Month: March 2022

Food and Drug Administration officials on a key committee said Thursday they were not planning to make a decision about granting emergency approval for a Covid-19 vaccine just yet. This all but ends the chances of a vaccine getting the green light in the US before the November 3 presidential election, and likely over the next month.

The Vaccines and Related Biological Products Advisory Committee was convened to go over the early results of Covid-19 vaccine clinical trials, the benchmarks to approve a vaccine candidate, and how to maintain safety throughout the process. However, no decisions are on the agenda.

“Of note, the committee is not asked today to vote on any issues discussed,” said Marion Gruber, director of the Office of Vaccines Research and Review at the FDA during the meeting.

President Trump has made it clear that a Covid-19 vaccine would improve his electoral prospects, and he has been leaning on regulators like the FDA to approve a vaccine on this timeline. That’s raised concerns that the agency would yield to political pressure and grant approval to a vaccine before it’s ready.

Trump also put out a video earlier this month saying that a vaccine would be cleared for use soon after the election. “We’re going to have a great vaccine very, very shortly,” Trump said. “I think we should have it before the election, but frankly the politics gets involved and that’s okay, they want to play their games, it’s going to be right after the election.”

But while vaccine development is proceeding in record time, researchers and other experts have said many times such a deadline is unlikely. Even the Trump administration’s own health officials at the Centers for Disease Control and Prevention have already said November is nearly impossible.

There are now 11 vaccines in phase 3 trials, including candidates from companies like Moderna, AstraZeneca, and Pfizer. However, some of these companies have only just completed enrollment in large-scale clinical trials, at which point they will have to administer the vaccine and observe infection patterns, which could take months.

And although there’s currently no evidence that the White House is directly meddling in vaccine research, some scientists worry that the president’s public pronouncements about a vaccine — especially ones so nakedly tied to his political prospects — are a form of interference that could undermine the fragile public confidence needed to deploy it successfully.

Trump has “created enough perception of political interference that there may not be deep trust in a vaccine, even if it’s a good product,” said Nicole Lurie, who led emergency preparedness at the Department of Health and Human Services (HHS) under President Barack Obama. “There is incredible public skepticism of the [FDA] because of what’s happened with prior emergency use authorizations, and because the president appears to continue to try to mess with the system.”

However, according to researchers, it’s unlikely the FDA would compromise a vaccine, given the vastly higher stakes for public health. Even getting to the point of considering emergency use for a vaccine would require much more information than it has now, and gathering that data requires several critical and time-consuming steps.

Why getting a vaccine approved by November is nearly impossible

Prior to the coronavirus, the fastest a vaccine had ever been developed was four years (for mumps). Most vaccines have taken a decade or longer.

But with the Covid-19 pandemic, scientists and governments have poured a staggering amount of money and know-how into the vaccine effort. That’s led to rapid progress.

It took researchers just over two months between the time the virus’s genome was sequenced and when phase 1 human vaccine trials began. There are now 11 vaccine candidates in phase 3 clinical trials, the final step before a vaccine gets the green light for widespread use.

That’s why some scientists are optimistic that a vaccine could gain approval by the end of the year or early 2021.

But phase 3 trials are slow and tedious. There’s little that can be done to speed them up, and they’ve only just begun. Although the Russian government recently said it has a Covid-19 vaccine ready to go, other researchers have warned that the vaccine, known as Sputnik V, didn’t go through this critical step and was tested in only 76 people. And even if it is a viable vaccine, it would still need to gain FDA approval before it could be used in the US, which demands more data.

Jonathan Zenilman, a professor at the Johns Hopkins University School of Medicine who has overseen clinical trials for vaccines, explained that Covid-19 phase 3 trials are large, aiming to enroll 30,000 participants each. For example, Moderna, a company developing an mRNA Covid-19 vaccine, is one of the teams that’s furthest along. It was the first in the US to start enrolling participants across 89 sites for its phase 3 trial.

