The Brief

On Wednesday afternoon, a four-person astronaut crew is set to strap into a SpaceX capsule and undock from the International Space Station.

The members of NASA's Crew-11 mission are coming home about a month early because one of the crew has a health condition worrisome enough that the space agency decided the person needed to get thoroughly checked out on the ground.

NASA astronauts Zena Cardman and Mike Fincke, along with Russian cosmonaut Oleg Platonov and an astronaut from Japan named Kimiya Yui, are expected to splash down off the coast of California early Thursday morning.

This is the first medical evacuation of the International Space Station in its 25-year history. Officials have stressed that it's not an emergency evacuation, as the astronaut's condition is stable. The identity of the astronaut and the nature of the problem have not been released for privacy reasons.

During a change-of-command ceremony beamed down from the orbiting outpost on Monday, all seven people on board the International Space Station spoke on camera, and none appeared obviously ill.

"Our timing of this departure is unexpected, but what was not surprising to me was how well this crew came together as a family to help each other and just take care of each other," said Cardman, "and this includes very much our teams on the ground."

"We are all OK. Everyone on board is stable, safe, and well cared for," Fincke wrote in a social media post, saying that coming home early was "the right call, even if it's a bit bittersweet."

Another NASA astronaut, Chris Williams, and two Russian cosmonauts will remain on board the station. A replacement four-person crew is scheduled to launch in a SpaceX capsule in February.

NASA's Crew-11 is shown taking off on a SpaceX rocket from the Kennedy Space Center in Florida last August for the International Space Station. NASA decided to end the mission and return to Earth a month early because one of the four members has an undisclosed medical condition.

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NASA trains crews for medical emergencies and even has considered what to do if an astronaut dies in orbit.

Previously, space station officials had predicted that they might have to bring an astronaut home early for health reasons as often as once every three years or so during the lifetime of the orbiting outpost.

"And we've not had one to date," James Polk, NASA's chief health and medical officer, noted in a press briefing.

The first public sign of the current medical issue came on Jan. 7 when NASA abruptly called off the first planned spacewalk of the year, saying the agency was "monitoring a medical concern with a crew member that arose Wednesday afternoon aboard the orbital complex." The next day, the agency announced plans to bring its Crew-11 team back early.

Polk said this situation was serious enough that the team wanted to do a full diagnostic workup on the astronaut, "and the best way to complete that work is on the ground, where we have the full suite of medical testing hardware."

It's not the first time that teams back on Earth have had to triage medical conditions in space, given that the station has been continuously inhabited for a quarter-century and astronauts can suffer from the usual routine ailments that affect mortal humans — as well as physical issues associated with unusual movements of body fluids because of microgravity.

"We've had a host of different things that we've treated on orbit," Polk said, listing health troubles like toothaches and ear pain.

They've even dealt with problems like a blood clot in an astronaut's jugular vein that was discovered accidentally, during a research study on blood circulation in space.

In that case, NASA consulted with Stephan Moll, an expert on blood clots and bleeding disorders at the University of North Carolina at Chapel Hill. He says a clot in this vein is uncommon on the ground, to say nothing about space, and there were a lot of unknowns; untreated, it might just resolve on its own, or it might progress to more serious complications.

Fortunately, for reasons Moll says he can't disclose, the station happened to have an injectable anti-clotting drug on board, which the astronaut took until pills could be sent up on a resupply mission.

Injecting the drug in space wasn't easy, however, as microgravity turned the liquid in the vial into floating drops that had to be hunted down with the needle. "In space, it took about 20 minutes for the astronaut, initially, to fill one syringe," he says, so it was quite cumbersome but doable.

Moll says he was really struck by the professionalism of the whole NASA team in working through this conundrum. "I was so impressed how detailed-oriented and thoughtful people are, not just assuming things," he says.

And he remembers getting a call on his home phone from the orbiting astronaut, up on the station, who wanted to talk things over with him directly.

"They're just in a different environment, but it comes down to the same concerns that other patients have," says Moll. "They're just normal people up there."
Copyright 2026 NPR

Standing on a busy street in Skid Row on a recent sunny day, Mary Marfisee tried to block out street noise as she popped her stethoscope into her ears. Dozens of people were milling about. Dogs barked. Music blared. A constant thrum of cars drove past.

But Marfisee is used to the commotion.

