• A Day In Beijing Is Like Smoking Only One Sixth Of A Cigarette? It’s Almost…Disappointing! – this was one of my most fun projects, and still very controversial.
• Official School Air Pollution Action Plan: You’re Not Going To Like It – another very controversial post, I detail why Beijing schools should enact no-outdoor-activity cutoffs when the AQI reaches 200.
• Alen Air Purifiers Battle IQAir and Blueair – I had geeky fun running around my apartment for 3 days with 4 purifiers, one particle monitor and a spreadsheet. And the winner is…the consumer!
• Happy Birthday, Dad. You Died Far Too Young – the most painful article I’ve ever written, I offer this as a homage to my father, who died of alcoholic cirrhosis.
• Hey Laowai: Now You Can Use Weibo In English. Here’s How – not medical but important and also very popular, I give step-by-step instructions on using China’s coolest website, Weibo (you can always follow my Weibo at weibo.com/daniudaifu). Also non-medical but culturally important was my article helping people use group-buying websites in China (tuangou), which have saved me tens of thousands of RMB on everyday purchases in just two years
• High Cholesterol Hits Home… – another very personal article, I describe my brother’s efforts to control his dangerously high triglycerides
• Radiation Hits China — In “Harmless” Amounts. What Level Actually is “Harmless”? – this was enormously popular all over the world, not just in China, during last spring’s radiation scare in Japan.
• Air Pollution Masks: Buy Them Now! Here’s Where — And Why – I detail why I think N95 masks should be the new Beijing accessory.
• Welcome To Beijing! Here’s What You Need To Know To Stay Healthy – I detail my top ten wellness tips for Beijing’s newcomers
• Diabetes: What Natural Medicines Work — Or Don’t Work? and Diabetes: What’s The #1 Way To Prevent It? – this one-two punch offers practical tips on both avoiding and treating the global lifestyle epidemic of diabetes

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It’s truly an amazing step, and I hope it gets even better over the next few months. I’d like to see a couple improvements:

• Correction, Feb 3: this reading is actually one monitor, on the western side of the city, and not a city-wide average, as I had incorrectly stated before. I’m told that other PM2.5 monitors will be added as the year progresses. Right now the PM2.5 data is a city-wide average. I’d prefer to see hourly updates from each of their monitors. As you can see from their PM10 data, the readings vary widely between city districts and between rural and urban monitors.
• I’d also like an archived database to access previous results
• There is no AQI posted for each PM2.5 number, which decreases its real-world usefulness. You have to convert yourself (just multiply the PM2.5 reading by 1,000 and use this online calculator)

How Does It Compare?

One obvious question is: how do the numbers compare to the US Embassy’s famous Beijing monitor? I’ve checked a couple times and found the numbers relatively the same:

• January 26 morning (10 readings): US Embassy is 73 ug/m3 (= AQI 155) and BJMEMC is 80 ug/m3 (= AQI 159)
• January 27 morning (10 readings): US Embassy is 93 ug/m3 (= AQI 167) and BJMEMC is 72 ug/m3 (= AQI 155)

It’s only a couple readings so far, but those AQI differences are surprisingly and reassuringly similar.

Now What?

I really give credit to the BJMEMC for pushing this data many years ahead of schedule. It’s a very positive step which should be acknowledged. China is now ahead of many developing countries, which mostly publish only PM10 data. So now that there is official data, what’s next?

• Will the US Embassy shut down their site, since it technically is no longer needed?
• Will local schools start having air pollution action plans?
• Will such data actually quicken public efforts to clean the air?

Stay tuned…

PM2.5 Beijing Air Pollution Monitor

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On the January 11 broadcast of EZFM’s Beijing Hour radio show, host Paul James and I discussed the very welcome and long-overdue crackdown on the stem cell industry in China. We also talk about the astoundingly good news that the Beijing Ministry of Environmental Protection will start to publish hourly PM2.5 data by January 23rd — an amazing four years ahead of schedule. You can listen by clicking on the links above.

More Podcast Information

You can always listen live to my radio interview each Wednesday around 7:35am Beijing time, on the Beijing Hour program on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the China Radio International network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.

