and their adverse impacts on human health receive considerable attention from both the public and policymakers. The severity of recent wildfire seasons has state and federal governments outlining budgets and prioritizing policies to combat the worsening crisis. This surging attention provides an opportunity to outline the actions needed now to advance research and practice on conservation, economic, environmental justice, and public health interests, as well as the trade-offs that must be considered. Scientists, planners, foresters and fire managers, fire safety, air quality, and public health practitioners must collaboratively work together. This article is the result of a series of transdisciplinary conversations to find common ground and subsequently provide a holistic view of how forest and fire management intersect with human health through the impacts of smoke and articulate the need for an integrated approach to both planning and practice.

Investigation of COVID-19 Outbreak among Wildland Firefighters during Wildfire Response, Colorado, USA, 2020

A COVID-19 outbreak occurred among Cameron Peak Fire responders in Colorado, USA, during August 2020–January 2021. The Cameron Peak Fire was the largest recorded wildfire in Colorado history, lasting August–December 2020. At least 6,123 responders were involved, including 1,260 firefighters in 63 crews who mobilized to the fire camps. A total of 79 COVID-19 cases were identified among responders, and 273 close contacts were quarantined. State and local public health investigated the outbreak and coordinated with wildfire management teams to prevent disease spread. We performed whole-genome sequencing and applied social network analysis to visualize clusters and transmission dynamics. Phylogenetic analysis identified 8 lineages among sequenced specimens, implying multiple introductions. Social network analysis identified spread between and within crews. Strategies such as implementing symptom screening and testing of arriving responders, educating responders about overlapping symptoms of smoke inhalation and COVID-19, improving physical distancing of crews, and encouraging vaccinations are recommended.

Effect of fire spread, flame characteristic, fire intensity on particulate matter 2.5 released from surface fuel combustion of Pinus koraiensis plantation- A laboratory simulation study

PM2.5 is one of major pollutants emitted from forest fires. High PM2.5 concentration not only affects short-term human respiration health, but also poses a long-term threat to human cardiopulmonary functionality. Therefore, it is of great importance to quantitatively assess the PM2.5 released by forest combustion in forest fire studies. In this study we examine relationships between the PM2.5 concentration and environment and fuel characteristics laboratory experiments. In the experiments, fuel beds with controlled moisture contents and loads were first built; then 144 ignition experiments were conducted for various combinations of wind speeds using a wind tunnel device. Fire behavior characteristics and PM2.5 concentrations released from fuel combustion were measured and analyzed. The experimental results show that the relationship between fire characteristics, fire intensity and the influencing factors of wind speed, fuel moisture content, and fuel load can be explained by the fundamental theory of forest combustion. Although PM2.5 concentration rises with the increase of wind speed, the decrease of fuel moisture content, and the increase of fuel load, there appears to be a fuel load threshold for a given combination of wind speed and fuel moisture content that the increase of PM2.5 concentration decelerates quickly after the load passes the threshold value. After screening fire behavior characteristics that affect PM2.5 concentration, we found that fire line intensity and flame width are the ones with the strongest association with the concentration. With flame width as independent variable, we have built two regression models to predict PM2.5 and fire line intensity which are treated as dependent variable; the models have high accuracy with R2 = 0.92 for predicting PM2.5 and R2 = 0.97 for predicting fire line intensity. Study results can be used as reference to protect the health of forest fire fighters, and can be helpful for forest fire smoke management.

Portuguese Volunteer Firefighters in the Context of the Challenges Posed by the COVID-19 Pandemic

The COVID-19 pandemic is producing not only epidemiological consequences on a global scale, but also political, economic, and social repercussions. The health care professionals that have been on the front lines fighting the pandemic need the support and assistance of other organizations to meet the many daily challenges. Volunteer firefighters stand out for their outreach approach and implementation of the Human2Human paradigm that has enabled them to meet the needs of the most vulnerable population that have been hit the hardest by the pandemic. This study adopts an ethnographic-action method considering Portuguese volunteer firefighters to explore the characteristics and relevance of these initiatives in areas such as combating isolation, medical assistance, containing the spread of COVID-19, and promoting public–private partnerships. The findings reveal that factors associated with altruism are central elements in the emergence of these initiatives, although some locally or nationally coordinated initiatives have been replicated in other contexts. It is also noteworthy that volunteer firefighters also present initiatives that can be fit into more than one category.

