119. How to Protect Yourself from Wildfire Smoke

Quinn:
Welcome to Important, Not Important. My name is Quinn Emmett, and this is science for people who give a shit.

Quinn:
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Quinn:
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Quinn:
All right, let's get to it. Folks, this week's episode is a timely one. We are going to help you understand, as far as the best in the world know, what's in wildfire smoke, what we know and think it does to your body, your kids' bodies, your nieces, your nephews, your students, your patients, your grandparents, your parents, and most importantly, what you can do to stay safe. And again, this is a really important one. All you have to do is look outside. But maybe you live in New York, or Boston, or the mid-Atlantic, or Maine. You got your first ever air quality warning. Maybe you think the smoke is less harmful because, yes, sure, my sky is red and it looks like Lord of the Rings, but I'm all the way in New York, and that smoke drifted 3,000 miles to get to me. That is, it turns out, very much not the case.

Quinn:
Our guest, my guest today is Dr. Mary Prunicki, and she is the person you want to listen to about this stuff. She is on top of it. She's been doing it for a long time. She's living in it. She is the Director of Air Pollution and Health Research at the Sean N. Parker Center at Stanford. She works in immunology. This is what she does.

Quinn:
What does wildfire smoke do to our bodies and our immune systems? Look, I don't have to tell you the main action step here. Until we decarbonize everything, until we learn to manage our forests like the indigenous people did for thousands of years, before we showed up and ran over everything, and made our cities too expensive to live in, so people were living in the actual forests... Until we do all of that, this is something we're all going to be increasingly living with, no matter where we are. Look at Siberia. Look at South America.

Quinn:
So, folks, please listen to this, take care of yourself, and please share this one to help as many people as we can. Huge thanks again to Dr. Prunicki and our entire production team for coming on the show and getting this thing knocked out and into people's hands as soon as we can do it. And if you haven't been listening recently, folks, been too busy, go back, check out our recent incredible conversations about the future of mosquitoes, how to invest with climate in mind, how to find out of the universe is going to end, what happens when trees talk to each other, and of course, how you can help beat poverty.

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Quinn:
My guest today is Dr. Mary Prunicki, and together, this one's a little more timely. We're going to try to help you folks understand wildfire smoke. What it is, what's in it, as far as we know, and again, as far as we can tell, and by we, I mean Dr. Prunicki. I'm on the receiving end, just like you folks are. What it means for your health, your kids' health, should you have them, grandparents, and more. Dr. Prunicki, welcome.

Dr. Mary Prunicki:
Thank you. Thank you for having me.

Quinn:
Absolutely. Could you do me a favor? Tell the people real quick who you are and what you do.

Dr. Mary Prunicki:
Sure. My name is Mary Prunicki. I'm the Director of Air Pollution and Health Research at Stanford University, under the Sean Parker Center for Allergy and Asthma Research. We're an immunology lab, and we look at the impact of air pollution and wildfires on health, specifically immune health.

Quinn:
Fascinating. I think just that in itself, that you're an immunology lab has probably got some people's ears perked up, because I imagine there's some folks even, we get a pretty nerdy audience here, but I imagine there's still some folks going, "Wait a minute, that doesn't sound great." So, I look forward to digging in on this. Dr. Prunicki, I do like to start... We've done, god, I don't know, 120 of these or so. We ask one question to set the tone a little bit. It's a little self-serious, a little tongue in cheek, but it's fun. People usually cackle to start with. But instead of saying, what's your entire life story? We like to ask, Dr. Prunicki, why are you vital to the survival of the species?

Dr. Mary Prunicki:
I'm not sure I am, but I do feel like the research that we do does potentially impact a lot of people, especially given the wildfires in the west, and actually worldwide, with climate change.

Quinn:
Sure, sure. Clearly, something we're going to be dealing with for a little bit, not just in this moment. I've got to say, that is why I wanted to... Thank you for that answer, by the way. Most people do just cackle and say, "I'm not," but then sometimes I get something bold and thoughtful, because we talk to some incredible humans, and they're out there for a reason. But like you said, this is how affecting everybody. This isn't just the forests around Silicon Valley that are on fire. It's a lot of places. And I try to use this show not just for my own interests, but as a platform to have conversations about the biggest science-based issues of our time, and I do try to make the conversations usually something a little more evergreen. So, less like, holy shit, this is what's happening this week, and more, here's some context for something we're all going to be dealing with as a species, with our ecosystems, for a while. And as we get to our bread and butter, the most impactful actions you can take to drive some systemic change, and to feel a little better yourself.

Quinn:
This one is a little bit of both, and so I'm really glad we're doing this, because I think it will be able to help people. Because it's not difficult now to look outside, almost wherever you are, or one of these increasingly popular and prevalent where the fires are burning right now maps. I mean, the New York Times has one. And to smell that smoke.

Dr. Mary Prunicki:
Right.

Quinn:
So many of the fires are burning in the west, but thanks to the jet stream, you've got places like Maine putting out air quality warnings, and I think it's very... Being on the east coast for a lot of this this year has been very disorienting for a lot of people here. But it's very serious, and I know that, I understand, perhaps incorrectly, but I'm excited to be educated that we're very much in the throes of understanding the ramifications of these things. So, we've been living with versions of regular pollution for a while, as they call it, PM2 and nitrogen dioxide, and you see California in the old days, and still, and London, and New Delhi, they've got air pollution from industry, and transportation, agriculture.

Quinn:
But this wildfire smoke seems like it's something new to a lot of people, so if we could take a step back, because again, my first goal is always to give people sort of, not lowest common denominator, but real context before we get too nerdy with it. Could you actually define for everyone what we talk about with sort of, again, this is terrible, but regular pollution, PM2, and sort of where that comes from, so that when we differentiate for wildfire smoke, they can really understand what we're talking about?

Dr. Mary Prunicki:
Sure. You mean, talk about what particulate matter is, and where it comes from?

Quinn:
Yeah, sort of when people say this is what's been causing asthma and this, and it comes off roads and tires and stuff like that.

Dr. Mary Prunicki:
Okay. Yeah, so when we talk about air pollution, there's a variety of pollutants, but probably the most research has been done on particulate matter, and the number denotes the size of the particulate matter.

