County supervisors this spring for such a voluntary database. Supporters applauded the effort to give more notice and assistance to the more than 1 million county residents with some type of disability, such as cognitive impairment or limited mobility.

“If we know that people perish in these situations, what are our answers?” said Hilary Norton, who runs FASTLinkDTLA, a nonprofit focused on mobility issues. “This is the time for people to really understand the magnitude for people in need when things like this happen.”

Amid the increasing frequency of natural disasters across the U.S. — brought into sharp relief by the in Texas — state and local governments from Oregon to North Carolina have turned to disaster registries to prioritize help for vulnerable residents when fires, hurricanes, and other environmental catastrophes strike. But while some politicians say these registries are a potential solution to a public health problem, many disability advocates see them as ineffective tools that give people a false sense of security because there is no guarantee of evacuation help.

“They’re described in a way that communicates that if you place your information in this registry and you will need assistance, they will be able to plan for it, so in a disaster you will be safer. And in reality, that is simply not the case,” said Maria Town, president and CEO of the American Association of People with Disabilities.

Town, who has cerebral palsy, had been in Houston for six months when Hurricane Harvey hit in 2017. Texas makes a free registry called the State of Texas Emergency Assistance Registry available to cities and counties to help them identify needs in their communities, but how or if they use it is up to them. Fewer than 5% of people who registered were contacted during Harvey, and even fewer got evacuation assistance, according to a by the National Council on Disability, a federal agency that advises on disability policies and programs. The hurricane .

“I heard people say, ‘I thought I was safe. I registered,’” Town said of the calls she got during and after Harvey.

Neither the Texas Division of Emergency Management nor officials in Kerr County, the area hit hardest by the recent floods in Texas Hill Country, responded to questions about whether any accommodations were made for residents on the registry during the early July catastrophe.

Many registries, like , expressly tell participants they still must make their own evacuation plans. The Florida Department of Health oversees the registry and, like in Texas, shares the information with local emergency management officials for their use. In North Carolina’s Rockingham County, individuals must apply to be on the registry, and inclusion is not guaranteed. The registry page for Jackson and Josephine counties in Oregon warns that it can take up to three months for residents’ information to be made available to rescue workers.

The National Council on Disability says registries are harmful. “They are ineffective and provide a false sense of security of future guaranteed assistance,” Nicholas Sabula, a spokesperson for the organization, said in a statement.

The California Governor’s Office of Emergency Services also “” using registries, saying they can deter people from making their own disaster plans and raise privacy concerns. Disability advocates have also cited privacy as a concern.

But Los Angeles politicians behind the registry effort insist they are worth looking into — at least a third of those who died in the Eaton Fire had issues that could affect their mobility and therefore their ability to flee in the face of disaster, according to . Anthony Mitchell Sr., an amputee in a wheelchair, and his 35-year-old son, Justin, who had cerebral palsy, were among the 18 people killed when the wildfire ripped through the Los Angeles County community of Altadena in January.

Further driving the initiative is the aging of L.A. County’s population: The California Department of Finance’s Demographic Research Unit has estimated that more than a quarter of Los Angeles County residents will be 60 or over by 2030 — about 2.5 million people.

Supervisor Kathryn Barger, who represents Altadena and along with Supervisor Janice Hahn, “wants to drill down and explore its usefulness,” according to her communications director, Helen Chavez Garcia. Barger had not yet talked to the first responder community or had conversations about how emergency services would use the registry, according to Chavez Garcia.

Victoria Jump, an assistant director at the county’s Aging & Disabilities Department, is conducting the feasibility study — which she noted does not include cost estimates — and will make a recommendation to the Board of Supervisors this month on whether to support the project. The board will decide whether to move forward. Jump said she’s gotten largely positive feedback in more than a dozen community sessions.

It’s not the first time Los Angeles has considered and even implemented a disaster registry. The county maintained a voluntary disaster registry called Specific Needs Awareness Planning, but acknowledged in 2016 that the program did “not guarantee priority service to those who register” and had a “low return on investment.” It was discontinued, and registrants were migrated to a mass emergency alert system called . a mile in the dark to evacuate when he realized it would be impossible for a ride-hailing service to pick him up given the conditions.

Norton, of the mobility nonprofit FASTLinkDTLA, said the registry needs to be about more than just collecting names of disabled residents. “No one wants to create false hope,” Norton said. “It’s an agreement to explore the possibilities. It’s that balance of asking now, in order to make sure in the next disaster they are not left behind.”

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Pesticides are a and are commonly used where Bejarano lives in California’s Imperial Valley, a landlocked region that straddles two counties on the U.S.-Mexico border and is one of the main producers of the nation’s winter crops. It also has some of the worst air pollution in the nation and one of the highest rates of childhood asthma emergency room visits in the state, according to data collected by the

Bejarano has since learned to manage her now-19-year-old son’s asthma and works at , a local rights organization focused on environmental justice in the Imperial Valley. The organization trains health care workers to educate patients on proper asthma management, enabling them to avoid hospitalization and eliminate triggers at home. The course is so popular that there’s a waiting list, Bejarano said.

But the group’s program and similar initiatives nationwide face extinction with the Trump administration’s mass layoffs, grant cancellations, and proposed budget cuts at the Department of Health and Human Services and the Environmental Protection Agency. Asthma experts fear the cumulative impact of the reductions could result in more ER visits and deaths, particularly for children and people in low-income communities — populations to the disease.

“Asthma is a preventive condition,” Bejarano said. “No one should die of asthma.”

Asthma can block airways, making it hard to breathe, and in severe cases can cause death if not treated quickly. Nearly 28 million people in the U.S. have asthma, and about 10 people still die every day from the disease, according to the .

In May, the White House released a that would the Centers for Disease Control and Prevention’s National Asthma Control Program, which was already gutted by in April. It’s unclear whether Congress will approve the closure.

Last year, allotted $33.5 million to state-administered initiatives in 27 states, Puerto Rico, and Washington, D.C., to help communities with asthma education. The funding is distributed in four-year grant cycles, during which the programs receive up to $725,000 each annually.

Comite Civico del Valle’s academy in Southern California, a clinician workshop in Houston, and asthma medical management training in Allentown, Pennsylvania — U.S. city to live in with asthma — are among the programs largely surviving on these grants. The first year of the current grant cycle ends Aug. 31, and it’s unknown whether funding will continue beyond then.

Data suggests that the CDC’s National Asthma Control Program has had a significant impact. The agency’s has shown that the program saves $71 in health care costs for every $1 invested. And the asthma death rate decreased 44% between the 1999 launch of the program and 2021, according to the .

“Losing support from the CDC will have devastating impacts on asthma programs in states and communities across the country, programs that we know are improving the lives of millions of people with asthma,” said Anne Kelsey Lamb, director of the Public Health Institute’s Regional Asthma Management and Prevention program. “And the thing is that we know a lot about what works to help people keep their asthma well controlled, and that’s why it’s so devastating.”

The Trump administration cited cost savings and efficiency in its April announcement of the cuts to HHS. Requests for comment from the White House and CDC about cuts to federal asthma and related programs were not answered.