Modeling the systemic risks of COVID-19 on the wildland firefighting workforce

Wildfire management in the US relies on a complex nationwide network of shared resources that are allocated based on regional need. While this network bolsters firefighting capacity, it may also provide pathways for transmission of infectious diseases between fire sites. In this manuscript, we review a first attempt at building an epidemiological model adapted to the interconnected fire system, with the aims of supporting prevention and mitigation efforts along with understanding potential impacts to workforce capacity. Specifically, we developed an agent-based model of COVID-19 built on historical wildland fire assignments using detailed dispatch data from 2016-2018, which form a network of firefighters dispersed spatially and temporally across the US. We used this model to simulate SARS-CoV-2 transmission under several intervention scenarios including vaccination and social distancing. We found vaccination and social distancing are effective at reducing transmission at fire incidents. Under a scenario assuming High Compliance with recommended mitigations (including vaccination), infection rates, number of outbreaks, and worker days missed are effectively negligible, suggesting the recommended interventions could successfully mitigate the risk of cascading infections between fires. Under a contrasting Low Compliance scenario, it is possible for cascading outbreaks to emerge leading to relatively high numbers of worker days missed. As the model was built in 2021 before the emergence of the Delta and Omicron variants, the modeled viral parameters and isolation/quarantine policies may have less relevance to 2022, but nevertheless underscore the importance of following basic prevention and mitigation guidance. This work could set the foundation for future modeling efforts focused on mitigating spread of infectious disease at wildland fire incidents to manage both the health of fire personnel and system capacity.

2021 Climate and Health Review - Uncharted Territory: Extreme Weather Events and Morbidity

Extreme weather events (EWEs) affected health in every world region during 2021, placing the planet in "uncharted territory." Portraying the human impacts of EWEs is part of a health frame that suggests public knowledge of these risks will spur support for needed policy change. The health frame has gained traction since the Paris COP21 (United Nations Climate Change Conference) and arguably helped to achieve modest progress at the Glasgow COP26. However, reporting rarely covers the full picture of health impacts from EWEs, instead focusing on cost of damages, mortality, and displacement. This review summarizes data for 30 major EWEs of 2021 and, based on the epidemiological literature, discusses morbidity-related exposures for four hazards that marked the year: wildfire smoke; extreme cold and power outages; extreme, precipitation-related flooding; and drought. A very large likely burden of morbidity was found, with particularly widespread exposure to risk of respiratory outcomes (including interactions with COVID-19) and mental illnesses. There is need for a well-disseminated global annual report on EWE morbidity, including affected population estimates and evolving science. In this way, the public health frame may be harnessed to bolster evidence for the broader and promising frame of "urgency and agency" for climate change action.

"SARS-CoV-2 is transmitted by particulate air pollution": Misinterpretations of statistical data, skewed citation practices, and misuse of specific terminology spreading the misconception

In epidemiology, there are still outdated myths associated with the spread of respiratory infections. Recently, we have witnessed the origination of a new misconception, to the effect that SARS-CoV-2 is transmitted in the open air by way of particulate air pollution (atmospheric particulate matter (PM)). There is no evidence to support the idea behind this misconception. Nevertheless, more and more people are involved in animated debate and the number of studies concerning atmospheric PM as a carrier of SARS-CoV-2 is growing rapidly. In this work, the origin of the misconception was investigated, and the published papers which have contributed to the spread of this myth were analyzed. The results show that the following factors lie behind the origin and spread of the misconception: a) The specific terminology is not always clearly defined or consistently used by scientists. In particular, the terms 'particulate matter', 'atmospheric aerosol particles', 'air pollutants', and 'atmospheric aerosols' need to be clarified, and besides they are often equated to 'infectious aerosols', 'virus-bearing aerosols', 'bio-aerosols', 'virus-laden particles', 'respiratory aerosol/droplets', and 'droplet nuclei'. b) Authors misinterpret statistical data and information from other sources. Interpretation of the correlation between PM levels and the increasing incidence and severity of COVID-19 infection, is often changed from "PM may reflect the indirect action of certain atmospheric conditions that maintain infectious nuclei suspended for prolonged periods, parameters that also act on atmospheric pollutants" to "PM could cause an increase in infectious droplets/aerosols containing SARS-CoV-2." This is a dramatic change to the meaning. Moreover, it is often not taken into account that PM may reflect activities in areas with high population density and this population density at the same time contributes to the spread COVID-19. c) Skewed citation practices. Many authors cite a hypothetical conclusion from an original study, then other authors cite the papers of these authors as primary sources. This practice leads to the effect that there are many witnesses to a 'phenomenon' that did not ever occur. Thus, the terminology used in interdisciplinary communications should be more nuanced and defined precisely. Authors should be more careful when citing unconfirmed data (and hypotheses) as well as in interpreting statistical data so as to avoid confusion and spreading false information. This is especially important now in the era of the COVID-19 pandemic.

