Update on Health Issues Related to Mold, Mildew and Mud in Hurricane

February 29, 2008

FEMA Announcements Last Updated: Sep 29th, 2005 - 07:29:19

http://communitydispatch.com/artman/publish/article_2249.shtml

and Flood Affected Areas

By Center for Disease Control and Prevention

Sep 29, 2005, 07:08

Wednesday, September 28, 2005

MR. SKINNER: Thank you, , and thank you all for joining us

today for this important call.

There continues to be a lot of interest, and rightly so, about the

potential health concerns for people in areas that have been

impacted by Hurricanes Katrina and Rita. One particular concern that

continues to be gathering a lot of attention are the potential

health effects to mold and mildew, and so we decided to pull this

media briefing together.

With us today is Dr. Redd from the Centers for Disease

Control and Prevention, Mr. from the Environmental

Protection Agency, and Mr. Fred Cerise, the secretary of the

Louisiana Department of Health and Hospitals.

What we'll do is have each one of them provide two or three minutes

of opening remarks and then we'll open it up for question and answer.

And let me remind everyone on the call that we do have someone from

the state of Louisiana, you know, Mr. Fred, Dr. Fred Cerise on the

line, but much of what we're going to be talking about is also

applicable to the other areas that have been impacted by these

hurricanes in Mississippi and Alabama and parts of Texas as well.

So we hope you are able to get some useful information from this

call and with that, I'd like to begin by having Dr. Steve Redd

provide some opening remarks.

DR. REDD: Thanks, Tom.

I want to just reiterate a couple of the things that you mentioned,

that mold exposure is just one of the hazards or potential hazards

that people are going to be exposed to as they return to their homes

and start their lives in the aftermath of these hurricanes.

The mold issue is something that will affect the entire Gulf Coast

region but is going to be a particular problem in New Orleans

because of the flooding that's occurred there and the duration of

the flooding.

What I would like to do in my remarks here is go over briefly just a

little bit about what mold is, what the health effects are, and then

our recommendations for cleanup and protection from mold exposure.

So molds are a class of organisms that is separate from plants and

animals. They have some characteristics of both of those but they

live on organic material and the thing that--they're present

everywhere. The thing that kind a keeps them in check in indoor

environments normally is the limitation of moisture.

They require a nutrient source, the right temperature and water, and

normally, there's not enough water present to promote their growth.

As we know, both from wind and rain damage, and then from flooding

as well, the conditions for mold growth in the Gulf Coast region in

many buildings is really optimal now.

The health effects of mold--the second thing I'm going to talk about-

-there are really three major categories.

The first is infection and that is particularly a problem in people

that have suppressed immune systems. Either they're taking medicines

that prevent their immune systems from fighting infection normally,

or they have illnesses that suppress their immune system.

The second general category is allergy and this is for people who

have allergies to particular molds. If they're re-exposed to those

molds, they'll have symptoms like hay fever or skin rash or

worsening of asthma.

The third category is that of toxin-mediated disease. Some molds are

capable of producing toxins. They won't produce these toxins at all

times but under certain circumstances, like the nutrient supply is

getting short or some environmental issue, they may start producing

toxins and those can be dangerous if they're eaten or if they're

touched.

There's up to now not been evidence that airborne mold toxins have

produced disease.

Now the next category is talking about what to do to get rid of

mold. The thing that we say under normal circumstances is you have

to identify the water source. In this case that is no mystery but

once the water source is addressed and further water intrusion is

stopped, the surfaces that are mold-contaminated, that can be

cleaned need to be cleaned, and those that can't be cleaned need to

be removed, and we do not recommend testing or sampling for mold.

We believe that if mold is present, it needs to be removed, and the

real distinction is the amount of mold that is present.

So for small amounts of mold, those can be taken care of by the

property owner. Larger amounts, and usually we use a rough yardstick

of ten square feet of mold, that that needs to be taken care of by

professionals who have more experience with the kinds of personal

protection measures that need to be put in place to prevent exposure.

