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Posts Tagged "warnings"

28Jun

Smoky summers: Health experts extend their warnings to pregnant women

by admin

When wildfire smoke enveloped Metro Vancouver last summer, Nikki Rogers noticed soot collecting on the walls of her White Rock condo and closed her windows to keep the bad air out.

“I tried to stay inside because I did not enjoy being outside,” recalled Rogers, who works in a hair salon. “I would never do any kind of exercising or jogging or walking outside because anything that promotes heavy breathing outdoors would be terrible.”

This summer she will take even greater precautions because she is pregnant. And this is the first year that Vancouver Coastal Health and Metro Vancouver have included pregnant women on their list of people especially vulnerable to wildfire smoke, along with asthmatics, the elderly, and people with chronic heart and lung conditions.

Rogers said she will research the best way to keep herself and her baby safe, but laments that wildfire smoke is one more thing expectant mothers will likely need to worry about this July and August.

“We shouldn’t have months of just smoke in the air. That’s just awful,” she said. “Every year it gets worse and worse. It is just getting out of hand.”


Nikki Rogers, who is pregnant, will keep the windows of her White Rock condo closed this summer to keep any wildfire smoke out.

Experts believe British Columbians are about to experience another hot, smoke-filled summer, basing their prediction on the higher-than-average temperatures and drought so far in 2019 — a trend that is expected to continue.

“We expect increased wildfire and smoke risk, and that includes in the southwest where we are,” said a Metro Vancouver air-quality engineer, Francis Ries.

Just in the last week, a stubborn wildfire on steep terrain near Lions Bay snarled traffic on the busy Sea to Sky Highway for days, and a fire broke out Monday near Pender Harbour on the Sechelt Peninsula.


A helicopter dumps sea water on June 23 on a wildfire near Lions Bay.

NICK PROCAYLO /

PNG

Fires started earlier in 2019

Hotter, drier conditions contributed to fires in early spring, far sooner than in other years. Since April 1, the B.C. Wildfire Service has recorded 377 fires that have burned more than 110 square kilometres.

The summers of 2017 and 2018 were the worst on record for smoky skies — a provincial state of emergency was declared both years over wildfires — and much of the haze in Metro Vancouver drifted in from big fires in other parts of B.C.

The smoke led officials to issue a record number of air-quality advisories, and give extensive advice on how residents should try to remain healthy.

This year, local health and municipal agencies added pregnant women to the list of those most vulnerable to the smoke after lobbying by Sarah Henderson, an environmental health scientist at the B.C. Centre for Disease Control.

She advocated the change based on an “evidence review” and academic research that showed mothers exposed to extreme wildfire smoke give birth to smaller babies.

A University of California, Berkeley study found that pregnant women breathing in wildfire smoke during their second trimester in 2003, a terrible fire season in Southern California, had babies that were about 10 grams lighter than women not exposed to smoke. The results were small but “significant,” researchers found, because they showed “climate change can affect health.”

Ten grams would be enough to “push some babies into a low-birth-weight category,” added Henderson, noting undersized infants can face challenges.

Based on pregnancy and population statistics, Henderson predicts a repeat of last summer’s smoky skies could lead to 20 babies in B.C. being born a bit smaller. It’s not a big number, but one that could hurt 20 families.

“And that is kind of the tip of the iceberg in some ways because nobody has looked at preterm birth or malformations, if that smoke exposure happens to pregnant women,” added Henderson, who is also an associate professor in the UBC school of population and public health.

She has applied for funding to do her own study of the outcome of women who were pregnant in B.C.’s Interior, where the smoke was the thickest during the last two summers.


Sarah Henderson of the B.C. Centre for Disease Control.

Wildfire smoke is a toxic, chemical soup

Wildfire smoke contains many pollutants, but the most dangerous to human health is fine particulate matter, a mixture of solid particles and liquid droplets that are generally 2.5 micrometers or less in size — about one-30th the diameter on a strand of hair.

“The very small particles can be inhaled deeply into your lungs and then get into your blood stream, and irritate and lead to inflammation,” said Emily Peterson, a Vancouver Coastal Health environmental health scientist.

A typical summer day in Metro Vancouver would feature 10 or 15 micrograms a cubic metre of these fine particulates, but during the height of last summer’s smoky skies the quantity jumped tenfold.

Smoky air makes it harder for lungs to get oxygen into the blood stream, and it can irritate the respiratory system and cause inflammation in other parts of the body. Common symptoms include eye irritation, sore throat, coughing, wheezy breathing and headaches, and there is an increased risk of infections for some, such as pneumonia in older people and ear infections in children.

At-risk people — including those with chronic lung or heart conditions and now pregnant women — should “pay attention to the smoke much earlier” this summer, said the VCH medical health officer, Dr. James Lu.

“We do start with the vulnerable population, but if the smoke (concentration) is high enough we do encourage people who are normally healthy to take precautions as well,” Lu added.

Among the precautions backed by medical experts: Stay inside places with filtered air, such as most community centres, libraries or malls; drive with the windows up, the air conditioning on, and the recirculate-air button activated to reduce the amount of smoke getting into your car; and drink lots of water.

