Kena Hudson's 7-year-old son Clarence has asthma that's sometimes landed him in the hospital. Typically, when wildfire season starts in Northern California, he'll stay indoors but continue to see friends and attend school.
This year, a record spell of wildfires is blanketing much of the state in smoke. Facing a dual threat of reduced air quality coupled with a coronavirus pandemic, Clarence will have to stay indoors around-the-clock.
"We're in a pandemic and a heat wave, and we don't have air conditioning," said Hudson, who's based in Oakland, where temperatures are usually mild. "We can't open up the window, we're trapped, we're hot and no one can come over to play."
Californians across the state are now facing a crisis across multiple fronts. As the coronavirus pandemic drags on, lightning strikes and hot weather have fueled dozens of wildfires. Millions face losing power, and thousands have already been evacuated.
The health effects could also be dire, according to medical experts. Some fear that people with chronic respiratory conditions will avoid seeking care if their symptoms worsen because they fear exposure to the coronavirus.
Andrew Kornblatt, who lives in the East Bay, has asthma and is recovering from a surgery. He's doing his best to avoid refreshing websites with maps showing the spreading fire, but his anxiety is off the charts. "I keep thinking about where we would go if things go south," he said.
Dr. Sachin Gupta, a pulmonologist based in San Francisco, said he expects that it could be a lot more challenging for Bay Area companies to bring people back into work, particularly those with asthma or other respiratory conditions. "If you think about indoor office spaces, patients with chronic lung conditions were likely already nervous with the pandemic," he said. "But with the air pollution and struggles to ventilate spaces, would they want to go in now?"
There's also the concern that the air quality, which ranked the worst in the world in Northern California on Wednesday, could make coronavirus symptoms worse. Research from the spring found that patients in areas with high levels of air pollution were more likely to die from the infection than those in less polluted areas.
California has reported more than 640,000 confirmed Covid-19 cases with more than 11,000 deaths.
"With the wildfires, we're going to see increases in PM 2.5," said Dr. Neeta Thakur, a pulmonology and critical physician at UC San Francisco, referring to fine particular matter.
"There's some studies that have suggested an association between increases in particulate matter and severity of Covid-19 infections," she said. "Although how those are related is less well understood."
Rachael King, a tech worker based in San Francisco, lives alone but takes walks in the city to feel like she's part of a community. King has been battling asthma since she was a child.
Since the wildfires started, she's largely remained indoors to ensure that her asthma won't get worse. In previous years with the wildfires, she could still socialize by seeing friends at restaurants with filtered air or at home. Now, she feels completely isolated.
"Right now I'm doing okay," she said. "But I'm concerned that if this lasts, it will take a toll. It feels like it's just one thing on top of another."
The fires and heat also present another burden for California's already struggling businesses. For restaurants, which only recently set up spaces for outdoor dining, it's a disaster.
When San Francisco chef Dominque Crenn was driving on Tuesday night in the Bay Area, she saw smoke on the horizon. The following morning she spotted the ashes on the tables of Atelier Crenn, her fine-dining restaurant and realized she could not serve guests outside. Indoor dining has been banned in the city since March because of the coronavirus.
Instead of cancelling reservations, Crenn cooked meals for all her diners and her team personally dropped them off to their homes.
"We are getting exhausted," Crenn said by phone. "It's suffocating physically and mentally, and we don't have control."
Crenn believes the city needs to find a way to re-establish indoor dining soon before the damage to restaurants becomes unrecoverable.
"We need to make things happen because we are in survival mode and we can't survive more than another month like this," she said. "The tech companies didn't make San Francisco. We make San Francisco. The wine country, the restaurant owners, the chefs, the farmers. People don't travel from around the world to hang out with tech people. It's the innovation around the food and culture."
San Francisco waterfront restaurants Waterbar and Epic Steak will remain open for outdoor seating for now because of their location and strong breeze. "We can see some haze and smell the smoke a little bit," said Pete Sittnick, managing partner of the restaurants.
But Sittnick said many of his friends running popular Bay Area restaurants are already suspending operations. His restaurants closed down their outdoor dining in 2018 with the fires, but continued to serve people indoors. That's no longer an option.
Daycares across California, which recently re-opened by taking in fewer children and offering ventilation, are also facing shutdowns.
Dr. Roxana Daneshjou, a dermatologist based in Silicon Valley, said her husband tried to drop off their young daughter to a Stanford University-run daycare on Wednesday.
But staffers told her husband the facility was closed because it could not adequately ventilate the space. In an emailed statement, Stanford confirmed that the temporary closures are due to "unhealthy air conditions caused by ongoing wildfires in the Bay Area."
Daneshjou said it's a major challenge for the Bay Area's working parents to find last-minute alternatives. And that could have an impact on those who are working in nearby hospitals. "I am concerned for people who are attending [physicians] at the hospital at Stanford, because backup childcare is so difficult."