Quinn:
Okay.

Dr. Mary Prunicki:
So, PM2.5 are particles that are 2.5 microns and smaller, whereas PM10 are particles 10 microns and smaller. And the reason that the size makes a difference is because the larger the size, the less it can impact our airways. So, PM10 goes about halfway down our airway. PM2.5 is small enough to go all the way down the base of our lungs, and then cross over into our bloodstream. And so, the thought is that the smaller the particle... There's also ultra-fine particles. The smaller the particle, the more damaging, because the more it can penetrate.

Dr. Mary Prunicki:
And so, a lot of the research is focused on air pollution and looking at PM2.5, and it's without a doubt shown globally, the more you're exposed to chronically, the shorter your lifespan, and the lesser your quality of life. So, that's just, you can look at a graph showing different parts of the world and how much exposure people get, and their lifespan is shorter if they're exposed to more.

Dr. Mary Prunicki:
And so, when we talk about wildfire smoke, about 80% of the smoke is composed of PM2.5, and a lot of other things, a lot of toxins and things like that. But that's why when we talk about toxicity from smoke, we have a good base from air pollution research to kind of understand what's probably going on with the wildfire smoke.

Quinn:
Okay. And that's really helpful. I mean, I think when you're doing this every day... I mean, god, I'm nowhere near your level or a scientist, but trying to help people in a generalist way keep track of the way these things are going, and we have a lot of readers and listeners from all over the world. You start to see more and more of this research about infants, or babies in utero, or pregnant women, or older people.

Quinn:
I saw something this week, Alzheimer's Association, I believe, about older women and dementia. And obviously, because it's America, that marginalized people are far more exposed to these things, whether it's in California, the uncapped oil wells, or transportation, or something like 60% of Black people in America live within 30 miles of a coal plant. Whatever it might be. And then, of course, we saw with COVID, so many people were adversely affected who had preexisting conditions. I know we're still a long way, in some ways, on causation on some of these things, but it's not great.

Dr. Mary Prunicki:
Right.

Quinn:
So, let's dig into this wildfire thing, if we can. And again, just for folks on the east coast who are new to this, why these things are happening. I am not, and I imagine, Doctor, you're not, we're not against wildfires. Yes, they are inherent to nature. They're useful. They're good for forests and vegetation. The issue is, in a broader way... Again, just context, the greenhouse gas emissions from this industrial era have caused global warming, and in the west, and in Siberia and other places, warming has resulted in drier vegetation. And along the way, we've simultaneously, we've moved more into these places, so we've suppressed these fires, as opposed to how indigenous peoples controlled them for thousands of years before we showed up.

Dr. Mary Prunicki:
Right.

Quinn:
And we've suppressed them because, while things have been drying out, again, we've been moving into these areas, and so now, when they burn, it's not just vegetation. As you were saying, with some of the other things that are in this smoke, it's homes that are burning, and businesses, and cars, and roads, asphalt, bridges, yada, yada. Fires make it hotter, which makes more fires. They create their own weather. They create lightning, and it makes more fires. We spit out CO2, which means any decarbonization gets worse. Anyways, the point is, where there's fires, there's smoke, to reverse it, and that's what I want to dig into.

Quinn:
So, Doctor, you said that we have this, because of decades of research into air pollution, and I know that's always increasing every day, the research, that is. But what do we know so far about how wildfire smoke differs in content, I guess, at least, or wherever you would like to start, from more typical pollutants? And then, I guess, we can get into how it actually affects our bodies.

Dr. Mary Prunicki:
Right. The thing about wildfire smoke, well, particulate matter in general, it's composed of what's around for it to be formed. So, particulate matter is not some homogenous thing. It really depends on what's being burned.

Quinn:
Okay.

Dr. Mary Prunicki:
So, wildfire smoke, for example, from a wildfire in a forest is going to look different chemically than wildfire smoke from a town being burned down, where you have plastics and chemicals and things like that going up in smoke. So, we know that, in fact, there was a recent study showing that the particulate matter from air pollution is more toxic... sorry, is less toxic than the particulate matter from wildfires. So, when wildfire PM2.5 is inhaled, it's more toxic than just general old air pollution PM2.5.

Dr. Mary Prunicki:
We know that there's going to be an increase in hospitalizations for respiratory events, up to 10 times more than, if you're exposed to the wildfire PM2.5, than just regular, elevated poor air quality. And we also know that if we look at the speciation of the PM2.5, or PM in general, sometimes we see it associated with different heavy metals, different toxins, different toxic chemicals. Things like polyaromatic hydrocarbons, cancer-causing agents, things like that, that are carried on the particulate matter. And so, when we inhale it, it's those things that are also adhered to the particulate matter that's causing damage to our body.

Dr. Mary Prunicki:
So, there needs to be more research on how a particular type of smoke impacts health, but we know in general, smoke is bad, regardless.

Quinn:
Sure.

Dr. Mary Prunicki:
It's just, how bad?

Quinn:
Sure. And so, you had alluded to some of the things that we can tell are in that. I know there was the study that some folks did, I and I apologize, I can't remember where. They studied some of the smoke that came out of the Paradise fire, and how, you know, it's not difficult to do the 1:1 of a bunch of homes burned, and they were probably built in X number of time, just like any place in America, and so suddenly you get to, oh, there's lead in this smoke, and things like that.

Dr. Mary Prunicki:
Right. The California Air Resources Board put out a report, and they looked at what was going on in the air during the Paradise fire, and I think it was the Butte fire. It was two fires. But with the Paradise fire, they saw an increase in lead levels for a day that people were exposed to with the smoke, and we know, any exposure to lead is bad. There were also increased other heavy metals, zinc and a few others, that didn't reach the threshold of toxicity, like the lead did, but we know that it's not just smoke, it's the heavy metals in the smoke, and other things, that we should be concerned about.

Quinn:
Sure. And like you said, baseline smoke, already not great.

Dr. Mary Prunicki:
Not good.

