Many of you know that I live on the coast of Central California which has been hit particularly hard with wildfires this summer. I thank all of you who have called or messaged me to check in. Fortunately, we were about 5 miles from these devastating fires and mostly we have just had to deal with smoke and some very surreal sunsets. I have several friends and patients who have lost homes and my heart goes out to them and their families. Wildfires are terrifying and unpredictable, at least in the beginning and then they become predictably unpredictable.
This fire started with a strange set of extremely hot and dry days. Rarely do we have temperatures in my area above 80 degrees but prior to these fires we had several days in the high 90's to low 100's, and then we had a lightning storm. Growing up in the Midwest summer lightning is common but in California it is rare and this lightning had no rain. Just these massive bolts of energy striking every few seconds for five hours. I have never before seen lightning bolts this thick, they looked like they came from an alien invasion horror movie. I could see them striking the ground across the Monterey Bay and over the mountains going towards San Jose. With each one I waited praying no fire would start but knowing that this was going to be a horrible night. By the end of the storm there was a record of thousands of lightning strikes and something like 80 fires were triggered. Our fire officials were rapidly overwhelmed by the number and intensity of the fires. Our area has not had a major fire in over 100 years which meant that due to very zealous management of small fires we had a lot of dense foliage and old dry leaves some 4 feet deep waiting to burn.
Initially, the response was just to save lives, there was no effort to contain the fires just to evacuate people. I have heard stories of people driving through intense heat to escape, I know of people who died trying and I also know of people who stayed behind and successfully fought these fires and saved their homes and their neighbors home. As people were moved out of harms way the firefighters dug lines to keep the fires from spreading. They did an amazing job, the fire was initially moving so quickly over 80,000 homes were threatened but quickly that number shrank. But, nature also helped us, I was informed by a local sheriff that the initial fire took advantage of the fuel but once it climbed to the ridge tops it stopped moving. As the fire has run out of fuel and with hard work by our fire fighters the tide turned positive. In the end we lost just over 900 homes in our very small county of 275,000 people. The fire right now is just over 80% contained but will likely burn for over a year.
Our fire has been one of a huge number striking the Western United States, we have been having new fires on almost a daily basis in our region, some started by lightning others by campers and one because of a pyrotechnic baby reveal party. What we have in the Western United States is the perfect combination of forests that have not had natural fires in decades due to fire suppression, hot dry weather and people who have built homes in these beautiful areas. There really isn't a surprise that we are having bigger and nastier fire seasons and whether you believe global warming is valid or not we have had a sequence of warm and dry years.
So, what does this have to do with Covid-19? When I observe the progress of this disease I see something that seems to parallel the way a wildfire behaves, and I also see that our virus fighting and firefighting techniques have unique similarities. My observation of the virus is that it began like a wildfire in China, containment failed and embers spread through Europe and then the United States. But, this didn't spread out in a uniform pattern, like a fire it was opportunistic striking specific populations. The response to contain the "fire" was successful with shutting down society but there was a constant low grade fire, kind of beneath the radar. Ask any firefighter and he will talk about ash pits that stay hot for months and trees that burn beneath the bark for weeks, months, and sometimes over a year. That is why even though large areas of the world stopped having people socialize and interact there was still a constant and persistent presence of the virus. Like a fire it continued to have a slow low grade presence with little embers popping up in different places.
In the early days of the pandemic California congratulated itself on doing a great job with an early statewide shutdown. But, as I have mentioned in earlier posts the virus probably arrived in California in December or earlier starting slowly in low risk groups diagnosed as a bad flu. The shut down slowed the momentum but there was always a slow burn of cases waiting to flare up. As soon as restrictions were lifted, like a fire the virus spread aggressively in vulnerable populations of high density people with poor health. Those areas are like vulnerable forests that have years of undergrowth ready to burst into flames. We can call the virus bigoted as it has selectively attacked black and brown people, but the real culprit is low income, dense housing, poor health and diet, obesity, and poor pulmonary function. Every physician knows that these issues are common in the inner city poor. And, of course, minorities are over represented in these communities. This was the kindling waiting to burn.
Like a wildfire, New York City flared early and spread far, poor decision making failed to protect vulnerable populations particularly elderly in nursing homes and the virus took advantage. Ironically, as the virus calmed down officials took credit for what naturally happens in a wildfire as it runs out of fuel, the cases declined. But, the case numbers won't decline to zero no matter how much one suppresses activity. Unless, the government is going to behave like they do in China and round up people who leave their home to go for a walk, there will always be some level of social interaction and therefore the virus will have an opportunity to sustain itself. And like a fire if the virus is able to to smolder eventually there will be fresh kindling to burn.
Normally, with a virus pandemic we behave similar to first responders in a wildfire. We try to get people out of harms way by isolating the virus. If the virus breaks through those barriers we do our best to protect vulnerable populations and we try to establish the equivalent of fire breaks by limiting travel outside of the community affected. This is not normally a political issue. As we identify ways to slow the spread we try to get people to engage in safe behavior. We usually fail if we ask people to do too much. We need buy in. Wear a mask, distance socially, reduce your groups of people you interact with.
For example, in the 1980's HIV was spreading rapidly among people who were engaging in unprotected sex with large numbers of partners. You may recall the initial response by the government led by health advisors was abstinence, but that was an absurd proposition. Young people, who were the primary transmitters of disease, tended to engage in high risk behavior. But, once the gay community took on the problem and promoted "safe sex" the problem started to come under control. Likewise, telling teenagers they cannot congregate is unlikely to work, once you shut down the places they can go to like beaches and campgrounds and schools they start to congregate in homes without parental supervision. The predictable result is exactly what we have seen, a rapid rise in infections among people under the age of 40. The next step is to then go home and share that virus with mom, dad, grandma and grandpa. Kind of like having a campfire in a forest that hasn't burned in a hundred years.
How do we protect homes from fires? We ask people to reduce fuels around their homes for a periphery of 100 feet. We don't ask them to tear down their house and rebuild it made of cement. We don't force them to leave, and remarkably those homes that cleared brush and trees mostly survived these fires. So, where has been the effort to reduce the fuels that feed a virus? I have only seen global responses, close everything, stay in your home and don't go out. Are we surprised that this doesn't work? Not everyone can tolerate this. How about focusing our energy on people who have underlying health issues and elevated age? Protect them, provide financial support, and try to reduce the fuel that feeds the virus fire. Kind of like going into forests and clearing brush, creating fire breaks and access roaads. And then, when a vaccine comes out encourage people to get it and focus on those in high risk professions or with high risk health issues. You know the saying "an ounce of prevention..."
Nature has a lot to teach us, maybe it's time we listen.
