Wildfire smoke reaches the clinic: air readiness and health costs.
A Maryland study estimated $2.44 million in added cardiopulmonary encounter costs across six 2023 smoke hotspot days. EPA programs describe building readiness and monitoring responses. These figures answer different questions.
Smoke travels beyond the fire perimeter. It can reach schools, clinics and public buildings hundreds or thousands of miles from the burn area, where indoor filtration, local monitoring and health-service capacity shape the response. Recent evidence gives a useful view of those costs, but the figures describe different things.
A local health-system estimate, not a national damage total
A study of 12 hospital facilities in Maryland compared cardiopulmonary encounters during six wildfire-smoke hotspot days in June 2023 with calendar-matched control days. The authors estimated $2,435,513 in incremental costs from the increased encounters. Their 95% uncertainty interval ranges from $62,452 to $5,266,838. The result is an estimate for a defined health-system and exposure window; it is not a national estimate, a complete valuation of health harms, or insured property damage.
The study is a ground-level signal because it follows the smoke to clinical services rather than counting only acres burned. It also shows why a range belongs beside the central estimate: the uncertainty is large relative to the point estimate. The underlying paper describes its study design and limits in detail. Read the study.
$2.44M
Six hotspot days in June 2023; 12 Maryland hospital facilities; uncertainty interval shown in the source.
$13.58M
EPA’s 2026 grant notice total. Applications closed; the cited page did not confirm new selections on Oct 28.
Public buildings and monitoring are part of the response
EPA’s 2026 Wildfire Smoke Preparedness in Community Buildings opportunity covers planning, indoor and outdoor monitoring, portable air cleaners, clean-air shelters, HVAC improvements and weatherization. EPA lists $13.58 million for the notice and anticipated grants of $350,000 to $2.5 million. Applications closed April 15. On October 28, EPA’s page still said it anticipated notifying applicants in October, so this brief does not treat the round as awarded.
EPA’s WSMART equipment-loan program fills a different role: supplemental smoke monitoring for public air agencies. EPA said the 2026 season restarted with limited vehicle-mounted systems for Air Resource Advisors. The page describes equipment loans and shipping support, but no program-wide budget. It is not a public purchase program.
What these numbers do not answer
The health study does not estimate all missed work, school disruption, long-term disease or building-protection costs. The EPA grant total is an opportunity budget, not an award or a measure of avoided damage. WSMART’s equipment loans do not measure local smoke exposure by themselves. These sources point to practical needs—cleaner indoor air, usable monitoring, and staffed response—while leaving local outcomes to be measured.
What we will track next
- Whether EPA publishes the 2026 grant selections and project locations.
- Whether recipients report building upgrades, monitoring coverage and facility-level operating costs.
- Whether health-system studies publish comparable methods across different smoke events and regions.
Sources and evidence stage
- University of Maryland / CHEST · Maryland smoke and cardiopulmonary encounter cost study — Published research; modeled incremental encounter costs for six hotspot days at 12 hospital facilities.
- U.S. EPA · Wildfire Smoke Preparedness in Community Buildings — 2026 funding opportunity; closed April 15, 2026. The page checked Oct 28 still listed October as the expected applicant-notification month.
- U.S. EPA · WSMART — Agency equipment-loan program; the 2026 restart is limited to Air Resource Advisors for vehicle-mounted monitoring.