That leads us, actually, to the third or the final category I was

going to talk about, which is how to prevent mold exposure.

We recommend that people who are susceptible, that's people with

suppressed immune systems, or allergies, that they avoid areas with

mold.

For people who don't have those conditions, we recommend, for the

normal person who's just entering a building, we're not recommending

any specific protection, but if they're doing things that would

cause them to be exposed to airborne mold, such as remediating,

taking down walls, stirring up dust, we do recommend respiratory

protection and that generally means an N95 mask.

These are the kinds of things that can be purchased at normal home

supply stores, and I'd like to mention, finally, that all the work

we're doing is being done in close coordination with health

departments of Louisiana, Mississippi, Alabama, Texas, and federal

partners such as EPA, and that one of the really critical things

here is that this information about what kind of protection to use,

in what situation, is available on our Web site.

There are fact sheets and we're working to get that information to

the people who may be entering these kind of environments, so that

they can protect themselves.

MR. SKINNER: Okay. Thanks, Dr. Redd.

Now I'm going to introduce Mr. from the EPA who's

going to talk about this from the EPA's perspective.

Mr. .

MR. JOHNSON: Yes, thank you. Do I need to touch star one?

MR. SKINNER: No; you're on; go ahead.

MR. JOHNSON: Yeah, I would want to start by again echoing what Dr.

Redd just mentioned which is EPA and CDC have had a very close

partnership on the emerging mold issue over the last several years

and we have benefited greatly by their leadership on this issue and

tried to complement some of their public materials with some of ours.

I think you know that EPA's Indoor Environments Program is a

voluntary one and we spend a lot of time trying to get useful

information out to people on mold, and EPA's Website

www.epa.gov/mold is where we try to send our messages out to the

public so that they can take appropriate action regarding mold.

I want to just amplify briefly on just a couple of issues that Dr.

Redd spoke about. The first one has to do with cleanup and just

again echoing a couple of things. First of all, across the hurricane-

affected areas I think we're going to see a wide range of conditions

and there are going to be homes that have possibly been without air

conditioning for a few days, have a small amount of water

infiltration from damage possibly, and I think much of our

conventional guidance on mold applies directly and people can deal

with the problem without much difficulty at all.

In other cases where water infiltration has been much more

significant, much more lengthy, I think we all understand the grave

circumstances in New Orleans with the flooding, mold problems are

going to be much more severe. So we're dealing with a wide range of

potential cleanup scenarios across the affected area and it's not

going to be a one size fits all.

Again, I think the main point on the cleanup as Dr. Redd mentioned

is to first remove the water of the moisture source which may be a

challenge in and of itself, and then to remove the mold. And

removing the mold, the allergenic agent, is critical, so that's

essentially the steps there.

I want to talk a minute about a very substantial issue that I think

many people will face and that has to do with sampling and

contractors that are involved in mold remediation. The concern with

sampling is that in many cases sampling can be useful, it has a

defined purpose, and in many cases sampling for mold, testing for

mold, determining what mold levels are, is simply essentially a

financial diversion away from treating what the real problem is. So

we encourage people to make sure that when they are approached to

engage in some sampling to really understand why the sampling is

being recommended and to really understand the purpose of it.

Related to that is many people in the Gulf Coast region are going to

be faced with having to seek professional help to deal with their

mold problems and there are many excellent contractors out there and

we encourage folks that when they are faced with seeking

professional help that they do some pretty common-sense things like

check references, certainly look for experience, and it's our

experience that individuals with fire damage and water restoration

experience tend to be very good in the mold remediation area.

Lastly, pay close attention to contractors whose immediate

suggestion is to do extensive testing, as I said before.

So with that I think I'll stop and turn it back over to the

moderator.

MR. SKINNER: Thanks, Mr. . Now I'm going to ask Dr. Fred

Cerise to speak for 2 or 3 minutes and certainly give us a local

perspective on the situation. Dr. Cerise?