Quinn:
It's not helpful to add the toxic metals in. Obviously, you know, what happened with Paradise is such a tragedy, but we've already seen an entire town in Canada wiped off the map a month ago. And it's entirely possible, as most things throughout my day, that I'm incorrect on this, or somewhere off base, but I imagine that a percentage of these fires, certainly, if not most of them, are not directly burning homes and cars and things like that, yet. But, so they're burning more of our forests, our state forests and things like that. That smoke, so that's a lot of the stuff that's being blown through the jet stream to the east coast, or up and down California, and southern California, when that kicks off in a month and gets very hot. What do we know about what that, I guess, more common wildfire smoke, what do we already know about what that does to our bodies? Like you said, you're in an immunology lab, so how do those things connect? How did we get to that point where that makes sense?

Dr. Mary Prunicki:
Right. We know that when a population is exposed to the wildfire smoke, there will be an increase in respiratory and cardiac events showing up in emergency rooms, and hospitalizations. We know that people are going to be coming in for things such as asthma exacerbations, COPD exacerbations, acute bronchitis, pneumonia, and also things like arrhythmias, heart attacks, strokes. Pregnant women are impacted by the smoke. And we're finding more and more different populations that are at risk, and if you actually look at the data, end up needing some type of medical services during exposure to the wildfire smoke. We also know that as the smoke goes through the air, as it ages, it becomes more toxic.

Quinn:
Great.

Dr. Mary Prunicki:
We know that breathing smoke produced the same day is not as toxic as breathing that same smoke as it has aged a few days, and it has to do with the production of free radicals and things like that. But there's just nothing good to be said about breathing the smoke, whether you're directly by the source, or it travels. Which, it can travel thousands of miles, right?

Quinn:
Sure.

Dr. Mary Prunicki:
It can still cause problems.

Quinn:
And now, where does immunology come into all of this? Is that for any age spectrum, any demographic, or are you looking at something in particular? At what point were you like, oh, this goes... again, not to minimize it, but this goes deeper than some daily inhale?

Dr. Mary Prunicki:
Right. Well, so, a lot of diseases, their basis kind of comes from problems of inflammation, or problems with your immune system. But the way that we tie in is that for over 10 years we've been doing air pollution research, looking at kids exposed to elevated air pollution, and looking at their immune system. But then, more recently, we've looked at both kids, teenagers, and now we're studying other populations, like firefighters, looking at how exposure to the smoke impacts their immune system, impacts the association with subsequent disease.

Dr. Mary Prunicki:
So, what we know, we did a retrospective study looking at kids, just 6-8-year-olds, that were either exposed to a prescribe fire, which is a controlled fire that helps alleviate future wildfires. The smoke from that, versus the smoke from a wildfire. And these were kids about 60 miles away from the fire itself, and we found that the immune system was impacted less by the prescribed burn, in comparison to the wildfire, and the prescribed burn seemed to put out less pollution overall, which it's controlled, so that makes sense.

Dr. Mary Prunicki:
But there are certain changes that happen in your immune system that make you less effective at fighting disease, and changes that cause inflammation to be produced in the body. And inflammation is, as you know, not a good thing, either. We also looked at teenagers exposed to wildfire smoke, and we could see subclinically, so we could look at their blood, we could see elevations in the inflammatory markers. We couldn't see any clinical expression, like it's not that they were having a heart attack, or having trouble breathing, but if you look at their blood, you could see microscopic changes. And we don't know, does that lay the foundation for further disease down the road? Is that setting kids exposed to smoke in a different direction as an adult, for chronic health problems? We don't know the answers to that.

Quinn:
And does that just take time?

Dr. Mary Prunicki:
It takes more research, yeah.

Quinn:
Sure.

Dr. Mary Prunicki:
And looking over time for repeated exposures. And so, that's why some of our research, we're studying retired firefighters, who obviously have been exposed for years to smoke, and then we're studying active firefighters, looking at their blood before and after fighting a fire, to try to determine, how does... and from that, hopefully we can extrapolate. We're also looking at healthy people exposed to fires. How does that impact us acutely, and does it impact us long-term?

Quinn:
Well, the good news is, you've got about 10,000 firefighters to choose from on any given day. They're all making about a dollar. So, when you say, and obviously this probably varies quite a bit, but at least for the research you've done, when you say it's been studying kids, for example, you said 6-8 years old, or teenagers, that have been exposed, and the fires were, I believe you said, 60 miles away. When you say exposed, does that... over an hour? Over a day? Over a week? Over a month? What are we talking? What's the threshold of exposure to see some of those immunological adjustments, I guess, changes, whatever the medical term is?

Dr. Mary Prunicki:
I believe the fire that we looked at, I think that wildfire lasted, I want to say 1-2 weeks. I'd have to double check. But it was 60 miles away. And it was a retrospective study, but now, what would make... It needs to be replicated and looked prospectively, as it's occurring in time, sampling their blood repeatedly, which is something that we're doing, and looking for changes, if that makes sense.

Quinn:
No, of course. Thank you for dumbing it down for me. I greatly appreciate it. So, how much do we feel like... And again, I know you're among the most preeminent in this, but also, it's still relatively early days on this. What do we know about how much proximity matters for, I guess, exposure/level of toxicity? I just think about, again, what is it, last year in Los Angeles, or when Silicon Valley and San Francisco were surrounded for weeks at a time. Those weren't 60 miles away.

Dr. Mary Prunicki:
Right.

Quinn:
What, does that change anything, that calculus, at all, that we know?

Dr. Mary Prunicki:
Well, the higher the level of PM2.5, it's presumed the more toxic. So, last fall, some of the areas had elevated PM2.5 levels up to, what, 500 AQI? Huge, huge amounts of pollution in the air. So, it really, it's presumed that the higher the AQI, obviously the more dangerous it is to your health, and that you can see the impact quicker. Some people have sore throats, burning eyes, coughing. And then there's others with preexisting conditions or otherwise that will start having an asthma attack, or things like that. A heart attack. Sudden cardiac death. So, it really just depends on the person and the population, and then the level of exposure.

Quinn:
So, if I'm in Maine, or like Boston and New York, they got clobbered last week, and it looked like Mordor outside. Those AQI readings that they're getting, despite thousands of miles between them and the source from the fires, and the sources of the smokes, those are going to be, as far as we can tell, pretty accurate as to their real exposure. It doesn't matter how far it's traveled.

Dr. Mary Prunicki:
Right.

