Bushfire smoke: how pharmacists are helping


Bushfire smoke at Parliament House, Canberra. Image by Simon Troman.
Bushfire smoke at Parliament House, Canberra. Image by Simon Troman.

The anxiety caused by poor air quality and the rush on face masks is causing more trouble than the damage from bushfire smoke, says one pharmacist on the ground in Canberra

The first day of 2020 saw Canberrans wake to a yellow dawn after heavy smoke from surrounding bushfires rolled in across the ACT – just one of a number of locations around the country where smoke is causing a significant health hazard for at-risk people in particular. At the time of writing the air quality in the ACT was again considered “hazardous”.

Samantha Kourtis, proprietor of the Charnwood Capital Chemist in Canberra’s north, told AJP that anxiety and the search for face masks were taking a significant toll on some Canberrans.

“I was a pharmacist during the 2003 fires as well, and this time’s really different because of the build-up,” she said.

“The smoke haze has contributed a lot to people’s anxiety and worry, because it’s creating an anticipation of things that could be coming.”

She said that advice given by ACT Health, the Territory’s Chief Health Officer, the Health Minister and the ACT Emergency Services Agency has been excellent, and that staying indoors and minimising outdoor activity remains the best way to reduce exposure to the smoky haze.

However, when the wearing of P2/N95 face masks became part of this advice, it triggered a run on the masks.

“It created anxiety, and on top of that, panic,” Ms Kourtis says. “The demand was unprecedented. I’ve never experienced anything like it, even when we had the flu pandemic.

“The distress on masks is probably more distressing than the smoke haze.

“People’s desire to get and wear a mask is something I have never experienced at that level in my career.

“We couldn’t keep up with demand. We were placing orders, but because of the fires, couriers were not working, warehouses were closed and depots were closed, and despite the fact that pharmacies were ordering stock, a lot wasn’t being shipped to Canberra in a timely fashion, and so there was just no stock.”

Sam Kourtis in a car with a P2 mask
Samantha Kourtis heads out to deliver masks to her patients.

Ms Kourtis says that she has seen a lot of people wearing the masks incorrectly or even around their neck or on top of their heads: some wore dirty masks that were “clearly” past their use by dates, and some had been modified to make them easier to breathe through.

“So many people came in who had adjusted their masks so there were gaps. It’s hard to breathe through a P2/N95 mask, and so I don’t think people fully understood that the whole rationale behind them is that they need to form a perfect seal on your face to filter nanoparticles,” she says.

But she also says that “I believe a lot of people who were wearing the masks were wearing them because the mere fact of having a mask on their person made them feel better”.

“At the end of the day, if that makes them less anxious, then that’s okay.”

Ms Kourtis says that a number of people who came to the Charnwood pharmacy for masks became distressed and/or angry when they found they were not available.

“One woman was yelling so much she was spitting,” she says. This woman told one of the pharmacy assistants that it would be her fault if the patient and her husband died, because the pharmacy was rationing masks at two per patient.

A number of at-risk patients have also complained that it is unfair that they are being directed to stay indoors and not go outside, and want more masks, or masks which are easier to breathe through, in order to do so.

However, there have also been positives from the smoke, Ms Kourtis says.

“We had 10% atrocious behaviour, but we also had 90% of beautiful community support,” she says, telling the story of one woman who became distressed when she was not able to get a mask from the pharmacy because it only had enough for patients who had already signed up to a waiting list.

Another patient who had been on the waiting list, and had collected her masks, gave them to the distressed woman.

The haze has also given pharmacists an opportunity for interventions, Ms Kourtis says.

“It’s not great to stay inside, but it’s a very effective way of reducing smoke exposure,” she told the AJP.

“We’ve got a home delivery service. So I jumped in the car. We had a list of patients in our community who would need one, and we contacted people as well who had very wisely decided to stay indoors, who were eligible for Government-funded masks. We were more than happy to deliver the masks to them.”

Generally these people were following the advice to use air purifiers and seal doors and windows very well.

“When I was in there, I started checking asthma puffers. One lady was really unwell, and I found she had been using out-of-date puffers.

View of smoke from Mt Ainslie, Canberra. Image by Simon Troman.
View of smoke from Mt Ainslie, Canberra. Image by Simon Troman.

“For these people, I was able to do an assessment of how well they were sealing up their house, assess their medicines if they had puffers, and also made sure patients taking medicines for heart disease were taking them as directed.