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Phase 3 requires recruiting participants from more diverse backgrounds compared with those in earlier testing stages in order to better represent the population at large, including people with some preexisting health conditions. (Participants are screened to ensure they don’t have conditions like immune system disorders that could cause complications with a vaccine.)

These participants also have to consent to being tracked by scientists for the duration of the trial, which is typically two years. They’re randomly split into groups that receive either the vaccine or a placebo. In a double-blind trial, neither the recipients nor the people administering the vaccine know at the outset who received the vaccine. That ensures participants won’t change their behavior in a way that could interfere with the trial (a person who knows they have a Covid-19 vaccine could end up taking more risks, for example).

Finding tens of thousands of people who meet all these requirements for a phase 3 trial is tedious. Simply enrolling enough people is a process that can take months.

Although some Covid-19 vaccine phase 3 trials began in July, few have completed the enrollment process. Moderna said it is close to wrapping up enrollment.

After getting consent from volunteers and enrolling them in the trial, you have to give them the vaccine. Many Covid-19 vaccine candidates require two doses spaced up to four weeks apart, so just getting someone the full vaccine dose can take around a month. For most of the vaccine candidates in phase 3 trials, that would take them well into, if not past, October.

“Then you have to wait for people to get Covid, and you can’t do anything with the data until you have a certain number of Covid cases,” Zenilman said. To get a statistically meaningful result, researchers typically wait until they see around 150 infections in their group. At that point, they can “break the blind” and see who got the vaccine and who got the placebo — and compare the numbers to see whether it’s working.

Right now, many places in the US are still maintaining pandemic control measures such as social distancing and mask-wearing. Such tactics help control the spread of the virus, but for a vaccine trial, they also limit how quickly research teams can get the data necessary to draw conclusions about whether the vaccine is working. That’s why researchers are aiming to test their vaccines in rising Covid-19 hot spots.

There is also no guarantee that any vaccine will clear clinical trials. And the first vaccine to gain approval would not be available for widespread use right away. Health officials have to contend with the logistics of manufacturing, distributing, and administering the millions of doses needed to control the Covid-19 pandemic, which could take years.

Moderna CEO Stéphane Bancel said on September 30 that his company’s vaccine, which is one of the candidates furthest ahead in clinical trials, would not be ready for widespread distribution until next spring. He told the Financial Times that the company wouldn’t even consider applying for an emergency use authorization until November 25.

It’s also likely that no single vaccine will be suited to everyone. Several vaccines will be needed to protect different demographics, including older people, those with weaker immune systems, or those with certain preexisting health conditions. So even after the first Covid-19 vaccine gets approved, some people will still have to wait for other clinical trials to conclude.

Officials say they will not budge on vaccine safety and efficacy rules

FDA regulators are adamant that a vaccine will not be approved until it is demonstrated to be safe and effective. According to FDA guidelines, a vaccine needs to provide protection against the coronavirus for at least 50 percent of the people who get it. The safety benchmarks are higher for vaccines than for other drugs because vaccines are given to vastly more people, which magnifies infrequent problems. And since vaccines are given to healthy people rather than those who are already sick, there is a lower tolerance for side effects.

But at the same time, HHS launched the $10 billion Operation Warp Speed in June with the explicit aim of delivering 300 million doses of a Covid-19 vaccine by January 2021.

In an August 7 editorial in JAMA, FDA Commissioner Stephen Hahn acknowledged the tension between the need for speed and the need to hew closely to established rules.

Hahn and his co-authors, Anand Shah and Peter Marks, wrote that “the emphasis on speed has provoked public anxiety about the safety and effectiveness of vaccines developed on expedited timelines. Among the concerns are that the regulatory standards for approval will be lowered under political pressure for a vaccine.”

However, Hahn and his co-authors also wrote that “there is a line separating the government’s efforts to focus resources and funding to scale vaccine development from FDA’s review processes.” In other words, the FDA says it will not compromise its standards for approving a vaccine, despite pressure for faster results.

