Climate Change and Health Seminar Series: “Dust storms, socio-environmental factors, and COVID-19 in Puerto Rico”

February 08, 2022

Information

Dr. Pablo Méndez-Lázaro joined YCCCH for this monthly seminar series to discuss his research and forecasting work on dust storms and COVID-19 in Puerto Rico.

January 31, 2022

ID7429

To CiteDCA Citation Guide

00:09<v ->Is recorded, and the recording</v>
00:11will be published later online
00:13on our Yale Center on Climate Change website.
00:16And during the seminar, if you have any questions,
00:19please feel free to type in your questions in the chat box.
00:24So without further ado, Pablo, welcome.
00:28<v ->Thank you Kai,</v>
00:29and thank you for the audience for being here.
00:31Thank you for the invitation for me, it's an honor
00:34to be sharing the information
00:36that we have from different research projects,
00:40and sharing with people outside of Puerto Rico.
00:44Please let me know when you can see
00:46my screen as not duplicated.
00:49Can you see it well?
00:51<v ->Yes.</v> <v ->Okay, perfect.</v>
00:52Thank you, Kai.
00:53Let me move this out of here, and also let me minimize this.
00:58So again, thank you for the invitation.
01:00I'm Pablo Mendez-Lazaro, I'm an Associate Professor
01:02at the University of Puerto Rico Medical Science Campus.
01:05I've been working at their
01:07environmental health department for 13 years.
01:10I'm a geographer by background,
01:13but then I switched right there,
01:16interdisciplinary research and graduate school
01:19on Marine science and (indistinct)
01:20and climate change.
01:22So therefore probably
01:25I can have a little bit of flexibility
01:28when changing from one topic to another.
01:31In this case,
01:32I'm gonna be talking about atmospheric conditions
01:34that are impacting or affecting public health
01:39and what kind of research we're doing in Puerto Rico,
01:43mainly with Saharan dust.
01:46Basically we do have two research projects
01:49that are funded by NASA, NASA ROSES,
01:52which is also their health and air quality program.
01:57The first one is a research project
01:59that we submitted back in 2017.
02:01We have been working with three different working groups
02:06and mainly we proposed to use the early warning system
02:11to develop early warning system
02:12using satellites information around bay stations,
02:15and also to quantify the impacts mainly
02:18on respiratory diseases on Puerto Rico.
02:20I'm gonna be speaking about a little bit,
02:22what is Saharan dust?
02:23Most of you probably are aware
02:24of the Godzilla dust event that occurred in 2020,
02:27but for those of you that are not aware,
02:29I'm gonna be explaining a little bit,
02:30what is Saharan dust,
02:32and this is an analysis in Puerto Rico.
02:34So to do that,
02:35we proposed three different working groups,
02:37and for ones which was the responsible of working
02:40on analyzing the intrinsic relationship into the dust
02:43and public health,
02:46using different methods and approach.
02:48Qualitative analysis but also quantitative analysis
02:51using secondary databases.
02:53The second one, the second working group
02:55was the one responsible of analyzing,
02:58we call it atmospheric forcing and air quality.
03:00And these ones were the one responsible
03:02of analyzing and doing the characterization
03:04of the dust using ground based stations,
03:06but also diesel particular matter.
03:09And you will ask, "Okay, so why diesel particular matter?"
03:12Because in our case we believe that,
03:13not in our case, I think that all of us agree,
03:16I'm preaching to the choir in this case but
03:18natural sources of air pollution are interacting
03:22with anthropogenic sources of air pollution.
03:24And one of the main sources of air pollution in Puerto Rico
03:27could be considered diesel particular matter,
03:30the anthropogenic sources, right?
03:31And one of the main natural sources of air pollution
03:34are the dust that are coming
03:35from the other side of the Atlantic.
03:37So we were wondering as well,
03:39what could happen if both of these aerosols
03:43and pollutants get together
03:47and how the conditions in the air quality
03:50can get deteriorated because of the simultaneous events.
03:54And the third working group
03:56is the one that we call decision, support tool,
03:58computation, and visualization.
03:59And this one is the working group
04:00that is responsible of developing
04:03the early warning system in collaboration
04:05with the National Weather Service,
04:07the office in San Juan and the Department of Health.
04:10So we call it like a, it's like a co-design,
04:13it's a human design center approach
04:17where we are working directly with any users,
04:20to see how can we help them to improve decision making
04:25for these kind of hazards.
04:26And how to protect the population
04:28when this threat is arriving to the Caribbean.
04:31Mainly as again, we started with Puerto Rico,
04:33but this kind of tool could be scalable
04:36to the rest of the Caribbean,
04:37because what we're using are satellite information
04:39and this information is available for the whole region.
04:45So to do that, I first built a team,
04:50a multidisciplinary team, this is who we are.
04:52A multidisciplinary team of epidemiologists,
04:57dermatologists, people from remote sensing,
05:00chemistry, atmospheric science and climatology.
05:03All of us working together
05:05to do this kind of research
05:07and developing early warning system
05:08for the Caribbean region.
05:10And what is this Saharan dust?
05:12So in the case of the Caribbean and the Sahara,
05:16this is our aerosols and mineral dust
05:19that are coming mainly from the Saharan desert.
05:21The Sahara desert is one of the biggest desert worldwide,
05:23and it can provide over 20 billions of tons
05:27that can reach into the Americas.
05:28When I'm saying the Americas,
05:30not only to the Caribbean region,
05:31because it depends on what season of the year.
05:34South America can be impacted
05:36by this dust coming from Africa,
05:37but also North America and the Caribbean region.
05:42In the Caribbean,
05:44these events are associated with increase
05:46on excessive risk of emergency room visits
05:48and hospitalizations related to respiratory diseases.
05:51This has been observed in Granada, Guadalupe, Martinique
05:56and in Puerto Rico as well.
05:59Well, we were working with this
06:01natural source of air pollution affecting public health.
06:06All of a sudden it appears, the coronavirus, SARS‑CoV‑2.
06:11So, which is the responsible of the COVID 19 pandemic
06:13that we're suffering.