The Information Wars

Fresno, in the heart of California’s Central Valley, is one of the country’s top 20 “asthma capitals,” with high rates of asthma and related emergencies and deaths. It’s home to programs that receive funding through the National Asthma Control Program. Health care professionals there also rely on another aspect of the program that is under threat if it’s shuttered: countrywide data.

The federal asthma program on asthma rates and offers a tool to study prevalence and rates of death from the disease, see what populations are most affected, and assess state and local trends. Asthma educators and health care providers worry that the loss of these numbers could be the biggest impact of the cuts, because it would mean a dearth of information crucial to forming educated recommendations and treatment plans.

“How do we justify the services we provide if the data isn’t there?” said Graciela Anaya, director of community health at the Central California Asthma Collaborative in Fresno.

Mitchell Grayson, chair of the Asthma and Allergy Foundation’s Medical Scientific Council, is similarly concerned.

“My fear is we’re going to live in a world that is frozen in Jan. 19, 2025, as far as data, because that was the last time you know that this information was safely collected,” he said.

Grayson, an allergist who practices in Columbus, Ohio, said he also worries government websites will delete important recommendations that asthma sufferers avoid heavy air pollution, get annual flu shots, and get covid-19 vaccines.

Disproportionate Risk

Asthma disproportionately affects communities of color because of “historic structural issues,” said Lynda Mitchell, CEO of the Asthma and Allergy Network, citing a higher likelihood of living in public housing or near highways and other pollution sources.

She and other experts in the field said cuts to diversity initiatives across federal agencies, combined with the rollback of environmental protections, will have an outsize impact on these at-risk populations.

In December, the Biden administration through the EPA’s Community Change Grants program to help disadvantaged communities address pollution and climate threats. The Trump administration moved to cut this funding in March. The grant freezes, which have been by the courts, are part of a by the Trump EPA to eliminate aid to environmental justice programs across the agency.

In 2023 and 2024, the National Institutes of Health’s received $40 million for research, including on the link between asthma and climate change. The Trump administration has that money. And a essentially halted all NIH grants focused on diversity, equity, and inclusion, or DEI — funds many of the asthma programs serving low-income communities rely on to operate.

On top of those cuts, environmental advocates like Isabel González Whitaker of Memphis, Tennessee, worry that the of environmental regulations will further harm the health of communities like hers that are already reeling from the effects of climate change. Shelby County, home to Memphis, recently on the American Lung Association’s annual for having so many high ozone days. González Whitaker is director of EcoMadres, a program within the national organization Moms for Clean Air that advocates for better environmental conditions for Latino communities.

“Urgent asthma needs in communities are getting defunded at a time when I just see things getting worse in terms of deregulation,” said González Whitaker, who took her 12-year-old son to the hospital because of breathing issues for the first time this year. “We’re being assaulted by this data and science, which is clearly stating that we need to be doing better around preserving the regulations.”

Back in California’s Imperial Valley — where the majority-Hispanic, working-class population surrounds California’s largest lake, the Salton Sea — is an area called Bombay Beach. Bejarano calls it the “forgotten community.” Homes there lack clean running water, because of in the groundwater, and residents frequently experience a smell like rotten eggs blowing off the drying lakebed, exposing .

In 2022, a in Bombay Beach after an asthma attack. Bejarano said she later learned that the girl’s school had recommended that she take part in Comite Civico del Valle’s at-home asthma education program. She said the girl was on the waiting list when she died.

“It hit home. Her death showed the personal need we have here in Imperial County,” Bejarano said. “Deaths are preventable. Asthma is reversible. If you have asthma, you should be able to live a healthy life.”

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When triple-digit temperatures hit the Pacific Northwest this summer, the emergency room at Seattle’s Harborview Medical Center was ill prepared. Doctors raced to treat heat-aggravated illness in homeless people, elderly patients with chronic ailments, and overdosing narcotics users.

“The magnitude of the exposure, this was so far off the charts in terms of our historical experience,” said Dr. Jeremy Hess, an emergency medicine physician and professor of environmental and occupational health sciences at the University of Washington.

Doctors, nurses and hospitals increasingly are seeing , from overheating to smoke inhalation from wildfires and even infectious diseases. predicts annual U.S. heat deaths could reach nearly 60,000 by 2050.

For some medical professionals, this growing toll has stimulated a reckoning with the health care industry’s role in global warming. U.S. hospitals and medical centers consume more energy than any industry except for food service, to the U.S. Energy Information Administration. Hospitals 2.5 times as much energy per square foot as typical office buildings, on average. They also contribute mountains of medical waste and emit atmosphere-damaging gases used in surgery and other procedures.

But the health care sector is beginning to respond. The Health and Human Services Department’s newly created , in addition to focusing on climate-related illness, says it will work “to reduce greenhouse gas emissions and criteria air pollution throughout the health care sector.” The office could help change regulations that restrict sustainability efforts, climate activists say.

Already, many U.S. hospitals have begun installing solar panels, while others are trying to cut surgical waste and phase out ozone-damaging chemicals. Activists are pressing for the industry to cut back on energy-intensive protocols, such as ventilation requirements that mandate a high level of air circulation, measured as air changes per hour. They say they could be reduced without harming patients.

“I think there is recognition among physicians that climate change is likely to continue and worsen over time,” said Hess. “We don’t necessarily do as much as we could otherwise to reduce our footprint and advance sustainability, and that’s where I’d like to see our health systems go.”

But the industry is moving cautiously to avoid harm to patients — and legal liability. They “don’t want to make any mistakes. And part of not making mistakes is a resistance to change,” said Dr. Matthew Meyer, co-chair of University of Virginia Health’s sustainability committee.

The University of Vermont Medical Center was one of the first U.S. hospital systems to focus on initiatives. It has succeeded in reducing emissions by roughly 9% since 2015 by renovating and building structures to be more energy-efficient and converting off-site medical centers to run 50% on renewable natural gas. One of its hospitals cut waste by more than 60% through reuse and recycling.

Managed-care nonprofit Kaiser Permanente, meanwhile, has focused on greening its energy consumption. By September 2020, all of its 39 hospitals and 727 medical offices had achieved carbon neutrality. At most Kaiser Permanente hospitals, solar panels provide one-quarter to one-third of energy needs.

Kaiser Permanente aims eventually to generate enough electricity through solar technology to eliminate the need for diesel-powered backup generators at its hospitals, which are heavily used in areas with stressed power grids. In 2017 and 2019, forest firesÌýin California forced the health network to evacuate its Santa Rosa Medical Center. Subsequent power shut-offs by the utility company PG&E forced its Santa Rosa and Vallejo medical centers to rely on backup generators.

“To have those facilities be out for a week or more is just not tolerable,” said Seth Baruch, Kaiser Permanente’s national director for energy and utilities.

Increased energy sustainability has brought a small financial windfall. Kaiser Permanente saves roughly $500,000 a year in electricity costs through its grids and solar panels, Baruch said. (KHN is not affiliated with Kaiser Permanente.)

Reaching consensus on emission-lowering steps can be difficult. It took seven months for UVA’s Meyer, an anesthesiologist, to persuade his hospital to phase out most uses of desflurane, a that damages the ozone layer and is a potent greenhouse gas.