But what about the emergency use authorization (EUA) process? Could the FDA create a limited exception for a vaccine like it did with hydroxychloroquine?

Marks, the director of the Center for Biologics Evaluation and Research at the FDA (the body that governs vaccine approval), said the agency could do that, in theory. But as with the agency’s standard process, the rubric is stricter for a vaccine than for a drug, and regulators would still need to see data demonstrating that a vaccine meets the minimum benchmark of preventing infection in 50 percent of people who have been vaccinated.

“I think as we think about EUA here, the calculus for a vaccine is going to be different than the calculus for therapeutic,” Marks told reporters at the National Press Foundation on August 12. “I think we … optimally would like to see the data that’s from a trial that’s reached its efficacy endpoint.”

That would come near the end of a phase 3 trial, which, again, is unlikely to yield results for months. So there may not be enough evidence to warrant vaccine approval before the November election, even on an emergency basis.

And if there were political meddling to push out a vaccine before it’s ready, in spite of all these constraints, there would be strong opposition among the career scientists at the FDA. “I think you would see a revolt at the agency,” Zenilman said.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a recent interview with Today, Explained host Sean Rameswaram that he is also confident the process will be transparent.

“The FDA has pledged publicly multiple times that they will not approve a vaccine unless they’ve established that nonpolitical scientists agree that it’s safe and effective … And if it turns out somebody tries to force it out, I tell you, I will be one of the first ones that will object to that,” Fauci said.

Trust is critical for deploying a Covid-19 vaccine. But trust is fragile.

A vaccine can’t end the Covid-19 pandemic on its own. It has to be given to enough people to achieve herd immunity, at which point a large enough percentage of a population is protected against the virus so that it can’t easily spread.

Even in the most ideal scenario with a highly effective vaccine, getting to herd immunity would require immunizing millions of people. And already, many in the United States are saying they wouldn’t get vaccinated. A Gallup poll conducted July 20 to August 7 found that one-third of Americans said they would not get an approved Covid-19 vaccine if it were ready immediately. A CNN poll conducted August 12-15 found that 56 percent of Americans said they would get a vaccine, a decline from 66 percent in May.

Whether due to general hesitancy around vaccines or swirling conspiracy theories, public health researchers are concerned that if enough people don’t elect to get immunized, the Covid-19 pandemic will persist.

That’s why even the appearance that political considerations influenced vaccine approval could be dangerous.

Vaccine makers have pushed back against the pressure to speed up development even further as well because if the public perceives a vaccine was rushed, it could make people hesitant to use their product.

“The perception of political pressure and the perception of things being hurried really risks trust,” said Jesse Goodman, a former chief scientist at the FDA who’s now a professor of medicine at Georgetown University. “It’s not just trust in this Covid vaccine, but trust in the whole public health response to Covid and trust in vaccines in general.”

In March, after the president repeatedly promoted the anti-malaria drug hydroxychloroquine as a treatment for Covid-19, the FDA issued an emergency use authorization for the medicine, despite scant evidence of its effectiveness. In June, the FDA revoked this authorization.

Restoring that trust will take time. It will require transparency about the progress and results of clinical trials, as well as how decisions are made in federal agencies. It will also demand clear and coherent messaging.

But even that might not be enough.

“Personally, I think it will take a new president and new leadership at the top of the FDA before we’re going to be at a point where the public can start to have more trust,” said Lurie.

Which means that even with the urgency of thousands of people dying, taking the time to get a vaccine right is critical — from the vaccine itself to how it’s tested, documented, communicated, and administered. Rushing will likely only cost us more time.

The Republican National Convention on Tuesday spent more time on the opioid epidemic than the entirety of the Democratic National Convention.

