Rates of depression, respiratory problems and kidney abnormalities are soaring among survivors of the Maui wildfire, according to the preliminary findings from a groundbreaking study.
The University of Hawaii (UH) has partnered with community health groups to track, understand and address the impacts on health and social conditions caused by the deadliest American wildfire in more than a century, which killed 100 people and destroyed more than 2,200 buildings as it razed the historic town of Lahaina.
In the largest post-disaster exposure study of its kind, researchers hope the 10-year initiative tracking 2,000 survivors will help affected residents access timely medical and psychosocial care to prevent – or intervene early in – serious conditions such as cancers, cardiovascular disease and birth defects linked to the fire.
According to initial results from 224 participants recruited during the first two weeks of the Maui wildfire exposure cohort study (MauiWes), shared exclusively with the Guardian, almost half the participants (49%) said their health was now worse than prior to the wildfires.
It also found:
55% are experiencing symptoms of depression – significantly higher than the rate reported by Maui residents (33%) in a 2023 survey. Depression rates were higher among older residents, with 75% of fire survivors in their 50s reporting low mood, insomnia and poor concentration, among other symptoms. About 1.3% of participants reported recent suicidal thoughts.
74% are experiencing respiratory issues, with 49% exhibiting signs of lung obstruction and 33% experiencing compromised lung function linked to low oxygen levels.
Initial blood biomarker tests indicated that 8% to 18% of participants may have compromised kidney function.
Three out of four participants have an elevated risk of cardiovascular disease, including 21% with high blood pressure at a level that warrants medical attention.
It’s too early to draw firm conclusions, since the study uses a convenience sample – people volunteer to participate – and the sample size is still too small to compare results with the general population. But significant numbers of people are presenting with breathing difficulties, rashes and fatigue to the researchers and at primary care clinics.
“The observed kidney function issues and respiratory symptoms are very concerning … These health problems are likely related to environmental exposure,” said Dr Ruben Juarez, co-researcher and professor of economics at the UH Economic Research Organization.
“We want to collect health data in advance to prevent what happened after 9/11 and other disasters, so that political decision-makers can intervene early. This is a prevention study, and nothing of this scale and speed has been done in the past,” said Juarez.
One in eight participants – 13% – do not have health insurance, largely because they lost their jobs in the fire, the study found. The proportion of uninsured fire survivors is much higher than the general population, which was 1.7% in Maui last year.
Six months after the fires, health – along with housing – are among the top concerns for survivors, especially for those with children at schools near the burn zone.
Sonny Galanza, a groundskeeper at a golf course, whose home burned down, is despondent after six months alone in a hotel. “I lost everything apart from my car and passport. I feel like there is no hope for us; there’s no long-term housing. It’s tough being alone here,” said Galanza, 50, whose elderly parents relocated to Honolulu to stay with relatives.
At a recent registration event at an upscale resort where hundreds of survivors are still sheltered, a group sat filling in the detailed 30-minute health questionnaire online, while a line of people waited for bloodwork and lung function tests.
Sandi Bridges, 57, and her husband, Channing Bridges, 60, registered to participate last month amid growing concerns about the long-term health ramifications. The couple escaped the fire on foot, breathing in the black smoke for hours. Their house survived the deadly fire, and they say the insurance company is pushing them to return as soon as health officials confirm that the water is safe. “I don’t want to go back to the burn zone. I feel like I won’t be able to breathe,” said Sandi, whose oxygen levels and lung function are abnormal. “I want to be monitored.”
The participants are immediately given the initial test results, and those with abnormalities are encouraged to seek medical care.
There are many potential fire-related toxins in the environment but trace amounts may not show up in standard clinical tests. Some toxins cause acute symptoms such as itchy eyes, skin rashes, coughing or trouble breathing. Others may cause biochemical or cellular changes linked to poor long-term outcomes including inflammatory conditions, cancers and cardiovascular diseases.
Maui health officials found cobalt and multiple synthetic chemical compounds, linked to serious health conditions such as cancers and birth defects, in the ash. Little is known about how these compounds interact with each other.
The second phase of the clean-up – moving the debris, which includes toxic heavy metals like lead, asbestos and synthetic cancer-causing compounds in the ash – is getting under way. There are currently 40 state air-quality monitors dotted in and around the burn zone, but none inside hotels, clinics or colleges where ash particles can blow and settle.
“The disaster after the disaster is the most scary for human health. We hope the study will give us ash biomarkers so that we know what to mitigate for. We have a small window to fix this, so the more we know, the better prepared we can be for what’s down the line,” said Dr Lorrin Pang, a member of the study’s scientific steering committee and principal health officer for Maui county, who is pushing for indoor air quality monitors.
The study has philanthropic seed money from the Maui Strong Fund for 1,000 adult participants – Lahaina residents present on the night of the fire, which displaced more than 10,000. Researchers hope to expand the study to include children and first responders, and in time track 2,000 fire-exposed people through detailed questionnaires, lab tests and health checks for at least a decade.
A comparative cohort of 2,000 people statewide who weren’t exposed to the fire will undergo similar social, psychological and blood tests. Researchers will also be able to access medical records and look for unusual trends and clusters of mental and physical health conditions, as well as social and economic outcomes that could be connected to the fire. Maui Medic Healers Hui and Roots Reborn Lahaina are among the traditional Hawaiian health groups involved in the project.
“We are trying to understand how the exposure and trauma impact long-term health outcomes, which is really important as many of the survivors are from communities – Native Hawaiian, Filipinos, Hispanics and Pacific islanders – with existing health disparities,” said Alika Maunakea, co-researcher and professor at the UH John A Burns School of Medicine.
“We want to support community based practitioners with our molecular findings, because ‘āina [land] and the environment is deeply connected to our health.”
• In the US, call or text Mental Health America at 988 or chat 988lifeline.org. You can also reach Crisis Text Line by texting MHA to 741741. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. Other international helplines can be found at befrienders.org
