Climate Change as a Public Health Crisis

In the US and around the world, wildfires are becoming too common of a scene. Some of us we are viewing them on our TVs, but some of us are unfortunate enough to be living in the West where this devastation is playing out.

We all know that drought, brought on by climate change, is the culprit and for me this is ringing alarm bells in the realm of public health. Now we are seeing something else as we continue through the pandemic: the wildfires are actually responsible for increased risks of contracting COVID-19. But, how?

Researchers writing for the Journal of Exposure Science & Environmental Epidemiology found that the increase of particulate matter from wildfire smoke was associated with a 6.3% increase in the COVID positivity rate. Smoke exposure could be altering people’s immune response, making them more vulnerable to infection. It could be due to the fact that particulate matter enhances viruses' pathogenicity through modifying immune responses and enabling the transport of the virus into the lungs.

Another thought is that the elevated concentrations of pollutants result in over-expression of the ACE2 receptor, which is the molecular target for SARS-CoV-2 in respiratory epithelial cells. This could also increase the virus's virulence. The exposure to the smoke may also be causing an overexpression of ACE2 respiratory cells and since COVID-19 particles can also attach themselves to pollution particles, they are in a sense hitching a ride and allowing the virus to spread more easily.

It is becoming increasingly acknowledged that climate change is adversely affecting public health – and now we aren’t just seeing it in faraway places anymore, but right here in the US and throughout developed nations. As a result, physicians and everyday citizens are joining environmentalists in calling for national climate solutions. Public health physician and Harvard professor, Dr. Regina LaRocque, has called climate change a true health emergency. She names storms, floods, droughts, wildfires, and the increase in insect-borne diseases as the culprits. She stated in an interview with the American Journal of Managed Care that this is a time for grave concern, since “the political will to achieve is insufficient to meet the biological problems that we are facing.”

While things have been getting worse as of late, this is not the first time Americans are seeing the effects of climate change. In 2016 in my home state of Louisiana, a Native American tribe felt some of the first impacts of climate change in the North American continent. Their island of residence began sinking, resulting in the Biloxi-Chitimacha-Choctaw tribe receiving $48 million in natural disaster grant money to resettle away from the sinking land. To quantify how devastated the tribe was, today there are less than a quarter of the original inhabitants still living on the island which lost 98% of its landmass since the 1950s.

As I mentioned, this has been happening for years around the globe and while we have always thought about it as “someone else’s problem,” (usually that means vulnerable communities) it is now at our front door. For too long poor nations have been the ones who have suffered the most from natural disasters, but now it is clearly surfacing as a global problem and from a public health standpoint, it is putting populations at considerable health risk.

In the US this year, heat-related deaths have increased. Now, combined with shortages in healthcare workers, and the complicating factor of the Delta variant creating a virus surge particularly among the unvaccinated, the concern is that hospitals are once again struggling to cope. To illustrate the problem, during the first heat wave in late June this summer, Washington state reported a death toll of 78 compared to just 39 heat-related deaths between the years 2015 and 2020. Even in places like Montana, temperatures are averaging 15 to 20 degrees above normal, and with that rise comes the increase of heat-related illnesses.

For the first time many eastern cities are suffering from poor air quality due to the western wildfires. The jet stream carried the smoke to Boston presenting an air quality emergency. The scent was so strong that firefighters in Boston fielded numerous calls from residents worried that a fire was burning nearby.

It isn’t just pulmonary concerns that worry us from a public health perspective. Skin cancer increases brought on by more UV radiation is a concern, along with mental health issues from populations who have been exposed to the treachery of wildfires – up to 30% of wildfire survivors develop a mental health condition including PTSD and depression.

Putting public health first, we need to take swift action to decrease greenhouse gas emissions – a big contributor is transportation and nitrogen-based fertilizers in farming. It is becoming an ethical issue in medicine. It has become urgent because the human population has doubled in last 50 years. The critical pressures of climate change act as force multipliers, increasingly magnifying the health impact of those pressures. Some are saying that the COVID-19 health crisis has been a “dress rehearsal” for the even larger crisis that is climate change.

While health professionals see this problem and they understand the long-term impacts that our current way of life is having on the health outcomes of our patients, the question to ponder is what is our responsibility as we stand as first responders to the looming public health crisis of climate change?

One blog I read recently is asking if it is time for a new Hippocratic Oath. We must ask, what does it mean to “do no harm” as we live in a world threatened by climate change and the resulting natural and human disasters that are occurring. I am quoting the blog here: “In a warming, unequal world, it is impossible to tend to patients’ health without addressing the larger environmental and social context—just as it would be absurd to ignore a raging pandemic. That is why physicians are increasingly speaking out in favor of measures to tackle climate change. Doctors are reframing the climate crisis to focus on people’s health—a narrative to which people across the political spectrum can relate.”

Resources:

• Effects of Climate Change, COVID-19 Spell Concern for Embattled US Health System (ajmc.com) 
• Increase in Covid-19 cases and a difficult wildfire season, makes for a perfect storm 
• Wildfire Smoke In New England is Public Health Threat | The Brink | Boston University (bu.edu) 
• Climate Change Calls For A New Hippocratic Oath | Health Affairs