In a touching speech, Ryan Holets, a police officer in New Mexico, told a story about how he adopted a child from a person struggling with homelessness and drug addiction. “Today, our beautiful daughter, Hope, is a thriving 2-year-old,” Holets said. “Crystal [the biological mother] is approaching three years of recovery. She is a dear friend and a constant inspiration to me and others.”

Since this was a political convention, Holets used the speech to support President Donald Trump’s reelection, boasting about Trump approving $3 billion a year in new funding to help combat opioid misuse and launching efforts to reduce opioid painkiller prescriptions.

“And it’s having an impact,” Holets claimed. “Drug overdose deaths decreased in 2018 for the first time in 30 years. Many of the states hardest hit by the opioid crisis are seeing the largest drop in deaths. We’re seeing that doctors are writing fewer prescriptions for opioid pain drugs. These are significant improvements that have a meaningful impact.”

The reality, however, is not so great. While drug overdose deaths did dip from a record high from 2017 to 2018, preliminary federal data shows overdose deaths increased in 2019, and local and state data suggests that 2020 will be even worse due to problems caused by the Covid-19 pandemic and the continued spread of fentanyl, a dangerous synthetic opioid, in illegal drug markets.

In fact, experts broadly agree that Trump and the federal government simply haven’t done anywhere near enough to address the opioid crisis. Referring to the 2018 drop in overdose deaths, Stanford drug policy expert Keith Humphreys recently told me, “I’m not sure that’s because of anything we did.”

Instead, the same structural problems that led to the opioid crisis and allowed it to fester remain: America still doesn’t support addiction treatment anywhere near enough, the treatment facilities that do exist are often detached from evidence and even fraudulent, harm reduction services like needle exchanges remain underused, and there’s still far too much opioid prescribing. For years, experts have called for a significant investment — including health care reform and tens of billions of dollars — to fix these problems, but nothing from the federal government, including under Trump, has approached the scale warranted.

So overdose deaths increased again in 2019 and are set to increase further in 2020.

But you wouldn’t know Trump’s failure from the Democratic National Convention. Based on the transcripts for all four nights of the DNC, Democrats didn’t mention “addiction,” “opioid,” or “overdoses” a single time at their convention.

It’s not because they don’t have a plan. Former Vice President Joe Biden, the Democratic nominee, has a very good plan — one that would make a serious investment into treatment and harm reduction as well as crack down on opioid prescriptions.

It’s also not because the issue isn’t politically salient. Several swing states, including Ohio and Pennsylvania, are among the most affected by the drug overdose crisis. An analysis by historian Kathleen Frydl found that the Ohio and Pennsylvania counties that flipped from Barack Obama to Donald Trump in the 2016 presidential election were hit particularly hard by opioid overdose deaths.

Yet Democrats seem ready to let Trump own the issue, even as many experts and activists say Trump has failed on it.

Trump’s approach to the opioid crisis has failed

Based on the preliminary federal data, drug overdoses spiked in 2019 to more than 72,000. That was higher than the previous record high for a single year, of less than 72,000 in 2017, meaning, if the early data is right, that all of the gains from 2018’s decline were erased and then some.

At the same time, there are several signs that things will be even worse in 2020. Fentanyl, which has increasingly supplanted heroin in illegal drug markets, appears to be spreading to the West of the US — a huge point of concern because fentanyl, as a more potent opioid than heroin, is more likely to cause overdoses. Overdoses involving stimulants, like cocaine and meth, are also going up.

All of this, experts say, is a result of federal inaction. It’s not that Trump and Congress have done literally nothing, but what they’ve done has been far too little: The single-digit billions they’ve put toward the issue fall short of the tens of billions experts say is needed, and their regulatory tweaks to improve access to treatment amount to too little, too late. The addiction treatment system remains not just underfunded but under-regulated, allowing fraud and abuse to take root in many facilities and a failure to follow any evidence-based practices in others.

Leana Wen, a health policy expert at George Washington University, summarized much of the expert consensus when she described the federal moves so far as “tinkering around the edges.”