Meyer other drugs could replace desflurane. But critics warned that the most common alternatives slowed patients’ postoperative recovery, when compared with desflurane. They said there were ways to neutralize excess desflurane in operating room air without discontinuing it entirely.

The “first do no harm” ethos of medicine can also be an obstacle to the reduction of medical waste. The Joint Commission, which accredits more than 22,000 U.S. health care organizations, has in recent years for hospitals to use more disposable devices instead of sanitizing reusable devices.

The commission’s primary objective is to cut hospital infections, but more disposable items means less sustainability. About 80% of U.S. health care sector arise from the manufacturers, and their suppliers and distributors, including the production of single-use disposable medical equipment, according to a study.

Complicating the issue, ethylene oxide — a chemical the Food and Drug Administration requires for sterilization of many devices — has been categorized as a carcinogen by the Environmental Protection Agency. In 2019, health concerns that use the gas, which threatened to create a shortage of clean medical devices.

Maureen Lyons, a spokesperson for the Joint Commission, said the private accreditor lacks the authority to change regulations. The procurement of disposable versus reusable devices is a supply chain issue, “not one that the Joint Commission is able to evaluate for compliance.”

For this reason, health care activists are lobbying for sustainability through policy changes. , an environmental advocacy group, seeks to undo state rules that impose what it sees as excessively energy-intensive ventilation, humidification and sterilization requirements.

In California, the group has sought to change a medical building code adopted statewide in July that will require a higher ventilation standard at health care facilities. The group says the new standard is unnecessary. While high rates of circulation are needed in intensive care units, operating rooms and isolation chambers, there is no evidence for maintaining such standards throughout a hospital, said Robyn Rothman, associate director of state policy programs at Health Care Without Harm. She cited from the American Society for Health Care Engineering.

Hospital groups have resisted sustainability commitments on the grounds they will bring more red tape and costs to their hospitals, Rothman said.

The American Society for Health Care Engineering, a professional group allied with the American Hospital Association, has developed sustainability goals for reducing emissions. But existing regulations make it difficult to achieve many of them, said Kara Brooks, the group’s sustainability program manager.

For example, the Centers for Medicare & Medicaid Services requires hospitals that treat Medicaid and Medicare patients to have backup diesel generators.

“Hospitals will not be able to eliminate their use of fossil fuels based on the current regulations,” Brooks said, but “we encourage hospitals to work toward their goals within the parameters given.”

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“Los trabajadores agrícolas están en la primera línea del cambio climático. Y, en algunos casos, estamos viendo una tormenta perfecta azotando a nuestros trabajadores: covid-19, humo y el calor de los incendios forestales”, dijo Leydy Rangel, vocera de la United Farm Workers Foundation (UFW).

Para trabajadores como Trejo Galdamez, que realizan sus tareas al aire libre, unos pocos grados pueden significar la diferencia entre la vida y la muerte. Aquí, los trabajadores agrícolas usan camisas de manga larga, jeans gruesos, botas pesadas y sombreros de ala ancha para protegerse del calor. Aun así, con frecuencia hay que llamar a la ambulancia.

Y las temperaturas son cada vez más extremas.

El 4 de agosto, tres de las comunidades desérticas de la región superaron sus , alcanzando los 122 grados Fahrenheit en Palm Springs y Thermal, y los 120 en Indio. para su temperatura más alta en agosto, cuando se elevó a 121 grados. California registró los meses de y más calurosos.

El calor es la principal causa de muerte relacionada con el clima en los Estados Unidos. Entre 1992 y 2017, el estrés por calor mató a 815 trabajadores estadounidenses y lesionó gravemente a más de 70,000, según la Oficina de Estadísticas Laborales.

En California, las relacionadas con el calor aumentaron un 35% entre 2005 y 2015, el último año para el que hay datos disponibles, con aumentos desproporcionados entre las comunidades negras no hispanas, latinas y asiático-americanas.

El personal médico del Valle de Coachella dice que ha estado tratando a un número creciente de pacientes que sufren de agotamiento por calor o insolación en los últimos años.

En 2018, California registró 6,152 visitas a salas de emergencias debido a enfermedades relacionadas con el calor. El condado de Riverside, que incluye Coachella, Indio y Palm Springs, tiene de visitas a emergencias vinculadas al calor en el estado.

“Si comenzamos a ver más de 120 grados en cualquier capacidad normal, realmente estamos en un territorio desconocido. El cuerpo humano no está diseñado para existir en ese tipo de calor”, dijo el doctor Andrew Kassinove, médico del departamento de emergencias y jefe de personal del JFK Memorial Hospital en Indio.

El hospital trata regularmente a las personas que trabajan al aire libre por agotamiento por calor, que se caracteriza por náuseas, aturdimiento, fatiga, calambres musculares y mareos. Con menos frecuencia ven insolación, una condición más peligrosa cuyos síntomas incluyen dolor de cabeza, confusión, vómitos, frecuencia cardíaca rápida, desmayos y falta de sudoración.

“Las temperaturas corporales basales que son realmente elevadas requieren ser tratadas con medidas para salvar vidas”, dijo Kassinove. A medida que las temperaturas se elevan por encima de la temperatura humana típica de 98,6 grados Fahrenheit, el cuerpo lucha por disipar el calor.

California tiene algunas de las protecciones laborales más estrictas contra el agotamiento por calor. Una adoptada por los funcionarios de seguridad laboral en 2006 fue la primera en el país en aplicarse a todos los trabajos al aire libre, obligando a las empresas a proporcionar a los trabajadores espacios con sombra, tiempo de descanso y agua adecuados.

Después que una histórica ola de calor azotara el noroeste del Pacífico en junio, Oregon y Washington adoptaron protecciones similares. Algunos miembros del Congreso han presentado similar y quieren que el Departamento de Trabajo establezca .

Pero los grupos de derechos de los trabajadores dicen que las reglas no siempre se hacen cumplir. Y los trabajadores agrícolas, que están desesperados por el dinero y a menudo se les paga por pieza durante la cosecha, muchas veces pasan por alto su propia seguridad, dicen.

“Es poco probable que los trabajadores agrícolas presenten quejas”, dijo Rangel de la UFW. Sin asistencia federal durante la pandemia, “no tenían otra opción, tenían que seguir presentándose al trabajo si querían alimentar a su familia”.

Los latinos, que representan la mayoría de los trabajadores agrícolas de California, son como grupo más propensos a tener afecciones que pueden agravarse por el calor, como presión arterial alta y enfermedad renal.

Los trabajadores de salud enfatizan la importancia de la hidratación e instan a los trabajadores a consumir menos refrescos, café y alcohol que son deshidratantes, dijo el enfermero José Banuelos del Central Neighborhood Health Foundation, de Coachella. “No puedes cambiar tu trabajo si es al aire libre. Pero le digo a la gente que use protector solar y una capa protectora”.

El calor también puede afectar el uso de medicamentos. Los antipsicóticos y antidepresivos, por ejemplo, pueden reducir la sed y, por lo tanto, causar deshidratación, al igual que los diuréticos, que a veces se toman para la hinchazón.

