Smoke and fog shrouded the Puget Sound region as fires continued to burn throughout the West Sunday morning, adding a new layer of anxiety and distress to a summer of pandemic, civil unrest and economic decline.

Recent wildfires across California, Oregon and Washington have killed 33 people, including a 1-year-old in Okanogan County. Firefighters are battling roughly 30 fires in Washington and Oregon, according to the Northwest Interagency Coordination Center.

All of that, manifested in the thick, ominous smoke blanketing the West Coast — on top of a global catastrophe — can have major effects on people’s mental health, in addition to their physical health, experts say.

Air quality is expected to remain unhealthy for sensitive groups in Puget Sound through the middle of the coming week. But cooler temperatures, lighter winds and higher humidity levels are slowing the growth of fires throughout the Northwest.

The Pearl Hill and Cold Springs fires — the two largest in Washington — were respectively 80% and 45% contained as of Sunday morning. The Pearl Hill fire near Bridgeport, Douglas County, has burned nearly 224,000 acres, with the Cold Springs blaze approaching 189,000 acres.

One new fire was reported in Washington 14 miles south of Pullman in the Wawawei Canyon, covering 310 acres. The blaze was 25% contained as of Sunday morning.

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The smoke mixed with fog and low clouds throughout Sunday. Starting Monday, multiple incoming weather systems should bring stronger eastward winds blowing the smoke to higher levels of the atmosphere, according to the National Weather Service’s Seattle office.

“As we get into Monday, through the day and beyond, it looks like the majority of the smoke will begin to move off to the east and mix out, giving us some improvement,” said Matthew Cullen, meteorologist with the National Weather Service. “It may not be a rapid ‘flip the switch and suddenly it’s all gone’ kind of thing, but the trend toward improvement looks to be on the way.”

Some areas won’t see as much of an improvement as others. The Columbia River Gorge will still be downwind of some of the Oregon wildfires, even after clean, marine air clears out Western Washington.

In the meantime, officials are advising people to hunker down and avoid the outdoors if they can.

“Folks are constantly wondering, ‘When on Earth will it end?’ and ‘What will I do in the interim?'” said Washington Department of Ecology atmospheric scientist Ranil Dhammapala, who also posts on the Washington Smoke blog.

With COVID-19, there are no easy answers, Dhammapala said.

“COVID advice has been ‘go play outside,’ ” Dhammapala said. “[It’s] been a challenge for everyone to communicate the right balance.”

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Dhammapala advises that while there is no one-size-fits-all solution, it’s best to stay inside and do what you can to filter the indoor air.

But staying inside under a Creamsicle-colored haze while a pandemic rages is taking a toll on many people’s mental health.

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Kesia Lee, 24, moved back in with her parents in Redmond when the California school she worked at as an outdoor educator closed because of the pandemic. Her three siblings have now joined her, two of whom had to evacuate from the Oregon wildfires.

During the pandemic, Lee had set a goal to spend time outside every day to help handle her depression. Since the smoke rolled in on Friday, she hasn’t been able to do that.

“I’ve been stuck at home with seven people, all of whom are not in a living situation they want to be in, all of whom are dealing with different levels of social anxiety and stuff like that,” Lee said.

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Lee said she feels privileged to be able to take refuge somewhere safe, but in the last couple of days, she’s said she’s had “wide-eyed conversations” with her siblings about the future.

“What makes things really hard is when I remember that because of climate change, this is not going to be a once-in-a-lifetime occurrence,” Lee said. “This is going to be our life for the next 50 years or however long.”

Joelle Craft, 42, said the cumulative impacts of what’s been happening in recent months are difficult to deal with when absolutely stuck inside. Craft, who has multiple sclerosis, once performed in and organized benefit shows for people with chronic illness, but that stopped when the pandemic broke out. In the months since, Craft said she’s felt that people with chronic illness have been receiving messages from media and some political leaders that they are expendable during COVID-19.

“It’s getting harder and harder,” Craft said. “The things I would do as a performer, I would go outside and I’d sing and the neighbors would enjoy and we’d make jokes, or I’d just go for a walk by myself and now you can’t go outside.”

“You can’t even just be, because there’s no fresh air,” Craft said. “This is the worst I’ve seen it and I’ve lived in Washington for 42 years.”

Jane Simoni, professor and director of clinical training in the University of Washington’s Department of Psychology, said things are particularly difficult on mental health right now because of the “syndemic” nature of concurrent, ongoing disasters.

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“It comes on top of so many other traumas,” Simoni said. “It’s COVID, it’s the biggest civil unrest we’ve seen in a while, the economic downturn, the uncertainty about the election, climate change. Any one of these would be a catastrophe and now we’re having all of them in the wildfires.”

All these stressful events can result in anxiety, panic attacks, post-traumatic stress and sometimes an increase in substance use, Simoni said. Some studies have shown that use of anti-anxiety medications goes up after severe wildfires, she added, and that domestic violence can increase.

It doesn’t help that many of the coping mechanisms a therapist might recommend to a client are off-limits in the unhealthy air, said Seattle mental health therapist Ashley McGirt.

“Many of the main things I recommend to improve our mental health and well-being — deep breathing, going outside, getting some fresh air,” McGirt said. “Now that’s gone. It’s one more thing that we’re losing.”

Smoke is likely even more stressful on average for low-income families and people of color, McGirt said.

“Marginalized communities tend to be lower-income communities; we also tend to live in multigenerational households so there’s a broad array of individuals in our homes, from the young to the very elderly, so that’s impacting us as we’re confined to this environment,” McGirt said. “The lower-income may not have access to filters or things that can clear the home. They may already be in a toxic living environment.”

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Simoni said that she would advise people who are feeling particularly anxious or depressed to identify and acknowledge how they’re feeling.

“Know that this is normal, this is appropriate to feel this way, and do what you do to cope in a healthy way,” Simoni said. “Talk to other people about it, try to do something in your house, take a break from the news once in a while.”

“Treat yourself a little bit if you need to do something that makes you feel good, and hopefully we know this is not going to be sustained,” Simoni continued. “It already looks like Monday will start to clear.”

On Sunday morning, Gov. Jay Inslee appeared on ABC’s “This Week with George Stephanopoulos” alongside Sen. Jeff Merkley, D-OR, to discuss the wildfires’ devastation, calling the situation “apocalyptic” and “maddening.” Inslee described talking with a woman in Malden, Whitman County, a town he said was “absolutely decimated” by the fires.

“What struck me, as I was listening to her, the only moisture in Eastern Washington was the tears of people who have lost their homes and mingling with the ashes,” Inslee said. “Now we have a blowtorch over our states in the West, which is climate change, and we know that climate change is making fires start easier, spread faster and intensify.”

Both Inslee and Merkley refuted recent comments from President Donald Trump blaming the wildfires on “forest management.”

Asked about disinformation on social media complicating response efforts, Inslee encouraged people to vote against politicians who deny climate change.

“This is not a debate. The time for excuses, for denial, for downplaying this, those days are over,” he said. “The days of consequence are upon us.”