One expert calculated that people doing exercise or working outside during the height of the wildfire smoke could inhale the equivalent of two packages of cigarettes a day.

Because most people typically spend 90 per cent of their days indoors, Henderson highly recommends buying a portable air cleaner, which plugs into a wall socket and can be moved from room to room. These purifiers remove 40 to 80 per cent of the fine particles found in smoke, but people with respiratory conditions are encouraged to buy higher-performing HEPA (High Efficiency Particulate Air) filters, the Centre for Disease Control says.

If people are outside and want to wear a mask, Henderson said the best option is a well-fitted N95 respirator. A surgical mask can offer limited protection. A cloth mask is close to useless at keeping out the fine particles in smoke.

Doctors’ visits, asthma prescriptions skyrocket

Most people can manage irritations from smoke without medical attention, but those with severe symptoms should see a doctor.

Wildfire smoke caused a slight rise last summer in the number of people visiting Vancouver Coastal Health emergency rooms, although the increase wasn’t even across all communities: North Vancouver and Richmond had more hospital visits, while other cities did not, said Lu.

“What we did see were increased visits with respiratory symptoms, asthma and people short of breath,” the medical health officer told Postmedia.


Dr. James Lu of Vancouver Coastal Health.

The B.C. Health Ministry could not provide information about higher traffic in emergency rooms in other health regions, saying its data does not let it differentiate between treatment specifically for wildfire smoke and other respiratory issues.

However, Centre for Disease Control statistics suggest medical services across B.C. were harder hit when wildfire smoke was heavy. In the summers of 2017 and 2018, 45,000 extra doses of asthma medication were dispensed and there were 10,000 extra visits to doctors for asthma-related conditions in B.C., Henderson said.

“It does stack up, the impact is quite extreme,” she said. “On a very smoky day in Metro Vancouver, there were 350 extra doctor visits.”

The Centre for Disease Control tabulates this information daily in the B.C. Asthma Prediction System, which was launched after previous severe wildfire seasons. The surveillance system tracks asthma-related doctor visits and the prescriptions filled for lung conditions, and is used to warn health officials about the anticipated effects of wildfire smoke.

This summer is also expected to experience a boost in asthma treatments, given what happened in May after a significant wildfire near Fort St. John. “We had this one day of smoke in Fort St John, and the asthma visits skyrocketed,” Henderson said.

During the past few years, Vancouver Costal Health has sent reminders to family physicians to help their patients get ready for smoke expected in July and August — such as ensuring medications for patients with chronic heart or lung disease are up to date.

“I think what we are hoping for is to perhaps educate the public and primary-care physicians in helping people to be prepared so that they don’t really need to come to the emergency,” Lu said.

More than 3,000 ‘smoky skies’ bulletins issued

The provincial Environment Ministry issues “smoky skies” warning bulletins when wildfire smoke gets bad in all areas of the province except Metro Vancouver, which releases its own air quality advisories.

In 2017, 1,646 air-quality advisories were issued across B.C., and that jumped to 1,742 in 2018. There have been 69 warnings so far this year, but that number will likely increase as the majority of 2018 bulletins were issued between late July and late August.

The province monitors 63 regions, and six of those have had 100 or more smoky skies bulletins since 2017 due to bad fires nearby, including Quesnel, Penticton, Prince George, Williams Lake and Kamloops. Other communities in B.C.’s Interior and the Cariboo region have also been hard hit, with just under 100 bulletins issued in the last two years in Vernon, Kelowna, Cranbrook and 100 Mile House.


A wildfire near Fraser Lake in May.

Submitted /

B.C. Wildfire Service

Only Haida Gwaii, off B.C.’s northwest coast, has had no smoke-related air quality warnings since 2017.

The Environment Ministry was unable to provide information about how many advisories it issued in years with far fewer forest fires than 2017 and 2018. But statistics from Metro Vancouver indicate those two years were off the charts.

There were 22 days in Metro Vancouver last summer with poor air quality due to forest fires, mainly between late July and late August. In 2017, it was 19 days of unhealthy amounts of smoke.

The region’s figures, dating back to 1996, showed no other years with near that number of hazy days, the closest being 10 days in 2009 and 2015, when there were also some forest fires. In several years, including 2011, 2013 and 2016, there were no days with poor air quality.

Metro Vancouver’s advisories show much of the air pollution came from forest fires in other parts of the province, but the air was also affected by some local blazes, such as a bog fire in Richmond and a barge blaze in Surrey.

No air quality advisories have been issued so far in 2019; Metro Vancouver said the smoke residents smelled earlier this week from the Lions Bay fire was “below advisory thresholds.”

Ozone pollution rises due to wildfires

Metro Vancouver’s summer 2019 outlook warns of the potential for increased ozone due to higher temperatures and wildfires. Ozone is described as “good up high; bad nearby” — ozone in the atmosphere protects from UV radiation, but when lower to the ground it damages lungs and destroys ecosystems according to a Colorado State University academic paper, Ozone Levels Elevated in Presence of Wildfire Smoke.

