Guest guest Posted January 12, 2002 Report Share Posted January 12, 2002 Toxic Black Mold The Millennium's Silent Killer Fact or Fiction? You be the judge. On-Line at http://www.startremodeling.com/toxic_mold_brochure.htm Compiled by Jimmy Mc www.StartRemodeling.com revised January 07, 2002 I have added this brochure to the site due to the fact that many people can not read the Microsoft.doc attachments sent to them. I have also decided to put it all on one page, and although long, it is a worthwhile and very educational read for those of you concerned about Toxic Mold and it's easily printable. I will still be sending out the brochure via email to you very soon. - Jimmy ---------------------------------------------------------------------- ---------- Table of Contents > Nasty Sounding Stuff, Isn't It? Introduction Common Symptoms > Mold & Mildew: A Creeping Catastrophe Know Your enemy Mold and Medical Problems Immediate Response Required Roles of Adjusters and Experts The Future of Mold Claims > Combating Mold and Mildew 13 Common Breeding Grounds for Mold / Solutions It's Doing that to my Health? Dispose of it Properly or You'll Just make matters worse. ---------------------------------------------------------------------- ---------- Nasty sounding stuff isn't it? Stachybotrys Chartarum, Penicillium and Aspergillus – Toxic, Health threatening molds, found in homes, businesses and schools near you. These molds can be found anywhere that dark and dank conditions permit them to grow. When you try to kill them, they take to the air, spreading themselves with no forethought to the damage they can cause. They are just trying to survive. And they're good at it. Remember the story of the opening of King Tut's tomb? Mold was reportedly thick and pungent. The treasure hunters and laborers took ill after spending long days inside, and many died, but we now know it was NOT because the tomb was " cursed. " Only in the past decade or less have we begun to understand the potential health risks associated with exposure to mold contamination. Spores can be inhaled, absorbed through the skin or ingested on our food. And, because some people are more susceptible than others, one person may become debilitated by exposure to mold in the home, another person sharing the same environment is essentially unaffected. Infants, the elderly and anyone with immune system deficiencies due to disease, chemotherapy, etc. are particularly susceptible to serious illness following exposure to microbial contamination. Many species of mold and mildew (or the mycotoxins they produce) can cause or aggravate a number of ailments. Common effects from molds such as stachybotris atra, penecillium, cladosporium and several strains of aspergillius, are asthma, pneumonitis, upper respiratory problems, sinusitis, dry cough, skin rashes, stomach upset, headaches, disorientation and bloody noses. Numerous other species of mold and mildew are also toxic, and many mycotoxins are known carcenogens. Severe exposures can lead to internal bleeding, kidney and liver failure and pulmonary emphysema. Such health risks due to the presence of mold in a dwelling are a serious concern to occupants, and can pose potential liability for owners of rental properties. Contamination of residential properties by toxic mold and mildew is becoming more and more prevalent. Although mankind has been aware for thousands of years that mold thrives in damp conditions, only recently have we begun to understand how dramatically its presence can impact us. Toxic mold and mildew is not discerning, affecting both old and new buildings. The odor or appearance of mold can signal a variety of problems. The moisture that gives life to fungal growth in older buildings can be either a moisture problem created by tenant's use, or water intrusion due to leaky components, or both. In new construction, it could also indicate the existence of construction defects. " I Don't Remember Mold Being a Concern Twenty Years Ago " Molds and mildew are everywhere in our environment, and in nature, they perform the very important function of breaking down organic matter. These microbes need very little to survive and thrive: air, moisture (liquid water isn't necessary, most species propagate with only 40%-60% relative humidity), and food. Fungi are especially fond of building materials like sheetrock and wood, carpets, and enjoy soft goods such as furniture and clothes. Every home offers a smorgasbord for eager spores! There are a number of reasons for the increasing problem of mold and mildew in our homes, not the least of which is the fact that Title 24 to the United States Code of Federal Regulations, relating to energy conservation, brought new construction methods and materials, meaning that buildings don't " breathe " as freely, trapping moisture vapors inside the building. Most newer homes are built on concrete slabs, which emit moisture for several years as they cure, and because they are porous, moisture from the soil beneath the slab also vaporizes into the living space. Leaky roofs, windows, and plumbing, whether caused by poor construction or lack of timely repairs, often result in colonization of mold and mildew spores. The microbial spores become airborne, spreading inside wall cavities, behind cabinets and wallpaper, and through ventilation systems. When moisture and temperature conditions are favorable, widespread contamination can occur in a surprisingly short time. Introduction A 1999 Mayo Clinic Study cites molds as the cause of most of the chronic sinus infections that inflict 37 million Americans each year. Recent studies also link molds to the soaring asthma rate. Molds have been an under recognized health problem, but that is changing. Health- care professionals now know that molds can cause allergies, trigger asthma attacks and increase susceptibility to colds and flu. Anyone with a genetic predisposition can become allergic if exposed repeatedly to high enough levels. Last