DR. CERISE: Thank you. Good morning. As you know or are maybe aware,

the city officials in New Orleans are moving forward with plans.

They're trying to rehabilitate the city and people are coming back

into the city, particularly workers, but also business owners to

gather important information and things like that in order to keep

their businesses going. So yesterday there was a part of the city

that was repopulated on the West Bank of the river which was

generally a dry area, but in the coming days and weeks there will

periods where people are allowed back in to view their homes on the

East Bank of the river which is one of the more affected areas by

the water.

So certainly in addition to the mold and the extensive discussion

we've had on that, we've got other issues that we're paying close

attention to particularly from a public health standpoint, these

issues of clean drinking water and sewage systems which just doesn't

exist at this time on the East Bank of the river which is a major

area of Orleans.

So we're advising people that do come into the city whether these

are essential workers or people who are coming in for the day to

inspect a home or business that there are other risks associated

with coming back into the city and that has to do with the water

that is not suitable for drinking, people can be exposed to

bacterial contamination that could cause diarrheal illnesses.

The East Bank of Orleans is still under a boil advisory meaning that

there's potentially harmful bacteria still in the water supply and

could be ingested not only from drinking the water but also if it's

used to bathe or cook or brush teeth or wash hands or things like

that. So we're asking people to pay close attention to that.

We're also working with the businesses that are up in the area

because we do have restaurants that are supplying the food to the

workers and so we are making sure that they have sources of clean

water and they have proper hand washing and following techniques,

using disposable plates and things like that so that we're not

contaminating the workers.

We are making very prominent placards at these places from the

Health Department saying that they have been cleared to try to,

again, do as much as we can to educate the general public about the

safety.

So in addition to the issues of mold we have issues with drinking

water and sewage, and also a concern of people that would come back

and attempt to stay in the city at this time. We have other things

like hospitals. We don't have operational hospitals in the city at

this time. The 911 system is not operational. Major trauma care is

not readily available in the and there's a lot of cleanup going on

in the area with broken glass and things like that that you can

imagine. So we've got a number of concerns. We're working closely

with the city on addressing those things as, again, obviously people

are very anxious to get back into the city and get back into their

homes.

MR. SKINNER: Thanks, Dr. Cerise. With that, , I'd like to turn

it back over to you. We'll begin the question and answer, and

depending on how many reporters we have in queue, let's just allow

one question at this time. So we're ready to begin.

OPERATOR: Thank you, and at this time, if you would like to ask a

question, please press star followed by one on your touchtone phone.

To withdraw your request, you may press star two. Once again, to ask

a question please press star followed by one.

Our first question comes from Pope with the Times Picayune.

QUESTION: Good afternoon. Greetings from ground zero. I'm calling

because I've been hearing from colleagues and friends with children,

that they are anxious about moving back into New Orleans with their

children for fear of contamination, possible long-term health damage

to their children from stuff that may have been in the water, that

is blown around as the water dries.

What can you say to address those concerns? And please identify

yourself because I'm not sure which is who.

MR. SKINNER: Yeah. , it sounds to me like you're asking about

sediments and what are some of the possible health effects

associated with sediments and that sort of thing?

QUESTION: Yes. The whole [inaudible]; yes.

MR. SKINNER: Okay. I'll ask Mr. , do you want to try to take

a stab at that question, sir?

MR. JOHNSON: Sure. I can speak to it. I can speak to it a bit. Yes,

we, EPA has in close partnership with the state of Louisiana, we

have implemented a fairly extensive sampling program that is

focusing both on the floodwaters, on the sediment, and on the air

quality, and we are looking at a variety of potential contaminants,

including organic compounds, metals, CCBs. We're looking at fecal

coliform in the sediment in water, and petroleum hydrocarbons, and

the like.

And so I think, as you're able to see on our Web site, we are

evaluating that information and trying to provide, in partnership

with CDC, health advisories, and we have issued some health

advisories to focus on people limiting their contact with the

sediment, limiting their contact with the floodwater, and that's

what we've been up to.

