When dangerous air quality turned skies orange last week, hospitals in New Jersey were prepared for a wave of patients struggling to breathe. Hospital pharmacies stocked up on inhalers and other treatments, operations officials double checked air-purification systems and executives prepared to track a new public health disaster just months after the COVID-19 emergency officially ended nationwide. 

But instead of a wave, New Jersey’s 73 acute-care hospitals saw more like a trickle. State Health Commissioner Judy Persichilli said 143 people sought treatment for asthma or related conditions on Wednesday statewide, the highest number on average in two months but not nearly the volume that would overwhelm the health care system. Another 122 patients went to an emergency department with asthma-like concerns Thursday, she said.  

“We were expecting a surge in patients, but we have not seen that. It has been very minimal,” said Chris Freer, a doctor of osteopathy and the senior vice president for emergency and hospitalist medicine at RWJ Barnabas Health, which operates a dozen hospitals in northern and central New Jersey. Some hospitals reported treating two or three patients for breathing issues, he said, but the cases were not concentrated in any one area and most involved people with pre-existing conditions, like asthma or lung disease, that would make them more susceptible to being impacted by poor air quality.  

‘This is not the last time this will happen. This all goes back to, we can address root causes, or we can keep reacting to crises as they arise. And we have a choice to make.’ — Stephanie Silvera, Montclair State University

“This has been like a tiny speed bump. It’s not even like it’s impacting us,” Freer said Thursday, joking that “we’ve had a little practice over the past couple years with COVID.”   

While Canadian wildfires cloaked the region last week in the worst air quality in history – with readings in the 400s on a 500-point scale – the widespread impact on public health appeared relatively minimal so far, something health care experts attributed to lessons learned during the COVID-19 pandemic. By Friday, air quality measures had dipped to a more normal range, below 100. People appeared willing to listen to public health leaders, they said, and steps the government took during the pandemic, like distributing face masks and air filters, also proved beneficial last week. 

Nationwide, public health leaders warned of dangerous particulate matter in the air, which can hamper breathing and introduce toxins to the body. The risk is greater for those with lung disease or other pre-existing conditions, experts said, as well as seniors, pregnant people and children, who breathe more air relative to their size than adults. Schools throughout the mid-Atlantic cancelled sports and other outdoor events and public gatherings of all kinds were postponed.  

“When you think about what we’ve asked of the public over the last two or three years” to reduce the spread of COVID-19 “this is like, just stay inside for a day or two and put a mask on when you go out. It’s not that hard,” Freer said.  

Echoing familiar recommendations 

Gov. Phil Murphy echoed those recommendations at a media briefing Thursday in the same Newark conference room where he hosted his first COVID-19 news conference, in February 2020, which he said “felt like 1,000 years ago at this point.” Stay home whenever possible, he said, and wear a tight-fitting KN95-style mask if you do venture out, he said. Those forced to work outdoors – who tend to be lower-income or people of color — should also “take more breaks if possible and shorten the length of physical activity,” Murphy said, noting, “poor air quality impacts everyone.”  

“If anyone has any doubts,” Murphy added, “climate change is here. Unfortunately, this is our new reality.” 

State police distributed high-quality masks last week to NJ Transit workers and passengers at stations in Atlantic City, Camden, Hoboken, Newark and Secaucus, Murphy said, urging people to request a face-covering if needed. Over the past year the Department of Health has used federal funds to buy and distribute some 5,200 high-quality air-filtration units to 1,800 public schools and 450 child-care centers, officials said, which cover about three quarters of the facilities found to be at the highest risk for poor indoor air quality.  

“The goal of the program is to provide layered protection from respiratory illness and address other air-born irritants such as dust, mold and pollen. Although we began the program with COVID-19 in mind it has proven especially timely right now,” Commissioner Persichilli said Thursday. The COVID-19 virus – which over three years left more than 170,000 New Jerseyans hospitalized and contributed to the death of at least 36,000 – is spread primarily by tiny droplets that are easily dispersed in the air.  

Monmouth County public health officer Chris Merkel said his office had been fielding calls from residents who wanted to know if the masks they used for COVID-19 would protect them from the smoke. (Answer: yes, if they are well-fitting N95 masks.) Schools and daycare centers are also asking about how they can keep indoor air safe. (HEPA filters can help.) His office is also helping coordinate the wider government response to the emergency.  

“I believe people are certainly more aware of public health precautions after the pandemic,” said Merkel, who also leads the New Jersey Association of County and City Health Officers. “And they know who to call now because of the relationships created during COVID.”  

Acting intuitively 

Stephanie Silvera, an epidemiologist and public health professor at Montclair State University, was also encouraged by the public response to the smoke hazard. “I thought it was very interesting over the last few days how many people went right back to wearing a mask,” she said.  “As much as people did not like masks and fought against them, I think there is a recognition that there is a use for them.”   

Silvera also praised institutions for acting quickly – cancelling outdoor events, providing masks – based on public health recommendations, without waiting for official instructions. “I think we all have now learned we can follow really common-sense guidelines for public health prior to being told what to do in these situations,” she said.

‘As much as people did not like masks and fought against them, I think there is a recognition that there is a use for them.’ — Stephanie Silvera, Montclair State University

The clear evidence of the smoke hazard also reinforced the public health warnings, Silvera said, whereas COVID-19 was largely an invisible threat. The poor air quality is “not something hidden. It’s very obvious. The whole world looks orange – that’s not natural or normal,” she said. “So when the public health message is, ‘there is bad air quality,’ I think in a lot of ways it is easier for people to respond to that public health message in a positive way, because it is tangible.”  

But experts worry about the future, given the impact of climate change, which is increasing the frequency and danger of storms, wildfires and mosquito-borne diseases and other public health threats. Silvera is concerned about the long-term impact on people who work outdoors and on families that can’t afford air-conditioning. Merkel warns that the ongoing wildfires could also send smoke our way later this summer, when temperatures could exceed 90 degrees or more, creating new challenges for those stuck inside with windows and doors closed. 

“This is not the last time this will happen,” Silvera said. “This all goes back to, we can address root causes, or we can keep reacting to crises as they arise. And we have a choice to make.”  

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