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Construction of California's High-Speed Rail Could Increase Risk of Fungal Infection

Depending on who you talk to, the $68 billion high-speed rail project from San Francisco to Los Angeles is either an innovative project that will decrease greenhouse gases and lessen auto travel or is an expensive, under-funded project that will milk taxpayers, negatively impact the environment, and not improve the lives of most Californians. What I don't see people talking about is the potential for an increased risk of valley fever during construction of the rail line.

Valley fever, also known as coccidioidomycosis, is a fugal infection that is common in areas with hot summer temperatures and low rain fall. It can be contracted when fungal spores found in the soil become airborne and are inhaled. Symptoms include fatigue, coughing, fever, difficulty breathing, headache, night sweats, muscle pain, and rash. While many who are exposed to the airborne spores don't get ill or have mild symptoms, about 5 to 10 percent of cases develop a chronic lung infection that must be treated with expensive antifungal medications for months or even years.

An even smaller number of cases, about 1 percent, can develop the potentially fatal disseminated disease in which the fungus spreads to other parts of the body. This includes the skin, bones, joints, brain, and the membranes that surround the brain and spinal cord. African Americans, Latinos, Filipino's, and those with a weakened immune system (due to HIV, pregnancy, diabetes, organ transplant, certain meditations that suppress the immune system, or old age) are at increased risk for the disseminated version.

Valley fever has been a long-standing health problem for California. Spores can become airborne when soil is disrupted by earthquakes, construction, archeological digs, or even fire.

After the 1994 earthquake in Northridge, California, surrounding areas experienced an increase in the incidence of valley fever, including three fatalities, due to a dust cloud created by the quake.

In 2007, 10 out of 12 construction workers developed valley fever while digging a trench for a water pipe that traversed San Luis Obispo and Monterey counties.

In 2007, 10 out of 12 construction workers developed valley fever while digging a trench for a water pipe that traversed San Luis Obispo and Monterey counties.

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Valley fever has also been an issue in jails in the Central Valley even without construction or earthquakes. In 2013, about 197 inmates contracted the illness and four died. The state spends about 23 million dollars each year to treat both inmates and staff who have developed valley fever.

On January 4, 2015, construction of the high-speed rail began in Fresno, California. During construction, soil will be disrupted due to grading for the above-ground sections of the route and tunneling for the sections of the rail that will run underground. In both cases, fungal spores could become airborne. Tons of dirt will be transported from tunneling construction sites potentially releasing more fungal spores into the air. Considering the risk, it would make sense that the High-Speed Rail Authority (HSRA) would address these issues by informing residents of the symptoms of valley fever, providing free screening for those with symptoms, and offering treatment for anyone who develops the disease.

I spoke with Annie Parker, Information Officer for the HSRA, to find out what their plans were for dealing with an increased risk of contracting valley fever. It turns out this issue came up at a May board meeting related to the construction starting in Fresno. The HSRA says it will mitigate risk by "watering areas that will be disturbed and suspending dust-generating activities when wind speed exceeds 25 mph."

The HSRA says their evaluation of these efforts resulted in a risk of valley fever that is less-than-significant for residents in surrounding areas. The HSRA has also added precautions for construction workers including making sure they know the symptoms of valley fever, and that they wash their hands at the end of a shift, use vehicles with enclosed cabs, and wear NIOSH-approved respiratory protection.

I replied to Ms. Parker with additional questions. Could I see their evaluation? What about the tons of soil that will be disrupted during the tunneling part of the project? What about all the trucks full of dirt traveling on our highways potentially spreading fungal spores? I also asked if they had funding to screen residents for valley fever and treat those that contracted the disease or were they expecting existing health care systems to pick up the tab. These are important questions that should have been addressed before construction began. I did not receive a reply.

Considering that there are many unknowns and unanswered questions regarding our risk of valley fever, it makes good sense to know the symptoms, especially if you live or work near a high-speed rail construction site.

carole bartolotto

Carole Bartolotto, MA, RD