Quinn:
It could... Okay. Okay.

Dr. Mary Prunicki:
Right.

Quinn:
I'm just trying to help folks understand, yes, I'm 3,000 miles away, and I see smoke, but it's not as bad as being 20 miles away. It's just, it matters. The reading is what matters, I guess, and the length of time?

Dr. Mary Prunicki:
Right, the age of the smoke, the amount of PM2.5 you're actually being exposed to. So, if somehow you're 1,000 miles away, but you're getting a big dose of PM2.5, that's still bad. It doesn't matter that it was 1,000 miles away. It's still going to impact your health.

Quinn:
And I mean, conversely to, I guess, what one would think, or maybe it's entirely possible this is just me, but you would think over... For instance, with COVID, when we all finally understood that this thing was aerosol-based, a little gust of wind and this is blow and it's dissipated, and you're probably fine on a beach, unless you're screaming in someone's face. But for this case, if I'm 1,000 or 2,000 or 3,000 miles away from the source of this fire, it's actually probably taken a few days to get to me, and now the smoke has actually aged.

Dr. Mary Prunicki:
Aged more. Correct.

Quinn:
So, it's the opposite effect, as far as we can tell.

Dr. Mary Prunicki:
Well, I mean, we don't have really good data yet to say, okay, smoke that's four days old is going to have this impact on your health, as compared to very new smoke.

Quinn:
Of course. Sure.

Dr. Mary Prunicki:
It's not to that granularity yet, but we're working on it.

Quinn:
We've got plenty of smoke to work with, so you're welcome. So, talk to me about folks with preexisting conditions. We've talked about kids a little bit, and some potential, you've seen some markers that could potentially lead to long-term immunological changes. And again, my kids are young, but they're white, privileged kids who are going to be fine. I don't want them to be exposed to this. I, again, was a young, white, privileged kid, but I had exercise-induced asthma, and I went, I was a swimmer, and I probably went to the emergency room, I don't know, 15 times in five years, in the back of an ambulance, and I remember EMTs working on me in front of all my swim teammates, and how horrible that feeling was. And that was just an internal thing. That wasn't because of any external exposure or anything, where my family lived, or whatever it might have been.

Dr. Mary Prunicki:
Right.

Quinn:
But I remember getting to a point of my parents going, "You ran out our health insurance for the family because of this." But at least I had that, and we know so many kids don't, and so many people in California and Los Angeles, around the Bay Area, do not. So, there's a lot of kids that aren't going to be able to escape this sort of thing on a day-to-day basis, or permanently.

Dr. Mary Prunicki:
Right.

Quinn:
And we know that. I mean, they've been... Again, my friend, Molly Peterson, she's a reporter, she's done reports about the heat around schools, and how it makes it more difficult to learn. All this stuff, these kids... It doesn't get cooler at night. So, let's talk a little bit about healthy-ish middle-aged people, and if you could, I guess, some folks with preexisting conditions, and then older folks with respiratory conditions. I think, I mean, specifically, my mother-in-law who's kind of a respiratory nightmare, and when COVID was a hint of it, I was like, "Guess what? You're not leaving your house forever." So, here's the deal, because it's like, one swipe and she's out of here.

Dr. Mary Prunicki:
Yeah.

Quinn:
So, what do we, not her particularly, but what are the preexisting conditions most likely to be affected by an exposure to a certain amount of this?

Dr. Mary Prunicki:
Yeah. Definitely people with respiratory conditions, so people with asthma, people with COPD, things like that. Studies have shown kids age 0-4, and then older adults, 65-ish and above, those are the people that are most likely going to be coming in to the ER during a wildfire event for a respiratory condition, for some type of respiratory distress. In addition, if we talk about the heart, those are going to be the older people. So, again, 65 and older, those with preexisting heart conditions. You can have a heart attack. You can have the arrhythmias. There's actually a study looking at out-of-hospital sudden cardiac death. That's when you hear about people just literally dying on the spot. The heart just completely stops. They found that that is increased during wildfire events, and those weren't previously kind of acknowledged, because those people don't make it to the emergency room...

Quinn:
Interesting.

Dr. Mary Prunicki:
So, they weren't kind of tagged in that way.

Quinn:
Sure.

Dr. Mary Prunicki:
But if you look at the ages, that drops down to in the 30s for people being at risk.

Quinn:
No shit.

Dr. Mary Prunicki:
So, that's obviously a problem. People with strokes, that's going to be the older people that might have a stroke due to the wildfire smoke. If you look at vulnerable populations, that's going to be obviously the very young, the very old, people with preexisting conditions, people of color, people with... homeless people, people who are outdoor workers. I'm trying to think if I'm forgetting any populations. Pregnant women. All those categories are going to be at increased risk compared to just your general healthy adult.

Quinn:
Sure. Could you do me a favor, just take a quick step back, and this is something that's been on my list to talk about with someone at some point, because it seems to be, again, as much as... I'm a caveman, and I can try to understand the bare minimum of it. But could you talk to me, us, for a moment about inflammation. When you say that so much comes down to this, could you actually just paint that picture? What do we know about inflammation? I know it's a body's natural response, but does it go overboard? Are there other things that drive it? And what do we know about, again, besides some of the things that you've just indicated in the last minute here, what does it do? Why is that such a thing for us to understand?

Dr. Mary Prunicki:
Yeah, so, when there's inflammation in the body, there's components in the blood, inflammatory components that do their thing throughout the body, and it can kind of skew your immune system to be more in an inflammatory state, and it can skew it to be also more in an allergic type phenotype, is what we call it. And so, none of those things are good. You want to have an immune system that has plenty of the good, healthy kind of peacekeeping cells in your body, kind of keeping track of and keeping ahold of these inflammatory components. And one thing we know is, from air pollution studies, when someone's exposed to air pollution, they produce fewer of these T-regulatory cells, which are the good immune cells that kind of keep peace throughout your immune system. So, with fewer of those, your immune system kind of goes awry, and it's just kind of dysfunctional.

Quinn:
Okay.

Dr. Mary Prunicki:
Kind of slanted yet more towards an immune system that's reacting in an allergic-type manner, more than it should.