Isidoro, quien dijo que está buscando otros trabajos, a menudo ve a sus compañeros de tareas luchando en los campos. Si se sienten mareados, pueden sentarse a la sombra o subirse a un camión cercano para que le pongan aire acondicionado, o llamar al 911 si los síntomas persisten.

Pero es un motivo de orgullo no mostrar que el calor te está afectando, dijo, y las llamadas para descansar a menudo se reciben con risas.

Alrededor de Bakersfield, mientras se recogen uvas durante la cosecha de verano y otoño, las ambulancias son un espectáculo habitual, dijo Isidoro. “Todos los días se escucha: ‘Aquí viene la ambulancia’ o ‘Fulano de tal se fue temprano porque se sintió enfermo’”.

Pero muchos trabajadores ignoran las señales de advertencia, dijo Aguileo Rangel Rojas, otro trabajador agrícola. “Están bien arriesgando su salud, sin pensar en eso, para asegurarse de que pueden ganar un salario”.

Rangel Rojas conoce demasiado bien los riesgos. En 2005, su hijo de 15 años, Cruz, sufrió un golpe de calor mientras recogía uvas. Pasó 15 días en el hospital y la familia no estaba segura si sobreviviría. Los ojos de Rojas se llenaron de lágrimas al recordarlo.

“No teníamos dinero. No hablábamos inglés. Sin auto. Sin nada”, dijo. “No conocíamos nuestros derechos. Puede arrancarte el corazón”.

Después de la emergencia, Cruz dejó de recolectar y volvió a la escuela secundaria; ahora es un empleado de UFW. Su padre, ahora de 53 años, todavía trabaja en el campo con su esposa.

En agosto, Rangel Rojas comenzó a trabajar por las noches, cuando las temperaturas bajan a los 80 grados. Pero incluso sin calor extremo, existen riesgos. La evaporación de los cultivos se mantiene espesa en el aire, creando una humedad que puede provocar tormentas eléctricas e inundaciones repentinas.

Un relámpago brilló a su alrededor mientras estaba cortando apio en un tractor en un amanecer reciente.

“Nos puede alcanzar un rayo en cualquier momento y todos podríamos morir”, dijo. “Debería poder ocurrir que esté lloviendo y los jefes nos pidan que dejemos de trabajar, pero no lo hacen. No podemos darnos el lujo de sentarnos detrás de un escritorio”.

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“Farmworkers are at the front lines of climate change. And, in some instances, we’re seeing a perfect storm battering our workers: covid-19, wildfire smoke and heat,” said Leydy Rangel, a spokesperson for the United Farm Workers Foundation.

For workers like Trejo Galdamez, whose jobs depend on outdoor work, a few degrees can mean the difference between life and death. Farmworkers here wear long shirts, thick jeans, heavy boots and wide-brimmed hats to guard against the heat. Even so, ambulances are frequently called to the fields, and heat-related illness appears to be increasing in the area.

And the temperatures are getting more extreme.

On Aug. 4, three of the desert communities in the region surpassed their , hitting 122 degrees Fahrenheit in Palm Springs and Thermal, and 120 in Indio. Thermal for its hottest temperature ever for August at 121 degrees.ÌýCalifornia registered its hottest and .

Heat is the leading weather-related cause of death in the United States. Heat stress killed 815 U.S. workers and seriously injured more than 70,000 workers from 1992 through 2017, according to the Bureau of Labor Statistics. In California, heat-related increased by 35% from 2005 to 2015, the latest year for which data was readily available, with disproportionate increases among Black, Latino and Asian American communities.

Medical staffers in the Coachella Valley say they’ve treated a rising number of patients suffering from heat exhaustion or heatstroke in recent years. California in 2018 saw 6,152 emergency room visits due to heat-related illness. Riverside County, which includes Coachella, Indio and Palm Springs, has among the of heat-related ER visits in the state.

“If we start seeing above 120 degrees in any regular capacity, we’re really in uncharted territory. The human body is not designed to exist in that kind of heat,” said Dr. Andrew Kassinove, emergency department physician and chief of staff at JFK Memorial Hospital in Indio.

The hospital regularly treats people who work outside for heat exhaustion, characterized by nausea, lightheadedness, fatigue, muscle cramping and dizziness. Less frequently they see heatstroke, a more dangerous condition whose symptoms include headache, confusion, vomiting, rapid heart rate, fainting and a failure to sweat.

JFK Memorial has treated 129 heat-related cases already this year, compared with 85 during the same period in 2020 and 75 in 2019, said hospital spokesperson Todd Burke.

“Core body temperatures that are really elevated require lifesaving measures to treat them,” Kassinove said. As temperatures rise above the typical human temperature of 98.6 degrees Fahrenheit, the body struggles to dissipate the heat.

California has some of the strictest worker protections for heat exhaustion. A adopted by occupational safety officials in 2006 was the first in the country to apply to all outdoor jobs, mandating companies to provide workers with adequate shade, downtime and water. After a historic heat wave hit the Pacific Northwest this June, Oregon and Washington adopted similar protections. Some members of Congress have a similar bill the Labor Department to establish federal standards.

But workers’ rights groups say the rules are not always enforced. And farmworkers, who are desperate for the money and often get paid per piece during harvests, often overlook their own safety, they say.

“Farmworkers are less likely to file complaints,” said the UFW’s Rangel. With no federal assistance during the pandemic, “they had no option; they had to keep showing up to work if they wanted to feed their family.”

Latinos, who represent the majority of California farmworkers, are as a group more likely to have conditions that can be exacerbated by the heat, like high blood pressure and kidney disease.

Health workers stress the importance of hydration and urge the workers to consume less dehydrating soda, coffee and alcohol, said nurse practitioner Jose Banuelos at Coachella’s Central Neighborhood Health Foundation. “You can’t change your job if your job is outside. But I tell people to wear sunscreen and a protective coating.”

The heat may also affect a patient’s use of medicines. Antipsychotics and antidepressants, for example, can reduce thirst and thus cause dehydration, as do diuretics, sometimes taken for swelling.

Isidoro, who said he’s looking for other jobs, often sees fellow workers struggling in the fields. If they feel faint, they can sit in the shade, or jump in a nearby truck for air conditioning — or call 911 if symptoms persist. But it’s a point of pride not to show the heat is getting to you, he said — and calls to slow down are often met with snickers.

Around Bakersfield, while picking table grapes during the summer and fall harvest, ambulances are a regular sight, Isidoro said. “Daily you would hear: ‘Here comes the ambulance’ or ‘So-and-so left early because he felt ill.’”

But many workers ignore the warning signs, said Aguileo Rangel Rojas, another farmworker. “They are OK risking their health, not thinking about it, to make sure they can make a wage.”

Rangel Rojas knows the risks all too well. In 2005, his 15-year-old son, Cruz, suffered heatstroke while picking grapes. He spent 15 days in the hospital and the family wasn’t sure he would survive. His father teared up at the memory.

“We didn’t have money. We didn’t speak English. Without cars. Without anything,” he said. “We didn’t know our rights. It can rip your heart out.”