06:15The first cases of COVID 19 in Puerto Rico
06:17were registered in March 2020.
06:20So very early after the pandemic,
06:21and I think that the first cases in Europe
06:24were registered in December, 2019,
06:27and then it took only a couple of months
06:29for the virus to get to the Caribbean region.
06:31And when that happened, we were able to wonder ourself,
06:36"Okay, so we have been working with Saharan dust,
06:38and this dust is associated with hospitalization
06:41and emergency room visit due to respiratory diseases.
06:44So what could happen to this patient
06:46or what could happen in the Caribbean,
06:48if we are facing two hazards?"
06:51Both are different hazards,
06:53but both of them are affecting the same system,
06:56the same respiratory disease system.
06:58One is air pollution, natural sources of air pollution,
07:01and the other one is a virus.
07:03But again, both of them are interacting,
07:05affecting the same system.
07:08So why we're doing this?
07:10And why we are also including
07:12some other environmental factors, okay?
07:15So air pollution is being
07:17as considered like the silent killer.
07:19And it's not only
07:21the anthropogenic sources of air pollution,
07:23but there's many other natural resources of air pollution
07:26that can exacerbate our health, right?
07:28And it's been acknowledge by the World Health Organization,
07:32but also by the CDC
07:33and some others important agencies worldwide.
07:38And some other factors that we are considering for example,
07:42I'm just gonna be talking about very slightly
07:45about the other one that is another climate hazard
07:48that could be considered a silent killer is extreme heat.
07:52And accordingly to the CDC for example,
07:54extreme heat, at least in the United States,
07:56it can be considered the number one weather related death.
08:00So is the one number one responsible for death
08:03when we're talking about climate and extreme weather events.
08:06So in terms of public health and mortality,
08:09when we're talking about air pollution and extreme heat,
08:12both of them are ranking first or second.
08:16It depends how do you look at.
08:19Both of them are considered number one
08:22in terms of impacting and affecting public health.
08:25In the left side,
08:26what I'm showing is the weather fatalities
08:28that occur in the United States
08:29in the 48 continental states.
08:32And as you can see for example,
08:34when we're talking about weather fatalities,
08:37they are not associated with hurricanes
08:39they are not associated with floods.
08:40Most of them again are associated
08:43with heat and extreme heat, right?
08:46So these are two very important component
08:48because you will see that,
08:51right after our result
08:53what we're seeing as preliminary results
08:55is that actually both of them are interacting
08:58with the pandemic and are exacerbating
09:01the conditions in the patients
09:03that are struggling with the virus.
09:07So as I mentioned, this is something
09:08that I think that all of us,
09:09if you're coming from the Yale School of Public Health
09:12and front of environmental health, most of you are aware.
09:15So there are multiple sources of air pollution
09:17and we have two first categories.
09:19The first one is the anthropogenic sources of air pollution,
09:23which are from transportation for example, airplanes,
09:28ships, trucks, vehicles, whatever,
09:31some others are from the industries.
09:33But also we have natural sources of air pollution,
09:36and this is where we are doing emphasis in our research.
09:39And the natural sources of air pollution
09:41and those one that
09:44the source of the pollution,
09:46it can be thousand of kilometers away
09:49from the places that are getting affected.
09:52And in our case for example,
09:53we're talking about natural sources of air pollution
09:55the are five to 7,000 kilometers
09:59away from the Caribbean region.
10:00But actually they have the capacity
10:03to be transported by the trade winds
10:05in some specifics seasons.
10:07And to impact the region
10:10mainly in the Caribbean.
10:13The Saharan dust are mineral dust are not the only one,
10:16and not the only natural sources for pollution.
10:18We can see also some volcanic ashes,
10:21we can see sulfur also from volcanoes.
10:25And we have also mold and spores
10:28that can be provided by the vegetation
10:30in the tropical landscape for example,
10:33but there are multiple other sources of air pollution again,
10:35that are affecting or are interacting with pollution.
10:40What is the Saharan dust?
10:41So these are mineral dust particles that can fly literally
10:45and can be transported by the trade winds
10:48they're coming from, mainly from the Saharan desert.
10:51But also the Sahel desert is another source
10:54of this kind of dust,
10:55but we are using the Saharan dust.
10:57Right, because this is the main source
11:00of the particles that are getting to the Caribbean.
11:02And we're measuring this as aerosols
11:04and aerosol is basically,
11:06different small particles that could be liquid
11:09or solid that are suspended in the atmospheres.
11:13As I mentioned, it could be that of sea salts
11:15as well, volcanic ashes, smoke from fires, biomasses
11:19and factory pollution, right?
11:21Again, in our case,
11:22we are particularly interested in working
11:25with this particle that are coming
11:27from the other side of the Atlantic.
11:29This particle are very important because
11:31they provide nutrients to terrestrial ecosystem,
11:36but also to ocean ecosystem, so is very important.
11:39But when we're talking about public health,
11:42that's the negative component.
11:44Because in some cases, this particle,
11:48they're coarse, right?
11:49So in some cases they're big enough,
11:51but to fly from the other,
11:53to be suspended for a long period of time,
11:56and to cross all over the Atlantic
11:58suspended in the atmosphere,
12:00some of this particle are very small in size.
12:03And that's why it could be dangerous for public health,
12:07because some of them have the capacity
12:08to get inside of your system very deep.
12:12And in some cases, because we're talking about particles
12:14that are very small, right?
12:16This is another way on how to see it.
12:18We have the source, which is in the African continent,
12:21in the Northern side, from Sahara and the Sahel.
12:24And we need some specific condition for this sediment
12:27to get lift by the air,
12:29and to be transported by the trade winds,
12:31to the other side of the Atlantic.
12:33So we need to consider the wind speed, wind direction,
12:37and also the conditions that are causing the lift
12:42to occur in the Saharan desert, right?
12:45So when this, all this planets are aligned,
12:48that means that a dust cloud could be transported
12:51to the other side of the Atlantic, okay.
12:54The main season in the Caribbean
12:56of the African dust arriving to our region
12:59are mainly during the Summer, right?
