More than a month after deadly wildfires ravaged Lahaina, all that remains is a wasteland of ash, debris, charred homes, melted metal and burned-out husks of cars.

While there is, for many survivors, a desire to return to search for sentimental items or a sense of closure, health experts urge people to take caution while in and around these areas as well as on the outskirts of the burn zone due to the toxic waste left behind.

Dr. Diana Felton, state toxicologist for the state Department of Health, urged survivors as early as August to take necessary precautions.

Felton said in a written statement that top hazard concerns in the burn area include toxic contaminants present in debris and ash.

“Debris and ash may include lead, asbestos, arsenic or other hazardous materials,” she wrote. “Dust, dirt, and soot can become airborne and be inhaled.”

Since the burn area in Lahaina includes many buildings constructed before 1970, she said, these contaminants may be present in building materials. Additionally, arsenic used as an herbicide in Hawaii may be present in the soil.

Maui County officials say the disaster area is currently restricted to authorized personnel only.

Officials say at this time, there is no list allowing residents to return to the disaster area in Lahaina, but there will be a “coordinated effort to develop a plan for the safe return of residents.”

Dangers include ash that could contain toxic, cancer- causing chemicals, with debris including broken glass, exposed electrical wire and other objects, officials warn. For those who can return to their properties, county officials urge all people to use personal protective equipment.

An unsafe-water advisory remains in place for Lahaina and Upper Kula.

The U.S. Environmental Protection Agency on Aug. 29 began removing household hazardous materials from properties in Lahaina — a task that is expected to take several months.

That task is considered phase one, to be followed by phase two, the removal of larger debris by the U.S. Army Corps of Engineers.

Gov. Josh Green, in his outline for the future of Lahaina, said residents and businesses will be scheduled in coming weeks — under supervision — to view what remains of their properties.

Toxic health hazards

The grassroots, Native Hawaiian-led group, Aina Momona, recently posted health concerns on Instagram, warning its followers that Lahaina is extremely toxic.

Images of people sifting through ash in their street clothes or walking through a burned home in shorts and slippers gives the impression that post-fire environments are relatively safe.

But this is far from the truth, the group warned, because homes and commercial structures break down into hazardous substances when burned, and ash and soot can be difficult to clean without making them airborne.

Everyone is at risk, with the greatest risk to infants, children, seniors and those with weakened respiratory systems. So people should protect themselves and others with personal protective equipment such as respirators and chemical- resistant gloves, and limit skin contact with soot.

“Aina Momona is deeply concerned about the short and long term health impacts of the fires,” said Trisha Kehaulani Watson, vice president of Aina Momona, in a text statement. “We are mobilizing to providing proper, highly quality PPE to people in West Maui. We are urging more testing and transparency with the test results. People need to understand the hazards, so they can effectively protect themselves and their families.”

Dr. Gina Solomon, principal investigator for the Public Health Institute in California, said it is important not to underestimate the physical hazards.

In a burn zone there are many sharp and jagged pieces of glass and metal in the wreckage which can cause deep puncture wounds and severe lacerations — and these can result in a serious, delayed infection, she said.

“For this reason alone, never go into a burned area without having your feet and legs covered and protected,” she wrote.

Solomon, who assisted in the aftermath of the 2018 fire in Paradise, Calif., warned that black soot is everywhere after a fire. A major ingredient in soot is a group of cancer-causing chemicals known as polycyclic aromatic hydrocarbons, which can damage skin and lungs if breathed in.

Taking measures to avoid skin contact with soot as well as ash is a good idea, she said.

If soot is in the air, then one should wear an N95 mask to protect airways. Wrapping a bandanna around your face, she said, is not going to cut it.

What happens with a fire is that the heat releases hazards, whether it be lead from a car battery or asbestos from a home’s siding.

Additionally, melted plastic and tires can release other toxic chemicals. Survivors should avoid contact with melted plastic, including the burned-out foam found in some sofa cushions.

Monitoring air quality

When ash or dust is disturbed, kicked up or blowing around in the air, then it’s a good time to mask, according to Anthony Wexler, a research scientist specializing in aerosol science at the University of California, Davis.

