As deadly wildfires rage across Oregon, Washington, and California, winds are blowing smoke across the surrounding areas, exposing millions of residents to hazardous levels of air pollution. Robert Gillio, a pulmonary critical-care physician, says that smoke inhalation can cause coughing, scratchy throat, burning eyes, shortness of breath, headache, fatigue, and even asthma attacks. To make matters worse, the fires are burning while we’re all still dealing with the coronavirus pandemic. “There is an association between areas with worse air pollution and worse outcomes for not only COVID-19 but for any issue where the immune system plays a role,” says family physician William Lang, chief medical officer at WorldClinic and former director of the White House Medical Unit.
For those with preexisting respiratory conditions living in areas affected by wildfire smoke, Lang says it may be necessary to leave home until the fires are under control or the winds change. Otherwise, according to the doctors we spoke with, the best thing you can do to protect yourself from smoke inhalation is to stay indoors whenever possible. Make sure your doors and windows are closed tightly — Reza Ronaghi, a pulmonologist at UCLA Health Santa Monica Medical Center, advises sealing any gaps or cracks with old clothes or duct tape — and consider using an air purifier with HEPA filters to reduce the concentration of harmful smoke particles. It may seem counterintuitive, but Ronaghi also says to avoid vacuuming or dusting during this time as you may disrupt settled air particles, causing them to become airborne again.
If you must go outside, a face mask or respirator can help you avoid breathing in dangerous smoke particles. Unfortunately, the masks our experts say are most effective in protecting against smoke inhalation — N95 masks, which are certified by the National Institute for Occupational Safety and Health (NIOSH) to filter out 95 percent of airborne particles — are already in short supply due to the COVID-19 pandemic, and the CDC and FDA have urged the public not to buy them to ensure they’ll be available for health-care workers.
But what about the cloth masks people are already wearing to protect themselves and others from COVID-19? Mitchell Grayson, a physician-scientist who specializes in pediatric allergy, asthma, and immunology at Nationwide Children’s Hospital and an adviser to the Asthma and Allergy Foundation of America, explains that fabric face masks are better for keeping particles from getting out (like your own respiratory droplets) than they are for stopping them from getting in. “That is why surgical masks and cloth masks are perfectly acceptable for protection from COVID-19, but because these masks don’t form tight seals and cannot filter out very small particles, they are not appropriate for smoke protection,” he says. According to Ronaghi, smoke particles are one-thirtieth the size of a single strand of hair and can easily slip through the gaps of a fabric face mask.
As Lang emphasizes, though, risk reduction, whether in the case of COVID-19 or wildfire smoke, is not an all-or-nothing proposition. “The goal is to reduce risk as much as possible,” he says. “N95 provides the greatest risk reduction, but a good cloth mask with a center filtering layer does still reduce risk substantially.” Below, we’ve rounded up some N95 alternatives — including a filter to add to and improve the efficiency of your fabric face mask — for staying safe if you’re in an area affected by wildfires.
Some doctors suggest looking for KN95 masks, which are considered the Chinese equivalent of N95 masks — with some caveats. “KN95 masks, in theory, meet the same standards, but they are certified by other countries which may not test to the same accuracy,” says Lang. He points out that while the FDA initially authorized KN95 masks for emergency use during the pandemic, it later retracted its approval of several brands that failed to meet NIOSH standards. If you want to go this route, the FDA lists currently authorized KN95 manufacturers and models here. “They are going to be at least more effective than regular [cloth] face coverings,” says Ronaghi.
If you’re outside — and more than six feet away from other people — a respirator mask with a P100 filter (“the P also filters out oil-based particles, which can get through the N respirators to some extent,” says Lang) is also very effective at stopping smoke inhalation. The problem is it’s not great for protecting people around you from possible coronavirus exposure. While the respirator’s exhalation valve makes it easier for the wearer to breathe, it actually renders the mask useless in preventing transmission of the coronavirus, as all of the wearer’s respiratory droplets are dispersed outside the mask. As Julie Lyou, a pulmonologist at St. Jude Medical Center, says, “Since the exhalation valve allows air to escape, it is not ideal for preventing the spread of COVID-19 infection.” In a pinch, she says you can use a surgical cloth mask to cover the valve if you have to be around other people.
If your only option is a cloth face mask, some doctors say adding a filter — like a PM2.5, which filters particles down to 2.5 microns in size — can add a level of protection. Grayson says that, while a filter won’t solve a cloth mask’s main problem of forming a tight seal, it’s “probably slightly better than nothing.”
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