Medical Examiner

Katrina Cough

The health problems of 9/11 are back.

Do you have your respirator handy?

People returning to New Orleans and other flood-ravaged areas have recently come down with a constellation of symptoms—coughs, sore throats, runny noses, and respiratory trouble—that has earned itself a name. The ailment is called Katrina cough, and local doctors say it is widespread. They attribute it mainly to the mold and contaminated dust left behind by the floodwaters that have been stirred up by cleanup and demolition work.

Shortly after Katrina hit, doctors worried aloud about the potential for a devastating outbreak—of cholera, say, or typhoid fever. When these worst-case scenarios didn’t come to pass, public health officials breathed a sigh of relief and moved on to other priorities. Katrina cough isn’t necessarily dramatic, and some experts have dismissed it as minor. But it can be serious for people with asthma, respiratory illness, or compromised immune systems. As we should have learned from the aftermath of 9/11, early symptoms like coughs can auger chronic health problems among people who aren’t protected from ongoing hazards. If Katrina cough follows the 9/11 pattern, more people are likely to become sick months or years from now—unless we start doing more to protect them.

Following 9/11, the EPA and OSHA failed to safeguard nearby residents and workers at Ground Zero from unnecessary exposures to asbestos, lead, glass fibers, concrete dust, and other toxins. The damage was caused not by a few days of rescue work, but by weeks and months of cleaning up the site or living nearby. The EPA offered assurances that the air outside of Ground Zero was safe to breathe—even though, as the agency’s inspector general found in 2003, the agency “did not have sufficient data and analyses to make such a blanket statement.” The EPA also caved to pressure from the White House Council on Environmental Quality “to add reassuring statements and delete cautionary ones” from its public announcements about the disaster. And in overseeing work at Ground Zero, OSHA decided not to enforce workplace health rules as it regularly would have, but instead acted primarily as an “adviser” to employers. As a result, the agency did not ensure that workers wore proper protective gear, especially respirators, though the equipment was widely available on the site. (For more on respirators and Ground Zero click here.)

The aftermath of Katrina differs from 9/11 in the specific toxins that have been unleashed. But so far, the failure of governmental agencies to protect people against long-term health risks is eerily reminiscent. Once again, activists contend, the EPA is downplaying risks faced by returning residents—this time from petroleum products, arsenic, lead, mercury, bacteria, and rampant mold. The agency has distributed flyers and made public service announcements about the potential hazards of mold, asbestos, lead, carbon monoxide, and other toxins. But virtually everyone I spoke with said that these materials either are not reaching people or are not helpful. Wilma Subra, a Louisiana chemist and environmental consultant who is a former MacArthur fellow, says that the agency has dodged the key question: who should return to areas touched by the hurricane and when. More than 16 percent of New Orleans children suffered from asthma, for example, according to the American Lung Association. They are at particularly high risk in mold-infested houses. But the EPA has declined to tell these children’s parents to keep them away until the cleanup has significantly progressed. Meanwhile, just as it did at Ground Zero, OSHA has decided to advise contractors and other employers rather than to enforce standards. (An OSHA spokesman said that enforcement would begin at a particular site if there was a fatality or a specific complaint there.)

Meanwhile, people fixing their own homes may find it difficult to follow the safety directives that the government has in fact issued, because they can’t find protective equipment like respirators. Web sites like this one from the CDC note that anyone working inside of a building that’s been soaked in floodwater should wear a respirator. But in the New Orleans area and possibly elsewhere, stores like Home Depot have mostly run out of the needed model, called an N95, which filters about 95 percent of particulate matter and costs about $18 for a box of 20. So says Johanna Congleton, the Louisiana director of Physicians for Social Responsibility, who adds that the doctors in her group have seen people cleaning their homes while wearing painter’s masks—which can actually trap particulate matter and make breathing problems worse.

Also troubling is the lack of protection for recovery workers hired by contractors. Subra says the workers she has seen have no respiratory gear. Contractors are reportedly hiring the workers, many of them Latino immigrants, in nearby cities like Houston. “I know men who have gotten so sick with diarrhea, skin inflammations and breathing problems they can’t work. … The contractors just hire more,” said Juan Alvarez, director of the Latin American Organization for Immigrant Rights in Houston, in a letter sent to Congress by the New York Committee for Occupational Safety and Health and other groups.

It’s not too late for the federal government to do better. If the EPA made a push for respirators, stores like Home Depot and Wal-Mart would probably restock N95s because they’d know people would buy them. OSHA could use its enormous influence over manufacturers. And OSHA needs to establish some means of enforcement to make employers take responsibility for the health of their workers; the ad hoc advisory playbook that the agency adopted after 9/11 is not a good model.

At the moment, however, the government is poised to take steps in the wrong direction. Bills pending in the Senate would relieve governmental contractors of liability for damage to property or people (including in cases of negligence), or would allow for temporary suspension of environmental rules against polluting air and water. And the EPA has approved a proposal by the Louisiana Department of Environmental Quality that would allow for the burning of construction debris in four New Orleans parishes. The incineration is supposed to use smoke-reducing technology, but environmental advocates are still worried about the release of toxins into the air.

Four years after 9/11, the high costs of loosening public health rules after a disaster are evident. Thousands of people who worked at Ground Zero or lived in lower Manhattan are still sick with respiratory problems and other illnesses because of the contaminants they were exposed to. Some do not respond to standard medications and can’t work. And the total price exacted by the toxins is still unknown: It won’t be clear for many years whether cancer rates are higher for the 9/11 and Katrina coughers.