Cruz stopped picking after that and went back to high school; he’s now a UFW employee. His father, now 53, still works in the fields with his wife.

In August, Rangel Rojas began working nights, when temperatures go down to the low 80s. But even without extreme heat, there are risks. Evaporation from the crops hangs thick in the air, creating humidity that can bring on thunderstorms and flash floods. Lightning flashed around him while he was out cutting celery on a tractor on a recent predawn morning.

“We can get hit by lightning at any moment and we could all die,” he said. “There should be an instance when it’s raining and the bosses have us stop working, but they don’t. We don’t have the luxury of sitting behind a desk.”

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The vaccine sign-up website, , is the state’s answer to a previous hodgepodge of vaccination appointment systems that residents had to log on to through websites belonging to various hospitals, pharmacies, clinics and many of California’s 58 counties.

The site, created by tech giant Salesforce, is being integrated into insurer Blue Shield of California’s with the state to take over its covid vaccination distribution system. My Turn is considered a clearinghouse, allowing most California residents to register for covid vaccinations and then receive an alert when they’re eligible to sign up for a vaccine appointment. The app then directs users on how to sign up for available appointments at certain venues.

The My Turn database, however, does not include information about vaccinations available at most pharmacies, or at Kaiser Permanente and Sutter Health hospitals. People who want to get vaccinated at those locations must contact the companies by phone or through their websites.

Like most aspects of state, local and federal government response to covid, My Turn’s rollout has been glitchy. Technology experts say the kinks are not surprising, given the multiplicity of health care information-sharing systems in the state, and a tendency of government officials to overlook the need for consumer usability when building IT systems.

California Department of Public Health spokesperson Darrel Ng said My Turn “is being continually updated to add features to make it easier and more convenient for Californians to make vaccine appointments. If there are technological snafus, they are corrected quickly.” Salesforce did not respond to a request for comment.

So far, more than 650,000 vaccines have been administered via the My Turn system and 600,000 more are scheduled, Ng said. But widespread failures on the site have unleashed a chain of desperate and sarcastic social media responses.

“Here in the Bay Area, with Silicon Valley and all its wealth & technological brilliance, here is how we vaccinate our populace a year into a pandemic,” William Boos , showing a screenshot of an error message saying an “authentication token” was missing.

Several Twitter users said they were unable to register for the first shot because no slot for a second shot was being shown as available through the system.

“Seeing spots open on 3/1 on @Walgreens for my category, but no second dose appointments are available. And the MyTurn website shows spots, but has an error message after you choose a time,” Jennifer Lazo.

Others say the system directed them to vaccination sites with no available slots.

“There are no appointments in San Diego County. Try it yourself. Put in that you are 65+. It’ll say you are eligible and bring you to a site in El Cajon where there are 0 appointments available,” another user.

One irregularity allowed anyone who had registered in the state to book a vaccine appointment in tiny, rural Kings County. Clinics had to turn away residents who had driven in from neighboring counties, and county officials stopped booking appointments through My Turn entirely until the issue was resolved.

Technological issues with vaccination websites have been an issue nationwide.

In , hundreds of seniors lined up one chilly mid-February morning after being told to come for second vaccine appointments between 7 and 8 a.m., only to learn the appointment offer was a computer error. Health officials in resorted to hand-counting vaccine doses to determine how many available appointments there were.

We asked four health tech experts to explain why My Turn and other systems are not running smoothly. Their responses have been edited for length and clarity:

Arien Malec, senior vice president of research and development at Change Healthcare:

The My Turn website and vaccination dissemination system are products of a reactive, rather than proactive, response that has plagued the medical and tech industries since covid first came on the scene. Everybody is making this up on the fly. My Turn, in particular, is a usability nightmare. The site clearly favors already tech-savvy users and doesn’t appear to have been properly vetted. Tech companies typically spend time and money on testing out software before being released to the general public. My Turn doesn’t seem to pass such muster. There are informal ways of doing usability testing that are relatively cheap. Given all the money that we’re spending on covid vaccination, and given the economic benefit of vaccinating more people, it is cheap at any price.

Hana Schank, director of strategy for the Public Interest Technology program at the New America think tank:

The issues with My Turn and other state-adopted vaccination sites are rooted in government officials’ lack of technological expertise. The people who are making the policy decisions are not equipped to make the tech decisions. Their ultimate goal is less focused on a good consumer experience and more on achieving a tangible result — which, in this case, is getting people vaccinated. Are people signing up? Yes. Are vaccines being distributed? Yes. Done. They think that checks their boxes. A tech issue is never just a tech issue. It’s always a bureaucracy issue, or it’s a silo issue or it’s a lack of expertise. The way the government thinks about success is from another era. Government is really bad at providing a good user experience.

Atul Butte, director of the Bakar Computational Health Sciences Institute at the University of California-San Francisco:

Considering where California was just two months ago, when the vaccines first began getting distributed in the state, My Turn should be viewed as a success. While the user interface may contain glitches, a lot of work goes on behind the scenes, trying to get the various counties and their health data aligned in order to get proper vaccination counts for residents. The website draws on four databases: one for ordering the vaccines and tracking shipments; one for inventorying at all sites; the California Immunization Registry, or CAIR; and finally the vaccine appointment scheduler. Each of those databases has many components. CAIR is spread across regions and its system is old; its user-facing website hasn’t been updated since 2013.

Dr. Chris Longhurst, chief information officer at UC San Diego Health:

Even if you had the perfect technology, and everybody was using My Turn, people are still gonna be upset because they can’t get vaccinated. We’re in the valley of despair right now, because we had the weather issues in Texas that impacted not only transportation with the vaccine, but also the manufacturing of some of the vaccine. And then you’ve got the state’s transition to Blue Shield as the new third-party authority, which is bumpy at best. Then you’ve got technology transitions — My Turn, and My Turn integration with electronic health records, that are also bumpy at best. And then you also have the governor opening up a bunch of new tiers for educators and essential workers. There’s no supply to meet that new demand. So that creates tremendous misalignment and frustration.

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The ban, which also affects other gas appliances, is part of a statewide campaign aimed at reducing climate change-feeding carbon emissions as well as health hazards from indoor gas exposure. A similar ban went into effect in Berkeley in 2020; Oakland and San Jose recently passed similar measures, and other California cities are considering them.

Officials championing the bans say they’re responding to evidence that gas stoves emit dangerous levels of toxic gases such as nitrogen oxide, nitrogen dioxide and formaldehyde, which can heart and lung problems, aggravate asthma and contribute to early , according to federally funded research.

Restaurant owners say it’s an outrageous, unnecessary law that will make expansions and opening in new buildings impossible. It puts salt in the wounds of businesses agonizing over covid restrictions, they add.

“If you get rid of the gas element, I don’t think restaurants can do it unless you’re like a coffee shop with a panini press,” said Matthew Dolan, executive chef and partner of restaurant 25 Lusk in San Francisco. “Whoever cooked up this idea should be reprimanded.”

Many are skeptical that properly vented stoves pose any health problems. Restaurants in California are required to have state-of-the-art ventilation systems that remove byproducts of burning natural gas and circulate fresh air, Dolan said. “The average employee isn’t really in contact with those issues,” he said.

