Millions of residents across the Midwest and Northeast are bracing for hazardous air quality this week as thick smoke from wildfires burning in Canada and Minnesota sweeps south and east, pushing pollution levels into dangerous territory.

Minnesota officials have issued an air quality alert stretching from Tuesday through Friday, covering the Twin Cities metro area, Alexandria, and Two Harbors. The state’s northeastern corner is expected to see the heaviest smoke as large fires continue to spread. In Two Harbors, the Tribal Nation of Grand Portage, and other parts of northeast Minnesota, air quality is forecast to hit hazardous levels—posing risks for everyone, not just vulnerable populations.

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Dan Westervelt, an associate professor at Columbia University’s Climate School, pointed to severe drought and heat as the key drivers. “It’s a perfect storm for really dry conditions to provide a lot of fuel for these wildfires to burn,” he said. Research shows that rising temperatures from burning coal, oil, and gas are making fires more frequent and intense.

Tyler Hasenstein, a meteorologist with the National Weather Service in Chanhassen, Minnesota, urged residents to stay indoors as much as possible to avoid both extreme heat and the incoming smoke. “Those two things coinciding with each other is not good from a health perspective,” he warned.

Officials in Michigan and Wisconsin also warned residents Tuesday about air quality issues that could persist for days. High levels of fine particulate matter from wildfire smoke may be especially unhealthy for sensitive groups, including children and those with heart or lung conditions.

In parts of Maine, residents reported a yellowish and brownish tint in the sky. “There is plenty of smoke upstream, so expect periods of hazy skies over the next day before the cold front pushes through,” the National Weather Service in Gray, Maine, said on social media Tuesday.

By Wednesday afternoon, intense smoke is expected to push into the East Coast and Midwest, including parts of the New England coast, northern Pennsylvania, Detroit, and Milwaukee, according to Hasenstein. Multiple counties in western and central New York were under an air quality advisory Wednesday until midnight, and the most intense smoke could reach as far south as Washington, D.C., by midday Thursday.

Fine particle pollution from wildfire smoke can cause shortness of breath, coughing, dizziness, or fatigue, and can aggravate heart and lung diseases and other chronic conditions. Experts recommend reducing or eliminating outdoor activities, wearing an N95 mask if going outside is unavoidable, and keeping indoor air clean by closing windows and running an air purifier or air conditioner. Long-term exposure to fine particulate matter from wildfire smoke is one of the leading causes of premature death.

The ongoing crisis highlights the intersection of climate change and public health, as policymakers face growing pressure to address the underlying causes of more frequent and severe wildfires. For now, millions are left to navigate the immediate health risks of choking smoke.