There is a long history of natural disasters that make people sick. Reports range from cases of valley fever after the Northridge earthquake in California in 1994 threw soil containing spores of Coccidia bacteria in the air, aspergillus infections caused by victims of the 2011 Japanese tsunami sucking bacteria-laden water, to people infected and killed by fungi carried on debris from the Joplin, Missouri tornado, also in 2011.
But it can be difficult to determine when an infection or reaction is specifically linked to mold, as disaster damage exposes victims to so many substances. “After those floods or hurricanes there’s so much going on: not only are you dealing with a house full of mold, but you’re tearing this house apart, so there’s drywall and dust and plaster and all kinds of things. of things you ‘are potentially inhaling,’ says Tom Chiller, physician and head of the fungal disease branch of the Centers for Disease Control and Prevention. “It is difficult to disentangle the effect of mold.”
Researchers are therefore faced with a conundrum: Their clinical instinct tells them that people are at risk, but they lack the data to prove it. People who are immunocompromised are always at risk for molds and fungal infections; their diminished defenses make them unable to eliminate the fungal spores that we all breathe in every day, leaving them vulnerable to organisms such as aspergillus and the fierce mutant yeast Candida auris. CDC estimates that more than 75,000 people are hospitalized each year with invasive fungal infections and cost the health care system an estimated $ 4.5 billion annually.
Most at risk are transplant patients who have received donor organs or have undergone treatment for leukemia, and who are taking drugs that suppress the immune system to support their recovery. These people, according to the researchers, should not be near a moldy house, let alone work to repair one, and should stay away from flood waters. But in a investigation of 103 immunocompromised patients the CDC and several Houston hospitals took after Hurricane Harvey, half admitted they had returned to clean up their flooded homes, and only two-fifths of that half said they carried a protective respirator.
The CDC has been working with some of these hospitals on a more complex, as yet unpublished post-Harvey project that examines medical records from a year before and after the hurricane to determine whether immunocompromised people have developed invasive fungal infections related to it. to the storm. . There is no clear signal in the data, says Mitsuru Toda, epidemiologist in the agency’s fungal diseases arm :, some hospitals have seen an increase and the numbers are low.
To complicate this finding, she adds, some fungal and fungal infections have incubation periods long enough that symptoms may not have manifested themselves within a year of the storm. Additionally, Toda says, some Houston doctors told the agency they were preemptively putting their most immunocompromised patients on antifungals, which protected those patients, but would have blurred calculations of the hurricane’s effect on them. health.
Ostrosky-Zeichner was one of these clinicians. “In theory, we should see hordes of mold infections after major floods and hurricanes, but we don’t quite see it so far,” he says.
Researchers are also concerned about the much larger proportion of the population, estimated at 40%, who are prone to allergies and could react to molds and fungi in their homes, as well as the rest of the population, who may develop disease. new allergies after exposure. “For most people, the health effect we see most often is respiratory,” says Felicia Rabito, epidemiologist and associate professor at the Tulane School of Public Health and Tropical Medicine. “A severe reaction would be like a respiratory problem; a less serious reaction would be allergic type symptoms. If you have asthma and mold is a trigger, you can trigger an asthma attack, which is a very serious reaction.
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