I woke up in my dark bedroom the other day, head pounding and mouth dry. Before I even got out of bed, I knew that Beijing was having one of its hazardous-air-quality days. There was a tickle in my throat. My eyes stung and watered the minute I set foot outside.

On a similar day a few days before, I’d walked only 10 minutes from my apartment to my friend’s place. By the time I got there, my coat, scarf and hair smelled the way they would have smelled after a night in a smoky bar followed by a couple of hours standing behind a car’s exhaust pipe.

If that’s what the air pollution is doing to my new winter coat, I wonder what it’s doing to my lungs.

The fine particulates in Beijing air, created by coal being burned to generate electricity and to heat homes, and by car exhaust and factories, are the most dangerous kind, doctors say, because they can lodge in the lungs, where they are absorbed into the heart, the blood and lung vessels, potentially causing heart disease and cancer. Adding to the problem are Los Angeles-like inversions that trap air within the city’s boundaries.

This winter has been particularly bad. January alone had 19 days of hazardous air quality, which means that levels of the smallest particulate matter soared to over 301 micrograms per cubic meter. The U.S. Embassy, which monitors Beijing’s air quality, says that hazardous air can lead to “serious aggravation of heart or lung disease and premature mortality in persons with cardiopulmonary disease and the elderly; serious risk of respiratory effects in general population.”

Not long ago, the embassy posted recommendations about what to do in hazardous air situations. When the pollution rises above 500 (which the embassy calls “beyond index,” although the term “crazy bad” also has been used), it advises people to stay indoors with air purifiers, be familiar with the signs of heart attack and stroke, and remain sedentary. Don’t burn candles. There’s even a link for a California site on dealing with wildfire smoke, which creates the same level of fine particulates as really bad air days in China. Justin Higgins, an embassy spokesman, said, “I think it’s fair to say, given the recent conditions, that we wanted to push our recommendations out there.”

Not the most polluted city

It’s hard to compare Beijing’s bad air days to conditions in the United States. A friend of mine who grew up in Los Angeles in the 1960s recalls the California smog as “a constant, eye-stinging haze that ranged from yellowish to brownish.” But the Clean Air Act in 1970 had an impressive effect, so much so that Salt Lake City had a minor freakout in December when its pollution reached a level that would be considered only moderate by Chinese standards: a smallest-particulate reading of 130. Utah officials deemed it a “public health emergency,” and USA Today described it as “sickening fog.”

By Chinese standards, it’s barely worth mentioning. In fact, 130 in Beijing is officially just “unhealthy for sensitive groups.” My husband and I consider 150 to be the rough cutoff for jogging outside.

On Jan. 12, the measurement reached 886, which one article equated to living in a smokers’ lounge. And Beijing isn’t even the most polluted city in China, according to the Chinese Ministry of Environmental Protection. That honor goes to Urumqi, in the far west of the country. We’re No. 3.

Foreigners living here talk about how the bad air causes them a plethora of health problems, from days-long headaches to bad coughs to sinus issues that require surgery. One expat told me that after a friend of hers had lived in Beijing for about three years, her doctor said her lungs looked like those of a pack-a-day smoker, even though she had never picked up a cigarette. Many parents refuse to let their children play outside, and one mother said her 2-year-old was starting to look like a vampire because he was so pale.

Chinese people living in the capital often wear flimsy cloth masks, more decorative than protective, and they’re starting to get worried that the air is affecting their health. The government ordered some factories shut down and limited the number of government-owned cars in the city, but no one seems confident that an immediate and sustainable solution is near.

Not our biggest problem

Years ago, longtime expats say, the cold winter winds often blew away Beijing’s air pollution, but now, with the city having grown and with so many households still burning coal for heat, the winter tends to have as many bad days as the summer.

We live in an apartment with large, drafty windows. My bedroom is the draftiest room in the house, so I usually know when I wake up whether the air quality that day is bad. The windows are so leaky that a strong wind will blow them open, and you can hear the cars on the street as if they were right next to you. The windows in the dining room is smudged with grime that seeped in from the outside.

When I venture outside, my eyes burn and my throat catches with the dryness and the cold and the stink. There’s a tickle in my throat and I’m developing what’s called the Beijing cough. People’s Daily described the cough as “the symptoms of dry cough and throat itching suffered by foreigners when they arrive in Beijing. It is a manifestation of their inability to adapt to the climate of Beijing” and will disappear when they leave the city, the paper writes. News reports say that thousands of people are jamming the hospitals with asthma and other respiratory ailments.

So why don’t I wear a mask outside or use a machine inside? I suppose it’s because there are enough other health issues that seem more significant.

Food safety is a big issue. Is it safe to eat Chinese-brand yogurt? What about strawberries from Yunnan or cauliflower from Beijing?

Water is also a concern. One cannot drink the tap water, so that means buying bottled water. But what kind of water should be used to wash fruit and vegetables? I don’t buy the special vegetable-washing detergent that some folks use, and I wash my fruit and vegetables with water that I’ve taken from the tap — and then boiled.

Transportation poses its own problems. In this sprawling city of more than 20 million, there’s no easy way to get around. Walking is dangerous, as cars often speed up if they see you scurrying across the street. Taxis can be hard to find. And the subway, which expands every day, is cheap but so crowded that I’ve had lipstick wiped from my mouth as I stood in a packed car. I’ve seen people unable to get off a train at their stop, prevented by the surge of crowds pushing into the car.

I have many friends who bike everywhere in town, but the stories of accidents and injuries and near misses have been enough to put me off.

As a result, air quality slips down my worry list. When the smallest-particulate reading hit 422 (the U.S. Embassy app warns: “Hazardous, protection recommended; health alert: everyone may experience more serious health effects, please avoid physical exertion and outdoor activities”) the other day, one of my friends texted me: “That does it. I’m going to take a nap. When I wake up it better be down to ‘very unhealthy’ or lower.”

I’m not sure who the veiled threat was aimed at, but I certainly appreciate the reaction. Sometimes in China, the only reaction is to stay inside, stay calm and figure out what to order for takeout.

Bruno is a freelance writer in Beijing. She blogs about her life at notbyoccident.blogspot.com.