Bushfire smoke: urgent need for a national health protection strategy

• DOI: 10.5694/mja2.50511
• Publication Date: 2020-02-23T14:01:55Z
• Authors: Sotiris Vardoulakis; Bin B Jalaludin; Geoffrey G Morgan; Ivan C Hanigan; Fay H Johnston
• Keywords: Extreme Weather

More nuanced health advice is needed to protect populations and individuals from exposure bushfire smoke Bushfires have always been a feature of the natural environment in Australia, but risk has increased over time as fire seasons start earlier, finish later, extreme weather (ie, very hot, dry windy conditions that make fires fast moving difficult control) becomes more severe with climate change.1-3 The 2019–20 bushfires particularly New South Wales, Victoria, Queensland Australian Capital Territory, caused at least 33 fatalities, extensive damage property destruction flora fauna, exposed millions people levels air pollution. Bushfire smoke, well prescribed burns, contains complex mixture particles gases are chemically transformed atmosphere transported by wind long distances.4 In this context, major public concern population atmospheric particulate matter (PM) diameter < 2.5 μm (PM2.5), which can penetrate deep into respiratory system, inducing oxidative stress inflammation,5 even translocate bloodstream.6 Such adversely affect outcomes. Mortality rates found increase Sydney on days high pollution.7 Hospital admissions, emergency department attendances, ambulance call-outs general practitioner consultations, for conditions, all during periods PM2.5 bushfires.8-11 risks pollution amplified when combined temperatures heatwaves, an effect mortality.12 Certain groups higher either because they typically breathe per bodyweight their organs still developing (young children), spend outdoors (outdoor workers, homeless people), or vulnerable due old age pre-existing condition (asthma, chronic obstructive pulmonary disease other condition, cardiovascular illness, diabetes). There evidence pregnancy associated reduced birthweight babies gestational diabetes mothers.13, 14 People lower socio-economic potentially risk, may poorer housing, literacy ability take preventive measures. Current protection related mainly focuses short term measures aimed reducing personal This includes stay indoors windows doors closed, reduce strenuous physical exercise outdoors, if experience symptoms concentrations increased. national standard 25 μg/m3 measured 24-hour mean (National Environment Protection (Ambient Air Quality) Measure: https://www.legislation.gov.au/Details/F2016C00215) consistent World Health Organization's quality guidelines.15 However, presented hourly averages useful planning daily activities, these better reflect current quality, change rapidly episodes. Currently, state territory government departments use range different metrics (such composite Quality Index based multiple pollutants), averaging times thresholds stratify messages colour-coded bands (very good, fair, poor, hazardous). discrepancies presentation information across jurisdictions confusing public. General also having access regular medication, such asthma checking older neighbours, seeking medical attention needed. advice, however, tailored brief episodes last only few hours days. situations like events eastern where persists longer (weeks months) affects large centres, there need detailed location-specific data forecasts. Reducing prolonged heavy become impractical periods; example, school children outdoor workers. Children adults carry out activities involve spending outdoors. Advice problematic periods, owing recognised benefits active travel walking cycling) exercise, potential lack indoor sports facilities. We believe would encourage be guided forecasts pattern nearby monitoring locations, plan ways minimise For were most locations early morning December 2019 episode (Box 1, A). Exercising cycling work within window help maintain good activity without substantially increasing smoke. Locations city's north affected much than some south highest peak 10 B). Real temporal spatial variation should made available online through media enable assess quality. Avoiding sources (road traffic, cigarette smoking, etc) advisable, although widespread likely dominate events. = μm. A: Hourly average between 1 22 2019, downloaded 15 stations region Wales Department Planning, Industry database (https://www.dpie.nsw.gov.au/air-quality/search-for-and-download-air-quality-data). straight line represents Measure). Note full validation not completed records passed initial automated process. B: (μg/m3) event pm. ineffective periods. Older houses Australia often quite "leaky", allowing creating unhealthy conditions. Well sealed conditioned environments (typically, modern apartments offices, libraries shopping centres) provide respite pollution, effective filtration systems place. many urban residents those restricted mobility, easy places. Temporary relocation area city could localised persistent its own (particularly cognitive mobility problems), especially larger geographical areas smoke.16 dwelling (eg, apartment) same neighbourhood practical less stressful solution asthma, pregnant women, people). priority create clean space home, sealing using conditioning possible, smoke.17 able afford units. Homes ventilated cleaner around midnight 2019; Box A), cool down homes avoid build-up pollutants. Access including preventers relievers, statins aspirin, important lung heart arranged consultation GPs. Maintaining healthy diet, plenty fruit vegetables, keeping hydrated effects. suggestive antioxidant fish oil supplementation dietary intake protective against exposure;18, 19 research support this. Much relates facemasks. These increasingly used highly polluted Asian cities, China.20 Use facemasks (outside occupational settings emergencies volcanic eruptions) routinely recommended authorities. effectiveness depends heavily facial fit, material masks. Surgical masks reasonable efficiency; design generally confers poor fit inward leakage PM2.5.20 Professional P2 N95 facemasks, efficient fitted, designed breathing thermal discomfort.20 drawbacks types children. do confer toxic carbon monoxide, nitrogen oxides volatile organic compounds) present closer front. number practical, ethical considerations ultimately inform decision about whether recommend distribute public, workers sensitive emergencies.21, Clear effectiveness, provided authorities individuals, professionals employers informed decisions. Nuanced balanced communication takes account risks, people's concerns practicality alerts, real forecasts, 2) hazardous enabling sensitive, accordingly. Source: National University Research School Population (https://rsph.anu.edu.au/news-events/news/how-protect-yourself-and-others-bushfire-smoke). Environmental understanding causes effects bushfires, consequences broadly, important. misconception burning wood fuels "natural", hence harmful health. no scientific supporting belief. Toxicological studies consistently demonstrated derived biomass activate inflammatory, genotoxic responses, similar road traffic particles.23 A recent systematic review epidemiological shown asthma-related landscape compared sources.11 Comparison pollutant regulatory standards μg/m3) highlights scale problem drives institutional action. local rapidly. At level, helpful AirRater smartphone app (https://airrater.org/) shares measurements jurisdictions. stations. capabilities fixed sites, portable equipment low cost sensors deployed emergency. It emphasised safe level any reduction reduces mortality morbidity. compare both contain mixtures chemicals route inhalation) common outcomes cancer illnesses, disease, risk). Although equivalence smoking specific cigarettes debatable,24 broader comparison helps raise awareness reinforces unprecedented raised populations. They tested existing shorter episodes, methods communicating information. Exposed seek interventions cleaners, activities) self-manage patients, women develop trade-offs 3).25, 26 Public local, user-friendly reliable essential managing clinical deterioration individuals. strongly actual rather index. time, averaged appropriate metric guide behaviour minimises evidence-informed at-risk investment monitoring, forecasting messaging, Australians Consistency essential. independent expert committee established environmental making Australia. new clear mandate resources evidence-based, accurate, Managing impacts integral response. Close collaboration health, education, environmental, management response agencies achieving best overall wellbeing. Further medium equity implications advice. Working towards ambitious mitigation targets strategy underlying overseas. was undertaken College Medicine, assistance Centre energy (CAR). CAR Data Analysis Technology platform (https://cardat.github.io) analyse data. Sotiris Vardoulakis received funding UK Institute Research, Medical Council, Natural England, EU Horizon 2020, Dyson Ltd. Geoffrey Morgan Ivan Hanigan receive Council. Not commissioned; externally peer reviewed.