CDC Article on Fungal Infections After Natural Disasters

Dear loyal readers,

Things have been crazy busy here at Spore Consulting, LLC - we moved the main portion of our office (and lives, since we're a home-based business) from Prescott to Tempe, Arizona over the last two weeks. More on that later.

We're never too busy to catch up on our reading, though. The CDC just released their latest issue of the online journal Emerging Infectious Diseases. In the March 2014 issue, there's an article on "Invasive Fungal Infections After Natural Disasters" that is eligible for continuing education credit.

This article was interesting to me for two reasons: 1) it described some of the risks associated with Coccidioides species fungi during disaster situations, and 2) it discussed indoor mold exposures after disasters.

My interest in Coccidioides species fungi stems from my undergraduate studies at the University of Arizona in Tucson, Arizona. The University of Arizona is home to the Valley Fever Center for Excellence, and I learned about their studies and attempts to get funding for their research into "Valley Fever" - the common name for Coccidioides infection. They developed an excellent online *free* continuing education course on Valley Fever that should be taken by any medical provider in the Southwest. 

The information the authors provided on indoor mold exposures after disasters was fascinating; however, this may lead to an increase in "toxic mold" and "black mold" tort lawsuits among homeowners and business owners who have experienced any sort of flooding or water intrusion event. I can't wait to see what the media makes of the article (hopefully they don't pick it up). 

The EID article referenced a 2004 Institute of Medicine book "Damp Indoor Spaces and Health" that, according to the authors of the article, "found sufficient evidence of association between indoor mold exposure and upper respiratory tract symptoms, cough, and wheezing, and evidence of an association between indoor mold exposure and some noninfectious health conditions that included asthma symptoms in persons with asthma and hypersensitivity pneumonitis in some groups of people. Although the report found no association between indoor mold exposure and invasive infection in healthy persons, there was evidence to support a link between exposure to Aspergillus and aspergillosis in severely immunocompromised persons." 

The EID article also discussed that most people who survived Hurricanes Katrina and Rita (and their aftermath) did not report invasive fungal infections, even in severely immunocompromised people.

The part I found most interesting in the EID article was this: "Global warming has also been hypothesized to select for fungi with tolerance to warmer temperatures. The relative scarcity of fungal diseases among mammals has been hypothesized to be associated with the inability of many fungal species to survive at temperatures >37�C; however, warmer ambient temperatures may enable nonpathogenic fungi to acquire the ability to infect warm-blooded hosts." 

When we do viable sampling for fungi (in sterile environments like operating rooms, bone marrow transplant patient areas, and sterile processing), we have the culture plates put in an incubator for 48- to 72-hours at 37 degrees Celsius to see if the fungi will grow at approximate human body temperature. If anything grows, we evaluate if the fungi have been reported as human pathogens or not. It would be interesting to see if the environmental laboratories have noticed an increase in pathogenic and non-pathogenic fungi able to grow and reproduce at human body temperature.

Emergency Preparedness and Response for Floods (e.g. Colorado)

In response to the incredible flooding in Colorado earlier this month, the National Institutes of Health (NIH) via their National Institute of Environmental Health Sciences (NIEHS) published a new web page with information on emergency preparedness and response in flood situations.

See the web page here on floods.

NIEHS emphasized the preparedness factor for responders to flooding, cleanup workers and restoration workers, homeowners, and business owners. The training/information covers safety awareness and post-disaster hazards.

On the page, there's also preparedness information about:

• earthquakes
• H1N1 (swine) flu, avian flu, pandemics
• oil spills
• wildfires
• resiliency
• radiological dispersion devices (RDD) a.k.a. "dirty bombs"

The Industrious Hygienist is always excited to find new references to explore and share with others! Thanks to NIEHS for the useful tools and guidance from a variety of federal departments. 

A molasses spill in Hawaii? I hearken back to 1919 in Boston.

I was intrigued to see the following news story from Hawaii about the molasses spill that occurred in Honolulu Harbor (or was first noticed, accounts differ) on Monday. According to the article, approximately 224,000 gallons of molasses spilled into the harbor and the United States Environmental Protection Agency is sending two spill experts to help the state characterize the damage and work towards a sustainable solution.

