When Pasteur demonstrated in the late 1800s that bacteria caused disease, it took a long while for the public to get a clear idea of what bacteria were and how they did what they did. In the 1930s, many people thought you could catch conjunctivitis by looking at someone who had an infected eye, and even today most people do not know the best way to avoid infections in general.
Still, most people agree on the basics: You catch an infection from other people, because a germ invades your body through broken skin, the digestive system, or lungs. If it makes you very sick, you go to a doctor, who will diagnose you and maybe take a blood sample to confirm his diagnosis. Then he will treat you with drugs or a shot of antibiotics and other therapeutic measures. He may have to operate. You go to bed, and if you do not die, you will get well, though you may carry scars (smallpox) or be otherwise disabled (polio).
When people are made sick by mold, it's a whole new ball game. You do not catch mold spores from other people the way you do germs. You catch them from buildings, or the materials you work with. The longer or more intense your exposure, the sicker you get. What makes you sick is usually not the organisms themselves, but the airborne toxins and allergens they produce. You may become so sick that you have to go to bed, but your doctor will probably not know how to diagnose you and you may look healthy to your friends. Even if you do get diagnosed, your medical insurance will probably not cover your treatment expenses. If you lose your job and your health, and sue the landlord to get the money for medical expenses and loss of income, chances are very small that you will win in court, because it is virtually impossible to prove to a jury that your health was damaged because of mold in the building. Juries need the equivalent of a smoking gun, and so far, there is no foolproof way to connect a moldy building with a sick person.
Even after you think you have recovered, you have not gained immunity, as you do after you have had chickenpox or measles; in fact, you may be more vulnerable to future exposures than you were to start with, just as you would be after exposure to other common toxins, such as lead.
(Gary Frost, in a recent letter about his own experience with mold, concluded by saying, "Mold is certainly smart. It is stunning to realize how opportunistic 'primitive' organisms are and how they maximize any benefits from change in their environments. These organisms don't need evolution.... They are responsive enough as is.")
Besides the responsiveness, or adaptation to different conditions that Gary mentions, they mutate with relative ease, and they associate with other microorganisms in proportions that change as the conditions change—i.e., as a location grows moister, the proportion of Stachybotrys species will increase, and so on. So it is hard to tell what you are dealing with.
In the tropics, the situation is even more serious. J. David Miller, in his excellent paper, "Fungi as Contaminants in Indoor Air," says,
In the cold climate of Canada, very few people encounter someone who dies from a fungal disease. This is not the case in tropical countries where diseases caused by fungi are common. There are a number of invariably fatal systemic infections as well as skin and nail mycoses and lung infections. Diseases caused by ingestion of fungal toxins [i.e., eating spoiled food] are leading causes of death in tropical and subtropical countries, especially liver cancer induced by the ingestion of aflatoxins, esophageal cancer caused by some Fusarium toxins and deaths caused indirectly by the excessive consumption of immune system depressors such as the trichothecenes (1).
Papers given at conferences may give statistics on moldy homes and schools as part of a larger picture, but somehow personal and newspaper reports of individual schools and homes are better at showing how mold can affect peoples' lives.
In a suburb of Dallas about six years ago, according to a 1997 report in the Fort Worth Star Telegram, health officials were puzzled by the illness of a suburban woman, who had suffered from flulike symptoms for two weeks after she moved into a condominium. A regional industrial hygienist with the health department was quoted as saying that "the neighbors found her crawling around on her hands and knees complaining of earthquakes." Health officials investigated her case and found that her illness was caused by fungus in the air-conditioning ducts of her condo. The industrial hygienist was quoted as saying, "She was totaled. Her system was overwhelmed. She was in the hospital for 60 days before they got her cleaned out."
The news report goes on to say that public knowledge of fungi does not reach far beyond mushrooms, athlete's foot and yeast infections, despite its deadly potential. Michael Rinaldi, a mycologist at Audie Murphy Veterans Affairs Hospital in San Antonio, is quoted as saying that in the last 10 years mycology, the study of fungus, has become one of the most critical in all of medicine.