"I'm going to listen to your lungs and see if they're ok. Is that ok?" Marfisee asked Hermione, a nervous woman in her twenties who declined to give NPR her full name out of fear for her safety. She was pushing a stroller loaded with plastic bags, stuffed with her belongings.

Marfisee pressed the stethoscope onto the back of Hermione's oversized sweatshirt.

"Your lungs are tight," Marfisee said with concern after a few beats. "Are you having trouble breathing?" she asked.

Everything about Marfisee's approach is slow and deliberate. Before touching Hermione's arm, she hovers her hand over it and makes eye contact. Then, she lowers her hand gently. It's a deliberate, patient approach she's developed over her long career as a family medicine physician.

Hermione's worried expression relaxed. She explained that she has asthma and her inhaler was running low on medicine. She also lost her emergency EpiPen, she said. But when Marfisee offered information about a few nearby clinics that would be able to take her as a walk-in patient, Hermione turned it down.

"Maybe later. They have a bed for me at the Union Rescue Mission," Hermione said, and Marfisee's face bloomed into a smile.

That's because Marfisee, an assistant professor of medicine at UCLA, is also the family medical services director at the Union Rescue Mission. The Christian organization operates a four-story homeless shelter that is one of the oldest and largest homeless missions in Southern California. She told NPR she's coming up on 20 years tending to the more than 5,000 men, women and children who come through the doors of the shelter every year. Over that span, she's also become a recognizable figure throughout Skid Row on regular walking rounds of "street medicine" delivered to unhoused people where they are.

The interaction with Hermione is a classic example of what typically happens with her patients — both inside the mission or on city sidewalks, Marfisee said.

"Their top priority" is finding stable housing. "Their health is at the bottom of the list," she explained.

As a result, small problems, such as infections, cuts or chronic health issues often fester and become much more serious, she said.

Christmas decorations adorn the walls at the Union Rescue Mission in Los Angeles. December 15, 2025.

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Women experiencing homelessness face unique health challenges with few resources

Los Angeles' Skid Row is an epicenter of the homelessness crisis — not just in California, but also the nation. According to a 2025 Los Angeles Homeless Services report, an estimated 43,695 city residents were homeless at the time of an annual count of the homeless population in February. Less than half — 16,723 — live in shelters while the rest are unsheltered.

Meanwhile, a 2024 study on homelessness in Los Angeles from the nonprofit research organization RAND found that Skid Row's unsheltered population continues to skew older and female. Data also shows that this group of women has significantly lower physical and mental health than those who are sheltered, due to factors such as lack of insurance and transportation. That's particularly true for basic services such as gynecological and prenatal care.

The homeless women Marfisee works with face even more challenges than men due to a lack of services, she said.

"There are clinics on Skid Row for general health services but nothing specifically set up to address women's health needs."

Union Rescue Mission's internal studies found that about 87% of women were not up to date with their preventative pap smear or mammogram health screenings.

And when women from shelters do try to get preventative care, they're often faced with a variety of challenges. Marfisee recounted one instance in which a patient who had a family history of breast cancer was trying to schedule a mammogram. After hours of calls, Marfisee said, the earliest appointment her team was able to schedule was nine months out. Then, there were more obstacles.

"She had to come in with her proof of Medicare. Well, she not only didn't have her medical card, she'd moved from address to address, didn't even have an I.D. anymore. So we had to start that whole process," Marfisee said.

Dr. Mary Marfisee and two UCLA medical students lead a cancer awareness talk in the Union Rescue Mission chapel in Los Angeles, educating women residents about cancer prevention and care.

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Another of her patients, a woman who had suffered from lower abdominal pains for decades, faced similar setbacks. When she wasn't in crisis mode — moving from one place to another, and in and out of shelters — the woman went from clinic to clinic seeking help, Marfisee said. But finding the root cause was difficult without consistent care from a doctor to see the case through.

It wasn't until Marfisee and her staff conducted an hours-long history that they learned she had had an IUD placed 32 years prior.

"We could correlate the pain to the birth of her daughter, who was 32 years old, and who was also [living at URM] with her," Marfisee said.

The team scoured their contacts and arranged an emergency appointment for the woman at a county hospital. That's where they confirmed that the forgotten IUD, which can last from 3 to 10 years, had never been removed and was "incarcerated into [her] lower uterine wall," Marfisee said.

She described it as a devastating and eye-opening moment that propelled her into action.

