We spent six months investigating the health impacts of Australia's catastrophic 2019 to 2020 bushfires AMA.

What has been the most lingering impact to the regions children and young people?

There have been a range of symptoms. Researchers are trying to figure out this exact question. From the families we interviewed, respiratory issues were prevalent. Families told us they had to use Ventolin to help with respiratory issues.

Other things included delayed development, such as growth, speech or fine motor skills – things like holding a pencil properly. People are still hugely traumatized by these fires. Many people were very open about what they experienced during Black Summer, and for some, it had taken a mental toll. Medical practitioners say there's definitely lingering mental health impacts for the affected communities. -AB

There’s a body of research that links wildfire smoke exposure during pregnancy to premature birth and underweight babies. The worrying thing is that being born early or less developed can set you up for an array of health risks later in life. Premature birth is the leading cause of death in children under the age of five, according to the World Health Organization. -AW

What is the Australian government planning to do? I would imagine that we’re past the point of preventing wildfires, but they could be mitigated with evacuations, respirators, etc

How much the government is doing is a contentious issue, as Amy and I discovered in our reporting. There was an official inquiry in the wake of the fires in 2020 that handed down 80 recommendations including the establishment of nationally consistent air quality information, health advice and interventions. There’s been some progress on air quality forecasting and making sure all the different states in Australia are speaking the same language when it comes to how polluted the air is.

However, many of the mothers and researchers we spoke to want practical measures such as state-subsidized air purifiers, a ready-supply of face masks and prioritized evacation plans for vulnerable people such as pregnant mothers and youg children.

On the prevention side, the best long-term weapon is slowing the pace of climate warming, which of course is stoking these wildfires. -AW

The ACT Government, for example, told us they distributed P2/N95 masks to vulnerable members of the community through pharmacies and some other select service providers.

There are a range of things being put in place in a practical sense. But researchers want more funding for studies as well, because once they have more data they can argue that things need to be prioritized. -AB

Did burnt man-made materials in certain geographic areas pose greater threats to human and animal health than others? e.g. burning solar panels in a less populated rural area causing toxic debris on grazing lands, or ash from uv films on windows are particularly toxic?

Are certain prevalent building materials reaching melting or combustion points of greater risk than others?

Good question. Some of it I’ve answered in my previous comments, but the point about varying combustion points is really interesting. I was amazed to learn during our reporting just how destructive the heat of a large wildfire can be. For instance, one family came back to their rural property near Batemans Bay, about four hours’ drive south of Sydney, to find everything in their metal shed had been burnt through. Even iron tools designed for branding had been melted and reduced to blobs of molten metal. Enormous gum trees had literally been reduced to powdered lines of white ash on the ground. So I suppose the point is there’s very little that can survive the fury of a large fire. -AW

People told us how fearful they were of being trapped in their cars with their children while evacuating as the flames closed in on their communities. The unpredictability and ferocity was something that we heard time and time again. Then we heard stories of things that were completely burnt down, while other structures standing right next to it remained standing. One family told us their neighbor jumped in a trough full of water – which was actually just a bath put in their paddock – but miraculously survived. They felt very lucky to be alive. If anything is in the path of a destructive blaze, as Angus said, it can be incinerated with little left behind. -AB

u/flattopmaker's and u/tim33z's questions made me think of some research that came out about the time of the Black Summer fires that got a lot of attention. Academics at Stanford University studied the impact on children’s cardiovascular systems of smoke from deliberately lit wildfires (typically aiming to reduce fuel load) compared with smoke from wildfires. They found pollutant levels were higher in the kids exposed to wildfires rather than prescribed burns. Worryingly, researchers found “there was a trend toward worsened health outcomes in the wildfire group compared to the prescribed group, including increases in wheezing episodes in those with no prior history of asthma, increases in asthma exacerbations in those with prior asthma, and rises in pulse pressure.”

Here’s the research if you’re interested. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801011/pdf/nihms-1024236.pdf -AW

I’m from Melbourne and recall in early 2020 that smoke and ash was abundant even though most fires were hundreds of kilometres away. I also remember many of us were wearing those things called face masks to prevent some irritants getting into our respiratory system.

While as long as the planet has had trees, I’d expect there to have also been bushfires. What difference is there to the toxicity of trees and bush land burning now, compared to 100+ years ago?

Yes, wildfires — naturally occurring and deliberately lit — have been part of Australia’s culture and history for thousands of years.

The question of how toxic one fire is compared to another is really interesting. And it’s one that we asked experts during our reporting. An out-of-control wildfire will burn through more than just trees and vegetation. It incinerates cars, metals, plastics and thousands of buildings. So many of the toxic materials used in those things — from asbestos to metals and minerals — can become airborne and are breathed in by people who are close by or hundreds of kilometers away.