13:00So it's also interacting with the hottest season
13:03in the Caribbean,
13:05and also it's interacting with the tropical storms.
13:10So you will see that
13:12the season start to increase the Saharan dust.
13:16These aerosols arriving to the Caribbean
13:18are increasing after May
13:21receiving a peak of the season
13:22during the months of June,
13:24and then starting to decrease again during July,
13:26August and September.
13:27And September is the peak season
13:29for the Caribbean region,
13:30for the hurricane Caribbean region, in our case.
13:34So the Saharan dust is also,
13:37and these aerosols are interacting also with the atmosphere,
13:40which is important because this is dry air.
13:42And in some cases,
13:43this Sahara dust also is associated
13:45with inhibition of the formation of tropical storms
13:50and powerful hurricanes.
13:51We still need to analyze better that kind of information,
13:56but the scientists are still wondering
13:59how these interactions could be positive, in some cases
14:03for hurricane formation in the Caribbean.
14:06These aerosol are also associated
14:08with an increase in PM2.5, as I mentioned.
14:10Some of them are big, bigger than PM10, for example,
14:15but some others could be as small as 2.5 or even smaller.
14:19And that's why they have the capacity to float
14:21and to be suspended in the atmosphere
14:23for thousand of kilometers, right?
14:26So when these dust clouds arrive to our region,
14:29it's also increasing the concentration of PM2.5
14:35during this season
14:36and it's associated with the peak events, right?
14:39And as you can see, I'm just citing here
14:42that the dust, it positively associated
14:45with cardiovascular and respiratory conditions
14:47in the Caribbean and in this case
14:49is related to Puerto Rico,
14:51but also is associated with asthma, hospitalization
14:54and emergency room visits in children's,
14:57which we are talking about kids
14:59in Trinidad and Tobago, Guadalupe and Granada.
15:03So one of the channels that we're using
15:08to identify these aerosols
15:09is the aerosol optical depth.
15:11The aerosol optical depth is by scattering,
15:13the light scattering that we're receiving
15:15using satellite remote sensing
15:18and information from different sensors
15:20that I'm gonna be speaking about.
15:22And so this is the, they have no maximum units.
15:25They can go from zero up to two until now,
15:28after we saw with Godzilla.
15:31So zero means that there are no visible particles
15:34in the atmosphere that could be identified
15:38using these sensors.
15:41And the higher the numbers,
15:43it means that a lot of particles are in the atmosphere
15:47are being identified using the satellites
15:50that are floating in the atmosphere, okay?
15:53In terms of the data that we're using,
15:55as I mentioned, we're using different sources of data.
15:58So we're using VIIRS,
15:59which is visible infrared imaging radiometer suite,
16:03and coming out from that sensor we're using AOD.
16:07AOD again is aerosol optical depth.
16:09Then we have a Scatter Angstrom Exponent.
16:12You see this is an important variable,
16:15because it is associated,
16:18the lower the value with this, the Angstrom Exponent,
16:22it means that the particles
16:24are more associated to be dust, okay?
16:27So it's a proxy
16:29because when you're using satellite information,
16:31you are not seeing necessary the distinction between dust
16:35and some other particle
16:36that can be floating in the atmosphere,
16:38as I mentioned with ashes.
16:41But if you look at other kind of signal, for example,
16:44and in this case the Angstrom exponent,
16:46you can have a better idea of what kind of aerosol
16:50is floating in that dust, okay, in that cloud.
16:54So we are using Angstrom exponent
16:57but also mass concentration.
17:00To understand and to see the better,
17:02how this atmospheric variables
17:05are interacting with other environmental factors
17:08nearby the Caribbean region,
17:10we're also using sea surface temperature
17:14to see how it can influence,
17:16if it have cooling effects over the ocean,
17:19or if it has a warming effect over the ocean.
17:22And it's three case,
17:24it depends on how it's occurring this dust cloud,
17:29the day, the concentration and the amount of dust
17:33that can be present.
17:34We're also using MODIS and UTCI, which is from Sentinel.
17:40This is a Universal Thermal Climate Index.
17:43To see again, the interaction
17:45with the occurrence of the Saharan dust
17:48in the Caribbean and the temperatures in our region.
17:52To do that,
17:53we started analyzing daily values since 2012, until 2020.
18:00You have all of the current databases.
18:04There are different satellites
18:06coming from NASA for example,
18:08some of the are geostationary data,
18:11and some others are orbital data.
18:13And where we say geostationary data for example,
18:16to use geostationary data,
18:18it means that it is a satellite or a signal
18:21that is providing you information very frequently,
18:25from the same part of the earth constantly, right?
18:30So like, as it can be with GOES-R, for example,
18:32we're also using GOES-R to develop the early warning system.
18:36But if you want to understand the trajectory
18:40of this system for example,
18:42so then we're using, for example, VIIRS,
18:44because VIIRS is a polar orbit and is a satellite
18:47that is turning around the earth
18:49and is providing you information
18:52about what is happening with this aerosols
18:54and the atmospheric conditions in other places of the world.
18:58So you can understand what is happening
19:00with the source of the dust
19:02that are probably coming to your region
19:04in the next couple of days.
19:06So we're using two different formats of information.
19:10One is geostationary data
19:12that are coming from GOES-R mainly,
19:13and the other ones that are coming from VIIRS
19:15that are orbital information.
19:18The orbital information has a limitation,
19:20because for example, in our case, Puerto is very small.
19:23So it means that the VIIRS is only providing data,
19:26very accurate data for the region,
19:29every couple of days, for example.
19:32It's not necessarily, it like between five to seven days,
19:36the interval or the frequency when you can have
19:40information for aerosols in the Caribbean.
19:43But if you're using GOES-R for example,
19:45GOES-R is providing you aerosol information constantly.
19:49Well, most of the time there are still,
19:51there are other limitations,
19:52but I'm not gonna be speaking about that.
19:54There are other limitation
19:55about this geostationary satellite,
19:58but it could be providing you
20:00very frequent information
20:02about the aerosol optical depth in the region.
