Baltimore wildfire smoke: Few are headed to the emergency room, but more could follow

In the Baltimore area, anyone walking outside in the past couple of days might feel a bit of a burn in their eyes and throat. Those with a chronic condition such as asthma may have a flare-up.

Despite plumes of smoke from Canadian wildfires that have drifted into the region, there’s been no rush on the emergency room, according to area hospitals. And while that could change in coming days if the air doesn’t improve, the real concern is what happens next.

“This is not a good trend,” said Dr. Mark Goldstein, chief of emergency medicine at Sinai Hospital. “Combined with the recent pandemic that has left people with chronic respiratory problems, this adds insult to injury. These weather patterns and climate disturbances could add to the public health burden for sure.”

West Coast cities may offer a window into what to expect from what officials are calling an unprecedented start to the Canadian wildfire season. There were 427 fires wildfires raging there Thursday evening, worsened so far this year by an unusually warm and dry spring.

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On the West Coast, wildfires frequently cause haze and poor air quality. Fortunately, most people living in the region seem to be protected from “periodic hits” of smoky air over the long term, provided their lungs are healthy, according to Dr. Gopal Allada, associate professor of pulmonary and critical care medicine at Oregon Health Sciences University. But for people with chronic lung disease, such as asthma, chronic obstructive pulmonary disease (COPD) or cystic fibrosis, it’s an entirely different story.

Allada said the area does see upticks in emergency department visits and hospitalizations among people with chronic lung disease when the air quality is poor due to smoke. He said doctors who treat those patients on a regular basis see increases in calls because symptoms have worsened, and medication dosages often must be adjusted or new prescriptions written to help manage flare-ups.

People with respiratory disease who are exposed to wildfire smoke periodically over time — as they are on most of the West Coast — will likely experience more frequent flare-ups, Allada said, and this will accelerate progression of their disease.

”It’s clear that the more of these flares that one has, it’s associated with more rapid long-term decline,” he said. Many chronic lung diseases such as COPD are incurable and ultimately fatal, with faster progression resulting in earlier death.

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Goldstein and several other emergency doctors from MedStar Health, the University of Maryland Medical System and Johns Hopkins Medicine sounded similar concerns.

While we may have been spared a lot of immediate damage, bad air will cause more damage to human health over the long-term — exacerbation of chronic conditions of the lungs, heart and other organs, and problems in previously healthy people.

Physicians said people are likely adhering to advice to stay indoors or avoid a lot time outside, especially if they have chronic lung or heart conditions. Lots of outdoor programs have been cancelled, including school recess.

Officials at the Maryland Department of Health said they were encouraging local health departments to hand out high-quality masks, like N95s or their equivalents.

Those having symptoms are likely managing them at home, said Dr. Gabor Kelen, professor and chair of the Johns Hopkins Department of Emergency Medicine. Some may still end up in the emergency room in coming days.

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“At some point, some people can’t keep up, they reach a tipping point and need our level of care,” he said, when they have more trouble breathing or when oxygen levels drop.

Still, he said, “In the long-run, climate change can’t be good for our overall health.”

Other environmental health experts said wildfires have been affecting health around the globe for a long time, and the East Coast has been largely spared. Now, we’re seeing an earlier and more fierce start to the fire season, and it’s spread over a larger area.

“We will probably see other fires popping up this summer,” said Peter DeCarlo, associate professor in the Johns Hopkins Bloomberg School of Public Health’s Department of Environmental Health and Engineering.

“The early start [to the fire season] is what we’d expect from climate change,” he said.

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Jason Scullion, an associate professor of environmental studies at McDaniel College, said burning vegetation releases carbon and increases the amount of carbon dioxide in the atmosphere, which accelerates climate change, at least in the short term.

Eventually vegetation grows back, and that sequesters some of the carbon dioxide. But the warmer temperatures make snowpack melt faster and reduce surface moisture available to vegetation, making areas drier and prone to more fires.

The cycle leads to an earlier start to wildfire seasons and more intense storms across North America.

”This year is unseasonably dry and that’s a broader trend that we’re seeing with some regions due to climate change,” he said. ”I’ll tell you that growing up, we didn’t have this on the West Coast. But now it’s normal. This is the new normal. It’s only going to accelerate as the climate continues to warm.”

On the ground in Baltimore, the air quality is supposed to improve in coming days.

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Health care providers say they will be ready for what comes in the short and long-term because of the bad air.

“We take the air we breathe for granted sometimes,” said Dr. J. David Gatz, assistant medical director of the University of Maryland Medical Center Adult Emergency Department.

“We assume it will be clean, healthy air,” he said. “As we move forward in a world struggling to talk about climate change and the impact on our health, questions are going to have to be addressed. Are there things we can do about poor air quality like we’re experiencing now? There are no easy answers.”

Reporter Cody Boteler contributed to this article.

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