The association of wildfire air pollution with COVID-19 incidence in New South Wales, Australia

The 2020 COVID-19 outbreak in New South Wales (NSW), Australia, followed an unprecedented wildfire season that exposed large populations to wildfire smoke. Wildfires release particulate matter (PM), toxic gases and organic and non-organic chemicals that may be associated with increased incidence of COVID-19. This study estimated the association of wildfire smoke exposure with the incidence of COVID-19 in NSW. A Bayesian mixed-effect regression was used to estimate the association of either the average PM₁₀ level or the proportion of wildfire burned area as proxies of wildfire smoke exposure with COVID-19 incidence in NSW, adjusting for sociodemographic risk factors. The analysis followed an ecological design using the 129 NSW Local Government Areas (LGA) as the ecological units. A random effects model and a model including the LGA spatial distribution (spatial model) were compared. A higher proportional wildfire burned area was associated with higher COVID-19 incidence in both the random effects and spatial models after adjustment for sociodemographic factors (posterior mean = 1.32 (99% credible interval: 1.05-1.67) and 1.31 (99% credible interval: 1.03-1.65), respectively). No evidence of an association between the average PM₁₀ level and the COVID-19 incidence was found. LGAs in the greater Sydney and Hunter regions had the highest increase in the risk of COVID-19. This study identified wildfire smoke exposures were associated with increased risk of COVID-19 in NSW. Research on individual responses to specific wildfire airborne particles and pollutants needs to be conducted to further identify the causal links between SARS-Cov-2 infection and wildfire smoke. The identification of LGAs with the highest risk of COVID-19 associated with wildfire smoke exposure can be useful for public health prevention and or mitigation strategies.

Medical Care at California Wildfire Incident Base Camps

OBJECTIVE

The California Emergency Medical Services Authority manages and deploys California Medical Assistance Teams (CAL-MAT) to disaster medical incidents in the state. This analysis reviews diagnoses for ambulatory medical visits at multiple wildland fire incident base camp field sites in California during the 2020 fire season.

METHODS

Clinical data without personal health information were extracted retrospectively from patient care records from all patients seen by a provider. Results were entered into Excel spreadsheets with calculation of summary statistics.

RESULTS

During the 2020 fire season, CAL-MAT teams deployed 21 times for a total of 327 days to base camps supporting large fire incidents and cared for 1756 patients. Impacts of heat and environmental smoke are a constant factor near wildfires; however, our most common medical problem was rhus dermatitis (54.5%) due to poison oak. All 2020 medical missions were further complicated by prevention and management of coronavirus disease (COVID-19).

CONCLUSIONS

There is very little literature regarding the acute medical needs facing responders fighting wildland fires. Ninety-five percent of clinical conditions presenting to a field medical team at the wildfire incident base camp during a severe fire season in California can be managed by small teams operating in field tents.

COVID-19 lockdowns drive decline in active fires in southeastern United States

The coronavirus pandemic, COVID-19, led to strict social-distancing guidelines that severely impacted human livelihood and economic activity. Workplace closures reduced travel, and early in spring 2020, improvements in air and water quality, reduced seismic activity, and reductions in greenhouse gas emissions were observed. COVID-19–related shutdowns emerged at the beginning of the prescribed fire season in the southeastern United States, where 80% of fires are human caused. Using active fire satellite observations and fuel treatment statistics, we estimated a 21% reduction in active fires from March to December 2020 (up to 40% on federal lands). This reduction in active fire may increase fire risk in the future and is detrimental to biodiversity and other ecosystem services inherent to fire-dependent ecosystems.

Fire is a common ecosystem process in forests and grasslands worldwide. Increasingly, ignitions are controlled by human activities either through suppression of wildfires or intentional ignition of prescribed fires. The southeastern United States leads the nation in prescribed fire, burning ca. 80% of the country’s extent annually. The COVID-19 pandemic radically changed human behavior as workplaces implemented social-distancing guidelines and provided an opportunity to evaluate relationships between humans and fire as fire management plans were postponed or cancelled. Using active fire data from satellite-based observations, we found that in the southeastern United States, COVID-19 led to a 21% reduction in fire activity compared to the 2003 to 2019 average. The reduction was more pronounced for federally managed lands, up to 41% below average compared to the past 20 y (38% below average compared to the past decade). Declines in fire activity were partly affected by an unusually wet February before the COVID-19 shutdown began in mid-March 2020. Despite the wet spring, the predicted number of active fire detections was still lower than expected, confirming a COVID-19 signal on ignitions. In addition, prescribed fire management statistics reported by US federal agencies confirmed the satellite observations and showed that, following the wet February and before the mid-March COVID-19 shutdown, cumulative burned area was approaching record highs across the region. With fire return intervals in the southeastern United States as frequent as 1 to 2 y, COVID-19 fire impacts will contribute to an increasing backlog in necessary fire management activities, affecting biodiversity and future fire danger.