You can listen to all my previous podcasts at the podcast archive.

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I’m very skeptical of the common practice in Chinese “health check” centers to do multiple screening tests for cancers. Many of these tests are neither specific nor sensitive enough for cost-effective screening, and most patients end up spending a lot of money on follow-up tests which prove benign. I’m not saying the concept is bad, I’m saying that many blood biomarkers are not ready for prime time. It’s really a shame, as many cancers including liver cancer are usually diagnosed too late to help the patient survive for a long time. Perhaps there’s now some hope with liver cancer, as a Chinese team has designed a blood test which may be more accurate than the common AFP test. This hopefully will turn out to be truly effective, especially for China, as liver cancer from hepatitis B is extremely common. I discuss this issue in my weekly radio broadcast on Beijing Hour; you can listen to the podcast with the above links.

Paul James and I also discuss recent news stories about the questionable nutritional value of many popular milk beverages, including Wahaha’s Nutri-Express line of milk+juice combinations. I’ve never tried them so cannot comment on the taste (milk with juice?), but in general the vast majority of this class of drinks are never as nutritious as the real deal. In other words, pure milk is usually a lot better than the super-sweetened mixes, and juices in boxes are almost always super-sweetened and also have less of the original nutrients. Your grandma was right: an apple a day keeps the doctor away.

More Podcast Information

You can always listen live to my radio interview each Wednesday around 7:35am Beijing time, on the Beijing Hour program on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the China Radio International network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.

You can listen to all my previous podcasts at the podcast archive.

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Step 1: Read Two Crucial Papers

The last two months have been amazing for anyone interested in public health in China. There has literally been an explosion of air pollution information in all forms of media, not only promoting the US Embassy’s PM2.5 monitor but actively discussing and criticizing many official air pollution stats. In other words, regular Chinese people have finally discovered what many expats in Beijing have already known for three years; the official PM10 daily pollution numbers were not nearly as helpful or as realistic as the US Embassy’s PM2.5 hourly feed.

This wonderful data explosion has culminated with two extraordinarily useful and detailed articles from two of my heroes of public health: Steven Andrews and Doctor C. Arden Pope III. Andrews wrote a dramatic research paper in 2008 discussing official pollution data in China, and last week on Chinadialogue he posted what is easily the most researched analysis to date comparing the US Embassy’s data with official data. It’s a must read.

The second is an even more scholarly article from Dr Pope, who has authored or co-authored most of the most important research on air pollution over the last 20 years. In his latest spectacularly useful research from Environmental Health Perspectives, he analyzes death rates from heart disease and lung cancers caused by smoking and air pollution. The detail is stunningly useful, and it also provided me with the data I needed (finally!) to actually measure mortality risk of air pollution, as well as to answer my original question above.

Step 2: Do The Math

First, just what is an average day in Beijing? We get rightfully scared about these occasional 500′s, but those are rare peaks. From Andrew’s paper, we get the data that the official average PM10 level from 2010 is 121 µg/m³, which converts to an AQI of 84, which is “Moderate” on the US EPA’s guideline. Andrew also did us all an enormous benefit and calculated that the US Embassy’s average daily PM2.5 over the last two years is 100 µg/m³ (which converts to an AQI of 171, “Unhealthy” for the US EPA).

Now we know the daily data. So how much of these particles do we breathe in a day? First, we need to know how much air an average person breathes. This can vary in the research literature, but our esteemed Dr Pope mentions that most studies use an average adult inhalation of 18m³/day of air. Now we can do our calculations. If we use:

• PM10 data: 121 µg/m³ x 18m³/day (÷1,000 to convert µg to mg) = 2.2mg/day of inhaled PM10
• PM2.5 data:  100 µg/m³ x 18m³/day (÷1,000 to convert µg to mg) = 1.8mg/day of inhaled PM2.5

Since Pope’s studies mostly use PM2.5 data for comparisons, we will focus mostly on PM2.5 and not the “official” PM10. As you can see, it’s not a stretch to use the US Embassy’s “unofficial” data, as 2.2mg and 1.8mg are relatively close numbers, in my opinion. Also, since it’s estimated that Beijing’s PM2.5 concentration is roughly 85% of PM10, then the numbers mostly are equal.