The California Restaurant Association Berkeley in 2019 over its ban, arguing that it makes it impossible to prepare flame-seared meats, charred vegetables and wok-prepared dishes, putting steakhouses, ethnic restaurants and others out of business.

“You cannot cook with an electric wok,” said Vice Mayor Chin Ho Liao of San Gabriel, a Los Angeles suburb with 200 restaurants, mostly Asian. “You can cook with them, but it won’t taste good.”

Defenders of the law say it’s a long-delayed recognition of the harm of indoor pollution, which isn’t regulated by the Environmental Protection Agency, and is especially important since 87% of the typical person’s life is indoors.

Research shows clearly that gas stoves put out potentially dangerous levels of toxic fumes. Electric stoves also pollute, but at lower levels. While it’s difficult to prove gas stoves diminish health, studies have shown correlations between their use and higher rates of illness.

Buildings for the second-largest percentage of San Francisco’s carbon footprint, next to transportation, and natural gas accounts for more than 75% of that. Roughly of California homes use natural gas for cooking, according to the California Energy Commission. But health impacts are potentially a more immediate risk than climate change.

A by UCLA’s Fielding School of Public Health in June found that in modeled scenarios where a gas stove and oven are used simultaneously for one hour, concentrations of nitrogen dioxide usually exceed the pollution levels dictated by national and California air quality standards. Gas appliances also release carbon monoxide and particulates.

“All of those have been shown to be detrimental to human health,” said Yifang Zhu, lead author of the UCLA study and a professor in the school’s department of environmental health sciences.

San Francisco Supervisor Rafael Mandelman, the sponsor of the city’s ban, said in a written release that building electrification is “a critical step in addressing the serious public health and safety hazards of natural gas, and of course the ever-intensifying climate crisis.” He also cited a , a clean energy think tank, which found high levels of harmful emissions in homes and businesses with gas stoves.

In November, California’s air regulation agency adopted a to curtail emissions from gas appliances in buildings and said pollution could exacerbate covid-19. Climate activists are the California Energy Commission to include a ban on gas hookups in its next building regulations update, a move that would affect the entire state.

There’s been a similar push in Massachusetts. The nation’s oldest medical society last December became the first to the health impacts of gas cooking — though it also noted that ventilation mitigates such effects.

When caring for children with asthma, health care practitioners should ask, “‘What kind of stove do you have?’” said Dr. T. Stephen Jones, a retired former Centers for Disease Control and Prevention official who on the matter passed by the Massachusetts Medical Society.

Society members were taken aback by the data on how gas stoves could make children sick.

“This is not really out in the general public. It’s not out among providers,” said Dr. , chair of the society’s environmental and occupational health committee.

Low-income people are at particularly high risk because they tend to live in smaller residences where gases can concentrate; may use kitchen appliances for supplemental heat; and cannot easily maintain or replace older equipment, especially if they rent, according to the UCLA .

A concluded that residents of 62% of the Southern California homes it measured were routinely exposed to nitrogen dioxide through hoodless appliances at levels that exceed health standards. A 2012 done at the behest of the DOE found particulate matter from indoor gas burning could hurt lungs and reduce life expectancy.

As outdoor air gets cleaner, policymakers are focusing more on indoor air quality, which was “under the radar previously” and generally not regulated by state or federal governments, Zhu said.

Critics of the bans argue that electricity is more expensive than natural gas and will drive prices up, making it especially hard for low-income residents. And not all cities are on board with the move away from gas.

More than 100 California cities, including San Gabriel, have approved , with language put forward by the Southern California Gas Co., calling for “balanced energy solutions.”

In addition to the near impossibility of properly stir-frying food with electricity, Liao is worried about making residents rely solely on the state’s overworked electrical grid, which was hit with rolling blackouts last year. He is pushing for the development of clean gas derived from methane captured from rotting food, a process called anaerobic digestion. Riverside has such a . But the approach needs more funding and development to be scalable, the vice mayor acknowledged.

The gas ban could pose an extra burden on restaurants struggling to survive covid strictures, owners and chefs say.

“This is the last thing in the world we need right now,” said Dolan. “It’s an added burden on an already burdened industry.”

But advocates for the change say people need to look at the issue a new way.

“When you actually stop and think about it as ‘This is a gas-guzzling device that’s in the middle of my house,’ it is sort of like a mind shift,” said Brady Seals, a senior associate at the Rocky Mountain Institute. “I don’t think it’s unrealistic to think that, in a generation or two, we’ll come to a place where our kids can’t ever imagine why we would want to burn a fossil fuel in our kitchen that emits some of the same pollutants that come from tailpipes.”

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The response was swift and resounding. In less than an hour, someone had set up a chat group for brainstorming the effort. By 12:24 a.m. the next day, 70 people had joined. By noon, the tracker was live. Now, just over two weeks later, the site, , involves about 300 volunteers. They operate what is essentially a call bank, dialing pharmacies and hospitals for updates about covid vaccine supplies and posting the results on the site.

The quick and ardent response to McKenzie’s pitch highlights just how desperate Californians have become amid a chaotic vaccine rollout that has overwhelmed public health departments. Similar crowdsourced websites have gone up in , , , and other states.

While helpful to some, however, the websites and apps have only compounded the frustration for many people seeking vaccines for themselves or loved ones but can’t secure an appointment no matter how hard they try because supply is limited. Critics say that, at best, they simply enable the tech-savvy and people with time on their hands — two groups that don’t necessarily overlap with those most in need of covid vaccination — while leaving poor and minority communities behind.

“If you have an hourly job, you’re not going to be on your phone every minute,” said Jeffrey Klausner, a professor of preventive medicine at the University of Southern California’s Keck School of Medicine, who likened the process of securing a vaccination to “The Hunger Games.”

“We need call centers. We need people going out into the community door to door, registering people as if there were a census. You need to somewhat structure the system to allow and prioritize access for the most disadvantaged — reversing structural racism, or factors that exclude certain groups.”

Rhonda Smith, executive director of California Black Health Network, said it’s vital to reach out to communities where vaccine hesitancy is strong. While technology can help centralize information, building trust and relationships is what’s needed to convince skeptical communities of the vaccines’ importance.

“They aren’t going to just respond to a text message or a random app,” she said.

Platforms like VaccinateCA acknowledge their limitations. “We recognize that this isn’t our core strength today,” said Zoelle Egner, a volunteer with the site. But the app could be a resource for organizations that work with disenfranchised communities, she said.

California is also working with an online platform called My Turn, developed by Salesforce, that will alert residents when they are eligible for vaccination and facilitate sign-ups. The state announced last week that it had hired insurance company Blue Shield of California to create and manage a statewide vaccination network.

While some platforms offer a central place to search for pharmacies and links to sign up for updates from hospital systems or local governments, they can’t provide more vaccine-filled needles. With limited supply, a thousand allocation snafus and conflicting information about who is eligible, consumers find themselves signing up for wait lists and spending hours trying to snag appointments, only to be told there’s no vaccine for them or their loved ones. The apps can’t do anything about that.

