Hastings doctors have called for residents to take daily precautions as the region continues a run of hazardous air quality conditions.
Some residents are wearing protective face masks while schools are keeping children indoors for the second week as thick blankets of smoke from bushfires burning across the Mid North Coast smother the region.
The NSW Department of Planning, Industry and Environment says an air quality index (AQI) score of more than 200 across each its measurable pollutants is considered hazardous.
Port Macquarie registered a hazardous visibility reading of 3185 between 8am and 9am on Tuesday, November 19, and a AQI rating of 246 for air-borne particles.
In comparison, the airborne particles rating in New Delhi, India at 6am, according to the US Embassy's air quality data, was 197.
"New South Wales is experiencing decreased air quality as a result of ongoing drought and an increase dust. The effects have been exacerbated by the large number of wildfires still burning across NSW with smoke drifting over nearby towns and cities," said a departmental spokesman.
The spokesperson said the air quality is not unusual for this type of significant fire event.
The department has installed a temporary air quality monitoring pod in Port Macquarie in response to the Lindfield Park fire which began burning in July.
The mobile air monitoring pod measures visibility, carbon monoxide, oxides of nitrogen dioxide, ozone, sulfur dioxide and airborne matter as well as meteorological measurements such as wind speed.
The data collected in Port Macquarie to date indicates that air quality can become poor overnight, from after about 8pm until mid-morning, and that this pattern varies with weather conditions.
Port Macquarie resident Ladda Artthajinda is one of many residents who have begun wearing masks to protect against the smoke.
"Normally I like to walk every morning but unfortunately I can't breathe properly and I need glasses because of the smoke," she said.
"The mask helps and protects me. The smoke is quite bad at the moment and people should be protecting themselves.
"Some people think it looks weird wearing the mask while walking but I don't care."
Port Macquarie general practitioner and Doctors for the Environment Australia spokesperson, Dr Sarah Mollard, said people need to take steps to limit exposure to bushfire smoke.
"As medical practitioners our concerns are that there is an ongoing smoke risk since July and it seems unlikely that the risk will dissipate in the short to medium term," she said.
"Friday obviously brought the air pollution issue to a head with extremely high air quality index ratings. As health professionals it's clear there are people who haven't received the health risks associated with bushfire smoke exposure.
"It's certainly been the experience of doctors on the ground there have been increases in presentations to the emergency department with respiration symptoms and general practices on those days the air quality has been worse.
"We know that even at lower readings than the 200 air quality cut off, people can be at risk of health consequences such as worsening of asthma and airways disease."
Of particular concern are those residents working outside without protection or people exercising in smoky conditions, said Dr Mollard.
"There are concerns about people who are required to work outdoors such as directing traffic outside schools or people working on roads without appropriate P1 or P2 rated masks," she said.
"There are still people outside exercising despite quite high levels of air pollution and this smoke exposure can lead to significant short term consequences.
"Itching or burning eyes, throat irritation and running nose is unpleasant if fairly minor. More seriously it can lead to exasperation of respiratory illness such as asthma and chronic airways disease.
"Workers and employers need to take steps to reduce harmful effects. People should be aware of conditions and have a look at what the air quality looks like before they make the decision to work or exercise outside.
"My understanding from overseas experience of air pollution is that long term exposure to air pollution can have further affects on people's health."
Dr Mollard said residents can be aware of conditions and adapt to them by wearing protective equipment, review their action plan and stay indoors on increased pollution days.
Read more: NSW breathing problems up due to bushfires
The North Coast Public Health Unit advises Mid North Coast residents to take health precautions while the bushfire smoke affects air quality.
Fine smoke particles affect the human cardiovascular and respiratory systems and can aggravate existing chronic health conditions, by penetrating deep into the lungs and entering the blood system.
"A huge productivity impact in Port Macquarie (is in progress), with businesses having to close due to staffing problems," said Port Macquarie general practitioner Dr Claudia Long.
"I have seen many patients with respiratory distress and other symptoms such as headaches and nausea from elevated carbon monoxide levels.
"This has also affected health service availability as staff members were sent home due to symptoms related to smoke exposure causing some general practices to close.
"The way the government talks about climate change doesn't match up with the reality we are facing. They say children shouldn't miss school to call for stronger action on the climate emergency but many schools were closed last week due to bushfire risk. Children were being sent home sick due to the health impacts air pollution."
Wauchope medical practitioner Dr John Blyth said communities should be working towards a renewable future.
"This is a climate emergency. Federal, state and local governments need to change priorities and start actively working towards a renewable future," he said.
"This must include planning for the impacts of climate change on our communities and adequate resourcing for emergency services".
The smoke is also dropping burnt vegetation along the Mid North Coast with bushfire ash and blackened leaves falling on local beaches.
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