Hard to Breathe: Houseless and Exposed to Wildfire Pollution

As the Kincade Fire sweeps through Sonoma County, prompting mass evacuations, California marks the one-year anniversary of the Butte Camp Fire, the deadliest fire in state history. Last year’s fire covered the Bay Area in smoke and pollution for nearly two weeks. Usually the first advice public officials give in those circumstances is to stay inside. But there are tens of thousands of people here who don’t have an inside to stay in, meaning they face increased exposure to unhealthy or even hazardous levels of air quality. KPFA reporter Lucy Kang went to find out what’s being done – and what happens if the air quality in the Bay Area reaches those levels again.


Clark lives in a cluster of tents on a strip of grass next to the sidewalk at the border between the cities of Berkeley and Oakland, at an unhoused community called Here and There Camp. He walks me around.

“This is our community tent, slash kitchen,” he says. “We have solar panels. We have music. We have a stove. You know, we have everything that normal house-y people have.”

Another thing they have: six lanes of traffic passing by, spewing exhaust a few feet away from the closest tents. For Clark in particular, this is a problem.

“Well, let’s start off, I have COPD,” says Clark.

That’s chronic obstructive pulmonary disease, a lung disease that makes it hard to breathe.

“And then a couple years ago, I had atrial fibrillation, which is when your heart beats irregularly and fast,” he says.

I met up with Clark to explore a question we’ve had ever since smoke from wildfires started darkening the skies of the Bay Area a couple years ago: when the air gets so bad that public health officials tell everyone to stay indoors, what happens to people who don’t have an indoors to stay in?

“I mean, we don’t have enough shelter on a day-to-day basis for people,” says Alameda County Interim Health Officer Dr. Erica Pan. “I feel like that’s the bottom line.”

“We know the numbers of homelessness have increased by 47%,” says Lucy Kasdin, Director of Alameda County’s Health Care for the Homeless. “So our ability on a daily basis, much less in an emergency, to be able to respond in a way that’s adequate to meet the need, I think is something that kind of, as a community we are challenged by.”

Last year’s Butte County Camp Fire was 150 miles away from where Clark sleeps. But it sent so much smoke this way the sky changed color for almost two weeks.

“You can, you can see it in the air, you know,” recalls Clark. “I mean, it’s pretty obvious that there’s a big fire going on.”

Schools closed. Health officials told the public to stay indoors. But they were struggling to open up safe places for people like Clark. Eventually it left him with just one option.

“I knew that I was going to have to check myself into the hospital sooner or later,” he says.

A year after smoke from the Butte County Camp Fire filled the skies in Alameda County, public officials are still identifying locations for clean air shelters. They couldn’t tell me how many. And they couldn’t tell me how many people they could fit.

Medical researchers are just starting to grapple with everything that air pollution – especially the toxic mix coming from the first few days of the Camp Fire – does to the human body.

“We used to think of the effects as being more compartmentalized and more related to our respiratory system, so our lungs,” says Dr. Coco Auerswald, professor at UC Berkeley’s School of Public Health. “In fact, it has a systemic effect on our body.”

When smoke enters the lungs, there’s a cascade of inflammatory responses that can attack almost every organ system. For someone who’s starting with multiple medical conditions, that can be very dangerous.

“It’s a really another assault on their bodies to be exposed to the smoke and extremely stressful because it just highlights their vulnerability,” says Dr. Auerswald. “And so if you’re exposed to an additional trauma, be it being violence or the physical violence of having to be in smoke all the time, that is absolutely going to exacerbate your mental health.”

What Clark noticed during the Camp Fire, is that it got harder and harder to breath. Eventually, he checked himself into Alta Bates Hospital. They told him his blood oxygen absorption had dropped.

“[For] normal people it’s about 95, and that particular day it was 80,” he says.

They gave him supplemental oxygen, and a steroidal inhaler.

“I almost died, basically,” says Clark. “And if I hadn’t checked myself in probably, you know one of those mornings when the air was heavy, that I would either die gasping for breath or something would happen like that.”

They kept him in the hospital for about a week. Then two more weeks in skilled nursing. Then, at Clark’s insistence, let him back out to the street.

Without enough safe breathing spaces, there’s only one other form of assistance public officials have: and that’s masks. Specifically, breathing masks rated N95 -– which means they filter out 95% of particles greater than 0.3 microns in diameter.

“Over the course of the Camp Fire, we were able to give out 13,000 masks throughout the county,” says Lucy Kasdin of Alameda County’s Health Care for the Homeless.

Wearing a N95 mask is not an option for many people, like Clark, who has breathing issues and a beard.

“There just a lot of caveats to that, and so that is why it’s a last resort,” says Dr. Erica Pan, Alameda County Interim Health Officer. “And they can really make it harder to breathe. And unfortunately it might impact some people who already have, who you most want to protect if they have underlying heart or lung disease.”

Also, there hasn’t been a lot of research on how effective N95 masks are during air pollution from wildfires.

“There’s no clear evidence that using an N95 respirator by members of the general public is beneficial to a person’s health during one of these situations, during a wildfire smoke air quality event,” says Dr. Pan.

The masks also get clogged and need to be replaced, so getting enough of them out there during an extended air quality event is a massive undertaking.

But the largest distributor of N95 masks in the Bay Area wasn’t an official agency – but a small operation, run entirely by volunteers. Quinn Redwoods, who uses they/them pronouns, is the founder of Mask Oakland. What they call “Mask Oakland HQ 1.0″ was run out of their house. Now, they take me to the storage unit where masks are being stored for this year. Stacks of cardboard boxes fill the room.

“So our math is that we brought in about a hundred thousand, and 15,000 are in this room,” says Quinn. “And then 85,000 went out.”

Volunteers and organizations handed masks out: on the streets, at BART stations, and in homeless encampments.

“One of the most emotional things that happens to me sometimes was like folks who were houseless trying to give me money for the mask,” says Quinn. “And I would have to explain like this was donated, like it’s okay. And they’re like, I really want to give you this dollar.”

Quinn says there are 15,000 masks in this storage unit ready to be distributed, three times what Alameda County currently has on hand.

Scientists say climate change is increasing the length of fire season and the size of fires. Which means, we’ll see more and more extended air pollution events like what happened in the Camp Fire.

For people like Jackie Williams in San Francisco, the damage has already been done. We’re in the Tenderloin, on Hyde Street. Jackie has been unhoused since 2014. She has asthma and says she’s been coughing since the fires last year.

“It’s like lately, I’ve been like having like straight like cramps up in here,” says Jackie. “And half the time, I don’t even be doing nothing, but just chilling back, burning out the batteries in my cell phones… If I allow myself to panic, I won’t be able to breathe. It’ll make your lungs and everything like constrict, and then that closes off your air passage.”

When asked if she wants to try to get shelter this year, she says, “Wildfire happens this year, I suggest they keep me a uniform and everything else, so I can go help them put it out. That’s about it.”


Lucy Kang is KPFA’s Features Reporter. This story was reported with help from Wren Farrell.

For more information on current emergencies, you can sign up for Alameda County’s AC Alert system at www.acalert.org. You can get more information on San Francisco by texting your ZIP code to 888777 or visiting www.sf72.org. 

Alameda County residents can still go to local cooling centers for respite while officials are in the process of determining which locations may be considered clean air sites under EPA guidelines.

Go to Mask Oakland’s Twitter account for the most up-to-date about the organization’s N95 mask distribution.