5 Questions: Lisa Patel on California Wildfires and School Ventilation

With the COVID-19 pandemic and the growth of wildfires, California schools need to improve their air quality, according to Stanford pediatrician Lisa Patel, MD. Fortunately, the funds are available.

The wildfires that annually burn hundreds of thousands of acres in California don’t just scorch the land; they also pump toxic smoke into the air. Pediatrician Lisa Patel, MD, an expert on the health effects of climate change, is worried about that smoke harming children, especially as the peak of wildfire season coincides with the beginning of the school year.

But Patel, a clinical assistant professor of pediatrics at the Stanford University School of Medicine, sees an opportunity in the confluence of two public health crises. The global COVID-19 pandemic prompted state and federal governments to fund upgrades to schools’ ventilation systems. Thanks to the new Action Lab for Human and Planetary Health program hosted through the Stanford Center for Innovation and Global Health, Patel is working in collaboration with Mary Prunicki, MD, senior research scientist at Stanford’s Sean N. Parker Center for Allergy and Asthma Research, and Michael Wara, JD, a senior research scholar with the Stanford Woods Institute for the Environment, to help school districts take advantage of the funds.

“We should have better indoor air quality for our kids; it’s beneficial for so many reasons,” said Patel, who spoke with science writer Erin Digitale about the situation. “COVID-19 has provided us with a moment in which we can think about several problems synergistically.”

1. During last year’s fire season, California students were learning online due to the global pandemic. This year, they’ll return to the classroom just as fire season intensifies. What concerns does that raise?

Patel: I got into thinking about wildfire preparedness and schools before the pandemic. Kids in places like Marin County [north of San Francisco], which was hit by smoke from devastating fires, missed upward of three weeks during the 2018-2019 school year due to wildfire smoke, evacuation orders or power outages. I had seen the data before the pandemic about what all those days of missed school mean for kids’ academic and socio-emotional outcomes.

Then the pandemic hit, schools across the state closed, and school district officials have since put a huge amount of time and resources into reopening our schools with an eye to pandemic safety. That’s very important, but I’m worried we forgot about this other risk factor, wildfire season, which is also hugely disruptive.

2. Why is wildfire smoke dangerous to children’s health?

Patel: A study that just came out in Pediatrics shows wildfire smoke is 10 times more toxic than other pollution we’re used to, which isn’t surprising because what’s burning includes houses and cars. The smoke includes ultrafine particles, all smaller than 2.5 microns. It’s a mixture of solids and liquids that become disbursed in the smoke. Because they’re so tiny, the particles can get into the lungs, into the vasculature, and enter our bodies, potentially setting off a cascade of inflammation. That leads, for example, to increased emergency-department visits because of asthma.

We’re also starting to see evidence of other health effects. I’m a pediatric hospitalist and work in the neonatal intensive care unit; last September and October, we saw an increased number of pregnant women coming to the hospital in premature labor.

3. The COVID-19 pandemic drew attention to indoor air quality and to buildings’ heating, ventilation and air conditioning, or HVAC, systems. Why should we upgrade these systems in our schools?

From a COVID point of view, we are thinking about fresh air exchange because it’s an airborne disease. HVAC systems can bring more air in from outside and facilitate more exchange of air so that respiratory droplets don’t linger.

HVAC systems can also clean the air of all kinds of pollutants that affect children’s educational achievement. If the systems are fitted with highly rated filters, they clean the air of particulate matter pollution made by diesel trucks or gas-powered cars, or the pollutants in wildfire smoke. There has been quite a bit of research into schools’ indoor air quality. We see improvement in kids’ test scores and fewer days of missed school when we improve indoor air quality.

4. How are California schools doing in regard to improving their ventilation?

I was hopeful, because of new concerns about ventilation in the pandemic, that HVAC systems would be upgraded while schools were closed. But what we’ve been learning is that many districts are juggling a lot of other demands around school reopening, and some don’t have the capacity to apply for funding to upgrade ventilation, even though funding is there.

Last October, the California state legislature passed a bill allocating up to $600 million for upgrades, maintenance and repairs to schools’ HVAC systems. There are also federal funds allocated through the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020, and the Environmental Protection Agency is putting together money to create clean air shelters, some of which may be located at schools, to provide places where people can access clean, filtered air. Every week we’re learning about new funding sources. We’re maintaining an active list of different pots of money and are partnering with several other organizations, such as the American Academy of Pediatrics and the nonprofit Mothers Out Front, to educate physicians and parents on how to help school districts access the funds.

Even with this funding, we see challenges ahead. Lots of schools don’t have HVAC systems, and schools that do often don’t maintain them. For instance, the filters may not be an appropriate grade or not be replaced regularly. That has to do with larger problems related to how school infrastructure is funded and maintained.

5. What else could help schools adjust to longer, more intense wildfire seasons?

Patel: After more than a year in a global pandemic, the Centers for Disease Control and Prevention has finally come out and said that in-person learning should be our priority for children’s health. We should have said this long ago. This generation of kids is going to have a lot to surmount from one year of missed school due to the pandemic, and I’m concerned about what continued disruptions from wildfires mean in terms of children’s progress.

The state is making a remarkable effort to help schools with wildfire air quality, and it has good guidance and resources. We need to tighten up a few things; for instance, right now, we leave it up to school districts to decide whether to close at certain air quality index levels. I think our goal is to make sure schools can continue operating despite days of poor air quality outside.

There might be days when air quality is so poor that even being transported to school is too risky and kids need to stay home, but there will also be a lot of days where schools can continue operating despite poor air quality. We can equip schools to monitor their on-site level of air pollution, and we can provide more education to parents and teachers so school communities understand why certain decisions are made and how they help kids stay safe.

Ultimately, it’s about climate change. There are things we can do now to mitigate the effects of wildfire smoke, but until we think about the root causes of climate change and address them at a policy level, wildfires will be a yearly and potentially year-round occurrence.