"We felt like we were doing Band-Aid women's health," Marfisee said. "We would just treat an infection or treat a problem, but not really get to the screening issues."

A resident at the Union Rescue Mission reviews a flyer providing information on different types of cancers and their risks. December 15, 2025

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Potential solutions meet red tape

It lit a fire in Marfisee to provide more resources for the 150 or so women who find themselves living at the shelter at any given time. Marfisee began contacting other clinics in the area but soon realized that they were not equipped to offer those services either.

"But I'm great at research," she boasted — and dogged, too.

In December she launched the first phase of a new women's health initiative at the shelter. Alongside some medical student interns, she leads regular town halls to raise awareness about important screenings, including cervical and breast cancer check ups. They encourage the women who attend to ask questions and talk about their own health.

But it's the next phase of the initiative that Marfisee believes will make the greatest difference in these women's lives. URM has partnered with a local hospital to bring a mobile health van to the shelter twice a month. That will allow Marfisee and other volunteer physicians to offer free pap smears and mammograms to the shelter's residents. She estimates they'll be able to provide up to 100 breast exams per visit.

"One of the things that [people who work with homeless women] always say is that these women are so resilient. And I understand why they say that," she said. "But I started to rethink that because they are not really able to take care of their gynecological health needs on their own. They can't really self-treat. They need to be told that this lump that they may have been palpating in the breast is something significant."

The van could be life saving, Marfisee said. Studies show that homeless women die from breast cancer at nearly twice the rate of the general population, largely due to a lack of access to adequate care and the fact that they are more likely to be diagnosed at a later, more advanced stage of the disease.

Unfortunately, she said, the plan to provide mobile health to these women hit a few red-tape and logistical snags, and is three months behind schedule; the van driver's schedule is booked up and the shelter needs to figure out how they'll be dumping any medical waste.

Marfisee, a self-described optimist, estimates they'll overcome the challenges and begin screening patients by February.

"No matter what it takes, we'll get it done. We just have to," she said.

UCLA medical students, working alongside Dr. Mary Marfisee, walk the streets of Skid Row in downtown Los Angeles, offering medical care to women in need. December 15, 2025.

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Meanwhile, the work continues

Back out on the street, in a small, neglected park about a block away from URM, Marfisee turns onto San Julian Street, which she calls "one of the roughest streets in the city."

There are more than a dozen adults at the park, in various states of alertness; some are in groups, others are alone. One of them is an older woman in a wheelchair. Her hands are gnarled, frozen in what looks to be a painful position.

She's got a scowl on her face as Marfisee and her students approach. But after a few minutes she warms up to them. They go over their set of screening questions: Any aches and pains? Skin issues? Cuts or bruises?

The woman's responses are quiet and mostly monosyllabic, but after a few minutes, she reaches out and takes Marfisee's hands into her own.

She's Marfisee's last street patient of the day. Heading back toward URM, Marfisee makes a note.

"Let's keep her in mind and make a note of where she hangs out, so we can follow up with her," she said.

Marfisee headed into the shelter where she'd jump right into seeing other patients. Maybe, she hoped, that might include Hermione.
Copyright 2026 NPR

Dr. Mary Marfisee and UCLA medical students Rashna Soonavala (right) and Jessica Menjivar Cruz (left). December 15, 2025.

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This story will be updated. Check back for details.

Ticket registration for the 2028 Olympic Games is officially open. Fans have until March 18 to join the ticket draw, and tickets will go on sale in April, starting with a pre-sale for locals.

After registration for the ticket raffle opened at 7a.m. Wednesday, some reported long wait times to register, and others still had questions about the process after signing up.

Here are answers to some of your questions.

When will I learn if I was selected for a time slot to buy tickets?
You'll get an email between March 31 and April 7 if you win a slot.

How many tickets can I buy?
You can buy up to 12 tickets.

Do kids need tickets? 
Yes. Kids of any age will need their own ticket.

The locals pre-sale is for people living in certain zip codes. How will Olympics organizers verify that the people purchasing the tickets are locals?
LA28 asks locals to register using their ZIP code and then use the same billing ZIP code when actually purchasing tickets.

Will I be able to buy multiple tickets for one event? 
Yes. LA28 says in its FAQ that you can transfer tickets to other "named ticket holders."

Can I buy group tickets?
Yes. Groups of 50 people or more can fill out an interest form to purchase group tickets.