Quinn:
Okay, that's super helpful. Thank you. I mean, to some people, inflammation's like, take some Advil, but that's obviously not what we're dealing with here.

Dr. Mary Prunicki:
Although that does decrease inflammation, but yeah.

Quinn:
Sure, sure, sure, but clearly we're on another level, here.

Dr. Mary Prunicki:
Yeah.

Quinn:
I want to talk just for a moment about, I stole a word from another sort of futurist, generalist, who primarily works on climate stuff, because it is a great word for what we're starting to go through, what a lot of folks have already been going through, but really what's going to happen over the next 10, 20, 50 years here, and he uses this word, that we're in a discontinuity. And it's that there's just so many systems, systems that we've either purposefully designed or inadvertently compounded over time, and how these things all intersect from, again, what happens when a respiratory novel virus shows up and it attacks a bunch of people with preexisting respiratory conditions and such.

Quinn:
But that also, we're also looking at things like how we measure things, and I saw somewhere... Again, please correct me wherever I'm wrong here, this analogy that exposure to air quality above an AQI of 150 for a certain amount of time, I can't remember, is the equivalent of smoking seven cigarettes. Is that correct? I mean, again, I just try to help paint a picture for people, so they go, "Oh. Got it."

Dr. Mary Prunicki:
Yeah. In Australia, they call it the ciggy index. So, they'll say, "Today, the air quality is four ciggies." And what it is, someone came up with a mathematical formula to equate how much exposure it is to smoking one cigarette versus the air quality. So, I believe it's one cigarette is equivalent to 22 microns per cubic meter of PM2.5. So, if outside, it's 90 microns per cubic meter of PM2.5, that's like going out and smoking four cigarettes.

Quinn:
Okay. But over how much a time? Are we talking like, walking to my car? Are we talking running around outside? Because obviously...

Dr. Mary Prunicki:
I think it's calculated per day.

Quinn:
Okay, that's helpful. Just a range, so people aren't like, over a month, or you've got 12 seconds to get to your car.

Dr. Mary Prunicki:
Yeah, I think it's like going outside and hanging out for a while, and you're breathing that in, it's like smoking four cigarettes.

Quinn:
Okay. You've smoked four cigarettes today. As usual in America, we're using an arbitrary number, instead of something that's profoundly more helpful and illustrative of the actual thing.

Dr. Mary Prunicki:
Well, it does help you visualize what you're doing to your lungs.

Quinn:
Sure. No, absolutely.

Dr. Mary Prunicki:
Because people understand cigarette smoking a lot better.

Quinn:
I mean, finally. And yet, you walk around these colleges, and you see these kids smoking, and you're like, "What are you doing?" We know so much. You want to run around...

Dr. Mary Prunicki:
Yeah. We can talk about that, or we could talk about the damage that e-cigarettes does. We could, yeah.

Quinn:
Oh, god. That stuff has just... I mean, these, they're just monsters. They're just absolute monsters, these people. So, I'm curious though, again, about those measurements, whether we're talking, sorry, the ciggy scale, was it? Or how did they frame it?

Dr. Mary Prunicki:
Yeah, the ciggy index. The ciggy scale.

Quinn:
Right, the ciggy index, versus... analogous to our AQI, the things you see on PurpleAir and all that kind of stuff that we're able to all see now. Now that we're understanding more, again, it's not every fire that has lead and all these toxic metals, but many more of them have, and if it's near roads, it's asphalt and things like that. How much were those scales and those ratings rated for old pollution, versus some of these newer things? Do those change? Is it 150-plus when it's got some of these toxic metals? I'm curious, do we adjust that?

Dr. Mary Prunicki:
You mean to say you're asking how accurate is the AQI scale?

Quinn:
Yeah, I guess, for this new era we're... Basically, just a greater variety of manmade shit is burning, essentially.

Dr. Mary Prunicki:
Right, right. Well, I mean, some people would argue that maybe the AQI scale should be more conservative, and I also thing that it really depends on the individual, like if you're experiencing symptoms, it doesn't matter what the AQI is. Get inside.

Quinn:
Sure, sure.

Dr. Mary Prunicki:
Breathe clean air. But I do think, especially the past years, with the Camp fire, and everything that's been happening, and the climate change issues, we're still learning how toxic the smoke can be, and how variable the toxicity could potentially be, depending on what's been burned. And it's just, the wildfire health research area has a lot to learn, as we realize that the wildfires aren't going away, and they're only going to get worse.

Quinn:
Sure, sure. That's helpful. I mean, I always appreciate that level of self-awareness, which it like, we're figuring it out when you are. These things aren't around here. But that's helpful that there's already sort of this thought of, look, we need to assess what's really in this thing, and we're trying to as it goes along. But obviously, that requires more fires burning, so again, you're welcome, we've made a lot of those.

Dr. Mary Prunicki:
I mean, even if you look at the firefighters, they're an under-studied population. They have a lot of health problems by the time they retire. They have a shorter life expectancy, presumably from the smoke that they're breathing, and they have an increased risk of certain types of cancers. And there's a lot mechanistically that we don't really understand, and we don't understand, at what point is it critical that they stop being exposed to the smoke, so that they don't have these outcomes later in life?

Quinn:
Yeah. It makes me get angry all over again about all the hearings and the unjust way the 9/11 responders were handled after, and all the sicknesses that they dealt with, and I just remember them arguing in front of Congress, and Jon Stewart arguing in front of Congress and holding these people to task on the show, going, look at these people. It's 10 years later. They worked for three days, or three months, or whatever it is. Look at what it's done. How can you not support these people, or at the very least study it? And go like, of course we shouldn't be breathing a building that fell down. We're bags of pink flesh. Our bodies are amazing, but they're clearly not made to process this stuff.

Dr. Mary Prunicki:
Right, right. And the thing with, for example, heavy metals is, your body accumulates it, and things like PAHs, the polyaromatic hydrocarbons, it likes to go to, it's attracted to fat, so it wants to go settle in your fat stores.

Quinn:
And what is PAH? Sorry.

Dr. Mary Prunicki:
It's polyaromatic hydrocarbons. There's different types, but some of them are associated with cancer. So, it's not like once you're out of the smoke, your body completely recovers, depending on what you've been exposed to.