20:05So with all this aerosol we have in place
20:08the first experimental decision support tool,
20:10this is how we're calling it
20:12in collaboration with the Puerto Rico Department of Health
20:15and different 19 organizations, health clinics,
20:18and the National Weather Service.
20:20It's been posted in the webpage of CARICOOS,
20:25CARICOOS is the Caribbean Coastal Ocean
20:28Observing System.
20:29And it's already a platform that is providing
20:32meteorological and climate information
20:34for Puerto Rico and the US Green Islands.
20:36So in this case,
20:37we're making leverage of that existing platform
20:39to provide to the audience
20:42the information that we're obtaining in this area.
20:45So we are retrieving data from
20:47four different regions in Puerto Rico.
20:49And this is the four tachometers that we have.
20:53We identified the level of risk
20:56based on the information that we obtain
20:58with the health clinics,
20:59with patients and with the secondary data that we analyzed.
21:03And based on that impact,
21:05we have the first warning system
21:08for level mild, extreme to very extreme conditions
21:13in term of air quality, and it depends on the color.
21:16And we have four different sites distributed
21:21in the most populated region of the island.
21:24To provide that information in real time
21:26and also we are developing the early warning system,
21:32meaning that it will be a forecast
21:34to give this information to the general public in advance
21:38for them to take precautious actions
21:41before this dust is arriving to the Caribbean.
21:46So this is our just example of how it looks like.
21:49The images are very raw, obviously,
21:51but as soon as you get into the webpage,
21:53you can use it in your app,
21:55and you can see the tachometers
21:57providing you in real time information
21:59about air quality associated with aerosols.
22:03This information had been used also
22:05to develop educational materials, and to do outreach
22:09with the National Weather Service in Puerto Rico,
22:12both in Spanish and English,
22:15and being used by the Department of Health.
22:18So now as we have like a prototype.
22:20As you can see here in October 3rd, 2021,
22:24we suffer one of the most recent dust cloud
22:27after the Godzilla dust event that occurred in 2020.
22:30And most of the agencies that were working with us
22:32and collaborating, they were using this information
22:36to make the population aware of their own healthy conditions
22:41that we were facing for sensitive group
22:44to take precautious measures.
22:47This is another example done on October seven,
22:50the agency were using our information
22:53to provide the best information as possible
22:55to the general audience and to sensitive groups.
23:01We did a couple of webinars
23:03impacting over 400,000 people in Puerto Rico.
23:06We did it with NASA, with the National Weather Service.
23:09We did it with the (indistinct),
23:11which is a, it's a science museum in Puerto Rico
23:16that are being responsible of
23:18providing a lot of education and webinars.
23:21So they did most of the outreach,
23:26and we did all of the science to the audience.
23:31So we have already now also
23:34an Air Quality Awareness Week in Puerto Rico,
23:38and it's happening all days, all year, sorry,
23:42and at the beginning of May.
23:44So during the month of May,
23:46we are giving webinars for the general audience
23:50in Spanish and English.
23:51Two different sessions for,
23:54to comply with Puerto Rico because,
23:55in Puerto Rico 98% of the population
23:58are Hispanic and Latino.
23:59And it's the main, is the principle language
24:03spoken here in Puerto Rico.
24:05Okay, so with that being said,
24:10something happened in between
24:12while we were developing the early warning system
24:15and when the first cases of COVID 19
24:17arrived to the Caribbean.
24:19So as I mentioned at the beginning,
24:22so the Saharan dust is associated
24:25with than accessories of emergency room visits,
24:27hospitalization,
24:28and in some cases, partially attributable to death.
24:32They partially attributable that doesn't mean
24:34that you are dying because of the Saharan dust,
24:37but with some other comorbidities
24:39and some other interactions,
24:41you might be suffering for exacerbations
24:44and you are most likely to die.
24:47So what we did is that,
24:49all of the sudden, the first cases of COVID 19
24:52getting into Puerto Rico in March 13th, 2020,
24:55and then NASA opened another call for proposal
25:00requesting to work with the COVID 19,
25:03it was a rapid assessment.
25:05So we wasn't expected an extreme event of dust
25:08as it happened during the Summer of 2020.
25:11But since we were already working
25:14with the Saharan dust previously for five years or more.
25:19We had this project, but we have been working
25:21with the Saharan dust for more years.
25:23So we were wondering what could happen if
25:27we have an extreme dust cloud event
25:31getting to the Caribbean, deteriorating the air quality,
25:34and also having a lot of cases with COVID 19, right?
25:38So if already the Saharan dust
25:40is associated with an increase
25:42in the demand of healthcare facilities,
25:45what could happen is we were seeing the news
25:48in other places of the world
25:49where the hospitals were collapsing
25:51because they didn't have the capacity
25:52to provide the services to the patients, right?
25:55So we were wondering when we were submitting this proposal,
25:57what could happen if both of them
25:59are simultaneously occurring in the same time, right?
26:04So we submit the proposal,
26:06we obtained the grant and we quickly get
26:11working with the research.
26:13As I mentioned, when we submit the proposal,
26:16it was in April, 2020, just a couple of weeks
26:21after the first cases of COVID 19
26:23reported in Puerto Rico.
26:24By that time, we were not expecting
26:26to have Godzilla dust event.
26:29And for those of you that are not aware
26:31of what was Godzilla, Godzilla was a dust cloud
26:34that arrived to the Caribbean region.
26:35And we stayed under unhealthy conditions
26:40due to air quality
26:41for more than three days in the Caribbean region,
26:44so it was a little bit overwhelming. (laughs)
26:47So what we did is that
26:48we design a couple of instrument
26:52to work with physicians, with patients,
26:55and to better understandable vulnerabilities.
26:57We design a couple of qualitative instrument
26:59because we believe that working in public health,
27:01that the qualitative instrument
27:03could be richer in some cases,
27:05because they can provide you
27:07information about various vulnerability
27:09risk perception
27:11about how the people are working with this risk.
27:14This is risk perception as well, right?
27:15So we recruited more than...