This article from Hawaii News Now explains that the responsible party, Matson Navigation Company, released more than a ton of molasses into the harbor. An investigation was done by Hawaii Department of Health when dead fish started showing throughout the harbor on Monday, about "three days after a faulty Matson pipe discharged 233,000 gallons of molasses into the water, resulting in a mass kill."

According to Reuters, the release was first noticed on Monday after a ship pulled out to sea, loaded with molasses. On Tuesday, Matson discovered a leak in the pipeline used to fill the ship. The Reuters article contained a statement from the Department of Health that the molasses would likely not harm humans, but it was "polluting the water, causing fish to die and could lead to an increase in predator species such as sharks, barracuda and eels."

CNN already beat me to the punch (or some sort of molasses-based beverage) on making the comparison, but this is not the first time molasses has caused such widespread devastation. Courtesy of Wikipedia, in 1919 Boston, a molasses storage tank burst and approximately 2.3 million gallons of molasses were released from the storage area of the Purity Distilling Company into North End Boston. The "wave" of molasses ranged from 8 to 15 feet high and was estimated to had moved up to 35 miles per hour, sweeping buildings off their foundations, damaging railroad girders, and killing 21 people (150 injured).  

Here's a picture courtesy of the Boston Public Library Flickr account:

Firemen in Boston's North End standing in sometimes knee-deep molasses. (c) Boston Public Library.

The Wikipedia article notes that the "harbor was brown with molasses until summer" (spill happened in January 1919). I couldn't find any information on whether the molasses spill into the Boston harbor also resulted in a large fish and other marine life die-off.

Many news companies ran articles with indirect quotes from a senior executive for Matson stating that Matson had not really planned ahead of time for the possibility of a spill. The Honolulu Star Advertiser ran a story that Matson "did not have a response plan for a molasses spill, even though its vessels export as much as 2,000 tons of the viscous liquid each week to the mainland from a pipeline at Hono�lulu Harbor."

The response plan they're talking about would likely be similar to a Spill Countermeasures and Control Plan (SPCC). An SPCC Plan requires companies with the potential to release oil discharges (and possibly other toxic substances, I am not an SPCC expert) to prepare an SPCC Plan, amend the plan when conditions change, and of course implement the plan, so that prevention of spills is the primary objective. SPCC Plans also cover preparedness activities and response to spills. SPCC is intended to protect navigable waters and their adjoining shorelines. There's probably a maritime equivalent, but the Industrious Hygienist lives in Arizona, so my knowledge of maritime standards is limited.

Yarnell Hill Fire and Prescott Firefighters

There's so much media attention on this story, but it's close to my home, so I feel the need to post about it. Please do what you can to help.

A fire started in Yarnell Hill this weekend (south of Prescott). ABC15 did a great job of distilling the facts, which I have copy/pasted below from their article with minor edits.

FIRE START DATE: June 28, 2013 at 4:30 p.m. 
LOCATION: West of State Route 89 between Yarnell and Peeples Valley.

SIZE: Approximately 8,400 acres (as of 15 minutes ago)

CAUSE: Lightning

NUMBER OF RESOURCES: 400

RESOURCES: 18 engines, 18 fire crews, 8 support water tenders, 2 crash/rescue vehicles, 2 structure protection vehicles, and 4 bull-dozers. On order are more 20-person hotshot crews, type 2 hand crews and other firefighting personnel and equipment.

LOSS: An estimated 200 homes and other structures have burned in Yarnell.

CONTAINMENT: 0%

INJURIES:  1

FATALITIES: 19 - A fire crew had to deploy their fire shelters late Sunday afternoon after strong winds pushed the fire to their position and 19 firefighters died in the line of duty.

ESTIMATED COST TO DATE: Unknown

EVACUATIONS: Residents in the communities of Peeples Valley and Yarnell.

The same shelter used for the Doce Fire is still open at Yavapai College at 1100 E. Sheldon in Prescott, and a large animal shelter is still open at the Hidden Springs Ranch on Hwy 89, just southwest of Hayes Ranch Road. There is also a shelter open at Wickenburg High School. 

The Doce Fire is estimated to be up to 96% contained, but fire crews are still working there. With the heat wave this last weekend, it was up to 104 F by my house in Prescott Valley. 