“We’ve seen high ozone levels at monitoring stations which we never, under normal circumstances, expect to have high ozone,” said Metro Vancouver’s Ries. “We almost never have high ozone in the western part of the valley, downtown Vancouver and through into Burnaby,” he said, except in 2017 and 2018 when “the highest ozone levels we received were in that part of the region.”

Ries said more studies, including ones that focus on B.C., are making a strong link between climate change and the exacerbation of wildfire seasons.


Francis Ries, Metro Vancouver air quality engineer, and Roger Quan, Metro’s director of air quality and climate change.

In 2017, 65,000 British Columbians were evacuated and 509 buildings burned during wildfires that scorched 12,000 square km of land. The 2018 forest fires were even more destructive, consuming 13,500 sq. km — although fewer people were evacuated (6,000) and fewer structures lost (158).

Over the last two summers, the provincial government grossly outspent its wildfire budgets — by 10 times in 2017, when it cost more than $650 million to fight the fires. This year, the NDP is trying to be better prepared for the unknown by nearly doubling its wildfire budget, boosting it from $64 million in 2018 to $101 million.

Smoky summers in Vancouver may become “the new normal,” if not every year then at least every other year, VCH’s Lu predicted.

“We do not expect this to go away. This is going to be a way of life, unfortunately,” he said. “So I think the need to include that in your consideration of how to stay healthy is important.”

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Twitter: @loriculbert




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29Apr

Canada warnings about meds should be more consistent with other countries: UBC prof

by admin


FILE – In this Friday, July 8, 2016 file photo, a prescription is filled at a pharmacy in Sacramento, Calif. On Friday, May 11 2018, Trump is scheduled to give his first speech on how his administration will seek to lower drug prices. (AP Photo/Rich Pedroncelli, File) ORG XMIT: NY766


Rich Pedroncelli / AP

VANCOUVER — Health Canada needs to be more consistent with three other countries when it comes to issuing warnings about the safety risks of certain medications, especially if the jurisdictions with similar demographics have already advised patients taking the same drugs, a University of British Columbia professor says.

Barbara Mintzes, the lead investigator of a new study published Monday, said that between 2007 and 2016, Health Canada issued safety warnings for only 50 per cent of drug-safety issues identified in the United States, Australia and the United Kingdom.

She joined researchers in analyzing 1,441 advisories over that period and found regulators in all four countries were only consistent in the decision to warn their populations 10 per cent of the time regarding issues with the same medication.

Compared with the other countries, Health Canada issued advisories for only 317 of 635 drug-risk issues, or nearly 50 per cent of the drug-risk issues identified by the U.S. Food and Drug Administration, the U.K. Medicines and Healthcare products Regulatory Agency and Australia’s Therapeutic Goods Administration, the study said.

The study was published in JAMA Internal Medicine, published by the American Medical Association, and also involves researchers from York University in Toronto and the University of Sydney in Australia.

Health Canada issues warnings on its website, and Mintzes said it also sends letters to doctors who prescribe the drugs.


Dr. Barbara Mintzes is shown in a handout photo.

Danny Abriel /

THE CANADIAN PRESS

“Some of the safety warnings are put out by Health Canada, together with the manufacturer, and that will come as an individually sent letter to each doctor within a specialty or … a broader set of all doctors who are practising in Canada,” said Mintzes, who is an affiliate associate professor at UBC’s School of Population and Public Health.

She said that in January 2013, Health Canada issued a warning about commonly prescribed cholesterol-lowering drugs, or statins, being linked to an increased risk of diabetes among patients already at risk for the disease.

However, the warning was issued a year after the United States and Australia informed patients about the drugs following large studies showing an association with diabetes, she said.

“Why did Health Canada wait another year after these warnings occurred in the U.S. and Australia?” asked Mintzes, who is also an associate professor at the University of Sydney.

The department said it regularly liaises with key international counterparts including the U.S., Australia and the European Union to determine if there are any emerging safety concerns. Once it becomes aware of any potential issues, an assessment is done to determine if a similar risk is warranted in Canada.

“Timing and content of risk communications can differ across jurisdictions for a number of reasons including, for example, how a product is used in Canada,” it said in a statement.

Health Canada should be more transparent about the information on which it bases its warnings, especially because clinical-trial data that were previously confidential have been publicly made available for some time following a similar stance in the European Union, Mintzes said.

“We could do more as a country to have more services available to people who are using medicines, with a user-friendly website that provides information to the public so they can just look up their drug fairly easily.”

Pharmacies in Canada are also inconsistent in providing patients with written information about drugs and possible adverse reactions, Mintzes added.

“We should have a legislated right to always having approved patient information provided to us every time we have a prescription dispensed.”

A study in 2013 by the Canadian Institute for Health Information said up to a quarter of patients who visit emergency rooms due to adverse reactions are admitted to hospital and that seniors at greater risk for such effects.

Antibiotics are among the most common drugs associated with adverse drug reactions, which are known to be associated with factors such as the number of drugs a patient is taking, the study said.


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