November 7, 2005
Resources
The Natural Resources Defense Council's New Orleans Air Quality Test Results (NRDC)
The Center for Disease Control and Prevention (CDC) Mold Report (html) (PDF)
The CDC's Environmental Health Needs and Habitability Assessment for Hurricane Katrina
Call Notes
Speakers: Stephen Redd, MD, Ron Moolenaar, MD, MPH, Gina Solomon, MD, MPH, Willie Fontenot
I. Introduction
Susan Marmagas and Polly Hoppin, CHE Asthma Working Group Coordinators introduce the 4th Asthma Call: Welcome to new CHE employees, Susan Marmagas, Director of Health Programs, and Julia Varshavsky, Program Associate
*We will have our fifth call in the next few months and resume the postponed topic of short-term funding issues and long-term financing of asthma programs.
Focus of today’s call: What are the respiratory issues in the Gulf Region in the context of Katrina, and how can the CHE Asthma Working Group be helpful to Gulf Coast communities facing these issues?
II. Presentations
1) Stephen C. Redd, MD: Chief of the Air Pollution and Respiratory Health Branch of the National Center for Environmental Health, at the Centers for Disease Control and Prevention
Stephen gave a personal view of his experience with respiratory health issues in New Orleans and the broader Gulf Region. Stephen and his team at the CDC were sent to New Orleans on Labor Day weekend when the large-scale mobilization effort finally took place, and in joint activity with the EPA as a part of a national public health response to the crisis. The CDC mission was to create an Environmental Assessment Report (eventually released on Sept. 17th, 2005) that would identify what overall issues would need to be dealt with in order for people to safely move back into their homes. In general, the CDC found many public health issues to address, including: 1) Wastewater and drinking water treatment 2) Solid debris removal 3) Toxins in sediments and soils 4) Public utilities such as power and natural gas 5) “Unwatering,” the removal of flood water 6) Occupational Safety 7) Public security and 8) Underground storage tanks. The most complicated of these seemed to be toxins in soil and sediment, and housing.
There were three main elements of toxicity to watch out for: 1) Carbon monoxide poisoning, due to loss of power and the rise of portable generators, 2) Mold, and 3) Exposure to particulate matter due to the incineration of excess debris.
Stephen’s team quickly realized that mold would be the most important immediate issue to address, especially after realizing that residents were taking up amateur remediation efforts. They quickly released a mold guidance document to address concerns such as protective equipment.
2) Ron Moolenaar, MD, MPH, Chief, Field Epidemiology Team, Air Pollution and Respiratory Health Branch, National Center for Environmental Health.
Ron’s team went to New Orleans to do concrete studies on individual level mold exposure. Several studies are just being analyzed now. One study involved visually evaluating mold growth levels through random selection/stratified samples. Out of 110 homes, 85 were possible to inspect, the rest being too demolished for inspection. There was a broad range of mold levels. It is notable, though, that at the high end, exposures were really heavy.
Another thing they did was try to get a sense of the knowledge of remediation practices among workers with some experience with it, as well as residents new to it. Ron’s team looked at where their information came from, what equipment they were using, the practical knowledge they had, and resources available to them. Approximately 100 workers and 100 residents were surveyed, and preliminary results show that people in established organizations were more likely to have been well-trained in how to protect themselves from mold more than residents. This information will help target educational material to the public.
3) Gina M. Solomon, M.D., M.P.H. Senior Scientist, Natural Resources Defense Council, San Francisco, Assistant Clinical Professor of Medicine, University of California at San Francisco
The NRDC was not called in until October, right before the mayor was about to let people in. Community groups and officials concerned about public safety wanted the NRDC to evaluate the situation, what the EPA results meant, and if it was truly safe for everyone or not. Gina mentions that there was no clear message about public health safety to the public.
Gina’s team met with community groups and public officials. Flooding had mostly subsided by the time Gina went down, but toxic dust clouds were everywhere due to the breakdown of drywall and general sweeping and cleaning. The EPA had previously tested the sediment and uncovered fairly high levels of Polyaromatic Hydrocarbons (PAH’s), diesel fuels, and arsenic.
Another concern was indoor pollution due to mold. Gina recalls an overpowering smell of mold, even in the middle of the street. The results of a spore count sampling will be ready soon, but preliminary evidence shows that mold in the flooded areas was about 20-30,000 spores per cubic meter, much higher than in non-flooded areas. Gina’s team will be going back for further investigations shortly.