Many users have found success. Melissa Reyes, who lives in Sacramento, was able to get her 76-year-old mother vaccinated after checking VaccinateCA. She called four pharmacies listed on the site before she hit the jackpot with her local Save Mart. She to VaccinateCA to thank the group.

For many others, success rests on luck: clicking through to the right pharmacy or supermarket website at the right time before all appointments are gone. For every exuberant user, there are often multiple frustrated people unable to land an appointment.

Misa Ahmad, whose 83-year-old father lives in Oakland, said VaccinateCA didn’t work for her. She ended up deciding to wait for her father’s health care provider, Kaiser Permanente, to contact him with an opening. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)

Her VaccinateCA search involved “going through trying to look at all of the places and figure out what they are, where they are, if they would be optimal for him, and then locating some and then trying to see if I can get an appointment. That is a very time-consuming process. And, unfortunately, my father has limited technological ability.”

Other users have found that the information provided is sometimes inaccurate, a product of ever-changing state and county regulations. Many Californians are still finding that, while Gov. Gavin Newsom announced that residents age 65 and older are eligible for the vaccines, their counties are still allowing only those 75 and older to sign up. Who is eligible for vaccination differs by county.

“What’s really frustrating is I keep getting texts and emails from the Department of Public Health saying, ‘You’re eligible for the shot; call your health care providers,’ and you call and no one is giving it to your age yet,” said Leanna Dawydak, a 66-year-old San Franciscan. She estimates she’s spent an average of four hours a day since Jan. 13 trying to find an appointment, only to be told she’s too young, lives in the wrong county or gets her care from the wrong health care system.

Some localities have purchased or set up their own apps, with mixed results. Orange County paid $1.2 million to tech company CuraPatient to create an app for organizing the vaccination of county residents. County public health officials had registered 493,000 people as of Jan. 29, with about 81,320 having received a vaccine.

But the app, Othena, has gotten bad reviews. Residents say its interface is unfriendly, with bugs that have resulted in people being improperly scheduled for appointments.

“It’s a disaster. It’s a total mess,” said Suzanne Haggerty, 60.

Haggerty, who has severe asthma, scheduled a vaccination through Othena, drove 45 minutes from her home to the vaccination site at Disneyland and spent two hours standing in line with her appointment and barcode in hand. She was turned away once she got to the front. A glitch in the app had cleared her for an appointment available only to those 65 and older. Staffers told her that about 50 people a day were being turned away for the same reason.

Still, some tech companies are confident they can ameliorate the scheduling fiasco.

Zocdoc, a web platform founded in 2007 to bring patients in for last-minute appointments with doctors, built a pilot program with New York’s Mount Sinai Hospital late last year for scheduling covid vaccinations for hospital staffers. Now the company has begun a partnership with the Chicago city government to offer its vaccine scheduler tool — free — to care organizations and public health agencies, said Zocdoc founder and CEO Oliver Kharraz. His company’s years of experience with scheduling software is a huge advantage, he said.

Zocdoc is the main platform for Chicago residents to make vaccination appointments free of charge, aggregating real-time appointment openings from various vaccination sites and care organizations. But vaccine supplies and shipments are out of his control, Kharraz said.

“I want to make the following disclaimer,” he said. “The vaccines, per se, are in short supply. So, I think Chicagoans should expect limited availability.”

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The ban, signed by Gov. Gavin Newsom at the end of September, covers 24 chemicals, including mercury, formaldehyde and several types of per- and polyfluoroalkyl substances, known as PFAS. All the chemicals are carcinogenic or otherwise toxic — and advocates argue they have no place in beauty products.

When the law takes effect in 2025, it will mark the first major action to remove toxic substances from beauty products in almost a century. Federal regulation of cosmetics has not been updated meaningfully since 1938, and are regulated by the Food and Drug Administration. By contrast, the more than 1,600 cosmetic substances and ingredients from cosmetics.

The California law, passed by wide margins in both houses of the legislature, “is a milestone for cosmetic safety in the United States,” said Emily Rusch, executive director of the California Public Interest Research Group, which was heavily involved in shaping the bill.

The Personal Care Products Council, which represents big companies like Amway and Chanel, was hesitant but eventually supported the bill and worked directly with legislators on its final form. The industry’s buy-in will help give the California law national repercussions.

“If you’re doing business in the United States, you’re doing business in California,” said Mike Thompson, senior vice president for government affairs at the council. “I would assume that this would really, in many ways, set up a new standard.”

Breast Cancer Prevention Partners, another activist group, advocated strongly for the measure because many of the banned chemicals have been linked to breast cancer, said Janet Nudelman, the group’s director of program and policy.

For salon workers like Kristi Ramsburg, the bill could offer the peace of mind that comes from knowing her workplace is freer of toxics. Over the 20 years she’s worked as a hairdresser in Wilmington, North Carolina, Ramsburg has done hundreds of straightening jobs on her clients’ naturally frizzy hair. Performing the procedure known as a Brazilian Blowout three to four times a week exposed her to harsh and dangerous/toxic products including formaldehyde and phthalates.

She experienced “sore throats, dizziness. My vision changed, definitely,” she said. “You’d be almost crying at first.”

dating to the early 1900s show that inhaling even small quantities of formaldehyde can lead to pneumonia or swelling of the liver. It’s been as a carcinogen, according to the FDA.

Ramsburg believes her exposure severely damaged her health. Over six years, she had surgeries to remove her gallbladder, ovaries and appendix. After her liver swelled dangerously, she suspected, based on medical consults and she read, that the formaldehyde she had been breathing for decades was to blame.

“I was just inundated with toxins constantly. I literally almost died,” she said.

Horror stories like Ramsburg’s are what motivated legislators, as well as the cosmetic industry, to support the California law.

that would have given the FDA more power to control or recall products containing the 11 federally regulated ingredients failed to gain traction in either chamber in recent sessions, despite the support of celebrities .

Advocates say the inadequacies in federal regulation have been apparent for years. Current law does not require cosmetics to be reviewed and approved by the FDA before being sold to consumers. And the agency can take post-marketing action only if a cosmetic’s ingredients were found to be tampered with or its labeling is wrong or misleading.

The FDA couldn’t even intervene when asbestos was found in cosmetics sold at the youth-oriented Claire’s and Justice stores. In a 2019 , then-FDA Commissioner Scott Gottlieb wrote that his hands were tied because “there are currently no legal requirements for any cosmetic manufacturer marketing products to American consumers to test their products for safety.” No action was taken.

FDA scientists moved to ban formaldehyde from hair straighteners as early as 2016, according to , but weren’t successful. A 2019 by government investigators found that using hair straighteners was linked with a higher risk of breast cancer, which rose with increased use. The study also found that using permanent hair dye was linked with an increased breast cancer risk.

After the federal legislation stalled, advocates changed their focus to California. The Golden State’s liberal leanings made it a likely place to pass a bill, while its status as the world’s fifth-largest economy meant any new law would have national impact. That has previously been the case, as when California set its own limits on car emissions or demanded nutrition labels for restaurant menus.