Quinn:
Sure. So, good news, bad news for everybody. We just had this whole pandemic, which is actually still going on. I'm not sure if you're aware of that. Super fun. It's back. Look, we always build towards these action steps, right? We try to get really specific, not just like, call your congressperson! But it's usually, call this specific congressperson about this, and read this script, and push this button. We know the best ways to reduce exposure to wildfires and smoke are decarbonizing and electrifying everything we can find, and burying all of PG&E's power lines wherever they stand, and listening to indigenous people, who are like, "We've been telling you, we had this under control for a long time."

Quinn:
Obviously, those haven't happened for a reason. They're incredibly expensive. The clock is ticking in a different way now, but they're going to take a while. But to protect one's own health, my mind goes to masks. Everyone's got these wonderful cloth masks that we've gotten, and some of them have filters. They've cut them from vacuum cleaners, or now there's whole industries, they're making them. Could you just do me a favor and disappoint me very quickly, and tell me how those don't work, before we get to what does work?

Dr. Mary Prunicki:
Cloth masks, surgical masks, they give you a small amount of protection. Not nearly what you need for wildfire smoke.

Quinn:
Okay. So, great. Everyone can keep those for COVID. You'll need something else. So, what does work? Let's talk about out and about, or even if it has to come in your house or your school, what can we wear on our person? And then we can get into, I guess, residential and commercial-type equipment.

Dr. Mary Prunicki:
Yeah, as far as what to wear, it needs to be an N95 mask, because that will filter the small particles. The thing you need to be aware of, though, an N95 mask does not filter gases, and so part of wildfire smoke is, it has gases. So, that's still an issue. That's why it's always better if you can just stay out and away from the smoke, it's better to do so. The other problem with the N95 masks is, you'd have to have a perfect seal, right? Which is not possible to do, especially long-term. For kids, it's super hard. If you have facial hair, you don't get the right seal. And so, the masks are great, but they're not really the end all and be all. It's better to be away from the smoke. It's better to be inside, assuming the air quality is good inside, and to just not mess with it, if possible.

Quinn:
I think, it reminds me of, again, all of these incredible front line medical workers who... Look, we've all seen the incredible diagrams online, and the modeling of, if you're in this part of the restaurant, and this person's got COVID, and they cough this way, you'll get this, but wear your mask, and it's as tight. It's the same, but when we've lost so many nurses and doctors and support staff because they're inherently in an environment where they're just surrounded by people who are infected and breathing that stuff, and I imagine that's the equivalent of this smoke. It's not the single direction puff coming at you. It's that if you don't have this tight seal, it's getting in. And, like you said, and gases.

Dr. Mary Prunicki:
Yeah. I mean, it's better to have it than not have it, but it's not a perfect solution by any means.

Quinn:
Do we know anything about... Again, let's assume, let's use that 150 number, or whatever you would prefer, because I'm a moron, how long is an N95 mask going to cut it if we're outside doing walking, or at a kid's game, or whatever it might be, or if we're working, we're someone who has to work outside?

Dr. Mary Prunicki:
Yeah, I mean, I think it depends on the mask. I know a lot of them will come with some type of informational sheet that says it's intended for temporary, not permanent use. It's disposable, or it will give you how many hours.

Quinn:
Okay, so follow the directions.

Dr. Mary Prunicki:
Yeah.

Quinn:
That's so weird. Okay, so that's helpful. So, N95s, follow the directions. They are temporary. Look at your AQI and understand. But best case scenario, obviously, stay away from it if you are able to do so. Let's assume we can get inside somewhere. Let's assume it's either our apartment, or our home, or a business that we have some of sort of say in. We've all, again, learned so much this year about HEPA filters, and filtration, and things like that.

Dr. Mary Prunicki:
Right.

Quinn:
Where schools, they have, I mean, and this is the thing, right? So many schools have spent so much money over the past six months putting in windows and bringing in fresh air. Fun fact, that's not great when there's wildfire smoke outside, so now we're talking about filtration, I imagine.

Dr. Mary Prunicki:
Right.

Quinn:
What is going to cut it? What is helpful? What is not? Any ideas?

Dr. Mary Prunicki:
Yeah. Well, I'd say number one, when you're talking about indoor air, know what your air quality is. I mean, to my knowledge, there's no standard method to measure indoor air quality in our schools, our businesses, so you've kind of got to start with what that number is, because there's a lot of factors of the building, how draft it is, and how good their HVAC system is, if they have an HVAC system. All those types of things will impact how well... If you have a MERV, MERV 13 is considered really good, but if your building has the right amount of filtration. When you're talking about your home, you have to make sure that whatever level of filtration you put in your unit, that your home can actually handle that type of airflow, because the tighter the filter, the harder it is to pull the air through. And so, it's not super simple to know what is most appropriate for your home.

Quinn:
Sure.

Dr. Mary Prunicki:
And then, air purifiers obviously are a good thing, but those are based on square footage, and they all have different clean air delivery rates. And so, probably the best thing is kind of be prepared, so you're not scrambling when the smoke hits.

Quinn:
Sure. And from what I understand, again, caveman, just from the alerts that pop up on my phone to replace my filters every however many weeks, that my wonderful AC guy yells at me, in a non-COVID year, those seem to be... and again, I know this isn't actually your profession, but they seem to be a closed system, where you've got the intake, and that's coming from one room, and exposing. So, it's not necessarily pulling in air from the outside, and again, my worry was just, I know that a lot of these schools, for example, have taken what in any other case would be the easy way out, which is just, do our windows open, because that makes such a difference for this aerosol for COVID.

Dr. Mary Prunicki:
Right.

Quinn:
Again, we're just in this horribly unique moment, and I'm just thinking of, again, we're just getting started. We're recording on July 29th. It will come out in a day or two. But everyone's going back to school in the next 5-6 weeks, and southern California hasn't even gotten started with their fires yet.

Dr. Mary Prunicki:
Right.

Quinn:
So, again, we've got educators and all kinds of folks that listen. I'm just trying to help them think through this.

Dr. Mary Prunicki:
Yeah, I mean, it's a debate, whether or not... When the wildfires were here last fall, some schools closed, some didn't. Is your air quality at home better than your air quality at school? Who knows, if you're not measuring it? And to make that decision of what to do with the schools, it's a huge issue.