MR. SKINNER: And Dr. Redd or Dr. Cerise, if you all have anything to

add, feel free to do that.

, let's go to the next question, please.

OPERATOR: Thank you. Our next question comes from Maggie Fox with

Reuters.

MS. FOX: Thanks. I'd like to expand on that because I think what

was asking was about whether this stuff's blowing around and in

the air, and my question expands on that, because when I left New

Orleans and went to Houston, I heard some amazing rumors from my

college-age niece, such as that the evacuees were carrying these

contaminants on their bodies, and that they could breathe mold

spores on to you. There's a lot of fear about that.

What can be done and what concerns do you have about some of these

fears that may or may not be founded in fact?

MR. SKINNER: Dr. Redd, do you want to take a crack at that question?

DR. REDD: Sure. I think from the mold standpoint, the specific thing

that you mentioned, that's not possible. Actually, the kinds of

effects that molds can cause, all the ones I mentioned would not be

communicable.

That the illnesses that people get are from direct exposure from the

environment and I think there's a chance that a mold spore could be

on--you know, a person could carry that from Louisiana to Texas but

I think that the number of spores and there's really not a

possibility of a health effect occurring from that kind of

transportation or a person actually carrying something on their body

for any distance, really. That I think that really shouldn't be a

concern.

might want to talk about the other exposure. I think it's

probably pretty much the same case, that there are environmental

exposures that expose the person but they're not generally going to

create a risk from that person transferring it to someone else.

MR. SKINNER: Mr. , do you want to add anything?

MR. JOHNSON: Sure. I can add something very briefly, and again, I

would direct you to EPA's Katrina Web site, and, in particular, the

air data. Within the last couple of days, we have posted some

additional air data which outlines the kind of monitoring we did pre-

Rita in the New Orleans area, to examine the particular issue of

windblown dust. At this point in time, we have had a number of

monitors out, in and around the city, in St. Bernard Parish, to look

at the particulate matter levels, and we have found at certain

locations, on certain days, that for unusually sensitive people, the

levels--we found some levels that would be of concern to them, and

we've also found somewhat higher levels in the unhealthy for

sensitive groups range.

These are all part of EPA's air quality index and it's reported

pretty explicitly on our Web page. So, in summary, EPA's very

concerned about the windblown dust. We are working hard with the

state to get the ambient air quality network reestablished following

the hurricane and we expect to be doing additional sampling in the

coming days and weeks.

MR. SKINNER: Thanks, Mr. . , next question, please.

OPERATOR: Thank you. Todd Zwillich with WebMD, your line is now open.

MR. ZWILLICH: Hi. Thanks for having us on. This doesn't count as a

question, Tom.

Just to recap, when you said you found unusually--you found some

levels that could be of concern to some people, you meant dust and

not mold; right? You were referring specifically to dust?

MR. JOHNSON: Yes. This is from the Environmental

Protection Agency. I was referring explicitly to particulate matter

measurement.

MR. SKINNER: Go ahead with your question.

QUESTION: Just a couple of quick examples of diseases that can be

caused by toxin exposure in a mold.

MR. SKINNER: Dr. Redd?

DR. REDD: Yes. Well, ingestion of grains or foods that contain

mycotoxins can, over the long term, lead to liver cancer. If high

doses are ingested over a short period of time, they can lead to

liver failure. I think these are not the kinds of problems we're

likely to see. It's really a situation where foods are stored in

moist conditions and mold grows and produces toxins, but those are,

those would be two examples.

MR. SKINNER: Next question, please.

OPERATOR: Thank you. Our next question comes from Miriam Falco with

CNN.

MS. FALCO: Hi. Thanks for taking these calls. For one thing, could

you clarify what the symptoms are, what the illnesses are. I might

have missed that. But my question is you've mentioned a couple of

times, that the EPA has done extensive testing, and you made a point

of explaining what home owners should look for when they're trying

to hire contractors.