27:18Sorry for those noises. (laughs)
27:20We recruited more than 55 physicians
27:23and over 100 patients to work with them.
27:27We also made a couple of memorandums of understanding
27:32and agreement with different clinics
27:34in order to receive medical records information,
27:37because not only understanding the number of cases
27:41that are getting into the hospital,
27:44but how these patients conditions
27:48could be exacerbated with the Saharan dust.
27:51And also we started to analyze
27:54the whole cost excess mortality,
27:57island wide, not only in some places,
27:59in interacting with the environmental factors.
28:02So this is like only a graphic showing
28:04when the first cases of COVID 19 arrive to Puerto Rico
28:08and to the Caribbean,
28:10and then how we suffered Godzilla dust event.
28:15The bigger the number in the right axis,
28:18as you can see are aerosol optical depth.
28:21It means that the most extreme values we observe
28:25for aerosols and these particles
28:28arriving to the Caribbean.
28:29It wast dust cloud huge enough
28:32that is almost covered all the Caribbean sea together,
28:37all of the lessers and fields,
28:38and also from Puerto Rico to Trinidad and Tobago.
28:42It was big enough,
28:43but also with a lot of concentration,
28:44higher values were observed during that time.
28:47In the central part of the graphic,
28:48what we're seeing here is that the black line
28:50are representing the years of 2020, the different month.
28:55And as you can see,
28:56it's marked a record for aerosol optical depth
28:59in our region.
29:01And again, Puerto Rico stayed for over three days
29:04with unhealthy sorry,
29:06with unhealthy conditions due to this Saharan dust PM2.5.
29:12And the bars,
29:13what we're seeing here are the number of cases
29:16that had been registered of COVID 19 and hospitalizations
29:23in some places of Puerto Rico, right?
29:25This is only a graphic,
29:27I'm not making any kind of assumption with the graphic.
29:30This is just to show you the patterns
29:32that were observed during that Summer.
29:34The lines are aerosol optical depth,
29:37the bars are hospital admissions.
29:40So in all places of Puerto Rico,
29:43as I mentioned in all our four tachometers,
29:45you can see the Godzilla dust event marking a record
29:49as never occurred in the last decades,
29:52or even prior to the decade.
29:54Satellite information, the one that we're using
29:56is only going back until 2012,
30:01but you using ground based station you can go as back as,
30:04as probably 20 to 30 years before from now.
30:08And it was also a record
30:10for this dust event in the Caribbean.
30:13These are only pictures for you
30:15that can see how the visibility decreases so much
30:19in some places of Puerto Rico.
30:20In the right side,
30:21we're are seeing the Southwest of Puerto Rico,
30:23this is Guánica bay.
30:24And on top of it, you can see the day before
30:28the arrival of the Godzilla dust event
30:30and then very early at 9:00 AM in the morning.
30:33So the visibility decrease up to three miles only
30:36in most of the island,
30:38when the visibility in Puerto Rico is mostly 20 to 21 miles.
30:42So you can imagine that the deterioration in air quality
30:45that had happened.
30:47So working with the physicians, most of them agree that
30:53there were the severity of the symptom
30:56of the patient of COVID 19
30:57could be most likely to be exacerbated
30:59because of the dust clouds.
31:01And when we were working with the patient,
31:03some of them were telling that they were more sensitive
31:06to these aerosols after being confirmed with COVID 19.
31:12So they were more sensitive after surviving the COVID-19
31:16than they used to be before having COVID 19.
31:20So in somehow it means that nowadays they're most sensitive.
31:24We also did another survey where we were lucky
31:27because we have 1500 participants that work with us
31:31provide a lot of information.
31:33Most of them were female, so we need to highlight that.
31:36So that's important to say, between 25 to 44 years old,
31:41but something very important is that,
31:42almost 65% of the population
31:44had at least one chronic conditions,
31:47and those individuals with at least one comorbidity
31:50are 14.37 more likely to need medical services
31:55when they are facing the Saharan dust in Puerto Rico.
32:01And this is what happened,
32:01for example, with the Godzilla dust event.
32:05Most of the people that participate,
32:0790% of them are indicating the Saharan dust is affecting
32:10both their family members, but also their own health status.
32:14So not only the participants,
32:16but also they consider that in their family members
32:18are also getting affected by this atmospheric conditions.
32:24Asthma is important
32:26because most of the respondent
32:27and the participants that participated saying that
32:2965% had only one chronic condition,
32:31but asthma was the most reported condition.
32:35Another important issue is that apparently
32:38these symptoms are mild to level to not that heavy
32:46or not that complicated because only 12%,
32:49only 12% of the 1500 that participated
32:53that were saying that
32:54the Saharan dust is affecting the health,
32:57of their family members and the own health,
33:00only 12% are seeking medical attention.
33:03So meaning that the impact on health of the Saharan dust
33:07is not necessarily need to be something that
33:10at least with this cases, right,
33:13that is gonna be saturating all of the hospital and clinics,
33:17but only 12% are gonna be visiting or are getting,
33:22their symptoms are so complicated,
33:23they need medical attention.
33:27To continue working with public health data,
33:29we are requesting the medical records
33:32in six different health clinics.
33:34So nowaday, we have 1200 medical records,
33:38the clinics provide this information in paper,
33:42so we are now doing the data entry.
33:44That's why we are requesting a no cost extension,
33:46to analyze this part of the project.
33:50And we requested all of the information
33:53from the first month once the COVID 19 get to Puerto Rico
33:58after one year after completely, right?
34:01Because when it was,
34:02when we were planning to end the analysis.
34:06We were not that lucky,
34:07it took us a lot of time
34:08because we were dealing with legal offices (laughs)
34:10and a lot of paperwork and memorandums of understanding.
34:13But finally, we have this information available.
34:15This is the only missing information that we still need
34:19to analyze, to better understand,
34:21how the patients that were admitted
34:23or visiting the hospitals,
34:26how their conditions were exacerbated by these symptoms.
34:30In terms of the databases,
34:31and I'm gonna be very quickly on this.
34:34Most of them are the one
34:35that are already mentioned at the beginning,
34:37what we were using, mortality, hospital admission,
34:40emergency room visits.