“It plays that pivotal role nationwide and has such a large economy, and so much of the cosmetic industry has a huge base here,” said Rusch, of the California Public Interest Research Group. “This type of landmark legislation has the effect essentially of setting a national standard. That was our intent.”

The Personal Care Products Council was open to the ban since the chemicals on the list — after some pruning during negotiations on the bill — include only those already prohibited in the European Union.

“You don’t want a patchwork of rules, either around the country or around the world. You want consistency,” Thompson said. “A lot of our companies may be already there, because they’re designing products for the European Union. … It’s just simpler for them to put out one product versus two.”

In recent years, growing consumer demand for transparency in beauty products has led to the development of a “clean cosmetics industry” whose products make up about 13% of high-end , double the percentage four years ago, according to the market research company .

Drug and department stores have also increasingly moved toward “clean” products. CVS in 2019 parabens, phthalates and chemicals that contain or can give off formaldehyde from its store-brand products.

Advocates argue that the state law will force all companies to provide transparency and consistency about what, exactly, is in the products consumers put on their hair and faces.

“In order to ensure and give assurance to the public that the worst of the worst stuff is out of cosmetics, we felt we really needed to standardize and to put that into statute,” Rusch said.

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As Hoopa’s fire chief and its pandemic team leader, Moon feared the impact of the blaze on the dense coniferous forests of the reservation, near Redwood National and State Parks, where 3,000 tribal members depend on steelhead trout and coho salmon fishing. He was even more terrified of a deadly viral outbreak in his tribe, which closed its land to visitors in March.

“We’re a high-risk community because we have a lot of diabetes, heart disease and elders that live in multigenerational homes. If a young person gets it, the whole household is going to get it,” Moon said.

Eventually, the three major blazes that burned nearly 100,000 acres around Hoopa were too much for the tribe’s 25-member fire team. Moon had no choice but to request help from federal wildland rangers and other tribal firefighters.

Native American tribes are no strangers to fire. Working with flames to burn away undergrowth and bring nutrients and biodiversity back to lands is an ingrained part of their heritage. But epidemics are also a familiar scourge. With the devastation that pathogens like smallpox and measles brought to Native populations following the arrival of Europeans, tribes are especially wary of COVID-19’s impact.

“When thinking about the potential of COVID-19 repeating history and wiping out entire communities and tribes, there is concern,” said Vernon Stearns, who as the fuels manager for the Spokane Tribe in eastern Washington is responsible for organizing controlled burns.

Some tribes have abandoned traditional fire suppression techniques, watching large swaths of land burn in order to protect a more fragile and essential resource: their people.

“The biggest fear the tribe had was COVID would hit our elders. And they are a very valuable resource of knowledge and connection to our ancestry and teaching of our ways to our children, who we also felt were at risk, and we obviously want to protect them,” said Ron Swaney, fire management officer for the Confederated Salish and Kootenai Tribes in Montana.

“I’ve seen how [the virus] has affected families close to me. I know the grief,” said Don Jones, fire chief of the Yakama Nation reservation in central Washington, where there have been at . “I’m not going to send sick people out to fight the fire. I’m not going to say, ‘Come on, guys, toughen up, go out there.’ Life takes precedence over that.”

Around the country, many tribes have full-time fire crews that traditionally aid one another and federal firefighters, sending out teams to help with blazes. But this year’s COVID-19 pandemic has pushed them to reconsider how much help they can give and receive in the face of encroaching infernos.

A Centers for Disease Control and Prevention found Native Americans and Alaskans were 3.5 times more likely than whites to test positive for the coronavirus. The rapid spread of the virus within tribes early in the pandemic led many reservations to aggressively control outside access. Casinos closed. Entrances to tourist areas such as lakes, hiking trails and fisheries were blocked off. Economically many tribes suffered, but COVID caseloads stabilized or declined.

The ongoing fire season is now threatening that progress.

Tribal families often live in multigenerational housing, sometimes in trailers or other small homes with no running water. Their isolated, tightknit communities can be sequestered from COVID-19 spikes in nearby towns but are ripe for an outbreak if the virus enters. Social distancing is a challenge on small, remote reservations. There may be only a single gas station or supermarket, where visiting fire crews would be likely to interact with the tribal population. Many tribes also lack strong internet connections, forcing fire crews to meet in person rather than stage briefings via Zoom, as federal crews have done elsewhere during the pandemic.

On the Flathead Reservation north of Missoula, Montana, COVID-19 hit the fire crew of the Confederated Salish and Kootenai Tribes before the fires did. A firefighter who came in direct contact with someone who was sick with the virus in early July took the tribe’s entire 12-person aviation team, consisting of an air attack plane and a helicopter crew, out of business for four days. While no fires were burning at the time, it was a worrisome wake-up call for Swaney.

“For a minute there, I really thought we would all be infected with COVID-19 and I was wondering who would be responding to the fires,” he said.

It was enough to convince Swaney that this year the tribe wouldn’t share any of its 60 firefighters with neighbors. It was a tough call because historically “in fire, when our neighbors need help, we go help,” he said.

At the end of July, Swaney had to accept help from nearly outside firefighters when lightning started a blaze in the mountains surrounding the bison-dotted grass valley his tribe calls home.

After the 3,500-acre Magpie Rock Fire was under control, Swaney learned that a federal wildland firefighter involved had tested positive for COVID-19 during his next assignment. He didn’t appear to have infected Swaney’s team, though four members have tested positive this season.

“We’ve had a lot of close calls,” he said.

Other tribes have sought to bolster their fire crews to do without the help of off-reservation teams. The Spokane Tribe in Washington earmarked it received from the CARES Act to hire an additional 10-person seasonal crew. It hoped to aggressively attack any fire and keep it small, thereby avoiding the need for outside firefighters who might also bring in the coronavirus, Stearns said.

The Yakama Nation, near the Oregon border, was still struggling with a coronavirus outbreak that had infected at least 6% of its population when fires started in July. The crews learned quickly that facing wildfire and a pandemic simultaneously would be an exercise in trade-offs.

Early in the effort, five fire crew members were taken off the line when several people got sick, leaving the 20 remaining members to make do. Federal firefighting is stretched thin as megafires consume vast areas of the West Coast — and other tribes were no help because they’ve restricted their fire teams’ movement to prevent COVID spread.

“We had no one else to call on. … It was pretty tough,” said Jones. “The stress level has gone up. You’re worried about exposure all the time.”

Ultimately, eight Yakama crew members tested positive for COVID-19. One of the firefighters who tested positive had already lost two family members to the virus. Another spread COVID-19 to a family member who ended up at the hospital on a ventilator but survived.

“Everyone in my program was affected one way or another,” Jones said. “Everyone lost somebody.”

The West’s brutal fire season is forcing tribes to concentrate on fires that start by lightning or accident, with no resources to give to prescribed burning.

“These fires are just gobbling up the ground,” said Jones. His tribe canceled the carefully controlled fires it normally conducts in September to avoid bringing together the large numbers of people needed to do them.

“Fires are just going to get bigger,” Jones said. “If we can’t do anything about it, we can’t do anything about it. We have to make sure everyone’s healthy first.”

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