Quinn:
Yeah, I mean, I think, my kids to date have been part of the LAUSD public school system, and there's... Look, my mom was a teacher. I'm the world's biggest supporter to teachers. They should make millions of dollars. But I'm also, I have a hard time criticizing a school system of 700,000 kids. It's like, do I want to be in charge of that? Oh my god.

Dr. Mary Prunicki:
No.

Quinn:
No, thank you.

Dr. Mary Prunicki:
That's a hard call.

Quinn:
There's no win, where 80% of the kids are on free lunch and free breakfast, and they don't have internet, and what do we do? They, in so many ways, have done an admirable job, but you're looking, and someone's going, "Okay, so you need to open the windows, because we've got a pandemic, but also, don't open the windows, because there's wildfire smoke. But also, we're not measuring it inside." So, it's just like... And again, I'm not trying to be a doomer here, I'm just trying to paint a reality of this moment, of helping people continually take a step back and think about all of the factors involved with what we're dealing with right now.

Dr. Mary Prunicki:
Right, and if you don't have air conditioning, it can get really hot, and you've got the smoke. Do you open up your windows and get a little breeze going through, and smell the smoke, or do you roast inside your house? Especially older people, it's a huge issue.

Quinn:
So, I know a lot of folks have bought these, and I got one, the PurpleAir monitors, and from what I can tell, they're pretty good, for a consumer side. I don't need you to promote any specific business or product. But do those also work inside, that sort of thing, at least? Is that, when you say we're not measuring the air, is that the kind of thing you should be looking for, or something different?

Dr. Mary Prunicki:
Yeah, you can actually purchase PurpleAir monitors for indoor or outdoor.

Quinn:
Oh, okay. Okay, cool.

Dr. Mary Prunicki:
Yeah.

Quinn:
This brings me to-

Dr. Mary Prunicki:
And some of the air purifiers come with their own little air pollution monitor on it, so you get an air quality.

Quinn:
Okay, that's super helpful. Yeah, by the way, entirely other conversation I just remembered is gas stoves, which turns out, real bad. And then, I remembered my ventilation hasn't worked on mine in 20 years. I'm like, I just can't even think about that right now. Doctor, I do want to get you out of here in just a minute, here. I'm going to ask you a couple of questions that we ask everybody, but last thing, any other facts on the ground? Any sort of practically, operationally, that you would like folks to be aware of, that we haven't covered? Because again, I'm trying to treat this, all of these as a sort of public service type thing, but this particular conversation, this is happening... Again, and I know this isn't your specific job, but what can we be doing better while we acknowledge that there's certain elements of this that are just out of our control, for a lot of folks?

Dr. Mary Prunicki:
Yeah. I mean, I would say, if you do have something like asthma, get your inhalers filled and ready to go.

Quinn:
Okay.

Dr. Mary Prunicki:
Also, I would say, if there's a wildfire and you're experiencing a lot of smoke, your community, check on your neighbors, especially the older ones, because maybe they could hang out at your house for a while and have some clean air.

Quinn:
Sure.

Dr. Mary Prunicki:
So, I would think anything you can do to... The homeless people, they're out in it. That's a whole other subject. So, I would say, just have concern and compassion for other people that may not be as fortunate as you, being able to get away from the smoke.

Quinn:
Sure. And again, I know this isn't your specific thing, and I don't want to give out specific medical advice, necessarily, but people with more pulmonary conditions, cardio stuff, do we get the home paddles, or what else can they do to be aware, besides get to the ER if you have to? Anything else?

Dr. Mary Prunicki:
Yeah. I would say, yeah, if you have a condition you're concerned about, reach out to your doctor, and maybe do it now, because it's probably coming, if it hasn't already hit, at least if you're out here in the west.

Quinn:
And if you're a doctor who is, again... Sorry. So many folks, again, on the east coast, to come back, are dealing with this for the first time. If you're a doctor who hasn't really ever spent a lot of time looking at this, because it's never been part of where you are, are there specific resources where they can get a little up to speed on what's going on?

Dr. Mary Prunicki:
Yeah, there are organizations. There's physician organizations that are focused on climate change. There's some pushes to do medical education and things like that. Some good resources would be, the EPA has a website. If you're in California... even if you're not in California, the California Air Resources board. A good one is the American Lung Association. They put out a report every year, and list every city, and how they do on air quality. They also have resources for wildfires. So, I would start with some of those. There's actually, if you Google it, a lot of worth resources where you can find out more how to protect yourself from smoke, or things to be aware of.

Quinn:
Okay, we'll throw all of that stuff in the show notes for everybody, as well.

Dr. Mary Prunicki:
Yeah.

Quinn:
That's all just profoundly helpful. I really appreciate it. I think there are a lot of folks, again, maybe this is their first time, and they're very, at the least, disoriented by what they see and what they feel and what they smell. But I think there's a lot of other folks that are obviously, again, after this year... Look, even if you got a light case of COVID, a lot of people now have some sort of long COVID, or preexisting condition of some sort, and this is just another added thing that makes you go like, well, what can I... what am I supposed to do?

Dr. Mary Prunicki:
Yeah. The research shows that there's an association between COVID rates and air pollution levels.

Quinn:
Awesome.

Dr. Mary Prunicki:
So, you're on the right track.

Quinn:
Good times. It's always great when the conversation goes exactly like I'm expecting it to. My wife this morning was like, I was like, "Hey, maybe she'll just be like, 'Eh, it's not that bad.'" She's like, "I don't think that's the way it's going to go." So, all right, I have a couple of last questions for you, and again, I know this was all very quick, so thank you for doing this. But you are doing some incredibly meaningful work, and obviously it's going to affect and help so many people over a long period of time here, as we fix our macro issues.

Quinn:
So, Doctor, when was the first time in your life when you realized, as either yourself or part of your group, the power of change, or the power to do something meaningful?

Dr. Mary Prunicki:
When was the first time in my life I realized I wanted to? Is that what the question was?

Quinn:
Sure, wanted to, or that you had the power to do so, or you looked around and said, "Oh, shit, I did that," or "We did this," or "I'm part of this cool thing."