It strikes me odd that in a conference call like this you're

pointing that out, which leads me to want to ask: Are you seeing

scams already? Are you--it sounds more like a consumer alert rather

than a medical alert. So what was the impetus for this type of

consumer advice?

MR. SKINNER: Mr. , do you want to take that and then we'll

ask Dr. Redd to elaborate a little bit more on the symptoms.

MR. JOHNSON: Yeah; absolutely. Well, mold is not a new issue and

it's been our experience over the last several years, that while

there are some excellent contractors out there, we feel that there

are also some contractors out there who have diverted people's

financial resources away from actually remedying the problem, and

have, you know, had them do things that we do not believe are

normally critical to fixing the mold problem.

And, for example, while EPA has not done, and has no plans to do

testing for mold in homes, that often is a path of first suggestion

by some, and our advice is, to the consumer is simply if you're

going to be doing testing, know why you're doing it, because it

oftentimes requires many samples, it's oftentimes difficult to

interpret, there are no standards for mold levels that you can

compare them against, and it's simply often a diversion of resources.

MR. SKINNER: Dr. Redd?

DR. REDD: Yes. The types of illnesses that you would see, for people

that have an infection, that could be pneumonia that would have a

cough and fever associated with it. It could be a fungal sinusitis

which would be pain in the sinuses, fever. For the allergy symptoms,

that would be runny nose, itchy red eyes, and that would be kind of

the hay fever complex.

Or for people with asthma, that are sensitive to mold and that are

exposed to mold, that could be shortness of breath, chest

tightening, problems with breathing, just the typical asthma

worsening type symptoms.

MR. SKINNER: Great; thank you. , next question, please.

OPERATOR: Thank you. Our next question comes from Mike Stobbe with

the Associated Press.

MR. STOBBE: Hi. This question's aimed at Dr. Cerise. Doctor, you

mentioned a situation where people are moving into the west bank and

now going back to the east bank. Are you seeing increased cases of

illness and injury now as compared to, say, a week ago?

DR. CERISE: Actually, we have not seen--they're just beginning to go

back. On Monday, they were repopulating a section of the West Bank

of the river. But we're doing surveillance at the hospitals that are

up and at a number of what we call DMATs, or these units, medical

units that are spread around the city, and we're doing ongoing

surveillance at those sites and we're not seeing a spike. Mainly

what we're seeing is injuries, whether they're intentional or

unintentional, but mainly injuries or accidents from people doing

work in the area. After that we're seeing some respiratory symptoms,

coughing, colds and allergic type symptoms, and then rashes from

contact with the environment or from other purposes as well. But

we're not seeing things that people were concerned about in terms of

diarrheal illnesses. We really haven't seen spikes in that. And we

haven't seen a big spike in respiratory type symptoms since people

started coming back, but that just is a new happening just over the

past few days.

MR. SKINNER: , next question, please.

OPERATOR: Thank you. Our next question comes from Betsy McKay with

The Wall Street Journal.

MS. McKAY: Thanks. This question is for any one of you. There seems

to be some confusion about going back to sediment and what could be

airborne from the sediment. We know that when the flood waters were

still pretty prevalent there was a lot of sewage related bacteria in

them and presumably that all dries up in the sediment. But does that

bacteria or any portion of it become airborne? And then is there any

health hazard related to that?

MR. SKINNER: Mr. , do you want to take the first stab at that

one?

MR. JOHNSON: Yes, I'll take a stab at it and hopefully Steve will

follow-up as well.

We were very concerned about this possibility as we were developing

our environmental sampling plans for the water, sediment and the

air, and particularly after finding fecal coliforms in the water and

in the sediment, the next natural question is the very question that

you posed.

What we did at EPA was we got with our Office of Research and

Development and we had a series of conference calls that probably

had 20 to 30 both CDC and EPA scientists on it discussing what the

value would be of monitoring for potential biological contaminates

in the air particulate or as aerosols.