Step 3: Compare To A Cigarette

Pope also uses the research standard that an average cigarette contains 12mg of inhaled PM2.5. Yes, there are differences in smoking habits (some of us even claim “I didn’t inhale”…) but this seems to be the standard in most research literature.
So if we compare the above numbers:

• PM2.5 data: 1.8 mg/d air pollution ÷ 12 mg cigarette = 15% of one cigarette

That means that a daily dose of Beijing’s average air pollution is equivalent to 1/6 of one cigarette. Do we agree? If so, let’s continue analyzing this shocking finding.

What About The Really Bad Days?

So what about the really bad days when the US Embassy’s 24-hour data hits “Very Unhealthy” 200; “Hazardous” 300 or “Crazy Bad/Beyond Index” 500? Let’s find out. First, you must convert the AQI to PM2.5 concentration, which is easy to do with the online calculator:

• AQI200 = 150µg/m³ x 18m³/day (÷1,000) = 2.7mg/d ÷12 = 23% of one cigarette a day
• AQI300 = 250µg/m³ x 18m³/day (÷1,000) = 4.5mg/d ÷12 = 38% of one cigarette a day
  
• AQI500 = 500µg/m³ x 18m³/day (÷1,000) = 9.0mg/d ÷12 = 75% of one cigarette a day

This means that even with an extremely rare average of 500, that’s still equivalent to smoking less than one cigarette a day!

What About Your City?

What about Shanghai, or Mexico City, or LA? Just find out the average daily PM2.5 concentration or AQI and plug in the numbers! For example:

• City X: PM2.5 concentration =  __ µg/m³ x 18m³/day (÷1,000) = 0.27mg/d ÷12 = __ % of one cigarette a day

So What Does This Mean?

Honestly, I was quite surprised by these numbers (assuming I did the math correctly). I had grown up hearing apocalyptic quotes such as “living in Mexico City is like smoking a pack a day”. Well, that just seems preposterous right now, in any city. According to Pope, a pack a day equals 240mg of PM2.5, which would be equivalent to a daily PM2.5 concentration of 13,333µg/m³, which is essentially impossible! So how on earth did such misleading urban legends start? And how can no scientist or reporter have answered this common question when these stats have been in Pope’s research papers for years?

My next reaction, as I’m sure many of you feel right now, was this: does this mean that air pollution isn’t as serious as we thought? I say no, it doesn’t mean that, but this data certainly puts things in a new perspective.

My Bottom Line

Once the shock wore off, a few major points lingered with me:

• Yes, this number is a lot lower than I would have assumed. But this absolutely does not mean that air pollution is now less dangerous. Hundreds of studies, many by Dr Pope, have documented the very real health risks of air pollution. And many studies have documented improved community health conditions after their air was cleaned up.
• But my #1 take-home message is that smoking is an astonishingly toxic and destructive addiction, and is far, far worse than the worst air pollution in the world. Even one cigarette a day is more toxic than a day in any city in the world! And China, with limited public health budgets, would get magnitudes more national health benefit if they focused on eliminating tobacco use when compared to eliminating high air pollution.

There is, of course, a much more important question than the parlor trick above: how much does air pollution increase mortality risk? I’ll try to answer that in a post for next week, but here’s a sneak preview of the crucial data from Pope’s article, discussing mortality risks of lung cancer (on the left) and heart disease (on the right) from PM2.5:

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Dairy Products: the most disgusting food safety scandal, by far, involved the contaminated infant formula in 2008 which killed 6 children and sickened 300,000 others, many with permanent kidney disease. Unfortunately, since then, this melamine chemical has been rediscovered in a few dairy products, and thus all of China remains justifiably wary of the entire dairy industry.

