How to Protect Children from Wildfire Smoke

https://www.nytimes.com/2020/09/18/parenting/wildfire-smoke-protection-children.html

Version 0 of 1.

Megafires are prompting a lockdown within a lockdown for millions of American children, as parents who have already curbed social activities in light of the threat of the pandemic seek to escape another potential health risk: smoke.

Wildfire pollution has been spinning and curling over Western states, a byproduct of one of the deadliest and largest fire seasons on record. Winds push smoke tendrils from California, Oregon and Washington across county lines and state borders, and the jet stream can carry this pollution across the country.

All this devastation is happening as kids return to school. In many states bedrooms are serving as classrooms, with lonely days of video instruction yielding to pent-up energy. So parents under these hazy skies are checking and rechecking air quality, looking for a window for kids to burn off some of that energy outside.

Within smoke are fine airborne particles, smaller than the width of a single strand of hair. These particles, called “PM 2.5” for their size in micrometers, sneak past natural defenses in the lungs and bloodstream. Because small children breathe faster than adults, run around more and have developing immune systems, they’re more vulnerable to the ill effects of bad air.

Fine-particle pollution isn’t good for anybody over the long term, but breathing it regularly threatens and exacerbates chronic health problems, including asthma, in children.

In the short term, smoke pollution can still damage lungs and throw immune systems out of whack. This raises risks for colds and the seasonal flu. (Preliminary research suggests similar risks to Covid-19 patients.)

Smoke and air pollution compound existing concerns about flu and Covid-19, experts say. “It adds another layer of urgency in my mind,” said Mary Prunicki, an air pollution expert at Stanford University’s Center for Allergy and Asthma Research.

Dr. Prunicki’s research has found that among kids already exposed to routine air pollution, wildfire smoke disrupted their immune systems more severely than smoke from planned burns. That’s partially because wildfires grow larger, but she also points out that, unlike controlled fires, megafires consume cars, buckets of paint, plastics and other chemical-laden objects and spew what’s left into the sky.

A parent herself, Dr. Prunicki has recently been looking at the Air Quality Index, or A.Q.I., before she leaves the house. It’s a color-coded scale, with six steps from green (good) to purple (hazardous), that the federal government uses to communicate the overall severity of air pollution, including the levels of PM 2.5.

Generally, an A.Q.I. up to 100 should be an acceptable level for most people to play outside. Over 100, polluted air becomes unsafe for sensitive groups, including children. Over 150 means the air is unhealthy for everyone. At higher levels on the A.Q.I., say above 200, smoke is very unhealthy and even hazardous.

Experts recommend checking the official federal site, AirNow, which also offers push alerts. Depending where you live, you can also check PurpleAir, a global network of inexpensive, privately owned sensors. They are less accurate than federal instruments but more numerous. Additional apps like AirVisual and Breezometer combine federal data with other sources.

The best way to avoid the risk of air pollution is an obvious one: Get as far away from it as possible. But not everyone can afford to do that.

Realistically, medical experts say most parents should think about the risk of wildfire smoke in terms of reducing it rather than eliminating it entirely. And, with kids socially distanced from friends, parents have to weigh the threat of exposure to pollution against the benefit of socializing outside.

“Every child I care for has been suffering so much from the pandemic and the shelter-in-place and the school closures and the loss of social interaction,” said Noemi Spinazzi, a pediatrician who sees low-income patients with chronic respiratory problems at Children’s Hospital in Oakland, Calif. “For most of my patients, spending time outdoors was, up until July, the saving grace.”

To defend against a shapeless enemy, doctors say to start where you spend the most time with it: at home. Tightly sealing your windows by repairing cracks, checking joints or taping them up with plastic can reduce exposure to air pollution by as much as 30 percent.

“You’re going to want to make sure your indoor air is as clean as possible,” said Dr. Stephanie Holm, co-director of the Western States Pediatric Environmental Health Specialty Unit, a publicly funded education center for prenatal and child health.

Holm’s group also recommends either portable high-efficiency particulate air (or HEPA) purifiers or central air systems equipped with high-efficiency “MERV 13” filters, which filter up to 85 percent of the particles around the PM 2.5 range. Such purifiers can cut smoke exposure by half or more. Even focusing on creating a single “clean room” in the house makes a difference.

Even if you’re scrubbing air inside, the outdoors will continue to beckon, especially where families share small indoor spaces.

Smoke pollution can start irritating lungs immediately, especially for kids with respiratory problems. So doctors like Dr. Spinazzi recommend time limits for all kids if air quality is unhealthy (at least 100 and 150 on the A.Q.I. scale). “I would say, all right, we’re going outside, but we’re setting the timer,” Spinazzi said. “And then that timer has built in the five extra minutes that it’s going to take to actually get back inside.”

No clear guidelines exist about how long to spend outside, said Ngoc Ly, a pediatric pulmonologist at the University of California, San Francisco. “I would say that probably under 30 minutes is fairly reasonable.”

Experts say it’s best to keep rambunctious time inside. It’s frustrating, but under smoke-polluted skies, activities where kids breathe heavily are more risky. A walk is preferable to playing soccer, said Dr. Ly.

If you absolutely have to get outside on a smoky day, a few precautions can help kids stay outdoors more safely for longer. The same N95 masks that health experts recommend for coronavirus can cut smoke exposure by as much as 80 percent, but they have to be fitted properly.

Medical and cloth masks are less effective but easier to keep on a child’s face longer, especially for kids already accustomed to them because of pandemic guidelines.

The federal Centers for Disease Control and Prevention recommend keeping kids away from deposited ash, and it’s another reason to wash hands thoroughly when you return inside.

If medicine helps control your child’s asthma, stockpile extra doses during fire season. And stay attuned to your kid’s reactions: watch for coughing and wheezing, and check whether they’re developing headaches or a dry mouth.

If a child has trouble breathing, becomes sleepy or refuses food or water, the Environmental Protection Agency recommends seeking cleaner air and medical attention. But Dr. Spinazzi say displaying any symptoms “is a red flag,” especially for children with asthma.

Molly Peterson is a Los Angeles-based reporter who works for the public radio station KQED. As a nonpracticing lawyer, she focuses on the intersections of climate, catastrophe and public health.