In a summer of smoke, a small town wonders: How are we going to do better than survive?

For much of the past month, Winthrop and its neighbors up and down the Methow Valley in Washington state have lived under an oppressive blanket of wildfire smoke. On certain days air quality has been the worst in the country - and possibly in the world - according to the National Weather Service, which described it as "almost off-the-charts hazardous."

The mayor runs three air purifiers around-the-clock in her house and leaves a box of free N95 masks on a bench outside town hall. The town's marketing director is considering enrolling her children in school in Oregon. A family doctor treats patients struggling to breathe and others knotted with anxiety, uncertain whether to stay or go.

"It's all people are thinking or talking about," said Jesse Charles, one of the few doctors in the Methow Valley. "This cloud that's over everyone."

It is another summer of smoke in America, as dozens of wildfires rage throughout the West and Canada. A historic drought and record heat waves worsened by climate change have crisped and yellowed the landscape, priming it for massive blazes. The wildfires burning in the West and in British Columbia have produced enough smoke to muddy the skies across much of the United States this summer.

As of Friday, more than 100 large fires were burning across 14 states. Smoke from Oregon's Bootleg Fire, the nation's largest at more than 413,000 acres burned, has already traveled to New York City and Washington, D.C. In recent days, the smoke over Minnesota and the Dakotas has pushed air quality into hazardous territory.

The hazy skies and campfire smell of smoke pollution may still be an alarming rarity for parts of the nation; but this corner of the Pacific Northwest is learning what it means to live with an extreme dose year after year.

In Winthrop, two massive wildfires - the Cedar Creek and Cub Creek 2 - have been burning for much of the past month on either side of town. They have consumed more than 113,000 acres of forest and produced billowing towers of smoke visible from Seattle on the far side of the Cascade Mountains. That smoke also settled in the valley and barely budged, amid scorching temperatures and not enough windy days to clear the air.

"It's kind of the worst-case scenario with smoke," Winthrop Mayor Sally Ranzau said. "It sandwiches us in there."

Even though it's only midsummer, Washington state has already had more than 1,200 wildfires. It's a record for this time of year and nearly twice the average number over the past decade, said Hilary Franz, who oversees Washington state's Department of Natural Resources.

In the typically drizzly Pacific Northwest people live for the blue skies of summer and wildfires are increasingly threatening those precious times. Over several days this week, an air quality advisory was in effect for the entire eastern half of the state.

"Unfortunately, year after year now, our summers are being completely lost to smoke," Franz said. "We move from one gray to the next."

There have been no deaths and five buildings have been lost in the two Winthrop fires, but that toll doesn't capture the social and economic harm the community is enduring. The mountains and forests in the area are a major tourist draw - attracting as many as 1 million visitors a year, town officials say - and that economy has ground to a halt. The scenic North Cascades Highway that brings many visitors has been shut down while firefighters battle flaming patches of snags. Many of the trails for hiking, biking and cross-country skiing that made this area a national destination for outdoor recreation run through lands that are burning.

One of the Pacific Northwest's most famous resorts, the Sun Mountain Lodge, was evacuated last month as the Cedar Creek blaze bore down on the building. To save the resort, firefighters dug bulldozer trenches throughout the manicured grounds. The 3,000-acre resort, one of Okanogan County's largest employers and a major source of tax revenue, is now shut down through at least August and faces a major restoration effort, said Eric Christenson, the lodge's director of sales and marketing.

"The thick smoke coated the surfaces of the lodge both on the inside and outside," he said. "The swimming pools are filthy. The hiking and horse trails - I imagine they're devastated."

On Thursday morning, as the air quality sensor at the Montessori school was reading about 260 - a level of fine particle pollution that the Environmental Protection Agency describes as "very unhealthy" - Abby Pattison stood on the deck of the nearby Observatory Inn, wearing an N95 mask and watering her plants. It was about half as smoky as it has regularly been over the past month; clear enough even to see across the street.

"This is actually not too bad," she said.

Pattison, 43, and her two business partners recently bought the hotel along Winthrop's main street, with its rough-hewed boardwalk and Old-West-style facades. The Seattle native had moved to this former gold mining town 11 years ago with her ex-husband and soon fell in love with the community and the opportunity to run on endless mountain trails. Both the town and its flow of tourists were growing, and she wanted to invest in helping shape its future. They named their hotel the Observatory Inn because of its high perch and - on a clear day - striking view of the mountains beyond. The sale closed on June 21.

Within a few days, the smoke rolled in.

Since then, the hotel's been mostly empty. She's had to warn away potential customers who call and aren't aware of the air quality. The only guests have been some evacuees from an aborted Outward Bound trip and the occasional firefighter, both being charged at cost, she said. Pattison and her partners have been meeting to discuss expensive new air filtration systems and strategies for the fall since the fires are projected to burn until it snows. This weekend the hotel will be completely vacant, she said.

"We had our rainy day budget and we had to tap into it right away."

Before the smoke blew into town, the hotel, as with much of Winthrop, had been having its best year on record as the pandemic eased and visitors flocked to outdoor destinations. Over Memorial Day weekend, Abilene Hagee could look out of Trail's End Bookstore and see throngs of people window-shopping along the main street.

"The boardwalk was more packed than I'd ever seen it. It was just wall-to-wall people," she said.

Not long after the fires broke out, her business plummeted by "90 percent, and it's been kind of hanging out there," said Hagee, who is also board president of the local chamber of commerce.

"The air quality's awful," she said. "We're a tourist town, economically driven by that. And how do you invite somebody to come and play in your area when it's so bad?"

Some restaurants, hotels, outfitters and guiding companies in the valley have closed, at least temporarily. Layoffs have set back housekeepers and food service staff members who were just recovering from pandemic disruptions. Many residents who could afford to leave decamped to the other side of the mountains in search of cleaner air.

"The economic impact is the hardest thing," Ranzau said. "I think the smoke event was worse than covid was. ... People were still here during covid. People didn't go away. There were still visitors. We still had tourists. The highway wasn't closed."

As his co-workers were laid off, took vacation or found other work over the mountains, Dave Dewbrey, 49, stayed behind, part of the skeleton staff still working at Methow Cycle and Sport. He works on repairs and other projects put off during last year's rush. But it has not been easy. He is allergic to smoke, he said, which feels to him like an exaggerated form of hay fever. Dewbrey swallows allergy pills every day and is never far from a handkerchief. Particularly worrisome is that his 2-year-old son has developed a cough.

"[We] were walking up the road out at our place. He would run, and then he would stop ... and he would do deep breaths. And I would think, 'Is this smoke affecting him?' "

Pattison, the hotel owner, decided to move her two daughters, ages 6 and 9, out of the valley when she could see in the distance the flames of the Cub Creek 2 Fire, which erupted July 16. The worst part, she said, was that her daughters were waking up in the middle of the night worrying about fires, unable to fall asleep. They've spent part of the time with their grandparents in the San Juan Islands, in western Washington, ever since.

"It just looked huge and very scary," she said. "We didn't really know what was going to happen at that point, with just how dry everything was, and it didn't seem like fire lines were really helping because it was so dry."

On Tuesday evening, a rainstorm helped clear some of the smoke and Pattison went to a movie at the Barnyard Cinema. The space had well-filtered air and she could see friends and try to relax. She was in the middle of "Roadrunner," the documentary about chef Anthony Bourdain, when a neighbor texted her.

"There's a smoke check on Davis Lake and we are gone," the neighbor wrote.

Lightning had just sparked a new fire within a couple miles from Pattison's home - the closest one yet - and the neighbor needed someone to "get the cats out and turn the sprinklers on."

Pattison stood up and rushed out of the theater. That night she considered packing up her home and moving out.

Situated in dry forests on the eastern slopes of the Cascades, the Methow Valley is familiar with forest fires. But the pace and intensity of those blazes - and the subsequent threats from smoke and bad air quality - have been increasing as the planet warms, driven by humans burning fossil fuels.

The average temperature in Okanogan County, which includes Winthrop, has risen 1.1 degree Celsius since 1895, slightly above the national average, according to an analysis of temperature data in the United States by The Washington Post.

The big fires and smoke years of the past decade are a part of daily conversation here; just as the charred tree trunks still visible on the mountainsides speak to the proximity of the risk. The Carlton Complex Fire of 2014 that burned more than 300 homes is still the state's largest wildfire. The Okanogan Complex Fire the next year left three firefighters dead. In 2018, flames threatened the town of Twisp, just south of Winthrop, while smoke blanketed the valley for days.