If you have a newborn baby, the healthiest milk in any country remains breast milk, so it would be wonderful to breast feed for as long as possible. Otherwise, most doctors I know in Beijing would recommend only buying infant formulas imported from other countries, from the most reputable brands, as well as from the most famous stores. I would definitely not recommend getting formula or anything of consequence from taobao.com, as the counterfeit industry is very large. As for regular milk products, again the trust issue is key. I think the American-owned Wondermilk brand of milks and yogurts is a good choice, as are the Green Yard brand and other local organic milks or imported boxes of milk. But don’t forget another option — soy milk! Making your own soy milk at home with a machine is a healthy, fun and fragrant way to start a family’s day. The best company is called Joyoung, and their machines can be found at almost all electronics stores for 300-400RMB. You can also buy simple machines to make your own yogurt, which is a very healthy food.

Fruits and Vegetables: Again, the main issue is trust: do you know exactly where this green veggie is from, and how it was made? If it’s from one of the handful of organic farms around Beijing and you’re comfortable with the farm’s practices, then that’s great. For most of us, this is an impractical or expensive option, so I prefer to buy organics as often as possible from the large internationally-run hypermarkets such as Carrefour, Metro, Walmart, Tesco and Auchan. I prefer organics not so much for the taste and quality, but more for their quality chain of ​production, traceability, and oversight by multiple governmental and organic agencies. In other words, you have a much better chance of getting healthy and safe produce from a heavily monitored farm than you would from a Shunyi corner market or farm. And make no mistake, you should be wary of getting produce from small farms in China, where pesticide, growth hormone and other chemical rates are enormous, not to mention very high rates of water pollution runoff.

No matter where you buy your produce, it remains crucial to wash them all very well, especially the leafy greens. If your ayi prepares your foods, it’s important that she is educated by you not only on proper food washing but also simple hygiene such as correct hand washing or not mixing raw meats and veggies on the same cutting tables. Take nothing for granted with your ayi! There are some food safety handouts online in Chinese and English from the World Health Organization which you can print out and show her; you can find them online at my blog here.

Meats and Fish: A diet rich in fish is beneficial at all ages, as fatty fishes are filled with nutritious omega 3, a crucial element for a child’s brain as well as for an adult’s heart. But finding any safe fish in China is a serious issue, as many local rivers and waterways are seriously polluted. I’m very happy with my recent discovery of Metro’s frozen food section, which has a large selection of fish from other countries, and whose quality (and price) is quite reasonable. As for meats, again I like organic meats at larger international markets, mostly again because they have their own, independent supply chains and traceability.

To sum up, we all need to be more careful here in order to ensure safe food for our families. But with a little extra knowledge, we can thrive just fine.

You can read more about food safety in my food safety archives. 

(This article first was published in my monthly “The Doc Is In” column in Beijing Kid’s November 2011 issue. You can read my previous columns here.)

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View This Poll

AQI 500 US Embassy Crazy Bad

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First, The Boring Tech Stuff

It’s very important to know that my home’s machines did not have new filters, so true comparisons to these new Alen Air machines cannot be done. My Blueair’s filters were at least 4 months past prime, and my IQAir’s pre-filter was in the red zone. (Still, their data is also interesting). Anyway, I spent a few days wheeling around each machine in one of 4 rooms:

• library, small bedroom and master bedroom: each around 10-12 square meters
• front living room, itself 30 square meters and open into a large hallway and dining room, with no doors

I then measured each room’s pollution levels with a handheld Particlescan machine. This machine measures PM0.3 particles, which are much smaller than the PM2.5 which the US Embassy monitors. These tiny particles are what most scientists think are the causes of pollution-related lung and heart disease, as they easily get absorbed into the blood stream via the lungs.

I was “lucky” enough to be testing on days with the US Embassy readings in the high 200′s, so this was definitely a real-world challenge for any purifier.

The Real World Results

The good news is that both Alen Air purifiers did quite well, and indeed better, than last year’s tests of the IQAir and Blueair. For example, on average:

• The A375 filtered out 94% of PM0.3 (96% at max setting) compared to the unfiltered part of my house (the hallway and back rooms); this was the best number I’ve had for any machine
• The Paralda filtered out 80% (83% at max), also very good
• My oldish-filtered IQAir filtered 76%
• The older-filter Blueair filtered 66%

Another very positive point is that all purifiers did really well in bedrooms with doors closed. In fact, all four machines at maximum settings removed 95-99% of PM0.3! At quieter settings it was less awesome but still very good. I think this is powerful proof that air purifiers in bedrooms can dramatically reduce your pollution risk while you sleep — an issue especially crucial for infants and children.