Susceptibility to fungus varies, it says. Infants, the aged, asthma patients who are being treated with steroids, and people with weakened immune systems are most susceptible. (The author failed to mention one other important group: women. In some occupations they are several times more likely to be affected than men.)
CNN Interactive, a website, had a story in November 1997 on a post-flood case of Stachybotrys growth in West Bloomfield, Michigan. The 14-month-old granddaughter had developed breathing problems, and the grandmother was getting headaches and often felt ill, especially when she was in the basement. These troubles came after the spring rains that flooded the basement, bringing on the growth of Stachybotrys, visible only as a small round black circle on the wall.
Dr. George Riegel of Healthy Homes commented on this incident, saying that few people who clean up after a flood do a professional job and contain the area (with tape and plastic sheeting), with the result that the mold spreads to other parts of the house. To remove it safely, he said, would cost that family close to $10,000. He also said that most black molds are not Stachybotrys. Stachybotrys grows only on wood and paper products, and can be found in only about 2 to 5 percent of American homes.
The grandmother said the news was rather unnerving. "I am ready to move, but where am I going? This is my home. I can't afford to just pack up and leave."
Hill Elementary School in Austin, Texas, was closed down at the beginning of March and students assigned to other schools when mold (a lot of Penicillium and a small amount of Stachybotrys) was found in the outer rooms in the main building. Further investigation revealed that the annex buildings and portables also had mold.
As usual, in cases like this in which a thorough investigation is done, several conditions were found to have contributed to the overgrowth: a spring in the crawl space beneath the building after rains (not a big problem); poor ventilation (air pressure higher outside the building than inside—a big problem, because this draws in contaminated moisture); condensation from cool roof beams, which dripped into the school walls (since the moisture barrier at that interface no longer was able to stop it); skylights (always potential sources of water troubles); and (as in most schools), outer walls lined on the inside with moisture-impermeable chalkboards, bulletin boards and cabinetry, all of which tend to trap the moisture within the walls.
Since the demolition is not complete yet, more pockets of mold and decay may come to light. The outlying buildings (annex and portables) have been found to have mold contamination too. The school board has authorized the schools superintendent to spend a million dollars to correct the problem. No one can be sure that the building will be ready for the fall semester, four months away.
The children were getting sick and parents were complaining last fall, months before the condition of the school was recognized as a problem.
The local paper ran a letter to the editor recently from someone who has been through this kind of crisis before. It says, in part:
Stachybotrys was found in a Bryan school building in 1996. I know because I was the principal. I requested environmental studies be conducted by a biologic hazards company. Instead, the district hired an industrial company unfamiliar with mold problems. Two environmental specialists reviewed the findings and found dangerously high levels of Stachybotrys as well as other molds. My health deteriorated, and I was granted disability retirement by the medical board of the Texas Teacher Retirement System because of the effects of toxic exposure to Stachybotrys.
My heart goes out to the staff and students who are still in the Bryan building.
A story about mold contamination of hospitals was sent to the Aspergillus discussion list. It was from a subscriber in Finland, replying in sympathy to someone who had observed water damage to ceilings in five hospitals she had been in. The Finnish subscriber said, "In my country too we have many mold-contaminated hospitals (at least 3 central hospitals), unfortunately.
"One of my friends has been diagnosed with occupational allergic alveolitis; she had been working in a mold-contaminated library, which was closed later and the staff was moved to another building. She complained that she got bad symptoms whenever she was in her central hospital. All the staff, even doctors, denied mold problems and said she was wrong. Now 3 wards of this hospital have been closed for mold reparation!!!"
[To find information about Aspergillus diseases, the Aspergillus web site, e-mail group moderators, the e-mail archive, FAQs and e-mail list commands, go to http://www.aspergillus.man.ac.uk/listinfo.htm].