The Prescott Firefighter's Charities is accepting donations for the families of the firefighters that were lost at Yarnell Hill. They have partnered with the United Phoenix Fire Fighters Association (UPFFA) and 100% of donations will go to the families. Donations are also being accepted at Chase Bank branches. The account number is 987218757. Questions re: these associations should be addressed to the UPFFA office at (602) 255-1500. 

The Daily Courier reports that the fire crews are working on the eastern flank of the fire to protect homes and structures close to the Yarnell Hill Fire. 

There has been an outpouring of grief and support throughout the nation, with flags lowered, mourning bands, and donations.    

The Yarnell Hill fire is not the only fire in Arizona - there is also a the Dean Peak Fire in Kingman that has led to evacuations in Pine Lake and Hualapai Mountain Park. American Red Cross - Grand Canyon Chapter has a reception and care center in Kingman for evacuees. They have also opened a cooling station at Kingman High School for snacks, water and coffee, so displaced residents can get out of the heat. The "Prison" fire in Tucson is still burning, is 5% contained, and has not threatened structures yet. 

Experts are saying that this could be one of the worst fire seasons on record. 

A summary of other charities for the Yarnell Hill Fire victims and firefighter families is below, modified from The Daily Courier:

• 100 Club of Arizona: Providing families of fallen firefighters with a $15,000 line-of-duty death benefit. Please donate to the 100 Club Survivors Fund in memory of the Granite Mountain Hotshots, or call 602-485-0100 to donate.
• United Way of Yavapai County: Opened an account at National Bank of Arizona for evacuees who have lost their homes and for the 19 families. Reference the Yarnell Fire Fund when making a donation at any National Bank of America branch. You can also donate through the United Way website, or by mail to UWYC, 634 Schemmer Drive, Suite 302, Prescott, AZ, 86305. 95% of donations will go to victims, with United Way working with the Prescott Fire Department and Yarnell to distribute donations.
• Prescott Fire Department: Accepting donations via mail to 1700 Iron Springs Road, Prescott 86301. Write "Granite Mountain Hotshots Family" on the check.
• The Hair Nail and Skin Institute (Prescott): Offering free haircuts, and hand/foot spa treatments to Yarnell Fire firefighters, law enforcement officers, other first responders, and evacuees  for the remainder of the year (with documentation). 
• Prescott College: Opening its Village residence hall to fire evacuees as a temporary shelter. For more information, call Bill or Shar at 928-713-8915.
• There are two events scheduled for Wednesday, July 3, 2014.
• The Prescott Noon Lions Club: Holding an emergency food drive from 8 a.m. to 1 p.m. Wednesday at the Albertsons on Sheldon and Marina streets, the Fry's supermarkets on Miller Valley and Willow Creek roads, the Safeway stores on White Spar and Willow Creek roads, and Costco on Highway 69.
• Heritage Memory Mortuary: Holding chapel services for anyone wanting to meditate and remember the heroes from 11 a.m. to 4 p.m. Wednesday. 

There is a Disaster Distress Helpline is a federal government service that offers 24-hour information, support, and counseling to anyone needing help with disasters such as the Arizona wildfires.

Disaster Distress Helpline

1-800-985-5990 or
Text TalkWithUs to 66746
TTY for Deaf/Hearing Impaired:
1-800-846-8517

I'll be providing updates as they unfold, and Mighty Spouse and I are figuring out how best to help tonight. 

Doce Wildfire Evacuations - video and update

This video is courtesy of The Daily Courier - it describes the areas planned for evacuation and the emergency relief efforts by the American Red Cross - Grand Canyon Chapter for evacuees of the Doce Fire. Per the American Red Cross: "Red Cross volunteers have set up cots and blankets for overnight stays, and evacuated residents can come to the shelter for meals, snacks, water and coffee. Evacuated residents also can receive aid from Red Cross nurses and mental health volunteers."

A press release from the U.S. Forest Service about the Doce Fire explains that the fire is still 0% contained and that the Southwest Area Type I Incident Management Team led by Tony Sciacca will be taking over management of the fire today.

Residents in Williamson Valley and possibly Chino Valley have been put on notice that evacuations may be needed in their areas. So far there have been no reported injuries or structures lost. 

