Smoke and Ash obscuring the sky above a soccer venue
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The eyes of the world will turn to New York New Jersey Stadium in East Rutherford, New Jersey for the FIFA World Cup final on July 19, 2026.
But this summer, another force of nature may steal the spotlight: wildfire smoke. As fires rage across the American and Canadian West, plumes of fine particulate matter have repeatedly blanketed the northeastern United States, turning skies orange and sending air quality readings into hazardous territory. FIFA, by all available accounts, still lacks a comprehensive contingency plan. The health stakes — for players and fans alike — are enormous.
“Air pollution is the most important environmental cardiovascular risk factor, with PM2.5 being the most studied air pollutant,” said Dr. Abeer Berry, director of noninvasive cardiology at DMC Huron Valley-Sinai Hospital. Berry added that air pollution is the fourth leading risk factor accounting for global mortality.
Wildfire smoke is not ordinary haze. It is a toxic cocktail of fine particulate matter or PM2.5, ozone, nitrogen dioxide, carbon monoxide and volatile organic compounds. PM2.5 — particles smaller than 2.5 micrometers in diameter — is the primary health concern. These particles are small enough to bypass the body’s natural defenses, penetrate deep into the lungs and even enter the bloodstream.
“The relationship between air pollution and cardiovascular disease is well established and supported by extensive epidemiologic data,” said Dr. Mohammed Alo, former assistant clinical professor of medicine at Midwestern University in Downers Grove, Illinois and assistant clinical professor of medicine at Ohio University in Athens, Ohio. ”Short-term exposure (hours to days) increases the risk of myocardial infarction, stroke, heart failure, arrhythmia, and sudden death by approximately 1–2% per 10 μg/m³ increment.”
“Longer-term exposure (months to years) amplifies these risks to 5–10% per 10 μg/m³, with prospective cohort studies showing 16–31% increases in ischemic heart disease mortality per 10 μg/m³ increment in annual mean PM2.5. Importantly, the exposure–response relationship extends to levels well below current regulatory standards, with no identified safe lower threshold at the population level,” explained Alo.
A Toxic Brew Of Chemicals In Wildfire Smoke
Research published in the New England Journal of Medicine has shown that wildfire PM2.5 may be more toxic than urban air pollution, containing higher concentrations of oxidative and pro-inflammatory chemicals. When wildfire smoke reaches urban areas, its toxic effects on immune cells can be up to five times more intense than the same dose of everyday city pollution.
Toxic chemicals from wildfire smoke are recognized as a destabilizing force for patients with coronary artery disease, according to Dr. Berry. “Air pollution increases cardiovascular risk factors like elevating blood pressure and heart rate, increasing insulin resistance and total cholesterol, bad cholesterol and triglycerides. It also can lead to increased calcium scores, accelerated plaque accumulation and higher likelihood of unstable plaque formation, she emphasized.
Why Elite Athletes Are Most At Risk
Elite athletes are paradoxically among the most vulnerable people in a smoke event. During a 90-minute match — potentially 120 minutes with extra time — professional soccer players cover 10 to 13 kilometers at varying intensities. At peak exertion, their minute ventilation (the volume of air breathed per minute) can increase tenfold compared to at rest. This means they inhale vastly more polluted air than a sedentary spectator.
Huge Forest Fire in Red Pine Forests
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A position statement from the Canadian Academy of Sport and Exercise Medicine warns that athletes exercising at high intensity during poor air quality episodes dramatically increase their inhaled dose of harmful particles. The consequences are not trivial. Short-term exposure to elevated PM2.5 is associated with impaired lung function, airway inflammation, increased airway resistance, and exacerbations of asthma.
Cardiovascular effects include endothelial dysfunction, increased blood pressure, altered heart rate variability, and a heightened risk of heart arrhythmias, or abnormal heart beats. For an athlete pushing their body to its absolute limit in a World Cup final, these physiological insults could impair performance, provoke an asthma attack or — in a worst-case scenario — trigger a cardiac event. New York New Jersey Stadium holds over 82,000 spectators. On a smoky day, tens of thousands of people — including children, elderly fans, pregnant women and those with asthma or heart disease — would be sitting outdoors for hours. The American Heart Association has identified these groups as particularly susceptible to PM2.5-related cardiovascular and respiratory events.
Even for healthy adults, hours of exposure at AQI levels above 150 (“unhealthy”) can cause throat irritation, coughing, headaches, and shortness of breath. At AQI levels above 200 (“very unhealthy”), public health guidance from the U.S. EPA recommends that the general public reduce prolonged outdoor exertion and that outdoor events be rescheduled. Beyond the stadium, millions of fans would be gathering at outdoor watch parties, tailgates, and fan zones across the region, compounding the population-level exposure.
“Patients with cardiovascular disease or risk factors should check the EPA Air Quality Index before planning outdoor activities,” recommended Dr. Alo.
The Logistical Challenges Mounting
FIFA faces a menu of imperfect choices, and the clock is ticking. Relocating the final to a city with cleaner air — say, Dallas or Los Angeles — is the most effective intervention from a health standpoint. Elimination of exposure is at the top of every public health hierarchy of controls.
But the logistical, contractual and financial barriers of moving the biggest single sporting event on Earth with days’ notice are staggering. Playing in a domed or retractable-roof stadium would dramatically reduce PM2.5 exposure for players and fans, especially if the venue has modern HVAC filtration. However, New York New Jersey Stadium is an open-air venue, and no nearby indoor stadium of comparable capacity is readily available. This option would likely require a venue change as well.
N95 Respirator Close Up In Hand
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N95 respirators can filter out more than 95% of PM2.5 particles and are recommended by multiple sports medicine bodies for athletes training in poor air quality. However, systematic reviews show that N95 masks modestly reduce oxygen uptake, increase perceived exertion and dyspnea, and can impair maximal exercise performance — effects that could be decisive in a World Cup final.
No elite soccer governing body has ever required players to compete in respirators, and it is difficult to imagine players accepting this in the most important match of their careers. Distributing N95 masks to 82,000 spectators is logistically feasible and would meaningfully reduce individual exposure, but compliance would be voluntary, fit varies widely, and masks do nothing to protect against ozone and other gaseous pollutants that pass through particulate filters.
Postponing the match by 24 to 48 hours, if air quality forecasts predict improvement, may be the most pragmatic compromise. Wildfire smoke episodes are often transient, driven by wind patterns that can shift within a day. This approach preserves the venue, the spectacle and — most importantly — the health of everyone involved. It is not without precedent: Major sporting events have been delayed for lightning, extreme heat, and even volcanic ash. Air quality deserves the same respect.
The science is clear: Wildfire smoke is harmful, and the harm is amplified by physical exertion. The American Thoracic Society, the American Heart Association, and sports medicine organizations worldwide agree that outdoor activity should be modified or curtailed when AQI levels are elevated.
FIFA has an obligation — moral if not contractual — to establish clear, pre-defined air quality thresholds that trigger specific actions: monitoring, advisory warnings, mask distribution, match delay or, if necessary, relocation. Waiting until matchday to improvise is not a plan. It is a gamble with the lungs and hearts of players and fans on the line.
Climate Change As An Ongoing Factor
Climate change is making these decisions unavoidable. The 2023 Canadian wildfire season sent New York City’s AQI above 400 — “Hazardous” by any standard. It will happen again.
World football’s governing body must address air quality for athletes and fans alike, maintaining vigilance and the highest quality standards. The reality is that it is a foreseeable, manageable public health risk that demands the same rigorous planning as heat illness, lightning, and crowd safety. The game deserves nothing less.