Fay Johnston at the University of Tasmania, who is one the world’s leading air quality experts, described to us how it works in detail. Wildfire smoke contains hundreds of substances including tiny aerosolized particles, carcinogens and harmful gasses like nitrogen dioxide and carbon monoxide.

Another doctor we spoke to said walking around Sydney during the height of the Black Summer fires was equivalent to smoking 37 cigarettes a day, and more than that closer to the fires.

We asked Indigenous experts how the harmful effects of wildfires were managed in the past. We were told that specific grasses and vegetation can be burnt, depending on the time of year, to minimize the smoke. -AW

There were recommendations from the Royal Commission that called on all levels of government to make better use of the fire and land management skills of Indigenous communities. The organization Firesticks told us there was a lot of momentum after the Royal Commission on this, but that has since fallen away. A Federal Government spokesman told us: “Australian, state and territory governments are progressing Royal Commission implementation of recommendations 18.1 and 18.2, which relate to Indigenous land and fire management and natural disaster resilience. “This includes collaboration through the Australia-New Zealand Emergency Management Committee on fire management and development of national guidance through the Australian Institute for Disaster Resilience.” They also say NEMA, which is the National Emergency Management Agency, has funded a range of grants, including $19 million through the Black Summer Bushfire Recovery Grants Program, to support Indigenous fire management research and practices. -AB

does diffuse smoke interfere with CPAP machine users?

In short, I don’t know the answer to that question, it’s a great one. We spoke to a number of families whose babies had to be put on CPAP machines to help with their breathing after birth. Mothers questioned whether CPAP machines would have been necessary if there wasn’t smoke from the fires. One had to have her baby removed from her for a second time to address breathing issues. She recalls looking out the window of the hospital at 10am and only being able to see a red dot in the sky amid the darkness of the smoke. Doctors told us they were delivering babies in smoke-filled medical theatres. -AB

are there any signs for regulatory change to building codes to require air filters (post covid and wildfires)?

Building homes that are more resilient to smoke is really important. And, actually, the fact that some homes block out smoke better than others makes it harder to formulate policies to protect the community. It also makes it harder for researchers to measure the impact of smoke exposure from a data perspective because people will be hit in different ways depending on the construction of their homes.

But there are sign of progress. Governments and academics recognize that improving building codes is one way to make sure future generations aren’t so susceptible to smoke while they’re in their own homes. It also makes it more feasible for communities to ride out bad smoke at home rather than having to evacuate to specific smoke-proof buildings.

The Australian Capital Government, for example, has said since the Black Summer fires that it’s committed to improving the sustainability standards of buildings and designing and upgrading facilities to improve resilience to extreme smoke events through insulation, air locks, automatic doors and draught-proofing. -AW

This is a great question. More broadly – not specific to smoke – there has been a lot of discussions around building codes since Black Summer. This has impacted some communities I’ve spoken to in the past few years because it changes the way you can rebuild your home. The materials and building standards can be different when you go to rebuild, for example to be more fire resistant. On a community level, one interesting thing the ACT government is doing is establishing clubs as refuges. “The community, including those who are most vulnerable, will be able to attend these refuges during heat and smoke events for respite,” a spokesman told us. Researcher Fay Johnston from the University of Tasmania told us there is work being done on safe places with air filtered systems in her state as well. -AB

Also... One of the problems about improving building standards and requiring air filters on new homes is the extra costs it imposes on construction. It’s also a blanket measure that may not actually be necessary for all communities.

One other thought on this. Families we spoke to found it almost impossible to keep out smoke in any practical way, even with air conditioners running all day and night, and after taping up doors and windows. One family I remember came back to their rural home after evacuating in early 2020 to find ash everywhere. Just everywhere. Even under the toilet seat. Three years after the fires, some families still have traces of soot on their properties. -AW

has there been any discussion or design concepts to use evacuation to underground locations rather than above-ground for people using critical services (e.g. evacuees from seniors homes, variously-disabled persons, high-risk pregnancies, hospitalized patients)? The idea here is to prevent multiple relocations and reduce the stress and service provision required for people who are less mobile or less able to cope with change (physically, mentally).

There is no discussion that I’m aware of about evacuating to underground locations rather than above-ground. I imagine there are some design experts out there who know if this has been considered – cost would likely be a huge factor. One of the things we were repeatedly told was there are difficulties in evacuating. One mum evacuated to Canberra, but the smoke there was just as bad, so she went home. Then she and her family were trying to block off doors and windows with wet towels and it simply didn’t work. The kids were trapped inside and this made it even more stressful. That is why there is some discussion about using the high grade air filters, known as HEPA units. Suggestions include subsidizing these filters, or making them available to hire from a local health service during periods of intense smoke. Some of us have become more familiar with what types of air filters are on the market these days due to Covid. Also, aside from having safe community evacuation spaces with filtered air, doctors say they need to make sure hospitals have adequate air filtration systems as well to keep people safe during this time. -AB