Another subscriber to the aspergillus mail list, Danitza Shanahan, contributed the following story to the list March 9. She saw it on page 24 of the Arizona Republic for March 5:
New Home Becomes a Horror
Mold Endangers Children's Health
A Mother's Dream
by Beverly Ford
When Michelle Harless finally scraped up the money for her first house, she thought she was prepared for the rigors of home ownership. But within months, her Glendale dream home became her worst nightmare. The stuff of that nightmare: mold fed by a leaky pipe.
Four months after moving into the three-bedroom house, Harless's 7-year-old son, Thomas Fuller, who suffers from cystic fibrosis, had to be hospitalized. Two months later, he was hospitalized again. Doctors said Thomas had lost 33 percent of his lung function because of a common but sometimes toxic mold, called aspergillus.
"When it came back aspergillus we were blown away," said Harless, 26. Her 2-year-old son, James Hatley, wasn't immune, either. He lost his appetite, developed red, cracked skin and began coughing and sniffling. Doctors thought he was suffering from seizures. Harless knew otherwise: It was aspergillus mold.
Then, she said, things went from bad to worse. Harless's insurance company told her that her policy didn't cover mold infestation. "I thought I did everything right," she said, "I had a home inspection. I had homeowners insurance, I had a home warranty. But it's a nightmare."
For weeks, Harless tried to convince the company that the mold was caused by a leaky pipe, which was covered under her policy. But the company stood firm. And despite her son's health problems, the company refused to reimburse the family for moving into an apartment, she said, or to pay to clean up the mold that had by now permeated the home.
"I felt trapped," Harless said. "Mold affects healthy people, but for my son it was a life-and-death matter."
The insurance carrier, Century National Insurance Co., declined to comment on Harless's claims. It was only when an insurance adjuster put up the money that Harless and her family were able to move into a nearby apartment. Soon, both children's health improved, although Thomas's lungs remain permanently damaged, she said. Harless and her husband continue to make payments on the $91,000 home while they wait to see whether their insurance company will pay for repairs. The firm has sent inspectors to examine the home and recently offered to work out a settlement.
A case similar to Michele Harless's, only worse, was reported in USA Weekend for Dec. 3-5, 1999. It starts out this way:
"It started with a series of leaks. Within a year, Melinda Ballard's 11,500-square-foot Texas dream home was quarantined; her 3-year-old son, Rees, was on daily medication to treat scarred, asthmatic lungs; her husband, Ron Allison, had lost his memory along with his job; and the family was living out of suitcases and locked in a seemingly endless battle with their insurance company. The problem? Household mold [Stachybotrys]."
This family is not poor: the house sits on a 72-acre estate in Dripping Springs, west of Austin. She is described as an heiress. But now she has to put on a HEPA mask in order to enter the house, which she does once a week to check the air conditioning. The men who are cutting out the moldy timbers have to wear moon suits. David Straus, a mold expert with the Texas Tech University Health Sciences Center, spent just 30 minutes inside the house, but was throwing up hours afterward, and now has severe hearing loss in one ear from the mold. The family suffered from headaches, dizziness and fatigue, then respiratory and sinus problems, in addition to profusely bloody runny noses and coughed-up blood.
The family is suing their insurance company (Farmers Insurance) for $100 million, and the County District Attorney has initiated a grand jury investigation to consider criminal charges against the company.
If you suspect your building has a mild or moderate mold problem, try to identify its source or sources so you can avoid them, or do something about them, or direct the attention of technical people to them. If you have been affected, your own reactions may be the best indicator available. Take notes on the date, area, presence of moisture (especially after a rain), any apparent mold growth, and effect on you. Forget about setting out petri dishes or measuring the humidity of the air.