PM2.5, NO2, wildfires, and other environmental exposures are linked to higher Covid 19 incidence, severity, and death rates

Numerous studies have linked outdoor levels of PM_2.5, PM₁₀, NO₂, O₃, SO₂, and other air pollutants to significantly higher rates of Covid 19 morbidity and mortality, although the rate in which specific concentrations of pollutants increase Covid 19 morbidity and mortality varies widely by specific country and study. As little as a 1-μg/m³ increase in outdoor PM_2.5 is estimated to increase rates of Covid 19 by as much as 0.22 to 8%. Two California studies have strongly linked heavy wildfire burning periods with significantly higher outdoor levels of PM_2.5 and CO as well as significantly higher rates of Covid 19 cases and deaths. Active smoking has also been strongly linked significantly increased risk of Covid 19 severity and death. Other exposures possibly related to greater risk of Covid 19 morbidity and mortality include incense, pesticides, heavy metals, dust/sand, toxic waste sites, and volcanic emissions. The exact mechanisms in which air pollutants increase Covid 19 infections are not fully understood, but are probably related to pollutant-related oxidation and inflammation of the lungs and other tissues and to the pollutant-driven alternation of the angiotensin-converting enzyme 2 in respiratory and other cells.

Excess of COVID-19 cases and deaths due to fine particulate matter exposure during the 2020 wildfires in the United States

The year 2020 brought unimaginable challenges in public health, with the confluence of the COVID-19 pandemic and wildfires across the western United States. Wildfires produce high levels of fine particulate matter (PM_2.5). Recent studies reported that short-term exposure to PM_2.5 is associated with increased risk of COVID-19 cases and deaths. We acquired and linked publicly available daily data on PM_2.5, the number of COVID-19 cases and deaths, and other confounders for 92 western U.S. counties that were affected by the 2020 wildfires. We estimated the association between short-term exposure to PM_2.5 during the wildfires and the epidemiological dynamics of COVID-19 cases and deaths. We adjusted for several time-varying confounding factors (e.g., weather, seasonality, long-term trends, mobility, and population size). We found strong evidence that wildfires amplified the effect of short-term exposure to PM_2.5 on COVID-19 cases and deaths, although with substantial heterogeneity across counties.

Toward a New Strategic Public Health Science for Policy, Practice, Impact, and Health Equity

The COVID-19 pandemic and its social and health impact have underscored the need for a new strategic science agenda for public health. To optimize public health impact, high-quality strategic science addresses scientific gaps that inform policy and guide practice. At least 6 scientific gaps emerge from the US experience with COVID-19: health equity science, data science and modernization, communication science, policy analysis and translation, scientific collaboration, and climate science. Addressing these areas within a strategic public health science agenda will accelerate achievement of public health goals. Public health leadership and scientists have an unprecedented opportunity to use strategic science to guide a new era of improved and equitable public health.

Wildfire Smoke Exposure: Covid19 Comorbidity?

Air pollution, particularly fine and ultrafine particulate matter aerosols, underlies a wide range of communicable and non-communicable disease affecting many systems including the cardiopulmonary and immune systems, and arises primarily from transportation and industry. A number of air pollution driven diseases also are Covid19 comorbidities. Thus, a number of studies on air pollution exposure, particularly particulate matter, strongly indicate air pollution is an important underlying factor in Covid19 transmission, severity, and mortality. This suggests that air pollution from natural sources, particularly wildfires, could play a role in the Covid19 pandemic. We tested this hypothesis on three wildfire smoke events in Orange County, CA, each of which was followed by Covid19 case increases after an approximately one-week lag. This lag was consistent with combined incubation time and testing/reporting times. Moreover, the three events suggest a dose dependency. The wildfire comorbidity hypothesis implies that at-risk-populations should reduce smoke exposure from wildfires, as well as indoors from biomass burning for heating, cooking, and aesthetic purposes.

Impact of exposure to smoke from biomass burning in the Amazon rain forest on human health

This review study aimed to determine the relationship between exposure to smoke from biomass burning in the Amazon rain forest and its implications on human health in that region in Brazil. A nonsystematic review was carried out by searching PubMed, Google Scholar, SciELO, and EMBASE databases for articles published between 2005 and 2021, either in Portuguese or in English, using the search terms "biomass burning" OR "Amazon" OR "burned" AND "human health." The review showed that the negative health effects of exposure to smoke from biomass burning in the Amazon have been poorly studied in that region. There is an urgent need to identify effective public health interventions that can help improve the behavior of vulnerable populations exposed to smoke from biomass burning, reducing morbidity and mortality related to that exposure.