34:43Environmental factor source are
34:44heat index, universal thermal climate index
34:47and aerosols, okay?
34:50In terms of the hospital admission, this is another graphic.
34:52And again, I'm not making another,
34:55not assumption about this graphic,
34:56but what I would like to show is that
34:59as we can see at the very first beginning,
35:01we did suffer a couple of cases of COVID 19
35:04and hospitalization in the six clinics
35:06that are participating with us.
35:09And then because of the lockdown
35:11and the curfew,
35:13and all of the restrictions
35:15that the government did during that period,
35:17we were able to control all of the local transmissions
35:20and the infections,
35:21and we can see how it went very low.
35:24But then all of a sudden,
35:27together with the Godzilla dust event,
35:30we can see how COVID 19 cases started to increase.
35:34I'm not saying again,
35:35that this is because of the Godzilla dust event,
35:38but it happening very,
35:42it's timely associated if you want, (laughs)
35:44because both of them occur
35:45during the same time and same period, okay.
35:48So once the cases started to increase during the Summer,
35:52then during the Fall, during the hurricane season,
35:55it started to decrease,
35:57there was a lot of, couple of curfews
35:58and lockdown and government restrictions.
36:00And then during the Winter, which it was expected,
36:03the COVID 19 cases started to increase again
36:06and then restrictions, and we can see it here.
36:09And again, I'm not saying that the environmental factors
36:11are the only one that are associated
36:12with COVID 19 transmission and infections,
36:15we need to consider so many other
36:17social behaviorals and patterns
36:20that has been confirmed by the scientists
36:24that are also related
36:27with the spread of the COVID 19.
36:30I show already this graphic,
36:31but it's just to highlight again,
36:33that right after the cases,
36:36when the cases started to rise during the Summer,
36:39we were also facing the Godzilla dust event
36:41during the same period.
36:43Again, I'm not saying that
36:46it was because of the Saharan dust
36:49that the COVID 19 cases get so high, okay?
36:54In case of what we have on the hospital admissions,
36:56this is our very demographic profiles.
36:59And in terms of the mortality
37:01is what I think what is very important.
37:03So we do have a couple of,
37:06nine or more different environmental variables.
37:09We only are analyzing in this case, nine of them,
37:13the one that we think
37:14that could be impacting health in Puerto Rico,
37:18and we build 18 different environmental indices,
37:21most of them retrieve from the satellites data.
37:27Since some of them, and both of them are correlated
37:32because these are atmospheric conditions
37:34that have a lot of co-linearity,
37:35so we only kept a couple of them
37:40to have a better understanding on how these variables
37:44are associated with mortality in Puerto Rico.
37:48So we started analyzing,
37:50we requested daily mortality
37:53from the Department of Health in Puerto Rico.
37:57And as you can see here, this is mortality, total mortality,
38:03all causes.
38:04Non accidental mortality, let me clarify that.
38:07This is non accidental mortality,
38:10and we create this table for you to see it, for example.
38:14So since 2015 to 2020,
38:19in Puerto mortalities,
38:22used to be higher during the Autumn and during the Winter
38:26still don't know why,
38:28but this is the patterns that we observe.
38:31As you can see, for the last five years per season,
38:37the higher mortality occur
38:39in the aftermath of hurricane Maria,
38:42not necessarily during hurricane Maria.
38:44Again, not too many people died during landfall,
38:47but many people died
38:48in the aftermath of hurricane Maria,
38:50weeks and two weeks ago.
38:53So after that,
38:55you can see another record that occurred in 2020,
38:59but surprisingly, it didn't occur in Fall or Winter,
39:03it occurred in Summer.
39:05So it means that it's associated also
39:07with the COVID 19 cases,
39:09again, not attributable 100%
39:14to the cases of COVID, but because of the pandemic,
39:17a lot of people were afraid to search for medical attention
39:21and a lot of other things that need to be considered
39:24making another record for mortality
39:27in Puerto Rico during the Summer.
39:29Which is weird because over the last five years,
39:32this is the only Summer
39:35that it marked a record on mortality,
39:38this is the first time that we're seeing this.
39:41And we're wondering also how much this dust cloud event
39:45should be exacerbating the conditions, okay?
39:50So when we started analyzing mortality,
39:53we first starting by saying,
39:55"Okay, so we have a seasonality
39:57for the Saharan dust arrival to the Caribbean."
39:59So we have Saharan days, for example,
40:01and we have non Saharan days.
40:03And those non Saharan days are those that are
40:06where we are not seeing aerosol optical depth.
40:10For example, the threshold that we use is 0.18,
40:14I'm not gonna go into the details. (laughs)
40:18And the other ones are the days
40:20where we can observe 0.18 or values above that
40:25for the aerosol optical depth.
40:27And we started to see that, for example, even though
40:33these aerosols are more associated to the Summer,
40:37but we can see a distinction also on mortality
40:40due to respiratory conditions without flu cases,
40:43because flu in Puerto Rico
40:45has a very marked seasonality as well,
40:48and it's more associated with Winter.
40:50So we took flu cases apart,
40:53and we take it out of the database and we only analyzed
40:56all of the other respiratory condition,
40:58and we started seeing some specific results.
41:04Analyzing it with COVID 19,
41:06we observed that actually during the Summer,
41:11the patients that had COVID 19 were more likely to die,
41:16when UTCI, UTCI is universal thermal climate index.
41:20This is another indicator to provide information
41:23about how is the sensitivity to heat, okay?
41:27So your thermal comfort
41:29in regard of temperatures, okay?
41:32So that is considering wind speed, wind direction,
41:36humidity, relative humility,
41:38and air surface temperature, obviously.
41:42But it's an indicator, it's an index,
41:43it's not an information that is being provided
41:45by the National Weather Service, for example,
41:47because what they're providing you
41:48is heat index or air surface temperature.
41:53But we are actually seeing and slightly increasing
41:58or slightly system higher, right?
42:00The mortality,
42:01and this is something that we observe during the Summer,
42:04which it makes a lot of sense, right?