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On these fronts, Trump hasn’t suggested going much bigger — and has at times proposed significant cuts to agencies involved in fighting the opioid epidemic.

So the crisis continues and, in most years, keeps getting worse, contributing to a decline in life expectancy in recent years.

The other actions Trump has proposed wouldn’t do much about the issue, either. He’s said his wall at the US-Mexico border would help keep drugs out, but the evidence suggests it wouldn’t. He’s called for tougher prison sentences and the death penalty for high-level drug dealers, but that’s discredited by a body of research finding that tougher criminal penalties don’t slow the flow of drugs into the US.

In fact, Trump has put out multiple proposals that would make the overdose crisis worse. For one, he’s repeatedly called for repealing the Affordable Care Act (“Obamacare”) and advocated for cutting Medicaid. The ACA alone expanded access to health care, including addiction treatment, to hundreds of thousands of people with addictions. A recent study in JAMA Network Open linked Obamacare’s Medicaid expansion to a 6 percent reduction in opioid overdose deaths.

Trump did declare a national emergency over the opioid crisis. But that led to almost nothing, as the Government Accountability Office concluded in a report. (The emergency declaration lapsed for nine days in January, as Dan Diamond reported for Politico, and no one seemed to notice.)

These failures were in some ways a prelude to the Covid-19 pandemic. The opioid crisis is an issue Trump should have taken seriously — it’s important to the country, but particularly his base of white voters without a college education, whom the crisis has hit especially hard. Yet Trump simply hasn’t taken the issue seriously or made it a major priority throughout his administration. As with Covid-19, the political incentives are there, but the president’s magical thinking and refusal to do the tough work of policymaking and governing has left a void of federal inaction on a serious public health issue.

Democrats aren’t talking about the opioid epidemic. They should.

Meanwhile, Democrats aren’t bringing attention to Trump’s failures. At their convention last week, they didn’t mention the opioid crisis at all.

Biden does have a plan. It would put $125 billion over 10 years — the largest commitment of any 2020 campaign — to scale up addiction treatment and other prevention and recovery programs, paid for with higher taxes on pharmaceutical companies’ profits. It would take steps to stop the overprescription of opioid painkillers while encouraging better care for chronic pain, and it would try to slow the flow of illicit drugs from China and Mexico. It would also move to “reform the criminal justice system so that no one is incarcerated for drug use alone.”

It’s a plan that could help a lot of people. It could help from a purely cynical political perspective: Ohio and Pennsylvania, two swing states, are among the hardest hit by the crisis in recent years.

It’s also a plan that could actually happen. While Democrats have spent a lot of the campaign talking about sweeping health care reform, a Green New Deal, and massive economic investments, these are proposals that are, frankly, not very likely to become law even if Biden wins the White House, especially if Republicans keep control of the Senate.

The opioid crisis is different. Several Republican senators, including Rob Portman (OH) and Shelley Moore Capito (WV), have shown a lot of interest in getting work done on the crisis. It’s telling that one of the few major pieces of legislation Trump has done was related to the opioid epidemic, even if experts agree it was too little, too late.

Simply put, starting from a place in which some Republicans and all Democrats are willing to work on an issue is certainly much better than a place in which no Republicans and not even all Democrats are willing to do something significant.

The issue could become even more relevant in the next few years. As Covid-19 (hopefully) fades, the overdose crisis will, unfortunately, stick around — and, based on the data, may even get worse as fentanyl spreads and stimulants make a comeback. With the right leadership, that could push the federal government to more action.

There are good reasons to be skeptical about whether Biden could get the full $125 billion he’s proposing to fight the opioid crisis. One thing I’ve heard consistently from sources in Congress is Republicans in particular are skeptical of spending too much money on addressing the overdose crisis. That will continue into a Democratic administration, likely even more so as Republicans become resistant to giving a Democratic president a victory.