In last year’s results from my previous apartment:

• The IQAir filtered 74% on average, 84% at max setting
• The Blueair 501 filtered 74% on average, 82% at max setting
• In the small bedroom with closed doors, IQAir filtered 79%, blueair 73%
• In the larger, open dining room, IQAir filtered 61%, Blueair 67%

Compared To Outdoor Air? Awesome

Don’t forget that the above numbers are comparing filtered rooms to a “control” room in a separate part of the house. So if you compare these above numbers to outdoor air, they perform even better. For all readings, I also stuck the Particlescan out of my 15th floor window and recorded this data.

On average, indoor air PM0.3 in my unfiltered hallway was 53% of outdoor air. I think that’s pretty good, and it’s a lot better than my previous apartment a couple years ago, which usually was around 70%. I think it shows how proper ventilation and window protection can help.

But what that also means is that these machines did even better than the numbers above. For example, if you’re comparing each room to outside air, the A375 got rid of 97% of anything bigger than PM0.3. Also:

• Small rooms with closed doors were 95-99% cleaner than outdoor air
• Open, large room was 29-39% cleaner than outdoor air

Don’t Forget Hunter, and Others

Last year I also wrote about a smaller and cheaper HEPA filter from Hunter, which in my readings routinely eliminated 50-70% of PM0.3 pollution even with the constant door opening in my 12-square meter office. At max speed with the door closed for a while, it got 91% of the pollution.

The Bottom Line

Clearly, with good filters, all these machines do really well in smaller rooms with doors, and I’m sure a bunch of other HEPA brands may also be ok. The larger rooms are always more difficult for all, but for the most important room — your bedroom — many HEPA models will probably be fine. Major differences between HEPA models include:

• Price
• Room size
• Reputation
• Noise
• Replacement filter costs
• Resale value
• Other “features” (ozone, UV, remotes…)

Y’all can research all this other stuff; I’m just providing some real-world data to add to your decision mix. By the way, here is what Consumer Search says about the Paralda and the A375.

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First I’d like to share my email exchange, almost verbatim, with Respro. It’s a bit technical but the science data is important:

Hi Dr Richard,

We have a European Standard that being EN149 FFP1. The tests carried out are done with particles 0.5 micron in aerodynamic diameter. We do not have Niosh testing (American), EN149 FFP1 is equivalent to N95 – FFP3 is equivalent to N99

Our products are primarily used in non-industrial sectors; motorcycle, cycle markets, some like the FB-1 mask are used by fire police and rescue services in the UK. We feel that it is important for our products to conform to industrial standards as a measure of effectiveness when marketing to the general public. Our products conform to technical specifications of European Standards for PPE (personal Protective Equipment) and our Sportsta and FB-1 masks which both carry P1 certification for lsolid and liquid aerosols ie dusts and mists, were CE Certified for use in industrial environments

EN149 is a homologated European standard applicable for the use of facemasks in the workplace for the filtration of dusts and water soluble aqueous mists. The test protocol used is primarily based on the masks ability to filter a given percentage of particulate material by means of seal and filter media.
The size of particle used in the tests are 0.5 microns in aerodynamic diameter. This particular part of the test is called the inward leakage test. Our Sportsta and Techno masks are rated at and average of 88% and conform to FFP1S levels. (my emphasis) This not to say that the cannot perform more or less efficiently.

Clearly fit is a major issue and the reason why we have two sizes and for the Respro Allergy mask we have four sizes…

URBAN POLLUTION AND FILTER TYPES
Traffic pollution is a cocktail of different gases vapours and particulates. There is no valid test for vehicle pollution and its uptakes, however some studies have suggested that wearing a mask reduces the incidence of cardio vascular disorders.

We use industrial standards for comparison:

Our filters are lab tested for uptakes against various chemicals which are listed below.

Our particle filter material is tested to 0.3 microns in size. The results confirm that 99% of all particles passing through the media is trapped. The typically range of particles found in industry which is where the material is normally used is 0.5 microns in aerodynamic diameter. Typical ranges of particulate pollution are from 0.5 to 10+ microns.