When I buy tickets, can I select my seat?
You will be able to choose a "seat category" but not a specific seat, according to LA28. Its website says that your seat will be assigned to you later on.

Will people be able to re-sell their tickets?
Yes. According to LA28, there will be an "Official Secondary Market." The organization didn't provide any additional details.

Will each ticket drop have tickets for all sports?
Yes. According to LA28, tickets for every Olympic sport will be on sale in each drop.

What brings Greg Reyes to this Walmart south of Savannah are the low prices. He and his wife keep a close eye on their limited budget; she's retired and he's disabled. Their grocery list is always the same. But the prices have been changing.

"I used to pay like $40 a year ago, and now we're paying like $60," Reyes says. In his bags today are some chicken, turkey and beef. Other things simply had to go. "We don't buy ice cream no more because it's expensive," Reyes says. "It's kind of sad, but we have to do it like that."

The cost of living in the U.S. rose 2.7% in December compared with a year before, according to Tuesday's federal data. That's a steady slowdown after a yearslong stretch of intense inflation, but still painful. The past year also brought a global trade war, as President Trump imposed sweeping tariffs on nearly all imports. And the world continued to grapple with extreme weather, from droughts to downpours.

All of this is showing up in our shopping carts.

Since 2018, NPR has tracked the prices of dozens of items at this suburban Walmart superstore. Walmart is America's most popular retailer and the world's largest, which gives it the power to negotiate with suppliers for some of the lowest and most stable prices.

Here's what we learned on our latest price-check visit, in December. (Or skip the analysis to see the full details of NPR's shopping cart.)

Prices in NPR's basket rose 5% on average last year

Almost half the items on NPR's shopping list got more expensive in 2025, including shrimp, Oreo cookies, Coca-Cola and Dove soap. Some price increases, notably on items made in China and Vietnam, appear to be tariff related. Other price hikes had to do with weather events affecting harvests of crops such as cacao and coffee beans.

Just under a quarter of the items on NPR's list got cheaper, including eggs, milk and Cheerios. And many packaged foods stayed the same after years of price hikes.

As affordability became Americans' top concern, big brands began to worry about shoppers switching to store-label competitors or skipping some purchases altogether. To entice weary shoppers, NPR found, Walmart offered more discounts in December than it had in previous years.

A few disclaimers about our method:

• We went through almost every aisle in this Walmart to come up with the 114 items. (The full table is below.) To account for possible changes in package sizes, we focused on the price per unit, whether it was an ounce of salsa or a square foot of aluminum foil.
  
• NPR reached out to the producers of all the items on our list that changed in price. Most companies did not respond. The few that did — including Kikkoman and Campbell's — noted that Walmart, as the retailer, has ultimate control over the prices that shoppers see on shelves.
  
• A Walmart spokesperson said in a statement: "We remain dedicated to providing our customers Every Day low prices, with the goal of having the lowest price on a basket of goods over time." A store, for example, might extract deals from suppliers or charge slightly more for several items in order to sell something else at a break-even price or even below cost.

Tariffs loom over store shelves

With tariffs being the biggest story in retail in 2025, signs of their impact inevitably showed up in Walmart's aisles. Though it's hard to pin any price increase on tariffs with certainty, the through line was noticeable.

Some of the biggest price jumps were on items imported from countries saddled with hefty tariffs: Walmart's store-brand paper folders made in China (up 46%), swai fish fillets from Vietnam (up 34%), Farberware's plastic measuring spoons made in China (up 19%) and Schwinn's infant bike helmet, which used to be made in China but is now made in Vietnam (up 18%).

Walmart, Farberware and Schwinn did not comment on the impact of tariffs to NPR, but several other companies did. Dole, whose canned pineapple from Southeast Asia got 25% more expensive, cited weather-related crop shortages and tariffs on goods imported from the region.

Reynolds Wrap, whose aluminum foil rose in price by 13%, called out "historic and sustained cost increases over the past year, driven by tariffs, global supply pressures, rising energy costs, and limited availability." Much of U.S. aluminum comes from Canada, and these imports now face a 50% tax.

Walmart in May warned that new tariffs would lead to higher prices, as Trump threatened 145% tariffs on goods from China. The White House later paused, changed up and even rolled back some of its trade plans, namely on food items. By August, Walmart officials said tariff costs were rising "each week," although the company was able to mitigate many of them. In November, incoming Walmart CEO John Furner said tariffs brought "less impact" than expected early in the year.