But that’s all the more reason for Democrats to highlight the issue. There are substantial differences here between the parties, on top of Biden versus Trump, that could make a big difference in people’s lives.

Democrats so far aren’t doing that. So Trump gets to own the issue, despite his poor performance.

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The National Hurricane Center warned that Hurricane Laura will cause “life-threatening storm surge” reaching up to 40 miles inland and rising up to 20 feet as the storm made landfall in Texas and Louisiana.

Laura reached the Gulf Coast after midnight on Thursday morning at an “extremely dangerous” Category 4 strength, with winds reaching 140 mph. After landfall, it weakened to a still dangerous Category 2 storm.

During a Wednesday news conference, Louisiana Gov. John Bel Edwards said Laura’s storm surge would reach levels not seen since 1957’s Hurricane Audrey.

“The storm surge flooding is starting now in Louisiana,” Edwards said. “It’s well ahead of the storm. It will just get worse over the next day or so.”

Texas Gov. Greg Abbott implored residents to evacuate. “The conditions of this storm are unsurvivable, and I urge Southeast Texans to take advantage of these final few hours to evacuate, secure their property, and take all precautions to keep themselves and their loved ones safe,” he said at a Wednesday press conference.

Laura is expected to cause flash floods and a life-threatening storm surge in areas from High Island, Texas, to the mouth of the Mississippi River, inundating places that rarely see such high water levels.

About 20 million people reside in the path of the storm and more than 500,000 have been ordered to evacuate, a task complicated by the Covid-19 pandemic.

“The combination of a dangerous storm surge and the tide will cause normally dry areas near the coast to be flooded by rising waters moving inland from the shoreline,” the NHC reported in its latest hurricane bulletin. Storm surge, where high winds push water inland several feet above high tide, is often the deadliest consequence of hurricanes.

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Laura may also spawn tornadoes and drench the Gulf Coast with up to 10 inches of rainfall. Initially, Laura was projected to make landfall alongside Hurricane Marco, but Marco weakened to tropical storm strength and quickly fizzled out as it made landfall on Tuesday.

Laura, on the other hand, underwent rapid intensification, a hallmark of several recent major hurricanes. Rapid intensification is defined as a gain of 35 mph or more in wind speed over 24 hours. In Laura’s case, the storm went from below hurricane strength with 65 mph winds early Tuesday to Category 4 strength on Wednesday, then weakened somewhat to a Category 2 storm after hitting land, with winds still dangerously high. Further weakening is expected on Thursday.

The storm’s US landfall comes amid an unusually active hurricane season, one that the National Oceanic and Atmospheric Administration predicted back in May.

For Gulf Coast residents, Laura is stirring eerie echoes of past storms. Hurricane Harvey in 2017 swept over Texas at Category 4 strength and inundated Houston with a gargantuan amount of rain that left the city soaked for weeks.

Laura is also making landfall in the US around the 15th anniversary of Hurricane Katrina, a Category 5 storm that resulted in 1,200 deaths as it struck New Orleans. Both Harvey and Katrina are tied as the costliest storms on record. Laura is now the strongest August hurricane in the Gulf of Mexico since Katrina, Colorado State University meteorologist Phil Klotzbach told USA Today. The storm is believed to have killed at least 23 people in Haiti and the Dominican Republic.

The destruction recent storms caused was fueled by coastal development in vulnerable areas as well as climate change amplifying sea-level rise, and the damaging elements of extreme weather like heavy rainfall.

It’s likely Laura will also come with a high price tag. “I do expect this to be a multi-billion dollar disaster,” said meteorologist Jeff Masters on a conference call with reporters on Tuesday.

Forecasts show that Laura’s current course takes the storm far inland to states like Arkansas before hooking east on Friday.