42:06We also observe that COVID 19 patients
42:10are most likely to die when we do have also other allergens
42:16that are associated with molds and spores in Puerto Rico.
42:21So that's another natural sources of air pollution,
42:23as I mentioned.
42:25And also when we had starting adjusting
42:30all this analysis per age and per season,
42:33we are observing that actually
42:35the numbers are continuing to rise
42:37and are even higher for COVID 19 mortality,
42:41as we could be expected.
42:42And again, in this case,
42:44we are not considering the vaccine because we close
42:48prior to the vaccination period in Puerto Rico,
42:52so we close it until March 2021.
42:55Vaccine is another story,
42:57and vaccination is changing obviously
42:59it might change all of these results,
43:01and the technology from the medical component,
43:06because there are new treatments,
43:07there are innovations in medicines,
43:10and a lot of other things that are helping
43:12for the patient not to die because of the COVID-19.
43:18In terms of other respiratory diseases,
43:20we also observe that aerosol optical depth
43:22is also associated with the mortality
43:25of ischemic heart disease for Puerto Ricans.
43:29And also it is consistent even when you are adjusting this
43:34per year, per season, per age,
43:36and the different adjusting that can be done
43:39using the Poisson model assumption
43:42observations and the regulation analysis that we did.
43:46For further considerations I think that
43:49we are hunger to analyze the medical records
43:53because we are still doing the data entry.
43:55We still have only numbers as I show you
43:58in terms of increases in hospital admissions
44:02and emergency room visits.
44:04And so we were more able to analyze
44:06and to have a better results with mortality.
44:08But mortality is only that is of the eyebrows meaning that
44:11if you are able to identify that mortality
44:15is increasing because of some specific conditions
44:19you might expect that also you might expect to see
44:23a lot of people searching for medical attention,
44:25but are not that fragile to die, for example,
44:29and some others that are getting affected,
44:31but not even considering
44:33to search for medical attention, right?
44:35So these are important findings because for Puerto Rico,
44:40I think that we are not only developing
44:42the early warning system for a hazard
44:45that is deteriorating public health in the region,
44:48but also this is one of the first time
44:50that we can provide evidence that the Saharan dust
44:53is in somehow related with mortality.
44:56As well again, partially attributable.
44:58Something is a statistical analysis,
45:01and some other is that by doing the qualitative analysis,
45:05talking with the physician and with the experts,
45:07with the informants,
45:08we might be able to explain better
45:11how this hazard is deteriorating
45:15the health of their patients.
45:17We still have a lot of other questions
45:20that need to be answered in order to identify
45:23the vulnerable patients and population.
45:25I think that it's important
45:27that we are developing early warning system.
45:29You need to identify your target population,
45:32because this is how exactly,
45:34if you are talking about the population
45:36that are getting flooded or not.
45:38So you need to address your communication,
45:41your risk, your advisories
45:44to the more sensitive groups in order for them
45:48to take precautions before the arrival of this dust cloud.
45:55So we will continue working on this
45:58and we'll stop sharing my screen,
46:01and I'll be happy to answer whatever question you may have.
46:07<v ->Thank you so much for the wonderful presentation Pablo.</v>
46:10And just a reminder to the audience
46:13that if you have any questions,
46:15please do put them in the chat box.
46:18And well, for this seminar, we have 19 students attending,
46:22and we actually have already collected
46:26some of the questions from the students.
46:28So while the audience
46:30are putting their questions in the chat box,
46:33we are to start with two questions from students.
46:38Actually, there are two types of questions
46:41the students are mostly interested in.
46:43The first one is actually, Pablo you show us how to
46:47distangle the interactions between the dust and COVID
46:51and the all the environmental factors.
46:54So many students actually are wondering
46:57how to control for confounding factors
47:00like from human behavior.
47:03Like people may spend more time in doors
47:05during the Saharan dust.
47:10<v ->That's a pretty good question.</v>
47:12With the data that we have
47:13from mortality and medical records,
47:17it's a little bit complicated
47:18to have that kind of information.
47:21The only way that I will say that it will be useful
47:24to receive more accurate information in that regard
47:27will be by doing interviews.
47:30One on one interviews with the patients, for example,
47:35identifying or doing focus group directly with all of them.
47:39That's another way on
47:40how can you measure exposure, right?
47:43Well not measure,
47:44but at least having a proxy
47:45on the exposure for Saharan dust.
47:49So yes, it was complicated
47:50because during this Godzilla dust event,
47:52we were struggling with COVID 19.
47:55One of the recommendations already in Puerto Rico,
47:57and I think that is also in the United States as well happen
48:00is that the agency were telling,
48:02were suggesting the population to open the windows and doors
48:06to let the clean air to get in. (laughs)
48:09So, we'd receive a lot of memes
48:11from people that were saying,
48:12"Okay, so if I open the doors and the windows,
48:14then my house will be full of sand. (laughs)
48:18So what do I do?
48:20I cannot open the windows.
48:21I cannot open the doors
48:24because I have an outdoor hazard,
48:27but if I keep it closed,
48:29then if someone bring the virus inside of my house,
48:32I might probably get infected with the virus."
48:35So yes, it was a little bit not funny,
48:39but a lot of people took it that way.
48:42And you can see a lot of memes that came out
48:44during that season.
48:47<v ->Thanks Pablo, yeah, this is very complicated.</v>
48:49And when it gets to real policy recommendations,
48:52I think a lot more research is needed.
48:56I do see another question from Robert Dubrow,
48:59Professor Robert Dubrow is the director,
49:01faculty director of our center.
49:04So he ask, "Is there evidence that climate change
49:07is affecting Saharan dust in the Caribbean?
49:11For example, is there anything known about
49:13what caused the Godzilla dust event?"
49:17And I also wanna mention that this question,
49:20it combines with one of the students question
49:22that wondering, not just dust,
49:26but also other like hurricanes in Puerto Rico,
49:30"Does climate change, you know, introduce some additional,
49:33these extreme weather events and can they play a role
49:37in the COVID prediction in Puerto Rico?"
49:39So two separate questions, but kind of related, thank you.
