The room at Toronto General Hospital’s emergency department was busier than usual, even for a Monday in June. I was shadowing Dr. Maya Holden, a pulmonologist, who pointed to the waiting area where three elderly patients sat with portable oxygen tanks, all admitted within hours of each other.
“Wildfire season hasn’t even peaked yet,” she said, adjusting her glasses. “But we’re already seeing a 40% increase in respiratory distress cases compared to this time last year.”
When I began investigating the health impacts of Canada’s increasingly severe wildfire seasons three months ago, I expected to document environmental damage and occasional air quality warnings. What I found instead was a healthcare system bracing for a new normal – one where smoke doesn’t just darken skies but fills hospital rooms across provinces and even across borders.
The numbers are staggering. In 2023, Canada experienced its worst wildfire season on record, with over 15 million hectares burned – nearly six times the 10-year average according to Natural Resources Canada. The smoke from these fires didn’t just affect nearby communities; it traveled thousands of kilometers, blanketing cities from Vancouver to New York in a hazy, orange fog that turned day into twilight.
“We’re essentially conducting an unplanned public health experiment on a continental scale,” explained Dr. Sarah Cooke, an environmental epidemiologist at the University of British Columbia. “When wildfire smoke travels, it doesn’t just carry particulate matter; it transports a complex mixture of chemicals that change as they age in the atmosphere.”
Standing on the shores of Lake Ontario last summer, I watched as the Toronto skyline disappeared behind a thick yellow haze. The CN Tower, usually visible from kilometers away, was barely a shadow. Air quality readings that day registered a PM2.5 level of 180 – classified as “very unhealthy” on the Air Quality Health Index. Normal readings typically hover between 0-10.
In Fort McMurray, Alberta, Dene elder Robert Grandjambe described how the community’s relationship with fire has transformed. “Our people have always lived with forest fires,” he told me as we sat on his porch overlooking the boreal forest. “But not like this. The elders say the land is speaking to us, telling us something is deeply wrong.”
What’s wrong, according to Environment and Climate Change Canada, is a climate that’s warming at twice the global average rate. Their climate projection models show that by 2050, the average area burned annually in Canada could increase by 74% if current emission trends continue.
For healthcare systems already stretched thin by the pandemic, this poses a serious challenge. Hospital admissions for respiratory conditions increase by approximately 4-10% during significant wildfire smoke events, according to research published in the Canadian Medical Association Journal.
In remote Indigenous communities, where healthcare access is already limited, the impact is even more severe. During a visit to the Tl’etinqox First Nation in British Columbia, community health representative Marilyn Baptiste showed me their emergency response center – a single room equipped with a few air purifiers and oxygen concentrators.
“When evacuation orders come, our elders often refuse to leave,” Baptiste explained. “Their connection to the land is stronger than their fear. So we prepare as best we can.”
The health impacts extend beyond the obvious respiratory issues. Research from Health Canada shows wildfire smoke exposure is associated with increased risks of heart attacks, strokes, and complications during pregnancy. Mental health services also report spikes in anxiety and depression cases during prolonged smoke events.
Dr. Kyle Jenkins, an emergency physician who divides his time between Vancouver and rural British Columbia, has witnessed these effects firsthand. “We’re seeing patients who’ve never had asthma suddenly developing symptoms,” he told me. “But what’s equally concerning are the mental health presentations – the anxiety, the fear, the sense of impending doom that comes with weeks of darkened skies.”
Canadian smoke doesn’t recognize international boundaries. Last summer, New York City briefly claimed the dubious honor of having the worst air quality of any major city globally as Canadian wildfire smoke drifted south. Hospital admissions for respiratory issues in affected U.S. states increased by up to 10%, according to preliminary data from the U.S. Centers for Disease Control and Prevention.
“This isn’t just Canada’s problem,” noted Dr. Cooke. “Atmospheric rivers don’t stop at border crossings.”
The economic costs are mounting as well. The Canadian Institute for Climate Choices estimates that health impacts from wildfire smoke could cost the Canadian healthcare system an additional $4.6-$9.4 billion annually by 2050 if climate change continues unabated.
Yet amid these sobering statistics, communities are adapting. In Kamloops, British Columbia, I visited a pilot project where local health authorities have established clean air shelters in community centers. These spaces, equipped with hospital-grade air filtration systems, provide refuge during the worst smoke events.
“We can’t control when the fires come, but we can control how we respond,” said Jennifer Kroeker, the project coordinator, as she demonstrated how their real-time air quality monitoring system works.
Researchers are also developing new tools. At the University of Toronto, I observed a team testing low-cost air quality sensors that could be distributed to vulnerable households, providing localized data more accurate than regional forecasts.
Back in Toronto, Dr. Holden finished her emergency department shift and joined me for coffee. Outside, the sky was clear blue – a temporary reprieve before what meteorologists predict will be another record-breaking fire season.
“What keeps me up at night isn’t just treating the acute cases,” she said, stirring her tea thoughtfully. “It’s knowing that for many Canadians, especially those with pre-existing conditions or limited resources, these ‘exceptional’ events are becoming routine threats.”
As our climate continues to warm, the line between wildfire season and respite grows thinner. The smoke that once seemed a distant concern now links communities across provinces and international boundaries in a shared vulnerability – and perhaps, in a shared responsibility to address its root causes.
In the waiting room of Toronto General, an elderly man with an oxygen tank caught my eye and nodded knowingly. He didn’t need to explain what brought him there. The evidence was as clear as the air wasn’t.