How to follow Hurricane Laura:

• The National Hurricane Center has a page updating every few hours with the latest watches and warnings for Laura. Check it out.
• Follow the National Hurricane Center on Twitter; it will provide updates with all the latest forecasts, hazards, and warnings.
• Follow the Capital Weather Gang’s Twitter account. These folks tend to live-tweet storm updates.
• Here’s a Twitter list of weather experts via meteorologist and journalist Eric Holthaus. These experts will give you up-to-the-second forecasts and warnings.

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Wildfires continue burning in California, with unhealthy air from smoke still cloaking some parts of the state. Combined with the Covid-19 pandemic, the fires are compounding risks that have been brewing for years.

Fire officials have grouped some of the smaller fires in an area into complexes to coordinate their response. The largest of these is the SCU Lightning Complex. It had burned more than 365,000 acres as of Wednesday across parts of the southern San Francisco Bay Area, including Santa Clara and Alameda counties. The SCU Lightning Complex was 25 percent contained as of Wednesday morning.

To the north, the LNU Lighting Complex near Napa has burned more than 357,000 acres and destroyed or damaged 937 structures. Thousands were forced to evacuate. The fire was 33 percent contained as of Wednesday morning, and officials anticipate the flames could spread further.

At least 650 wildfires have raged across the Golden State, burning more than 1.25 million acres, since August 15, leaving at least seven people dead, according to Cal Fire.

Many of the blazes were ignited by a massive dry lightning storm last week concentrated in the San Francisco Bay Area.

“We had close to 11,000 strikes in a matter of three days,” said Brice Bennett, a spokesperson for the California Department of Forestry and Fire Protection (Cal Fire). “With an already-warm weather pattern and very, very dry conditions here in California, with those lightning strikes coming through, over 367 new fires were started.”

Smoke, soot, and ash from the fires also shrouded Northern California in the dirtiest air in the world at several points last week.

Wildfires are nothing new for Californians, who have grown wearily accustomed to the destruction, smoke, and evacuations in recent years. But this summer’s blazes stand out for their scale, timing, locations, and intensity, even among recent record-breaking fire seasons. And as David Wallace-Wells writes for New York’s Intelligencer, “What is most remarkable about the fires of 2020 is that these complexes are burning without the aid of dramatic wind, which is typically, even more than the tinder of dry scrub and forest, what really fuels California fire.”

The wildfires are just one of several disasters affecting California right now. The state has been in a two-decade megadrought, and was scorched by a record-breaking heat wave in early August, with several days in a row of temperatures reaching triple digits in some places, even at night. Temperatures in Death Valley topped 130 degrees Fahrenheit. That heat led to rolling blackouts as utilities struggled to meet cooling demand.

All the while, the Covid-19 pandemic is still a threat, making the already difficult task of controlling wildfires even harder.

Here are the factors that have fueled the recent fires and are now complicating the efforts to control them.

Extreme heat, strange storms, and climate change set the stage for California’s fires

The lightning storm around the San Francisco Bay Area that sparked many of the current California fires was a rare event.

“The last time we had something like this was over a decade ago, actually,” said Bennett. The fact that lightning started these fires is also noteworthy. The vast majority of wildfires in California are ignited from human sources — power lines, arson, neglected campfires, and so on.

But the fires wouldn’t have been so bad were it not also for the extreme heat that’s been baking the state for weeks.

“This is a big, big, prolonged heat wave characterized not only by hot daytime temperatures but also record-warm overnight temperatures and an unusual amount of humidity,” said Daniel Swain, a climate scientist at the University of California Los Angeles and a researcher at the National Center for Atmospheric Research. “It turns out increased humidity plays a role in why there are so many fires right now.”

A decaying tropical storm earlier this month in the eastern Pacific Ocean sent a plume of moisture over California. Amid the scorching heat, the moisture formed clouds that generated immense amounts of wind, thunder, and lightning but very little rain. “The humidity was high enough to produce these thunderstorms, but not high enough to produce significant flooding rainfall that would mitigate fire risk,” Swain said.

