Homeless Unable to Escape Wildfire Smoke Smothering the Bay Area

The smoke-filled San Francisco skyline on September 9, 2020. (Photo credit: Erin Loscocco)

In California, we are no longer surprised by devastating wildfires; we expect them. When the smoke silently floods the Bay Area, I close my windows and turn on the air filters scattered throughout the house. My emergency evacuation bag is by the door, alongside a stack of N95 masks that can filter out up to 95 percent of airborne particles.

Every year breaks another record for the most destructive and deadly wildfire season on the West Coast. By July of 2021, the number of acres burned in California increased by 257 percent compared to the same time last year.

The Center for Disease Control (CDC), Environmental Protection Agency (EPA), and local public health agencies all agree that when the air quality reaches unhealthy levels, as they were for most of August and September in 2020, residents should stay home, close windows, and turn on an air filter.

Staying home is not an option for the 30,000 homeless people living in the Bay Area, or the 161,548 across California, who account for 28 percent of the country’s homeless population. The unhoused are especially vulnerable to the dangerous impacts of smoke because they have higher rates of respiratory diseases, such as a 23 percent higher rate of chronic obstructive pulmonary disease (COPD) and a 24 percent higher rate of asthma.

“People on the streets are a very vulnerable population, with higher rates of everything,” said David Modersbach, grants manager and wildfire smoke expert with Alameda County Health Care for the Homeless (ACHCH) centered in Oakland. “The one thing [the homeless] have in common is their health is impacted by multiple factors.”

In addition to heat, cold, stress, a lack of nutrition and sanitation, exposure to wildfire smoke is one more burden that threatens the health of people living on the streets. Over the past few years, some cities and counties in the Bay Area have been slow to provide air quality emergency plans that consider the homeless or provide clean-air shelters. To fill the gap, small community organizations and mutual aid groups have created networks that quickly mobilize during smoke events to give the homeless N95 masks, communicate resources, and advocate for clean-air shelters.

Size comparison for PM particles. (Illustration credit: EPA)

Wildfire smoke is a complex mix of gases, particulate matter, and potentially toxic metals. Particulate matter (PM2.5) with a diameter less than 2.5 micrometers (that’s 30 times smaller than the diameter of a human hair) is dangerous because the tiny particles are inhaled deep into the lungs and can cross over into the bloodstream. The EPA’s Air Quality Index (AQI) is the standard for measuring levels of air pollutants, including PM2.5. The higher the AQI, the higher the level of air pollution and the greater the risk to health.

According to the CDC, PM2.5 from smoke is especially hazardous for people with respiratory and cardiovascular conditions. Even short-term exposure for people with these pre-existing conditions can be detrimental to their health. A study published in June of 2020 in Environmental Health Perspectives, showed increased odds of ambulance dispatches related to respiratory and cardiovascular conditions after only an hour of exposure to high levels of PM2.5 from wildfire smoke.

“The immediate effects show the importance of individual preparedness,” said Dr. Jiayun Angela Yao, the lead author of the study and regional epidemiologist at the British Columbia Center for Disease Control. “With that kind of a timeline, if you don’t get prepared before a wildfire smoke event, it’s almost impossible to avoid the damage and [health] impact.”    

Mask Oakland, located in Alameda County, and Mask Sonoma, located in the northern Bay Area county of Sonoma, are two mask-distribution nonprofits that formed in response to the high AQI levels caused by the severe 2017 wildfires. The founders are ordinary citizens who saw the need for protecting the health of those without shelter.

“Initially, I was literally riding around on my motorcycle around roadblocks and handing out masks,” said Marcos Ramirez, one of the co-founders of Mask Sonoma. Now, Mask Sonoma is well known around the county and works closely with community organizations that mobilize when the smoke and fire hit.

Sonoma County not only has to deal with smoke but is sometimes threatened by nearby wildfires and has issued multiple emergency evacuations over the years. Yet, as the housed evacuate, the unhoused are often not alerted and are left behind.

“When Sonoma County did a huge evacuation, unsheltered folks were just left milling about, and day laborers still went to work,” Ramirez said. “We go to these places where people are forgotten, they’re wholly abandoned, and just left on the street.”

In 2017, in Alameda County, when the smoke from northern California fires smothered the Bay, Alameda County Health Care for the Homeless (ACHCH) had only two outreach teams to hand out N95 masks to the homeless.

“That was the first year we all started to learn about N95 masks,” Modersbach said.

Mask Oakland hands out N95 masks to the homeless. (Photo credit: Paul Kuroda)

Since then, ACHCH regularly stockpiles N95 masks for the homeless in preparation for wildfire season. The group divided the county into 14 zones, each with approximately 700 homeless people. An outreach team serves each zone and collaborates with partner organizations such as Mask Oakland to distribute masks to the homeless.

ACHCH and other groups have also been advocating for more clean-air shelters. Like cooling centers during a heatwave, clean-air shelters can be any building, such as libraries, with closed air filtration.

“It’s a whole mess,” said Modersbach. “The county says it’s not our fault, it’s the city’s responsibility, and the cities say because it's an emergency, it's the county’s responsibility. They're always fighting over it, and in the end, nothing gets done very well. We're in the middle saying, ‘Do something.’”

In September 2020, after three weeks of unhealthy air and several days with hazy orange skies and falling ash, Oakland opened four clean-air centers with no public notice beforehand. The four centers only had 26 visitors, some of whom just happened to discover the center as they walked by.

“That’s very telling about our counties,” said Modersbach. “It’s all about communication and what’s the messaging . . . but no nitty-gritty boots on the ground kind of plans for an actual response.”

The Alameda County Air Quality Communications Protocol was updated in May 2021 to include recommendations for opening clean-air centers. But the AQI threshold listed for opening the centers is above the level the EPA states is safe for people with pre-existing health conditions.

As another severe fire season sends smoke pouring into the Bay Area, many homeless may spend weeks breathing in smoke-choked air that could send them to the emergency room.