“We made lots of interventions – making sure they had spacers, making sure they had enough relievers as people are using a lot, making sure medicines were in date. That was incredibly rewarding for me. Lots of pharmacists across Canberra are making these deliveries as well.”

She added that the number of people who are happy to talk about their reliever puffer technique has spiked, giving pharmacists the chance for another intervention.

Ms Kourtis says she hopes that Canberrans are able to stay calm, and if they are concerned, see their GP to ensure their asthma action plan is up to date; if they do not have an asthma diagnosis, they should still see their GP to have any worrying cough assessed, as they might still benefit from medication.

“Doing that has far better results than panicking and tracking down masks,” she says.

“Pharmacists have done their best, but people really need to consider seeing their doctor for a thorough assessment.”

 

Dealing with smoke

Last week, the PSA and Pharmacy Guild issued a statement saying that the two organisations had worked together to get 100,000 P2 masks to community pharmacies for distribution to patients.

“Around the country, pharmacists have rallied in support of their communities and are doing what they can to help as bushfires devastate so many parts of Australia,” Pharmaceutical Society of Australia ACT Vice President, Professor Mark Naunton said.

“In the ACT this week, pharmacists have stepped up to coordinate and provide access to protective masks for Canberrans most sensitive to smoke, such as those over 65, pregnant women and people with chronic health conditions such as asthma and cardiovascular disease.”

Guild ACT president Simon Blacker said that he had seen “a mixture of joy and relief” at these pharmacies.

Bushfire smoke at Lake Burley Griffin, Canberra. Image by Simon Troman.
Bushfire smoke at Lake Burley Griffin, Canberra. Image by Simon Troman.

“The teams of pharmacists and staff were excited to be empowered to help, and this is a common trait of all community pharmacies and those that work within them.”

Late last week, Federal Health Minister Greg Hunt announced that the government would provide an additional 576,000 P2 masks to South Australia, Tasmania and Australian Defence Force personnel to support bushfire-affected communities.

An additional 505,000 masks have been reserved for New South Wales and 505,600 masks have been reserved for Victoria, following a request from these states.

The Government has also begun to replenish its national stockpile of P2 masks, he said.

Meanwhile, AMA national president has again stressed the need for people vulnerable to smoke to stay indoors, speaking to 2GB’s Zoe Bingley-Pullin, Gerald Quigley and Ed Phillips.

Ms Bingley-Pullin cited the case of 19-year-old Courtney Partridge-McLennan from Glenn Innes, NSW, who died in November 2019 of an asthma attack triggered by the bushfire smoke. Ms Partridge-McLennan is not the only Australian to have died as a result of the smoke: in early January, an elderly woman disembarked from a plane in Canberra onto the tarmac, experienced respiratory distress and died.

“The concern is that if you have pre-existing respiratory disease, cardiac disease, if you’re pregnant, if you’re elderly, if you’re very young, these very small particles will be very deleterious to your health and can set off an asthma episode, trigger a cardiac event, or significant other issues,” Dr Bartone said.

“And the other thing that we need to remember is that this is now longer than any time in recent history, in recent memory, the weeks upon weeks of this continual, low-quality, very smoke haze-affected air. And, in a research sense, in a worldwide sense, we still don’t have enough literature to know about the long-term effects.

“So the message is, really, if you don’t need to be out in that smoke-affected air, don’t.”

He warned that people who have never suffered an asthma attack may also be at risk.

“There’s a group of Australians who are yet to have their first asthma episode, who don’t know they have underlying asthma, or have poorly treated asthma.

“They don’t understand their asthma treatment plans, or they don’t have a plan to begin with, or they don’t implement it as wisely as they should, or, worse still, they might borrow their mate’s Ventolin puffer when they get a bit tight in the chest.”

He urged such people to visit their GP for an assessment.

Last week Asthma Australia also called on Environment Ministers to implement real-time and consistent air quality reporting of PM2.5 and 10 nationally.

“Bushfire smoke fluctuates rapidly,” the organisation said. “Information and advice based on average concentrations of PM2.5 over a 24 hour period is not helpful. Side effects can be experienced as soon as pollution levels begin to increase – they do not wait 24 hours.

“People at risk, organisations, schools and businesses have no access to timely, accurate and reliable information to make informed decisions to stay safe.”

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