Filter Types:

We offer several types of filter all of which are interchangeable within the range of masks providing they are the same size.

1. Sports filter – for sub-micron particle filtration (Respirable dusts

2. City filter – for micron particle filtration (inhaleable dusts PM10) and Organic vapour uptake. (City Mask/ Nightsite mask standard issue)

3. Techno filter – for sub-micron particle filtration (Respirable dusts

4. Allergy Particle – for sub-micron particle filtration (Respirable dusts

5. Allergy Particle/Chemical filter – for sub-micron particle filtration (Respirable dusts

PM10: = ABOVE 10 MICRONS IN AERODYNAMIC DIAMETER SIZE
PM1: = ABOVE 1 MICRONS IN AERODYNAMIC DIAMETER SIZE AND BELOW 10 MICRONS
SUB MICRON: = LESS THAN 1 MICRON IN SIZE
Particulate Types:

Inhalable and Respirable.

Inhalable particulates: are the particles big enough to be trapped within the nasal hairs and the mucous membranes at the back of the throat.
Respirable particulates: are the particles that pass beyond the nasal hairs and the mucous membranes of the throat and pass into the lung sacs and subsequent blood barrier. These particulates can carry carcinogenic chemicals used in petrol (benzene, pyrene, etc) to the blood barrier…

I hope this is of assistance and please feel free to ask any further advice.

Kind regards
Mairead McClean – Team Respro® Customer services
—————————————————————————————————————-

Dear Mairead,

Thanks for the reply, which is very informative! I have a question: you say that “results confirm that 99% of all particles passing through the media is trapped.”, yet you also say that “Sportsta and Techno masks are rated at an average of 88% and conform to FFP1S levels”. Are you saying that technically the filters are 99% efficient down to PM0.5, but in real world testing, the effectiveness is 88%? The difference is mostly due to fitting issues?

Thanks,

Richard

—————————————————————————————————————-

Hi Dr Richard.

You are absolutely correct in your conclusion,. The difference is due to ‘inward leakage’ Face masks are not hermetically sealed to the face so they have something called ‘inward leakage’. That is, a certain amount of unfiltered air will pass around the sealing point on the face. Some air will pass through the seal and as the nose is a very sensitive organ it will pick up minute levels ( PPB Parts per billion). Ensuring the mask is correctly fitted will ensure the minimum of inward leakage. This is why we have 4 sizes.

Respro Vs Totobobo: Who’s The Winner?

So I think 88% real-world is pretty darn good. But if you reread my Totobobo piece, a randomized controlled cross-over study showed a “median (interquartile range) 135-fold reduction in airborne particle counts” with Totobobo masks in a real-world setting in 22 healthy subjects. So real-world testing clearly shows Totobobo is more effective than Respro. I also much prefer Totobobo due to better pricing and also because it’s much less extreme-looking than the Respro series. But you can all make your own decisions; and Respro actually is more effective than I had thought. In any case, it’s nice to finally get this data!

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The most evidence-based official air pollution action plan for schools states that no outdoor activity should be held when the PM2.5 AQI is above 200, with severe restrictions from 150-200. Anyone who tries to enact school action plans with higher cutoffs of 250, 275, etc. really needs to provide strong scientific evidence why their criteria should be less stringent. Using higher cutoffs for the simple reason that this would be “too disruptive” is not a morally justifiable argument. And not having an action plan at all in Beijing, in schools nearby the US Embassy, is simply not acceptable. Local politics does not trump universal science.

I state this upfront because I wanted to get your attention to a good news/bad news document. The good news is that I’ve finally found two credible and official school air pollution action plans: one from the most polluted parts of the US in California, and another from the US Environmental Protection Agency’s website. I’ve been scouring the WHO and other places and this is the best I’ve seen anywhere. So that’s the good news: our local schools finally have a guide from credible sources for our own action plans.

The bad news is that their school activity cutoffs are likely much more strict than what most schools are now doing, and this means more limitations than before. And it soon could be even more strict, as the California scientists are discussing revisions which will lower their highest restriction from a PM2.5 AQI 200 down to 150. And that’s only for the healthy kids; for those with asthma and other diseases, the restrictions are even more strict. And since the annual average PM10 in Beijing is ~140 AQI, and the US Embassy’s PM2.5 readings are often higher, you see how disruptive such strict adherence could be.

The most important document is the image below, which comes from the PDF file you can download here. It comes from California’s San Joaquin Valley school system, based in Fresno county, which is the #2 worst area in the US for PM2.5 pollution and is thus a good model for us in Beijing. Their plan was only implemented last year, on Halloween day 2010. I’ve been conversing via email with their scientists and I am very impressed that they’ve based their findings on discussions with the Sacramento Air District, UCSF-Fresno, the medical advisory committee of the American Lung Association, California and the Fresno-Madera Medical Society. You can click on the image to get a bigger, more printable version:

AQI School Guide San Joaquin Valley RAAN PM2.5 Ozone

I’m sure that school leaders, teachers and parents may want to read the science they based it on. David Lighthall, PhD,  the Health Science Advisor for the San Joaquin Valley Air Pollution Control District, has graciously provided us with their top-sourced scientific evidence at the following links (his wordings from his email):

• “We sponsored a new epi study in the SJV that is now available at www.cvhpi.org. It found compelling evidence of how elevated PM2.5 in particular (even as low as 30 ug/m3 per day) resulting in an elevation of daily ER admissions for asthma with a nearly perfect linear concentration (dose) response function.”
• “The US EPA has created an incredible health policy reference document in the Integrated Science Assessment for PM, which was compiled as part of their scheduled review of the 2006 PM 2.5 and PM 10 NAAQS. It can be found at: http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=216546#Download along with a companion Policy Assessment. In respect to your issue, I would recommend looking at the studies reviewed and their conclusions in Chapter 3, Source to Human Exposure, and Chapt. 4, Dosimetry. Also, Chapt 6, Health Effects of Short-term Exposure. (You can find even more PM2.5 info here: http://www.epa.gov/ttn/naaqs/standards/pm/s_pm_index.html“

The second official document is from the US Environmental Protection Agency, which last summer created a School Flag Program website. This provides their evidence-based recommendations on what schools should do during air pollution crises regarding PM2.5 and ozone.  Their link above has multiple handouts which may be invaluable to schools for setting up their own plans, as well as for providing the background on why these action plans are necessary in communities such as ours. They also have an incredibly useful PDF file, called “Air Quality and Outdoor Activities: Recommendations for Schools“ that gives exact details as to what schools should do at the different AQI levels for ozone. That’s the catch for now — it’s only for ozone and not for PM2.5, which is much more important to us here. The US Embassy’s monitor also publishes an hourly ozone AQI next to the PM2.5, but in general terms the PM2.5 is more important to monitor. I emailed the EPA and they are working on a PM2.5 chart for schools  – but they specifically mentioned the above Fresno county chart as the only one they were aware of for PM2.5.  Here’s a small screenshot of the ozone guide:

AQI Action Plan for Schools -- Ozone

My Bottom Line

I think I’ve made it pretty clear, today and over the last two years of this blog, that it’s my personal opinion that Beijing schools have a moral imperative to provide a safe environment for their students, and that air pollution action plans are now essential to us lucky Beijingers because we can access hourly PM2.5 data from the US Embassy — a luxury that no one else in China currently gets.

My views are my own, and mine is not an official policy statement of my clinic or any other company, so you’re perfectly welcome to disagree with me. Having said that, I honestly see no reason now why Beijing schools couldn’t simply adopt the San Joaquin Valley plan above (first image) and follow the US Embassy’s AQI. I think it’s perfectly reasonable to debate the cutoffs, but again you’d have to have a good reason why not to follow what seems to be the world’s most well-researched recommendations. And again, there really is no excuse for not having any plan at all.

One more thing: simply keeping kids inside the gym on bad days is not a total cure — not if your  school isn’t controlling their indoor air systems with proper air filters. If the kids are playing in the gym on an outdoor AQI day of 300 but the gym AQI is 250, that’s not much of a help.

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