Gina’s team also tested for fine particulate matter (PM10), as well as endotoxin, a component of the cell wall in gram negative bacteria that has been found in sewage spills and wet areas indoors. The results were not as dramatic as expected overall, although many side streets showed high spikes of PM10. Endotoxin tested at an order of magnitude lower than levels shown to cause dangerous respiratory effects.
Overall, Gina said many people complained of upper respiratory tract symptoms, and some of lower respiratory tract symptoms.
4) Willie Fontenot, former employee in the Attorney General’s office in Louisiana
As a lifelong resident of Louisiana, Willie Fontenot shared his concerns about the disaster preparedness of the Gulf Region, and reflected on his family’s personal experiences in the aftermath of Hurricane Katrina. He will keep in touch with CHE about how members of CHE can be of service to those who are distressed.
III. Discussion
Q. Claire Barnett, Executive Director of Healthy Schools Network, Inc. asked if there are any intentions to conduct indoor mold sampling in areas hurt by Katrina that have been previously overlooked, such as the Baton Rouge area and up into Mississippi. People are concerned about mold and possible effects on children in these areas.
A. Gina Solomon responded that these areas are harder to sample in because the effected areas are much patchier than the flooded areas. The NRDC is not equipped to do it, especially considering that indoor sampling is already labor intensive. Instead, the NRDC has tried to come up with example situations and advise people based on those. For example, it may not be safe to re-occupy a second floor of a flooded apartment building, even if it seems safe.
Q. Claire Barnett asked Stephen if the CDC or the EPA plans to make general guidelines for remediation and building assessment available for the public.
A. Stephen Redd responded that the CDC to address the problem of dangerous remediation efforts has put out mold guidelines, but that there is a gap between what is recommended and what actually happens that needs to be addressed. Stephen also mentioned that guidelines would not be much different from isolated flood recommendations. The problem with big disasters is that the number of places becomes cumbersome, and the economics become much more complex due to the expensive cost of remediation. Also, areas of high mold exposure may not be structurally sound, which complicates matters, although he could not comment in-depthly on structural integrity.
Q. Kevin Stewart, Director of Environmental Health of the American Lung Association in Pennsylvania asked about the practical matters of residents practicing remediation on their own. Specifically, he would like to know if there has been any investigation in the Red Cross’s recommendation to residents using bleach for remediation. The ALA recommends hydrogen peroxide as a less toxic alternative. Also, are N95 safety masks working for people?
A. Although Ron Moolinaar could not comment on bleach vs. hydrogen peroxide, he did have preliminary study observations that some people have been using masks, but many times inappropriately or they did not seem to fit well.
Gina commented that although her team was handing masks out, none of the government agencies have been giving out masks or any respiratory protection. She saw many people with bandanas or dusk masks, and heard that Home Depot had sold out of N95’s.
Susan closed by saying that the call raised a number of questions and issues, and gave us a sense of the experiences of people working on respiratory issues at every level in the Gulf Region. She suggested that CHE partners find ways to talk about these issues more in-depthly, starting through email, and figure out how a body such as CHE can be of help to the Gulf Region.
Participant List Claire Barnett, M.B.A.Executive Director
Healthy Schools Network, Inc.
773 Madison Avenue
Albany, NY 12208
518-462-0632
cbarnett@healthyschools.org / Healthyschools@aol.com
Marie Chan
IAQ Steering Committee Member
Novato Unified School District
9 Pioneer Court
Novato, CA 94945-2119
415-892-4655
my.ch@comcast.net
Anthony J. DeLucia, Ph.D.
Board of Directors
Kingsport Tomorrow
214 Commerce Street, Suite 103
Kingsport, TN 37614-0575
423-246-2017
delucia@mail.etsu.edu
Steffi Domike
Coordinator
Collaborative on Health and the Environment of Pennsylvania
c/o PennFuture, 425 6th Avenue, Suite 2770
Pittsburgh, PA 15219
412-258-6687 / 412-521-0951
che-penn@comcast.net
William Fontenot
Former employee of the Louisiana
Attorney General’s Office
225-383-5673
wafont@cox.net
Bindi Gandhi, M.A.
