Stanford University Medical Center doctors gave Alex Lee a parting gift at the end of his heart operations earlier this year: surgeon's masks.
They knew Lee, 19, would be returning home to Fairbanks, Alaska, and gave him the masks to protect himself from air polluted with suspended particulate that can cause irregular heartbeat or a heart attack. Diagnosed with Down syndrome, Lee is not in position to take his doctors' stronger suggestion — moving away from his hometown air.
"They gave us a box of masks and said, 'Stay out of it the best you can," said his mother, Patrice Lee.
The young, the elderly and the weakened in Fairbanks risk accelerated health problems every winter because of particulate. Much of it comes from wood smoke produced by homeowners trying to cut their fuel bills. Municipal officials say natural gas is the long-term solution, but that is years away. The Environmental Protection Agency has taken notice and says it will impose sanctions and a federal attainment plan in two years if state and municipal officials don't come up with an acceptable one of their own.
Lee and her son do their best to avoid breathing air that ranks among the dirtiest in the country.
"The only option for us was to stay holed up here in the house with HEPA filters and doing the best we can not to breathe the air," Lee said.
Air problems in Fairbanks, Alaska's second largest community at around 97,000 people, start with geography. Temperatures every winter reach 40 to 50 below zero. Fairbanks and nearby North Pole are partially surrounded by hills that create a bowl effect, said Cindy Heil, an air planner for the state Department of Environmental Conservation. In a meteorological phenomenon known as an inversion, cold air along the ground can be capped by a layer of warmer air, trapping emissions.
Carbon monoxide used to be the main concern. A vehicle inspection and maintenance program and newer cars solved that.
The issue now is particulate, the mix of solid particles and liquid droplets ranging from dust and soot to microscopic pieces.
A human hair is about 70 micrometers in diameter. The most dangerous particles, according the EPA, are less than 10 micrometers.
"They get breathed deeper in the lungs and cause more problems," said Kate Kelly, the EPA Region 10 director of air, waste and toxics. Research ties particulate to pollution to heart attacks, decreased lung function and premature death in people with heart or lung disease.
National air quality standards allow no more than 35 micrograms of particulate per cubic meter averaged over 24 hours. On Nov. 26-28, a monitor at North Pole recorded 24-hour averages of fine particle matter — 2.5 micrometers in diameter or less — at 152, 167 and 151 micrograms per cubic meter, making for "very unhealthy" designation. At least one hour during the three-day period spiked at 245. Those same days, readings at a Fairbanks monitor averaged 71, 58 and 82, an assessment that rated only "unhealthy."
Gary Schultz, 58, lived in Fairbanks for more than 30 years but in January was diagnosed with atrial fibrillation, the most common form of irregular heartbeat. He went from an active skier to someone who had trouble keeping up with his daughter on a trip back from the mail box. Concerns for his own health and smoke near his daughter's middle school prompted the family to move, reluctantly, outside Seattle.
Fairbanks particulate likely is underreported, he said. The two Fairbanks monitoring stations are on public buildings downtown, away from neighborhoods burning wood.
"We essentially gave up on Fairbanks," he said. "I don't think anything is going to improve up there."
Three winters of Fairbanks noncompliance — an average of 14 days per year — got the attention of the EPA. A compliance plan is due Dec. 14, a deadline Heil and other officials acknowledge will not be met. They hope to complete an acceptable compliance plan within 18 months, before the EPA by law must withhold federal highway construction money. After two years, the EPA must impose its own compliance plan.
Solutions to air problems, Kelly said, are best tailored close to home but local compliance efforts in Fairbanks have met resistance.
"Everybody wants clean air," said state Rep. Tammie Wilson, R-North Pole. "We just have to make sure that we can also heat our homes."
Wilson sponsored a citizen initiative passed in October that bans the borough regulation of home heating devices. The borough, she said, has no business stepping in with restrictions when no one knows if they will work.
"We're still waiting here for a model, a model that shows us that if we do A, B and C, we can then get into attainment," she said. "We have not seen anything from the borough, from the state or from the EPA showing us that that is even possible with the technology that is available to us."
The borough now can only encourage voluntary measures, such as avoiding the burning of green wood.
Fairbanks North Star Borough Mayor Luke Hopkins said an acceptable attainment plan might still be possible using incentives such as replacement program for inefficient wood stoves and underwriting fuel oil costs on inversion days. Getting 7,000 homeowners to voluntarily use oil instead of wood on the worst days might do it, he said. The entire borough, he said, has a financial incentive to avoid losing federal road money and living under a federal air quality attainment plan.
"I don't want that. I don't think anybody wants that," he said.
Patrice and Alex Lee remained mostly hunkered down last week as temperatures hovered near -40, awaiting a change in the weather or the season. Her son, she said, grew especially close to a Stanford surgeon and anesthesiologist who wanted to see Alaska's northern lights until they heard about the particulate problem.
"They're not coming," Lee said. "They wanted to come in the winter to see the aurora. They said, 'You're just crazy to live there.'"