The conclusion of the entire group, and it was the consensus that I

heard, was that monitoring of biologicals in the airstream would not

really be a useful tool for helping to inform public health

decisions because there are no actionable levels, there is no

relationship between any levels that might be found in the air and

the likelihood of a public health outcome.

So for some of those reasons which the CDC is really I think in a

much better position to respond to, the decision and the advice

coming from the two agencies' scientists was that we would not

pursue that.

MR. SKINNER: Dr. Redd, do you have anything to add?

DR. REDD: Obviously I concur with that statement. I think the big

thing to recognize is that when the fecal coliforms are dried

they'll die and there won't be a risk of infection from that. There

will still be some material that will be left from that and that is

probably the most significant risk for that which I think is

probably not as significant as the allergic risk for mold that would

be some kind of irritative or allergic kind of response. And as Mr.

mentioned, there is no actionable level that you could say

this level is dangerous and below that threshold it is not dangerous.

MR. SKINNER: Thanks. , let's take a couple of more questions.

OPERATOR: Thank you. Our next question comes from from

MedPage Today.

MR. SMITH: I just want to get a sense probably from Dr. Cerise, but

if anybody wants to comment that would be good. The hospitals in New

Orleans in particular are not operating as well, although I assume

throughout the rest of the Gulf Coast things are pretty good or at

least not as bad.

If people go back into areas where there's lots of mold and start to

have symptoms, what can the health system do? Are we looking at a

lot of health symptoms that might overwhelm the facilities?

DR. CERISE: It's a good question and it's a point that we are trying

to make in terms of folks coming back into the city. Certainly for

repopulating the city one of the things that we want to make sure is

we've got the medical infrastructure to handle folks coming back and

living in the city.

Right now we have three hospitals up in the surrounding areas of

Orleans and they are not at capacity. They're able to accommodate

more at this point in time, so we haven't seen those hospitals reach

capacity. We also have a number of like I said type of emergency

room units set up around the city and to this point none of them

have been close to being overwhelmed. They are there as

precautionary measures. They're providing services.

But we feel like there's plenty of capacity at this point. And the

three hospitals, they're large hospitals that didn't go down during

the hurricane so they maintained power, they have water and sewerage

and they have a significant ability to ramp up should they need to

do that.

We also have, in fact it's arriving today or tomorrow, a large Navy

vessel, the USS Comfort, that's got 250 beds. It's primarily being

brought in for tertiary care purposes. If there's trauma or severe

problems that happen in the city proper that need immediate

attention, that vessel will be available as well.

MR. SKINNER: , let's take one final question, please.

OPERATOR: Thank you. Our final question comes from Maggie Fox with

Reuters.

MS. FOX: I just want to follow-up on the very earliest thing. If

this testing for mold isn't called for, do you just treat mold if

you happen to see it? Is that it, just eye-balling it?

MR. REDD: We recommend visual inspection and the threshold for

different actions, there really are two. One is if there's a surface

that is nonporous that can be cleaned, that would be the preferred

approach. If the contaminated material is porous, then that needs to

be removed. If it's a large area that's porous, that would call for

professional remediation.

MR. SKINNER: That was Dr. Redd from CDC.

MR. JOHNSON: This is from EPA. I would just add to that that

one of the challenges of visual inspection is often times mold

problems can actually be hidden behind wallpaper, behind wallboard

and the like, so sometimes that is a consideration as well.

MR. SKINNER: Thanks. , thank you. Thank you to all of our

participants. Thank you to the media who dialed in. Stay tuned for

further updates. We'll continue to keep you all informed as new

developments come about. Thank you again for your interest.

Listen to the telebriefing

February 29, 2008

Those poort people to be told such a bunch of BS is criminal, those three idiots

should be taken to the shed filled with a bunch of mold that we were all exposed

to for a few days and than tell us they can't get sick from breathing it in!

K

!!

tigerpaw2c <tigerpaw2c@...> wrote: