Massive clouds of smoke from the Pacific Northwest wildfires lingered over the region Sunday, posing serious health risks for millions of people and complicating firefighting efforts even as crews reported progress in slowing some of the blazes.

Air quality across Oregon was listed as “hazardous” or “very unhealthy” by state environmental officials, and a dense smoke advisory from the National Weather Service remained in effect for much of the state until at least 6 p.m. local time Sunday. Similar warnings were in place in Washington state.

The thick haze smothering the landscape has deepened the crisis brought on by the blazes, which officials have linked to at least 10 deaths in Oregon. In Portland, the air quality ranked among the worst in the world, making it potentially life-threatening for people with respiratory problems to venture outside. Even indoors, some residents were left coughing and fighting for breath.

In Michael Warner’s home in the backwoods of Marion County, the smoke was so bad he had to wear a mask inside. Over the weekend, the 50-year-old fled to the Oregon State Fairgrounds to take shelter. “My throat burns,” Warner said as he ambled around the evacuation site with his dog, his eyes swollen and watering.

Thomas Keyzers, 36, had hoped that he’d left behind the worst of the smoke when he, his wife and two children, ages 3 and 5, evacuated their home in Happy Valley. But the smoke followed them to Portland, even inside the hotel where they were staying.

He and his wife have been coughing constantly, and it’s getting worse each day. He’s worried about the health of his kids, he said. “It’s just like a 24-hour campfire,” he said. “You can only take so much of it.”

Officials and health experts urged residents to stay indoors unless absolutely necessary, keep doors and windows closed and use fans and air conditioners to keep air circulating in their homes.

Bridges, buildings and other structures were shrouded in an eerie gray fog. Visibility was a quarter-mile or less in some places, according to the National Weather Service, making it dangerous to drive and hindering firefighters.

“Our challenges remain reduced visibility, limiting our aerial reconnaissance, and rapidly changing fire conditions,” Clackamas County fire officials said in a statement Saturday.

The wildfires have engulfed more than 1 million acres of land in Oregon and displaced tens of thousands of people in what officials have called an unprecedented disaster. The death toll reported so far was likely to rise as emergency crews began sifting through the wreckage, officials said.

In California, record-shattering wildfires have charred more than 3.2 million acres and have been linked to 22 deaths. In Washington state, blazes have burned more than 665,000 acres of land and clogged the skies with smoke.

President Trump is slated to visit California on Monday for a briefing with emergency officials. Aside from a Friday night tweet thanking responders for their work, the president has said little publicly about the blazes that have wiped out entire neighborhoods and towns and destroyed vast tracts of land.

At a speech in Nevada over the weekend, Trump blamed the fires on poor forest management and boasted about the United States leaving the international climate agreement. He made a similar remark at a rally in August, saying, “You’ve got to clean your floors, you’ve got to clean your forests.”

On Sunday, Sen. Jeff Merkley, D-Ore., pushed back on Trump’s characterizations, telling ABC News’s “This Week” that the devastation was the result of a combination of ills, including rising temperatures caused by global climate change. “It’s just a big and devastating lie,” Merkley said of Trump’s statements. “The Cascade snowpacks have gotten smaller. Our forests have gotten drier. Our ocean has gotten warmer and more acidic.” The changes, Merkley added, are the “consequences of a warming planet.”

“We need to have to have a president follow the science,” he said.

Los Angeles Mayor Eric Garcetti, a Democrat, also accused Trump of negligence in responding to the fires. In an interview with CNN, he suggested the president was reluctant to help California, Oregon and Washington because they have Democratic governors.

“Leadership at the very top needs to be stronger, earlier,” Garcetti said, alleging that Trump’s “blaming of blue states over red states” in how he handles natural disasters hurts the federal response. “We need leadership that is equal across this country, instead of being partisan and divisive,” Garcetti said.

As the fires raged, emergency crews got some reprieve over the weekend as strong winds died down and cooler, moister weather moved in over some of the region.

The Riverside Fire in Clackamas County near Portland had blackened more than 132,000 acres as of Sunday morning, but officials said its growth had slowed. Evacuation warnings in Oregon City, Sandy and Canby were downgraded from Level 2 to Level 1, meaning the imminent risks were lower but that residents should be prepared to evacuate if the flames start encroaching again.

Elsewhere, the weather showed signs of worsening. In rural Jackson County, Ore., the National Weather Service issued a red flag warning for Sunday, with warm temperatures, low humidity and strong winds creating tinderbox conditions in the area along the state’s southern border. “This will help alleviate some of the smoke in the region, but will also increase fire danger,” the service said.

The South Obenchain Fire had burned roughly 30,000 acres in the central part of the county and was menacing several small towns, including Eagle Point and Butte Falls. Another active fire was burning near Medford, Ore., the county seat. Residents were under evacuation orders or warnings.

“Residents in these areas should continue to take precautions by keeping defensible space around their homes free of flammable materials, gutters clear etc.,” the National Weather Service said in a technical forecast discussion posted online “If you don’t have a ‘go bag’ ready, now is a great time to prepare.”

Dry, windy conditions were also forecast in northeastern California and western Nevada, according to the National Weather Service.

In Portland, 23-year-old Blazedol Howard wore a respirator mask over his face as he walked through the deserted streets downtown to get breakfast at a 7-Eleven. He said he had recently flown into the city from Indiana to march in Black Lives Matter protests and could smell the smoke during the plane’s descent. As he stepped out of the airport, the air felt suffocating. “I felt like I couldn’t breathe,” he said.

When Howard reached the 7-Eleven, it was already boarded up from the riots downtown, along with most businesses in the city. Across the state, other stores, coffee shops and restaurants – some of which had just recently reopened after closing for the pandemic – taped signs on their doors reading, “Closed due to the air quality.”

A few blocks from where Howard was, Christopher Murillo and his husband, Leo Cruz, braved the smoke to walk their three dogs and pick up coffee from Starbucks. The smoke was “excruciating,” said Murillo, 33. “It’s itchy, like a constant dry mouth, like wanting to hack up something and it’s all this white nasty stuff.”

They haven’t seen the sun for days, said Murillo, who grows organic produce and flowers with his husband. The skies are depressing, and the haze is inescapable – even at night, in their bedroom. “It’s like trying to gasp for air while you’re drowning,” he said.

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