The Industrious Hygienist will be following the progress of the fire via the Yavapai County Emergency Management - Regional Alert website. 

Residents of the Prescott area can sign up to receive notification information for this and future regional alerts from the Yavapai County Sheriff�s Office.  Messages can be received by phone, text or email. Click here to learn more and sign up for the Emergency Notification System.

For more Doce Fire information, call (928) 777-5682. 

How to Access Free NFPA Codes or Standards

In honor of National Safety Month - Emergency Preparedness Week, please take an opportunity to watch this video and learn how to access National Fire Protection Association (NFPA) Standards for *free* from the NFPA website. 

I just downloaded a free pdf copy of the NFPA 1600, " Standard on Disaster/Emergency Management and Business Continuity Programs: and am excited to review it. 

Standard 1600 has chapters on program management, planning, implementation, training and education, exercises and tests, and program maintenance and improvement. My favorite parts (so far) are in Annex C: Self-Assessments for Conformity with NFPA 1600 and Annex D: Plan-Do-Check-Act (PDCA) Cycle.

The PDCA cycle is particularly helpful in management systems. Here's how the NFPA depicts the PDCA cycle in Annex D. 

NFPA describes the PDCA cycle as a four-step process designed to improve business processes and quality assurance programs.

P = Plan
D = Do
C = Check
A = Act (or Adjust)

It's also referred to as the "change cycle."

ASQ, a global quality community, provides helpful case studies and descriptions about the PDCA cycle at their website. 

The procedure, as explained by ASQ, is:

1. Plan. Recognize an opportunity and plan a change.
2. Do. Test the change. Carry out a small-scale study.
3. Check. Review the test, analyze the results and identify what you�ve learned.
4. Act. Take action based on what you learned in the study step: If the change did not work, go through the cycle again with a different plan. If you were successful, incorporate what you learned from the test into wider changes. Use what you learned to plan new improvements, beginning the cycle again.

Hopefully you learned something useful about quality improvement and emergency preparedness in today's post. 

Doce Fire in Prescott National Forest

Who: Residents of west Prescott, Arizona

View of the smoke from the Doce fire in Prescott, AZ from my backyard.

What: The Doce Fire

Where: Reportedly started near the Doce Pit (sometimes called the Dosie Pit) in the Prescott National Forest 

When: Today

Why: The source is unknown according to The Daily Courier, but was likely human-caused. No lightning strikes were reported in this area and the U.S. Forest Service has no reports of fallen power lines in this area.

Here in the Prescott area, we're experiencing high winds (as usual) and low humidity (also as usual). The Daily Courier and KPHO report approximately 250 firefighters are on the ground.

There have been evacuations for several hundred homes in the area, but it appears the fire is spreading closer to more densely populated areas in west Prescott. So far it's at 5,000 acres and spreading. The American Red Cross has set up a shelter at Yavapai College along East Sheldon Street for evacuees. I was reading through the comments on The Daily Courier article and was heartened by the outpouring of offers to help take in pets and livestock, or help get the elderly or ill from their houses. 

Mighty Spouse and I are looking into what we can do and how we can help evacuees this week. This would be terrifying to experience first-hand.

Wildfiretoday.com is also covering the fire from an engineering and forest preservation perspective. 

View of the smoke from the Doce Fire in west Prescott, AZ from my front yard.

It's intriguing that this occurred during Emergency Preparedness Week in National Safety Month. Mighty Spouse and I have our emergency kits prepared and ready - we repacked them before we moved up here from Phoenix. We have enough food, water, entertainment, money, and pet supplies/carriers to last three days if needed.

Fore more information about personal and family emergency preparedness, visit the FEMA website, ready.gov. The basic recommendations are:

1.) Be Informed - Do you know what hazards and emergencies you could face?
2.) Make a Plan - Do you know how to contact your loved ones? Do you have an evacuation plan? Do you know the best routes from home to work to where your family will gather?
3.) Build a Kit - For at least 72 hours of survival, and don't forget medications or your pets' needs. 
4.) Get Involved - Volunteer, be part of the community planning process, join a Citizen Corps. 

More updates on the fire and how you can help in future posts.