What’s important to know is that ash can get into the air, and some of it can be inhaled. Walking around in ash stirs it up.

“What you have is both gases and particles that are being emitted in the smoke, and both of them can have toxins in them,” he said. “Particles themselves are not good for you to breathe, but the particles can also contain toxins, and the gases, also.”

Survivors with conditions like asthma could be affected, with worse asthma for a long time afterward. Those who have preexisting conditions should watch out for their health and check in with their doctors.

Children are particularly vulnerable, he said, because their lungs are still growing, and inhaling these contaminants over a long period of time could affect their lung capacity as adults.

Wearing well-fitted, good-quality N95 masks — not cloth ones — is important for protection from particles, Wexler said. The 3M Auras, for instance, make a good seal.

Even with these masks, one might still smell the gases emitted from the ash. For further protection from gases, he recommends using a respirator with activated carbon cartridges.

Compared with the Paradise fire, where homes were spread out in the woods, Lahaina town is a denser population with denser housing.

The burning of homes is worse than that of woody grasses or trees due to the materials homes are made of, including plastics, because the resulting chemical composition is dangerous, he said.

One advantage for Lahaina is its proximity to the ocean, and winds that potentially carry smoke and particles out over the ocean instead of to nearby communities.

In Paradise, homes were mostly in valleys surrounded by mountains that trapped in the smoke and kept it there for weeks.

The EPA is monitoring the air for fine particles of dust, which will be posted to the Air Now website as it removes household hazardous materials from Lahaina. At last check over the weekend, all were in the green, or good, range.

Health concerns

Dr. Maile Jachowski, a retired pediatrician, said she is concerned for both the short- and long-term health of the people who survived the Maui fires.

Jachowski flew to the Valley Isle from California to volunteer as an “aloha navigator” for Kipuka Maui.

She is focused on helping survivors with practical needs, offering a toolkit to help them recover birth certificates, driver’s licenses and other documents, in their own communities.

But Jachowski, who worked for many years as a pediatrician on Maui, is particularly worried for the survivors’ health.

She said people need to know to protect themselves in and around the burn zones, depending on the way the wind blows, she said, and families need easy access to PPE. The public also needs to have access to test results from the air and water in a timely manner to understand risks.

“We need to educate all the kanaka on the ground that it’s super important to protect yourself not only now,” she said, “but maybe in six months, two years, five years from now from lung disease, cancers, blood diseases.”

Jachowski advises survivors to see their doctors and to get a baseline wellness check so that they can be monitored in years to come. While it it not an immediate concern as people deal with trauma, it is important in the long run, she said.

Solomon, also a clinical professor of medicine at UC San Francisco, said based on her experience working in the aftermath of California wildfires, this is just the beginning of a long road to recovery for the Maui community.

“The biggest scars have been mental health scars,” she said of California survivors. “The trauma after an event like this is terrible. It’s hard for folks to deal with, and it does cause long-term scars in some people.”

Those who tended to do best, she said, jumped in to help others or take some action to bond together as a community.

“The way the community comes together and reacts and pulls through together determines so much whether the community thrives in the long run,” she said. “I certainly hope Lahaina will thrive. I think it can, despite everything.”

Returning safely to properties

>> State Health Department offers resources and safety tips at health.hawaii.gov/mauiwildfires.

>> Maui Emergency Management Agency also urges survivors to take health and safety precautions upon returning to their properties. Visit mauirecovers.org/recovery/returning.

A guide to hazards

>> Asbestos is a naturally occurring mineral fiber used for many years in building materials. Asbestos remains present after heat and fire, and breathing asbestos can cause cancer and other lung diseases. Most asbestos-related diseases develop after many years of regular exposure.

>> Lead is a heavy metal and was an ingredient in paint used in buildings constructed before 1978. Lead from burned painted structures is now present in the ash and soil. Lead is particularly harmful to the developing brain, so children and pregnant people are at most risk from lead exposure. Exposure to lead can also cause health problems in adults.

Source: State Health Department