49:43<v ->Let me see, how can I address this?</v>
49:45And thank you for both questions.
49:47Let me mention something very quickly
49:49related to the other one, to the first one.
49:51By using masks,
49:53one of the recommendations from the CDC,
49:56we are unable to minimize the exposure to this dust,
50:01right, to these aerosols.
50:02So that's something very important,
50:03and we need also to highlight,
50:05because most of the people in Puerto Rico
50:07are using mask outdoors, even outdoors, right,
50:09so that's important.
50:10Okay, so in terms of climate change,
50:12yes, there is evidence that in some cases that
50:16the Saharan desert is getting bigger.
50:20So that means, that could mean, let me say it like that,
50:24that most likely the source of mineral dust
50:28could be increasing in terms of tons of sediments
50:32that could be lifted by the air.
50:34But we need some other kind of conditions
50:36to make this dust to arrive to the Caribbean.
50:39And for example,
50:40wind directions and wind patterns, right?
50:42So if you don't have the wind velocity
50:45or the capacity to lift dust particles
50:47to be transported, floating in the atmosphere
50:49to the other side, it's another story.
50:53But yes, the source is increasing in the Saharan desert.
50:56So it's mean that it's getting dryer some places in Africa
50:59and also to the Southern part of Europe.
51:02So most likely, again,
51:04providing more sources of mineral dust to the atmosphere.
51:08If the trade winds continue to be the same,
51:11we could say that probably it will increase
51:15the amount of dust that we are receiving.
51:18But until now, there is no evidence suggesting
51:21that we are receiving most dust than ever.
51:24We do receive a record
51:27that it was marked by the Godzilla dust event,
51:29but it's not marketing a trend, okay?
51:33In terms of other sources of extreme event,
51:36for example, yes, hurricane Maria
51:39devastated millions and millions of trees and vegetation
51:42and green infrastructure, right?
51:44So right after hurricane Maria with a lot of humidity,
51:48we marked another record for mold in Puerto Rico,
51:53and mold is another natural source of air pollutions
51:56other allergens, right.
51:57And that was amazing.
51:58So hurricane Maria switched a little bit
52:01the pattern and the behaviors of these other allergens
52:05that are associated with the vegetation.
52:08And so meaning that these powerful extreme events,
52:11have the capacity also to change
52:13how these other allergens
52:15are being distributed along the year.
52:20<v ->Thanks Pablo, yeah.</v>
52:21I just want to mention one of the things that
52:25in terms of the dust,
52:27there's also some researcher in from the European side,
52:30say the Sahara dust
52:31also larger in size than the PM2.5,
52:34they do bring a lot of health effects
52:37to the respiratory systems.
52:38So I think in addition to the COVID work,
52:43your Sahara dust work is also very interesting.
52:47I do encourage audience, if you do have questions,
52:50please feel free to put it in the chat box.
52:53And if not then in the meantime,
52:55I want to ask a final question from the students.
52:58Actually, the students are very excited
53:00about the public health early warning system
53:04that you're creating.
53:05And they're wondering, you know,
53:07you study a lot about the interactions
53:09of these seasonal pattern, the environment factors,
53:13and they are wondering, like,
53:15"When you actually put them into the policy recommendations,
53:20what are the, you know,
53:23experience or source you have
53:25and how effective that could be?"
53:28<v ->Well, I have two great experience in Puerto Rico,</v>
53:32mainly with the Puerto Rico Department of Health,
53:34because you have two different agencies
53:36that are responsible of working with this, right?
53:39The National Weather Service
53:40is the agency responsible of monitoring the weather
53:43and the atmospheric conditions,
53:44but they're not responsible of issuing any kind of warning
53:47to protect public health,
53:49this is the responsibility of the Department of Health.
53:52So you need that coordination,
53:53one agency to monitor the weather
53:57and to provide that warning for the population.
54:00And the other one to tell the population what to do,
54:03because this is a public health issue, right?
54:06So I started working with them
54:08since the very first beginning.
54:10Both of them were very committed,
54:12wanted to work with us very closely,
54:15and so that's how we gained that trust.
54:18So now all of us together, we're working on that.
54:21So the recommendations are coming out
54:23from meeting groups that we're having,
54:26from all of our team,
54:28epidemiologists, physicians
54:29and climate atmospheric scientists,
54:32working with the National Weather Service
54:33and the Department of Health.
54:35And all of them are listed,
54:37so once the warnings are posted by the Department of Health,
54:42then you will see the list that is the list of actions
54:46that you need to do or to follow in the case,
54:49if you are as part of the sensitive group.
54:53<v ->Thanks Pablo, that's excellent point.</v>
54:56I think we anchor your point that, you know,
54:59to deal with the COVID pandemic also climate change,
55:02we need a multi department and the collaborations
55:06from researchers across
55:08and also from different governmental agencies.
55:13There's a follow up question from Rob,
55:16"How far in advance can you predict
55:18the levels of Saharan dust in the early warning systems?"
55:22<v ->Well, now I suppose that we might,</v>
55:25we might have up to 72 hours from now
55:31and will be available somewhere
55:34between this week and the other one.
55:36But for now, if you go into the webpage,
55:38what you will see is only the real time information.
55:42We're still working on the early component (laughs)
55:47to provide the information in advance.
55:50So we have this year to continue working completely
55:53on the forecasting.
55:54Yeah, for 72 hours.
55:56We will have it very soon this week or the next week.
56:00And we will have one full year
56:02to work it with the decision makers
56:04and with the community on how to improve it.
56:07To test it.
56:09<v ->Yeah, thank you.</v>
56:10Thank you, Pablo,
56:11for the wonderful presentation and very engaged discussion.
56:15And thank you all for joining us today.
56:16I think let's give the final,
56:19like applause to Pablo for the wonderful talk today,
56:23and thank you everyone for coming.
56:26<v ->Thank you for inviting me.</v>
56:28Happy to be here. <v ->Bye everyone.</v>
56:33<v ->Thanks Pablo.</v>
56:34<v ->Ciao Robert, good to see you.</v>