A Sydney GP working in the suburbs hardest hit by bushfire smoke plaguing New South Wales has said she is devastated for her patients, many of them unable to afford air filters, air conditioning or masks.

Dr Kim Loo works in Riverstone, which along with Richmond and St Marys on Tuesday recorded some of the highest levels of ultra-fine PM2.5 particles, small enough to enter the lungs and bloodstream. On Tuesday afternoon, the 24-hour average index for Rouse Hill stood at 430, with anything above 200 rated “hazardous”.

Levels ranged as high as 2,200 in some Sydney suburbs on Tuesday. Bathurst, Orange, Armidale and Goulburn also experienced hazardous air quality.

“My poor patients, many live on the margins of poverty,” a tearful Loo told Guardian Australia. “They live in houses that aren’t sealed. I know there are guidelines telling people to stay inside if they have certain health conditions, but that’s no good if your house isn’t sealed and you can’t afford an air filter.

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“It is disastrous and it’s unprecedented. We have no experience dealing with this for such a long period. I have patients on oxygen for lung disease and they’re on it for 16 hours a day and they can’t go outside at all now. They’re isolated.”

Loo is also angry. For several years she has been travelling to Canberra to talk to federal politicians, warning them of such a situation due to climate change. She has had meetings with state politicians as well.

“And then I get really upset and it makes me so sad, because what climate change does is amplify social inequity,” Loo said as she drove to her clinic to face another day of treating smoke-affected patients. “People who can afford to filter their air and live in places where trees aren’t burning, or to fly somewhere else when the smoke gets bad, don’t feel the brunt of this. The people on the margins walk to my surgery, they don’t own a car. They can’t pay for food, let alone smoke masks.”

In the week to 6 December, about 1,140 people presented to NSW emergency departments, 25% more than the usual weekly average. The largest increases have been in South Western Sydney Local Health District, which serves a region particularly affected by smoke. NSW Ambulance fielded about 2,330 calls in the same period, about 30% more than the average for a week. Hospitals are so far managing to cope with the demand.

The vice-president of the Australian Medical Association, Dr Chris Zappala, is a respiratory physician and he said the weeks of relentless bushfire smoke were taking a toll on people’s sense of well-being. Many people were cutting back on normal activities such as exercise because of smoke inhalation and irritation to their eyes and respiratory system, he said.

“There is no question that there is a quality of life and mental health cost from the confinement, and the worry that this prolonged period of smoke exposure causes,” Zappala said. “I had a mother of younger kids telling me her children were not allowed out to play at school, and the kids were experiencing boredom and agitation and other effects of prolonged confinement. People are appropriately not going out to exercise as much and it’s just a constraining, unhappy time.”

The strong message from the health department has been that people with underlying respiratory and heart conditions should be the most cautious, ensuring they take preventive medication and see a doctor or call an ambulance at the first signs of discomfort. But as the state experiences weeks on end of smoke, with no end in sight, should healthy people be concerned about impacts beyond temporary coughing and painful, watery eyes?

“It’s a fair question and the honest answer is the threshold of injury is different to everyone,” Zappala said. “We have to accept that while the majority of people will be OK, the longer it goes on the increased likelihood that more people will see diseases like asthma manifest for the first time.

“The airway can only deal with so much. If we overwhelm it, symptoms are likely to develop. It’s important to stress though the majority of healthy people will remain well even if this smoke goes for several more weeks. Once the smoke moves away, the normal cleaning mechanism of their airway will eventually clear all the debris out of the lungs.”

On Tuesday afternoon the NSW chief health officer, Dr Kerry Chant, reiterated the message that those with chronic health conditions should stay indoors.

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But a specialist in combustion and atmospheric chemistry at the University of Melbourne, Dr Gabriel da Silva, said advice to stay indoors would only be effective for so long.

“Eventually you need to be able to ventilate and allow clean air inside, or the indoor environment will start to acquire its own pollutants,” he said.

Da Silva said studies were starting to show that inhalation of fine particles due to air pollution led to a greater incidence of chronic diseases, cancers and neurological illnesses, and not just acute respiratory diseases.

“I would be concerned if I was experiencing this exposure, and particularly concerned about having to breathe it in,” he said.

“Even the baseline risk to health from industrial air pollution we experience in Australia has a significant impact on our health system, and while Australia has lived in the shadows of smoke stacks from coal-fired power stations and bushfires before, this seems to be something bigger.”

The CFMMEU secretary, Darren Greenfield, said labourers and tradespeople throughout the state had been told to go home for the day, as they had been told several times before throughout the fire season.

“Our members report the itchy throats, their eyesight’s been affected, and members with lung and breathing issues have been particularly affected,” he said. “Even just visually it’s impossible to be working in Sydney today.”



