Wearing a protective mask to filter dangerous air, Dale Hamlin, peer support specialist for Catholic Charities, prepares to bring N95 masks, water and hygiene supplies to homeless Portlanders Sept. 15. (Courtesy Catholic Charities)
Wearing a protective mask to filter dangerous air, Dale Hamlin, peer support specialist for Catholic Charities, prepares to bring N95 masks, water and hygiene supplies to homeless Portlanders Sept. 15. (Courtesy Catholic Charities)
Outstretched on a tarp near St. Francis Dining Hall in Southeast Portland, Ronnie coughed before propping herself up on her elbow to talk the afternoon of Sept. 17.

“Last night my right lung was really hurting,” said the 50-year-old, who’s been coming to the dining hall for about six years, after she left an abusive husband.

Ronnie lives in a city with a large homeless population and where for almost a week the air quality was worse than in any other major city on the planet. Day and night, many of the approximately 2,000 unsheltered Portlanders inhaled smoke-saturated air, blown in from the state’s massive wildfires.

By Friday, Sept. 18, rain, favorable winds and the unrelenting efforts of firefighters meant the air quality had improved dramatically in the Portland region — it was “very unhealthy” down from “hazardous,” and “good” by midnight. But given that the size and effects of fires have intensified in recent years, “this is definitely going to be something we have to keep in mind going forward,” said Andrew Rakestraw, outreach coordinator at St. André Bessette Parish downtown.

St. André Bessette offers a range of outreach ministries to those living on the streets, and it remained open even as a number of downtown establishments closed due to the smoke. Guests at the parish received breakfast, sack lunches and hygiene items.

Blanchet House, a Catholic-founded ministry providing food for hundreds daily in Old Town Portland, was among several Portland-based Catholic entities joining local government agencies and community groups to distribute N95 masks and water and encourage homeless individuals to stay in a shelter as haze cloaked the city.

“Our meal guests suffered terribly during this fire and smoke crisis,” said Scott Kerman, executive director of Blanchet House.

Dr. David Hotchkin is a lung specialist at Providence Portland Medical Center who also tends to patients in the critical care unit. Calls increased from those in stable housing who were experiencing physical distress from the smoke, and calls from those without stable housing had “gone through the roof,” he said.

“If you’re in a tent or makeshift shelter, you can’t get away from it at all,” said Hotchkin. “This is an incredibly vulnerable population.”

Many public areas like libraries that can provide respite from poor air were closed due to smoke and pandemic concerns.

One regular Blanchet guest, an elderly woman who uses a walker to get around, told staff: “I’ll put my blanket over my head to keep the smoke out tonight.”

The joint Office of Homeless Services between Multnomah County and the city of Portland helped coordinate opening two 24-hour smoke relief shelters, one at the Oregon Convention Center.

Yet many unsheltered people, like Ronnie, feel uncomfortable staying in a shelter. Some don’t want to leave the safety and familiarity of their established camps or their belongings during a pandemic, said Rose Bak, chief program officer for Catholic Charities of Oregon. Others had trouble relocating to the sites.

Staff from Catholic Charities and Blanchet handed out water and N95 masks to individuals remaining on the streets, explaining to recipients that the masks are different from most COVID-19 masks, which cannot protect from the smoke’s hazardous contents.

Some of the places where the homeless often wash themselves, such as fast-food restaurants, were closed for a few days, and Catholic Charities provided additional hygiene products. Staff distributed tents and tarps to those without, “so they weren’t living with ash constantly falling on them,” said Bak.

Staff also encouraged people to smoke less. “There’s a lot of cigarette smoking to relieve stress and reduce appetite, and the wildfire smoke adds to the assault on their lungs,” Bak said.

“I’ve seen a lot of coughing,” she added Sept. 17, the day before the air quality began to improve. “We worry about this population that’s in poor health to start with. I’ve been indoors much of the time and my eyes are burning and I can’t wear contacts.”

Wildfire smoke is not like campfire smoke, said Hotchkin. It contains a range of particles and gases, including ozone, carbon monoxide, nitrogen dioxide and particulate matter. This mix is what leads to the hazardous air quality rating.

In the United States the air quality index, stretching from 0 to 500, was established in 1977 as part of the Clean Air Act. The AQI tops out with hazardous air quality ratings listed as 300-500. On Sept. 13, Portland’s AQI was 516, off the scale. That shattered the record of 157 AQI from 2017. Smaller Oregon communities closer to the blazes have had even higher AQI in recent weeks.

Breathing in the smoke around the clock increases the risk of having a heart attack, stroke or developing pneumonia, Hotchkin said. Pre-existing health conditions present in the homeless community such as emphysema, chronic bronchitis, asthma and heart disease all make the impact of smoke even greater.

According to the Centers for Disease Control exposure to wildfire smoke can prevent a person from fighting off respiratory diseases such as COVID-19.

Hotchkin said there are risks of simply being outdoors in unhealthy air, but any exertion adds to the danger.

“For those without homes trying to go to a job or collect cans or get away from violent situations in camps, there’s an increased exertion and increased breathing,” said Hotchkin. “That increases the stress on the lungs.”

Larry, 61, sitting on a bench near St. Francis Dining Hall, had been avoiding movement as much as possible for that reason. “If I don’t take in as much oxygen I don’t need to breathe so deeply and the smoke does not bother me as much,” he said.

Darius Jones, Catholic Charities’ emergency culinary director of the dining hall, said drug use was at an all-time high in the unsheltered Portland community.

“The stress of the pandemic, the stress of homelessness and then the smoke on top of all that has meant more turning to drugs,” he said. “It’s been a stressful time for everyone, and most of us have food and we have shelter. Imagine if that was taken away?”

Dale Hamlin, peer support specialist with Catholic Charities, walked around the blocks surrounding St. Francis with N95 masks. He also carried his laptop to connect people with needed resources.

“The smoke has affected people pretty badly,” said Hamlin, standing outside the dining hall on smoky Sept. 17. “They’ve complained of sore throat, headache, feeling sick to their stomach. The older individuals talk about their chest hurting.”

Hotchkin said if the region continues to see more frequent fires and smoke exposure, many Oregonians, but most acutely the unhoused, are going to grapple with the health-related consequences.