Climate chaos roiled many industries

Some of the items with the worst price hikes are repeat offenders: coffee, beef and chocolate. They, too, were affected by tariffs — such as beef and coffee coming from Brazil — but the main culprit was the weather.

At this Walmart, the price of Maxwell House ground Colombian coffee rose by 46% in 2025 and its breakfast K-Cups by 34%. The costs of Hershey's and Lindt chocolates jumped around 26%. A pound of ground beef went up 30%, and the store now prominently displays a cheaper option: a blend of beef and ground pork.

The cost of coffee beans has soared as climate change has brought erratic rainfall patterns, floods and droughts to farmlands. Cacao harvests, too, have come up short for three years straight; West African farmers, who grow most of the world's supply, have dealt with extreme weather, changing climate patterns and disease in their aging trees. And the U.S. beef supply is at its lowest in decades, driving cattle prices to record highs, in part because of drought.

Kraft Heinz (which owns Maxwell House), Hershey and Lindt & Sprüngli in statements all cited the unprecedented higher costs of key raw materials, adding that they've also absorbed or offset part of those costs.

Shrinkflation continues in the laundry aisle

When inflation peaked after the COVID-19 pandemic, some manufacturers stealthily raised prices by shrinking their products — shampoo, paper towels, chips and candy — while charging the same or slightly more. In 2022, for example, NPR's Walmart visit found that Dove soap bars had shrunk by a quarter of an ounce, while rising in price by a few cents. (Dove maker Unilever did not comment.)

Last month, NPR spotted one case of shrinkflation: Tide laundry detergent. But the company says it's actually efficiency.

NPR first spotted Tide selling less laundry detergent per bottle in 2022: The amount of liquid had shrunk to 92 ounces from 100 ounces before the pandemic, and the price had risen by a dollar. After that, the cost stayed the same, but the contents shrank to 84 ounces in 2024 and then to 80 ounces in December.

The label continuously promised enough detergent for 64 loads of laundry.

Procter & Gamble, which makes Tide as well as Head & Shoulders shampoo (whose price rose almost 18%), told NPR that both products saw "meaningful upgrades" in the past year. Tide specifically got the "most significant upgrade to its liquid formula in over 20 years," according to the company, with a "boosted" level of active cleaning ingredients and updated dosage instructions.

"The result is superior cleaning performance in a smaller dose," a Procter & Gamble representative said.

Good news! Some things are cheaper

The biggest price drop finally came for eggs after record highs earlier in the year due to the persistent bird flu. By December, the price of a dozen eggs at Walmart dropped 30%. The cost of butter also dipped, by almost 16%, thanks to a glut in dairy production.

And as inflation-weary shoppers tighten their belts, brands have started doing something they rarely do: lowering prices. PepsiCo (maker of Lay's, Cheetos and Tostitos) last month said it would cut prices to boost sales. General Mills (maker of Cheerios, Betty Crocker and Annie's) also confirmed it plans to discount roughly two-thirds of its offerings. NPR's price check found Cheerios costing 19% less than a year ago.

A Walmart spokesperson also told NPR that the chain has added more discounts (or "rollbacks," in Walmart parlance) than it had in the past two years. The company cited 13,000 of them in the first three quarters of 2025, of which about 2,000 became permanent price cuts.

Copyright 2026 NPR

Last January, fires were raging across Los Angeles, smothering some 20 million people across the region in toxic smoke and ash.

L.A. residents worried that the air was toxic, the soil contaminated, and the water poisoned. Questions swirled about the health risks created by the burns — and there were few answers at hand from city, state or federal leaders.

Scientists from Los Angeles and around the country quickly scrambled into action as fires burned through the Pacific Palisades and Altadena. The priority, says UCLA physician and disaster researcher David Eisenman, was keeping people safe in the short term. But the fires also presented a moment to learn crucial missing information about the health effects of wildfires to help those affected and to better protect people's health from the inevitable next ones.

"This won't be the last wildfire that Los Angeles sees," says Eisenman. "Part of the community recovery process is to learn from what we experienced."

Researchers fanned out across the city to collect what data and samples they could. Doctors started thinking of ways to collect patient data to better understand the immediate and long-term health impact. They soon joined together to form a consortium that tied together 10 research institutions, developing a phalanx of research studies to explore some of the most pressing questions brought up by affected community members.

