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In these hazy skies, a public health warning from a warming planet

The Boston skyline was lost in haze Monday night as wildfire smoke continued to invade the region.Christiana Botic for The Boston Globe

When the wildfire smoke from Canada and the Western United States rolled into New England this week, it didn’t just bring hazy skies and a burnt orange sun. It also brought an increased health risk that vulnerable groups — like children or elderly people — would have asthma or heart attacks, and was bad enough that even healthy adults could be affected.

Over the last two days, it didn’t matter that the 1.5 million acres of land on fire were on the other side of the country. As the smoke made its way east, the air quality in New England was among the worst in the country — second only to the areas adjacent to those fires.


By 3 p.m. Monday, the air quality index in Boston had soared into the unhealthy zone — meaning that the concentrations of fine particulate matter were so high that members of the general public could start getting sick, and those among sensitive groups could suffer serious health effects, according to the Environmental Protection Agency.

Consider it a warning from a warming world, where wildfires fueled by drought and extreme heat are already on the rise and only expected to get worse.

“With climate change, we’ve got a changing planet,” said Dr. Marissa Hauptman, a pediatrician and the associate director of the Pediatric Environmental Health Center at Boston Children’s Hospital. “As a result, many of these health risks can come to regions where we didn’t used to expect them.”

It’s something that is increasingly playing out in exam rooms, said Dr. Shalini Shah, a pediatric and reproductive environmental health fellow at Boston Children’s Hospital.

On Monday evening, as Shah was working an urgent care rotation, one of her patients was a 5-year-old boy. His mother had decided to take him in when his asthma started flaring up, possibly due to a cold. But it was only when he got outside and began their trip via public transit that things got bad.


Smoke from Canada and the Western United States rolled into New England this week, bringing hazy skies and a burning orange sun in Weymouth.Stan Grossfeld/Globe Staff

“He told me, ‘I just couldn’t stop coughing once I got outside,’ ” said Shah.

The boy’s asthma attack mirrored what Shah said she expects to see from climate change: underlying conditions made much worse from the extreme environments they are exposed to. The boy was one of several patients with respiratory distress that Shah saw on Monday night, many of whom were children who suffered from asthma.

And it’s just a preview of what could happen in the coming days, said Kevin Stewart, the environmental health director for the American Lung Association. “Asthma episodes can happen a day or even five days later after exposure to wildfire smoke,” he said. “People with heart problems can experience consequences immediately, or even months down the road.”

As the world works to find solutions to stop the climate crisis, certain impacts are already playing out and — even under a best-case scenario — are expected to get worse. The most recent National Climate Assessment found that climate change doubled the area burned by forest fires from 1984 to 2015. As warming temperatures lead to earlier snow melt in the Western United States — and with less winter precipitation there — the summer season is longer and drier, leading to more intense and frequent wildfires. Increasingly, the concept of wildfire season in California is giving way to a year-round crisis where one fire is barely out before the next one sparks.


And because Earth’s climate systems are interconnected, winds from the West can carry smoke, giving New Englanders a taste of the public health emergencies that are all too common in fire-prone areas.

Aaron Bernstein, the interim director of the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health, recently published a new tool that physicians like Hauptman and Shah can use with their patients, whether dealing with asthma that has been triggered by wildfire smoke, or other health effects from climate change.

“Whether it’s how we talk about anticipatory guidance — the kinds of things a pediatrician might say about wearing sunscreen or being careful about lead paint — or how we think about what diseases to consider when a child presents with certain symptoms, or the medicines that we prescribe, which may alter the ability of a child to deal with the heat — we really tried to lay out the ways that everything that happens in a primary care office needs to be now looked at through the lens of climate change,” said Bernstein.

The paper, “A pediatrician’s guide to climate change-informed primary care,” which was published this month in the journal Elsevier Pediatrics, builds on the efforts of medical societies in recent years to illuminate climate change and health. Bernstein’s paper goes a step further, providing a road map for how well-child visits can ask questions that get to the heart of the climate risks and vulnerabilities that a child or family may face.


“The fact that climate change is bad for children with asthma, or for pregnancy outcomes or any disease you can think of, is not debated so much,” he said. “But no one necessarily connects that to how we need to change our practice. So that’s the key step.”

With a series of questions that allow pediatricians to determine if a family or child suffers from climate-fueled food insecurity, risks of water-borne diseases from floods, housing insecurity, or energy insecurity, the paper aims to make it easy for pediatricians to bring climate change into the exam room.

It’s a welcome step, said Dr. Lucy Marcil, a pediatrician at Boston Medical Center and a professor of pediatrics at Boston University School of Medicine. “In medical school, we did not talk about climate change at all as a health problem,” said Marcil, who has been practicing for seven years. “I’ve had colleagues who have said, ‘I don’t feel comfortable talking about this because I don’t know the science or the data.’ ”

As the health risks from climate change become less of a future concern and more of a present danger, these pediatricians are hoping they can use their trusted roles to help keep patients healthy, while connecting the dots between events happening in the world and the impacts patients may be feeling.

“There’s definitely a power to our voice,” said Shah, noting a study that found that primary care providers were people’s most trusted resources when it comes to communicating about climate change. “People are listening, and we need to use that gift.”


Sabrina Shankman can be reached at sabrina.shankman@globe.com. Follow her @shankman.