Even in winter, the Methow Valley struggles with clean air because residents have traditionally heated their homes by burning wood. But the onslaught of wildfires has pushed air quality to distressing levels, regularly above 400 on the state's air quality index scale.

Over the past decade, Okanogan County has spent more days with compromised air quality than any other county in the state, according to data from the state Department of Ecology's air quality program. This year has been the worst of all by some measures, as residents have spent nearly half their days breathing air that's other than "good" - including levels defined as "unhealthy," "very unhealthy" and "hazardous." There have already been more "hazardous" days recorded by the county's three official air quality monitors than in any year since the state started collecting date in 2006.

"It got bad fast and then it stayed bad for a month now," said Andrew Wineke, a spokesman for the state's air quality program. "Winthrop had some of the worst air quality in the world several times in the past few weeks."

The science is "really clear" that the state's summers are hotter and dryer and that climate change will continue to worsen the threat of wildfires, said Amy Snover, director of the Climate Impacts Group at the University of Washington. She owns a house in the area and has been visiting since she was a child; after the Cedar Creek blaze erupted last month, her parents were forced to evacuate.

Projections based on climate change models predict a quintupling of the amount of wildfire acreage that will burn in the Columbia River Basin by the end of the century, compared to the average annual area burned from 1916 through 2006, according to Snover.

"We expect exceptionally hot and dry weather to increasingly not be the exception," she said.

For those who don't leave by choice or necessity, the solution to coexisting with smoke comes down to finding spaces to breathe.

Liz Walker runs four air purifiers in her home - three plug-in HEPA filters and a box fan strapped to an air filter. Her house is a relatively new construction and meticulously sealed. Even so, on smoky days the air inside regularly exceeds 50 on the EPA's air quality index scale - considered "moderate," one step below "good." Others who have no purifiers or air conditioners and must open their windows on hot nights are forced to breathe extremely polluted air.

Walker, whose background is in toxicology and who has a doctorate from the University of Washington, has been fighting to improve the valley's air for years. Her organization, Clean Air Methow, is renowned in the area for raising awareness about the problem and getting air filters into the community, particularly among those who can't afford to fortify their homes against smoke. She calls what is happening this summer a "smoke disaster," and she believes the federal government should treat such events as they do other natural calamities, with funds for relief and recovery.

The consequences of these disasters are both visible and harder to track. Residents with respiratory troubles face acute health problems and difficulty breathing while others report sore throats, coughing, tightness in the chest, headaches and raspy voices. Many suffer from anxiety and depression. Staff members at a local social services organization, Room One, said that domestic abuse cases and residents coming to them with "suicidal ideation" spiked last month during the most intense smoke.

"This is normal summer now. The last 10 years, seven of those had smoke episodes that extended beyond a week," Walker said. "How are we going to do better than survive? How do we retain a love of place? A love of summer?"

The increasing number and size of wildfires could make Winthrop something of a cautionary tale as more smoke spreads across the country.

"The 2021 fire year is different from any before," Randy Moore, the chief of the U.S. Forest Service, wrote his staff in an Aug. 2 letter. The number of large fires burning, and the 22,000 personnel responding, were both nearly three times more than the 10-year average for the month of July. "Severe drought is affecting over 70 percent of the West, and the potential for significant fire activity is predicted to be above normal into October."

"In short, we are in a national crisis," he added.

At the Methow Valley Clinic, Jesse Charles, the family doctor, has treated a stream of patients whose asthma and chronic obstructive pulmonary disease have been inflamed and aggravated by the wildfire smoke. Some have been coughing up phlegm and breathing in a way he described as a "death rattle."

"They're totally drowning in their own lungs," he said.

He has been talking about air quality with every single patient since the smoke hit, he said, regardless of the ailment. Children are of particular concern.

"These wildfire events damage the development of children's lungs, in a long-term, permanent way," Charles said. "If you have the resources you should just leave the valley."

Researchers at Stanford University estimated that smoke from wildfires contributed to some 1,200 deaths in California last summer.

After he finished up work on Wednesday evening, Charles sat on the back deck of the local cinema and looked over the valley. The air quality had greatly improved that day - enough that people seized the chance to get outside, not knowing when the haze would be back.

A patient of his walked out onto the deck.

"Enjoying the fresh air?" he asked.

It was somewhat in jest; but she truly was relieved.

There was still smoke in the air, but nothing like they'd been living through for weeks. The sun was setting, and now she could see it.