Some questions were simple but frustratingly hard to find answers to, like: What was in the smoke? Other questions, like those exploring the long-term health impacts, will take years to untangle. But answers are beginning to emerge.

Extra-dangerous smoke

Wildfire smoke is dangerous under any conditions. Exposure to high smoke levels is linked to respiratory problems such as asthma and COPD, cardiovascular issues and even dementia.

But from the first moment the Palisades and Eaton fires took hold last January, UCLA air pollution expert Yifang Zhu knew they were different. Because it wasn't just trees and plants burning: There was plastic from people's houses, and car batteries and asbestos tiles — a "toxic soup" of air pollutants, she says.

What was in that soup, and how dangerous it might be to human health — that wasn't clear. Official air quality monitors in downtown Los Angeles, miles away from the heart of the fires in Altadena and Pacific Palisades, recorded high levels of lead and arsenic in the air during the burns. Researchers from Caltech and the Georgia Institute of Technology later measured lead concentrations in air samples both near and far from the fires. Lead levels, they found, were elevated, even miles away, signaling that smoke and ash from the burns spread the dangerous heavy metal widely.

But many scientists suspected the smoke and ash spread other toxic particles and gases widely, too — chemicals that standard EPA and state monitors didn't test.

"We need to test more than just what the EPA calls for. And the EPA has limited resources," says Kari Nadeau, an environmental health scientist at Harvard University and one of the leads for the new research consortium. "But as academics, we can test for hundreds of things all at once, which helps the community. Because what you don't know, you don't know, but it can still hurt you."

Before the fires, Zhu and her team had been getting ready to sample the air at Aliso Canyon, where a natural gas leak in 2015 had caused major health problems for nearby residents. When the fires broke out, the team pivoted, taking their sampling equipment as close to the fires as they could.

That opportunity was special. Researchers are rarely ready to deploy at a moment's notice to capture samples during disasters such as the LA fires. The special circumstances let Zhu's team "set the stage about what's going on during this active fire burning all week," Zhu says.

Dust and ash from the Palisades and Eaton fires spread across the Los Angeles region.

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Zhu's team set up air filters to capture the ash, and they captured air samples inside and outside homes in the Palisades and Eaton fire regions. In the air samples, they looked for more than 20 different volatile organic compounds — gases, many of which harm human health, and are likely to be produced by the fires. And while the fires were still burning, they measured high levels of benzene, a carcinogen, at their outdoor sites.

Lingering risks

The high benzene levels dissipated after the burning stopped, Zhu found. But other dangerous gases actually increased later on, especially indoors. A few health-harming gases, including toluene and carbon tetrachloride, became more concentrated inside people's homes a few weeks after the fire.

The message was clear. "The fire impact doesn't really disappear with the active flame," Zhu says. Homes themselves can absorb dangerous gases in the drywall, furniture and other soft materials, releasing them for days and weeks after the smoke has dissipated. People need to know that their homes might be contaminated long after the fire is out, she says.

That wasn't the only lingering risk. Another research team started to look for a contaminant called hexavalent chromium, which can cause cancer, sometimes known as the "Erin Brockovich" contaminant, made famous by the movie of the same name. It can be produced when fires burn through certain types of soil or rock, as well as during industrial processes like welding. It's not often searched for after wildfires, but the researchers found it lingering in the air around cleanup sites long after the fires were out.

"It's actually one of those things that … makes you pay attention differently," says Joe Allen, an exposure scientist at Harvard University, who has been conducting ongoing research on building safety after the fires. And the contaminant was found in tiny particles so small that they can penetrate deep into people's lungs, bodies, and even directly to their brains.

"We've seen hexavalent chromium in soils after fires. I don't think anybody expected to see it in air. I don't think anybody expected to see it exclusively in the nanoparticle size range," Allen says.

Ash also contaminated people's homes, as well as soil and water across the region. The water impacts seemed to clear quickly, though longer-term effects are still being tracked. But levels of lead and other heavy metals inside people's homes and in the soil around them often remained high, even after cleanup was supposedly done.

"That is an ongoing question," says Allen. "Do we have enough funds to remediate all these properties, or are we just putting some people back into properties that are not properly cleared?"

Zhu was impressed by how much she and others learned about the dangerous smoke and ash. But she also worries they probably only scratched the surface. "We are only detecting things that our method allows us to detect. So even though we learn a lot from that, you know, I wonder what we missed," she says.