Much of California’s vegetation was also parched and primed to burn, and concerns that this would be an exceptionally bad fire year started to emerge in February as the state emerged from one of its driest winters on record. This was then followed by an abnormally hot spring. “There were a number of unusually significant early-season heat waves this spring both in Northern and in Southern California,” Swain said.

And California is now experiencing the impacts of climate change, which is manifesting in fires. The weather in California is becoming more volatile. Temperatures are also rising, which is causing the state’s forests, grasslands, and chaparral to dry out even more. The state already has millions of dead trees stemming from years of drought and pests like pine beetles. More heat could stress these ecosystems even further.

“It’s not just how hot are the heat waves; it’s how hot is it the rest of the time,” Swain said. “What really matters is the sustained warming and drying over seasons and years.”

Some of California’s current fires are in areas that don’t regularly burn

It’s important to remember that fires are a normal part of the ecology in California, from the coniferous forests in the Sierra Nevada to the chaparral shrubland in the south. Periodic blazes clear out decaying vegetation, restore nutrients to the soil, and help plants germinate.

Humans, however, continue to make California’s wildfires worse at every step. By suppressing naturally occurring fires, fuel has accumulated in forests and shrublands, increasing the danger when fires do ignite. People are also building closer to areas that are prone to burn. That increases the likelihood of starting fires and raises the blazes’ damage toll. People have also introduced invasive plant species like eucalyptus trees, which have spread throughout California and readily ignite. And burning fossil fuels emits greenhouse gases that are warming the planet, increasing the amount of vegetation that can burn.

Even with this backdrop, some of the fires in California stand out because they are raging in places that don’t burn very often.

“I think what’s key to understand is that different parts of California have very different normal fire seasons,” said Crystal Kolden, an assistant professor of fire science at the University of California Merced. “And that’s in part because California is such a big state. It has really variable topography and different vegetation or ecosystems across the state.”

Because the coastal forests are under the influence of marine weather systems, they are much cooler and retain more moisture than the pine forests of the Sierra Nevada and other inland areas. The coastal forests do burn periodically and are home to many species that have adapted to fire, but they rarely ignite during the summer.

That some portions of them have burned is remarkable, a product of high atmospheric pressure over the area that allowed heat to accumulate and overwhelm the cooling effect from the ocean. “Those coastal areas are incredibly dry, incredibly hot relative to normal, and that arid and hot condition had this potential to have really explosive fires,” Kolden said.

Covid-19 is adding a wallop to California’s fires

The Covid-19 pandemic has rattled every part of society, and firefighting efforts are not immune. “It definitely has affected our response, primarily in our inmate fire crews,” Bennett said.

California often relies on prison labor to bolster its firefighting efforts, with almost 200 inmate fire crews. Inmates are paid between $2 and $5 a day, plus $1 per hour when fighting a fire. But with severe Covid-19 prison outbreaks in the state, some inmates were released to relieve overcrowding. Others were hampered by infections, and many remain under quarantine. The number of available inmate fire crews has been nearly halved.

Anticipating a severe fire season, state officials did line up an additional 800 seasonal firefighters, but they have to take additional precautions. Fire crews are essentially staying in small bubbles, where they live and work with just each other, to help limit coronavirus transmission.

At base camps where fire crews rest and refuel, officials have designated more space for workers to maintain social distance.

The state is also facing a budget crunch, with the economic slowdown because of the pandemic. That’s led some fire prevention maintenance measures — like clearing dry grass away from roads and buildings — to languish.

As for the Californians fleeing the fires, Covid-19 has made it harder to coordinate evacuations and shelters. The declining air quality from the wildfires is also a threat to people with Covid-19, since exposure to air pollution can damage airways and make people more susceptible to respiratory infection. Extreme heat also worsens the public health impact of Covid-19 as people spend more time in enclosed spaces together to avoid the heat.

And the current round of blazes may take weeks to extinguish, raising the concern that stiff autumn winds — the Santa Ana winds in the south and the Diablo winds in the north — may spread the flames again.

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