Addressing Disparities in Asthma Health Educator/Policy Specialist
California Department of Health Services, Environmental Health Investigations Branch
580 Marina Bay Parkway, Building B, Third Floor
Richmond, CA, 94804
510-620-3605
bgandhi@dhs.ca.gov
Neil Gendel
Project Director
Healthy Children Organizing Project, Consumer Action
717 Market Street, Suite 310
San Francisco, CA 94103
415-777-9648
neil.gendel@consumer-action.org
Robert Gould, M.D.
President
San Francisco Bay Area Physicians for Social Responsibility
311 Douglass Street
San Francisco, CA 94114
408-972-7299
rmgould1@yahoo.com
Polly Hoppin, Sc.D.
Program Director
University of Massachusetts, Lowell
1 University Avenue
Lowell, MA 01854
978-934-4941 / 617-524-2365
phoppin@envhealth.net
Dwight Littlefield, RN, MBA
Program Manager
State of Maine, Public Health
286 Water Street, SHS #11
Augusta, ME 04333-0011
207-287-7302
dwight.littlefield@maine.gov
Susan West Marmagas, M.P.H.
Director of Health Programs
Collaborative on Health and the Environment
P.O. Box 501
Merrifield, VA 22116-0501
703-204-4702
susan@healthandenvironment.org
Rachel Massey, M.Sc., MPA
Research Associate
Global Development and Environment Institute, Tufts University
Medford, MA 02155
617-627-6793
rachel.massey@tufts.edu
Leyla Erk McCurdy
Senior Director, Health and Environment Programs
The National Environmental Education & Training Foundation
1707 H Street NW, Suite 900
Washington, DC 20006-3915
202-833-2933
mccurdy@neetf.org
Ron Moolenaar, MD, MPH
Chief, Field Epidemiology Team
Air Pollution and Respiratory Health Branch
National Center for Environmental Health
1600 Clifton Rd. MS E17
Atlanta, GA 30333
404-498-1017
RLM8@cdc.gov
Rachel Morello-Frosch, Ph.D, M.P.H.
Assistant Professor
Center for Environmental Studies and
Department of Community Health,
School of Medicine, Brown University
135 Angell Street, Box 1943
Providence, RI 02612
401-863-9429
Rachel_Morello-Frosch@Brown.edu
Frieda Nixdorf
Administrative Specialist,
Collaborative on Health and the Environment
Commonweal
P.O. Box 316
Bolinas, CA 94924
415-868-0970
info@healthandenvironment.org
Lisa Papi
Executive Director
Mold Across America, Inc.
P.O. Box 770991
Lakewood, OH 44107
877-280-6653
lisa@moldacrossamerica.org
Stephen Redd, MD
Chief, Air Pollution and Respiratory Health Branch
Centers for Disease Control
1600 Clifton Road MS E17
Atlanta, GA 30333
404-498-0825
scr1@cdc.gov
Sandy Santoro
Principal
Enviro-Style
8745 Hamburg Road
Brighton, MI 48116
810-231-2635
ssantoro@chartermi.net
Ted Schettler, M.D., M.P.H.
Science Director
Science and Environmental Health Network
39 Bromfield Street, #2
Newburyport, MA 01950
978-462-4092
tschettler@igc.org
Gina M. Solomon, MD, MPH
Senior Staff Scientist
Natural Resources Defense Council
111 Sutter Street
San Francisco, CA 94104
415-875-6100
gsolomon@nrdc.org
Eleni Sotos, M.A.
National Coordinator,
Collaborative on Health and the Environment
Commonweal
P.O. Box 316
Bolinas, CA 94924
415-868-0970
eleni@healthandenvironment.org
Kevin M. Stewart
Director of Environmental Health
American Lung Association of Pennsylvania
630 Janet Avenue
Lancaster, PA 17601-4584
717-397-5203
kstewart@alapa.org
Catherine Thomsen, M.P.H.
Epidemiologist
Oregon Department of Human Services-Health Services
800 NE Oregon Street, #827
Portland, OR 97232-2162
503-731-4025
catherine.l.thomsen@state.or.us
Julia Varshavsky
Program Associate
Collaborative on Health and the Environment
Commonweal
P.O. Box 316 Bolinas, CA 94924
415-868-0970
Julia@healthandenvironment.org