Early recognition of a mold problem, and identification of its cause and remedy, can keep the mold from getting a head start if you have done your homework, provided the financing and approval for assessment and remediation can be found. The above instances show that residents and staff in a moldy building have no good options left if the mold gets a head start. This situation may eventually change when buildings are built and maintained to prevent moisture accumulation, when doctors learn to recognize the effect of mold exposure, when lawmakers require insurance companies to cover people affected by a mold disaster, and when mycologists are able to make an airtight causal connection between the presence of indoor mold and the health of people who inhabit the same space. Any change from the present situation will be an improvement. At present, though, rich and poor alike have only one good option: preparedness.
1. Maintain a list, compiled from references if possible, of all the experts you may one day have to call on (an informed doctor, a consultant who can assess the mold problem and advise on cleanup, someone who is knowledgeable about construction of houses and management of HVAC systems, etc.). The nearest one may be in another town.
2. Gather information: Buy books on the topic, visit informative websites, talk with informed people, get friendly with the building engineer and competent local service people who specialize in duct and carpet cleaning, join organizations that have mold prevention and recovery on their agendas, e.g. C.U.R.E. (Citizens United for Responsible Environmentalism, Inc., an international nonprofit education and research organization based in California, focusing on educating doctors and the public about mold diseases and toxicoses—tel. 408/268-4085, fax 408/476-8552).
One book that everyone should have access to has just appeared in print: Guidelines on Assessment and Remediation of Fungi in Indoor Environments, available on the Internet at http://www.ci.nyc.ny.us/html/doh/html/epi/moldrpt1.html (2) Future revisions to it will be posted there too. For more information, contact the New York City Department of Health at 212/788-4290. An expert panel was convened in 1993, originally to develop policies for medical and environmental evaluation and intervention in cases of Stachybotrys atra [chartarum] contamination. This revised guideline covers all fungi.
3. Follow developments in research and make contacts. Go to a mold conference now and then, or read in the professional literature on current research, to be sure your information is up to date. This will also make people more willing to talk to you; you can put yourself on a grapevine if you have recent news to swap. (As far as I know, there are no extension or college courses on coping with mold, except perhaps in the historical preservation field.)
4. Study real situations. Even if there is no leak to be found, water can enter a building through porous building materials, including concrete. It may enter as water vapor and condense and collect in hidden places. There are many esoteric ways for water to enter a house and feed mold. They are hard to understand without some kind of hands-on experience or a good teacher or a couple of really good books. So study is unavoidable.
5. If you have to leave your home or job despite everything, it helps to be on good terms with family members and friends who might be able to put you up in an emergency. A good savings account may be more use to you than medical insurance.
If the mold problem is not too bad, or if the source of the problem is on neighboring property rather than inside your house, you could do as several C.U.R.E. members have done: install freestanding HEPA air filters in the office or bedroom, or even in every room in the house. Central HEPA filter units, with their own fan and air supply, can be installed as part of the central air conditioner. They work best if you have a good air return system. A good air filter large enough to handle a small or average bedroom can be had for $150-190. It will not work, however, if you set it on a deep carpet full of dust. This will just blow the dust up into the air. Set it on a stool or chair.
If you get really sick from mold, the first thing to do is to avoid further exposure (i.e., leave home or take extended leave from your job). Then ask your friendly local mycologist to recommend a good doctor. Or find an Internet list of doctors who can treat mold, and be prepared to travel, because there may not be one in your town. There are medicines nowadays that are effective against a fairly broad range of mold species.
1. Atmospheric Environment Vol. 26A, No. 12, pp. 2163-2172, 1992.
2. Guidelines on Assessment and Remediation of Fungi in Indoor Environments, available on the Internet at http://www.ci.nyc.ny.us/html/doh/html/epi/moldrpt1.html. the printed version, 14 pp. long, is issued by the New York City Dept. of Health, Environmental & Occupational Disease Prevention, 125 Worth St. c/n 34C, New York, NY 10013. It is intended for use by building engineers and management, but is available for general distribution to anyone concerned about fungal contamination, such as environmental consultants, health professionals, or the general public.
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