Dr. Mary Prunicki:
Well, it's not related to wildfire research.

Quinn:
It doesn't have to be.

Dr. Mary Prunicki:
Okay. So, I took time off from my career. My children have severe food allergies, and I decided when I was going to go back, I was going to study something I was super passionate about, and hopefully help change, make it better. And so, that's how I got started at the Immunology Lab, looking at allergy, asthma, and it ended up being environmental pollutants. But that was a turning point for me, just seeing what my own children went through.

Quinn:
Sure. So, you're saying you studied one entire thing, had a bunch of kids, and then you decided it wasn't enough, and to do even more? That's great. I'm a guy with a podcast in a half-finished room, here. Well, that's wonderful, and that's pretty awesome. Man, my children are very young and reckless, but it is easy to be inspired by them on a pretty daily basis. Doctor, who is someone in your life that's positively impacted your life in the past six months?

Dr. Mary Prunicki:
I would have to actually say my boss, my mentor.

Quinn:
Okay. Good answer.

Dr. Mary Prunicki:
She actually just went to, spent time at the World Health Organization in Geneva, trying to make progress on climate change, and the impact on our health on a global level. So, I think there's probably nothing more awesome than trying to literally help the world. She's very inspiring.

Quinn:
Wow. So, again, like you, it's just small potatoes, aiming low, et cetera, et cetera. That makes sense. Last one, and again, we've got medical students, we've got young doctors, old doctors, researchers, all of the above. Nurses, support folks. It's been a hell of a year. What is your self-care? How are you managing to impact so much research, have children, raise children, live a life, and also not go cuckoo?

Dr. Mary Prunicki:
It's actually running.

Quinn:
Okay.

Dr. Mary Prunicki:
I'm trying to run every morning, and now I've foolishly said I'm going to try to do a 10K in three weeks.

Quinn:
Okay!

Dr. Mary Prunicki:
I'm nervous, but...

Quinn:
First one?

Dr. Mary Prunicki:
First 10K, yeah.

Quinn:
Oh, you're going to kill it. It's going to be great.

Dr. Mary Prunicki:
No, I don't think so, but hey.

Quinn:
I believe in you. You're going to do awesome.

Dr. Mary Prunicki:
It will be humbling.

Quinn:
I think you're going to be awesome.

Dr. Mary Prunicki:
But if I run, I can handle everything better, handle the stress better.

Quinn:
It is wild how much exercise helps my anxiety. Oh my god.

Dr. Mary Prunicki:
Yeah.

Quinn:
The days I don't do it and the days I do are very different days.

Dr. Mary Prunicki:
Yeah. I think my kids want me to run, at this point.

Quinn:
Yeah. It's funny, my wife didn't have a lot of background in exercise, and so when we first got together, she was just like, "Why does this idiot have to go to the gym or do this thing every day?" And now it's to the point where she's like, "It would be great if you left and went for a run, because this is not so fun for everybody."

Dr. Mary Prunicki:
Yep.

Quinn:
Great, got it. Yeah. Last one, Doc. What is a book you've read this year that's opened your mind to a topic you hadn't considered before, or it's actually maybe changed your thinking in some way? And we've got a whole list of recommendations up on Bookshop.

Dr. Mary Prunicki:
Oh, man.

Quinn:
Anything. Doesn't have to be related to your career. Could be anything. Could be your running book, whatever it might be.

Dr. Mary Prunicki:
Well, then I'd have to think of the title of it. I believe it was a book called Night. My children are actually reading... I think it's called Night. My children were reading it for school, and it's about the Holocaust.

Quinn:
Elie... I'm going to butcher it. Wiesel, I think? The small one?

Dr. Mary Prunicki:
It's very small. But I actually, I couldn't finish it. It was so upsetting.

Quinn:
Yeah.

Dr. Mary Prunicki:
I'm not... I'm only partway through it, but I don't know. I'm not sure when I'll pick it up again. It was just really impactful.

Quinn:
Absolutely. That's, I was, I'm a monster pagan atheist, but I was a religious studies major, so I did all of those, and yeah, they're both necessary and also just incredibly difficult to get through and process.

Dr. Mary Prunicki:
Yeah.

Quinn:
But, yeah, perspective. Doctor, I cannot thank you enough for doing this. I truly am grateful to you for your time and your expertise, and putting up with me. That's always the biggest one. This is something that's affecting people today, tomorrow, yesterday, and a lot of people for the first time, and it's new to a lot of folks, and the consequences involved are definitely new to a lot of folks. I think, especially if you've been in California for a long time, or a short time, you go like, "This is the thing that happens," but it's something that's happening to you, and it's important to really understand, as far as we know, what that means, because we've been through enough.

Dr. Mary Prunicki:
Yeah. Thank you for having me, and I hope I helped shed some light on the topic. But I appreciate your interest in it.

Quinn:
Oh my god, absolutely. Absolutely. Well, I look forward to following up with you in a year when it's all fixed, and you can just run all the time, and you're good to go.

Dr. Mary Prunicki:
Okay.

Quinn:
Thank you so much, Doctor.

Dr. Mary Prunicki:
Thank you.

Quinn:
I really appreciate it.

Quinn:
Thanks to our incredible guest today, and thanks to all of you for tuning in. We hope this episode has made your commute or awesome workout or dish washing or fucking dog walking late at night that much more pleasant. As a reminder, please subscribe to our free email newsletter at ImportantNotImportant.com. It is all the news most vital to our survival as a species.

Brian:
And you can follow us all over the internet. You can find us on Twitter @ImportantNotImp. It's so weird. Also in Facebook and Instagram @ImportantNotImportant, Pinterest and Tumblr, the same thing. So, check us out, follow us, share us, like us. You know the deal. And please subscribe to our show wherever you listen to things like this, and if you're really fucking awesome, rate us on Apple podcasts. Keep the lights on. Thanks.

Quinn:
Please.

Brian:
And you can find the show notes from today right in your little podcast player, and at our website, ImportantNotImportant.com.

Quinn:
Thanks to the very awesome Tim Blane for our jamming music, to all of you for listening, and finally, most importantly, to our moms for making us. Have a great day.

Brian:
Thanks, guys.