What does this all mean for people's health?

Scientists have known that in the short term, wildfire smoke exposure leads to more respiratory issues, such as asthma and COPD; increases the risk of developing dementia; and affects people's immune responses. But the full array of impacts, and the long-term costs of exposure, are still muddy.

"We know a lot about the health effects of wildfire smoke," says Allen. But "we don't know all that much about urban wildfire smoke. We certainly don't know what happens when you expose a population of 20 million people in the greater Los Angeles area to smoke like this, enriched in these toxic metals and other pollutants. "

The research is beginning to uncover some of the health impacts.

Cheng and colleagues collected data from the emergency room at Cedars-Sinai, one of the busiest in the region, and particularly close to the Palisades fire. In the 90 days following the fires, they saw a 24% increase in respiratory issues — and a 47% jump in heart attacks.

It was "very striking," she says. "This actually surpassed heart attack rates during January of all prior years, even during the worst years of COVID."

Homes and businesses in parts of Los Angeles were reduced to rubble and ash.

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Abnormal blood tests also spiked, increasing by more than 100% over previous levels. That included unexpected blood sugar readings, signs of a disrupted immune system, and changes to people's metabolic profiles — signals, Cheng says, of bodywide stresses that could be precursors to many different health problems down the line.

"For a very large number of people who lived through these January wildfires, the wildfire exposures led to some kind of a biochemical or metabolic stress in the body that likely affected not just one, but many organ systems," she says.

The team is now tracking some of those patients, trying to understand what health issues their unusual bloodwork might have signaled coming.

The ER data is likely just skimming the surface, says Eisenman. Longer-term health problems, from heart issues to mental health stresses, are likely to linger or develop in the coming years.

Ongoing research will explore the different health outcomes for people who experienced different levels of smoke and toxin exposure. A UCLA-led study has enrolled over 4,000 people from across the city to follow their health changes long-term. Another study will focus on the specific health outcomes for those who stayed behind at their homes to fight the fires, giving them extraordinarily high smoke doses. The LA Fire Health study consortium is also tracking the long-term health impacts on firefighters and first responders.

Much of the emerging research is being supported by private philanthropy, says Eisenman. The wildfires happened just before the Trump administration began its campaign to tighten budgets for many of the science agencies that have historically funded post-disaster research, like the National Science Foundation.

"That gap was really filled in by the research community, who did ongoing and extensive and really thoughtful testing of air, of water, of soil, of debris for toxins, and really rapidly communicated those results back to the community," he says. But how to financially support the long-term future of some key studies, he says, is still uncertain, because many major federal research funding resources — like NSF and the National Institute of Health — have shifted priorities under the Trump administration.

How to protect yourself and your family

The biggest questions for the ongoing research, many of the researchers say, are about how best to protect yourself from similar fires in the future.

Allen says there are some clear lessons. Overall, the less smoke one inhales, the better. So while outside, he says it's crucial to wear an N95 mask, or even a respirator that can protect you from the fire's gases.

Indoors, keeping clean air is crucial, says Zhu. Using air filters, ideally HEPA-rated, can lower indoor pollution significantly. Carbon filters are particularly effective at removing the gases, Allen says. People can also install HEPA filters in a car's air-handling system to keep the air clean while they drive.

"You want to control what you can control," says Allen. So inside your space, clean up dust and ash thoroughly. Filter the air. And consider a low-cost air monitor to keep track of the air quality inside.

For people most impacted by the fires, Allen stresses that adequate cleanup of soil and buildings is critical. "It was a bit of the Wild West out there" after the fires, he says. A lack of standardized testing protocols and a hodgepodge of policies from different insurers "really harmed the survivor community."

That lack of guidance left many unsure whether their homes were safe to live in again, and many others were forced to go back to homes that were demonstrably still unsafe.

"We need more coordinated recommendations and rules to help people know whether their homes are safe," Allen says.

It will take years to get a full picture of the health impacts of the LA fires, many of the researchers say. But it's critical to learn from the tragedy, says Nadeau, the Harvard environmental health scientist — to "be able to say, OK, in the future, here's what to do to protect your children or protect your elderly community against stroke," or lung cancer, or the myriad other risks from the wildfires that will, inevitably, come again.

Reporting for this story was supported by the Nova Institute for Health.

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