year Dr. Sherris at the Mayo Clinic performed a study of 210 patients with chronic sinus infections and found that most had allergic fungal sinusitis. The prevailing medical opinion has been that mold accounted for 6 to 7 percent of all chronic sinusitis. The Mayo Clinic study found that it was 93 percent - the exact reverse. Newsweek, 12/4/00 There are over 100,000 known living species of fungus, some of which are beneficial to mankind. Mycologists estimate that there may be as many as 200,000 more unidentified species of fungus. Yeasts, molds, mildews, rusts, and mushrooms are types of fungus. Mold nor spores cause illness, other than allergy and/or infections. It is the mycotoxins released when the molds' food source (moisture) is severed. To help comprehend how small mycotoxins are, one common housefly could carry about 7.35 billion attached to its external body hairs. Consequently, IF 50,000 constitute a theoretically lethal dose, a housefly could carry a lethal dose for over 100,000 individuals. When the stachybotrys mold dries, the mycotoxin production increases up to 40,000 times. Outdoor spores are not a usual cause of toxicity, (except for allergies and infection), but when growing inside, molds produce toxins, which are in much higher concentration and can cause illness. Indoor mold spores indicate mold growth, which indicates mycotoxin production. Currently, we can measure spores, identify spores, but it is difficult to measure mycotoxins. Stachybotrys produces at least 170 known mycotoxins, and probably more that have not been identified. Molds, a subset of the fungi, are ubiquitous on our planet. Fungi are found in every ecological niche, and are necessary for the recycling of organic building blocks that allow plants and animals to live. Included in the group " fungi " are yeasts, molds and mildews, as well as large mushrooms, puffballs and bracket fungi that grow on dead trees. Fungi need external organic food sources and water to be able to grow. Molds can grow on cloth, carpets, leather, wood, sheet rock, insulation (and on human foods) when moist conditions exist (Gravesen et al., 1999). Because molds grow in moist or wet indoor environments, it is possible for people to become exposed to molds and their products, either by direct contact on surfaces, or through the air, if mold spores, fragments, or mold products are aerosolized. Many molds reproduce by making spores, which, if they land on a moist food source, can germinate and begin producing a branching network of cells called hyphae. Molds have varying requirements for moisture, food, temperature and other environmental conditions for growth. Indoor spaces that are wet, and have organic materials that mold can use as a food source, can and do support mold growth. Mold spores or fragments that become airborne can expose people indoors through inhalation or skin contact. Mold spores are fungal reproductive cells of about the same size as pollen grains. They can occur in various colors and shapes, such as round, spheroid, banana-shaped, or tadpole-shaped. They can occur in enormous quantities, and at all times of the year. Mold spores can be found and generated at serious levels indoors, as well as out. Fungi can invade healthy individuals and can cause a variety of effects. The most common response is allergies (runny nose, sneezing, sinus congestion, and skin rashes). Allergies result from inhaling mold spores. When environmental conditions become conducive, many molds develop fungal hyphae, small appendages containing spores. These spores are analogous to plant seeds and can be spread by the billions when air currents pass over the hyphae. Even dead fungi are capable of causing allergic symptoms. Mold spores can be airborne, and get indoors through doors, windows or cracks and crevices, or be carried in from the outdoors on shoes and clothing. Building materials that were left outside before use can harbor viable (living) mold spores for many years. Indoor environments are never entirely free of molds. As a general rule of thumb, in a " healthy " building the concentration of spores and the mix of mold species tend to be similar to outdoor environment levels. If buildings are air-conditioned, or windows and doors are kept closed in summer, the concentration of spores within should even be lower than outside levels. High moisture (above 70.0% relative humidity) in a building will invariably lead to mold, mildew, or other microbial growth. This growth requires four things: a nutrient source (found in most building materials), proper temperature (usually found indoors), mold spores (ubiquitous in ambient air), and water. Some molds also produce toxins (poisons) which are thought to be useful in killing competing molds in their vicinity. These toxins can also have deleterious effects on humans when ingested, inhaled or in contact with the skin. The fungi that produce toxins are known as toxigenic fungi. Many fungi produce secondary toxic metabolites which can produce adverse health effects (mycotoxicoses) in animals and human. These metabolite are collectively known as mycotoxins. The latest World Health Organization (WHO) publication on mycotoxins, available in 1990, indicated that there are more than 200 mycotoxins produced by a variety of common fungi. Historically, mycotoxins are a problem to farmers and food industries and in Eastern European and third world countries. However, many toxigenic fungi, such as Stachybotry chartarum (also known as Stachybotrys atra) and species of Aspergillus and Penicillium, have been found to infest buildings with known indoor air and building-related problems. Many indoor air quality related problems have been traced to the growth of fungus in buildings. Almost without exception, these buildings have usually had chronic water or moisture problems. Molds can have an impact on human health, depending on the nature of the species involved, the metabolic products being produced by these species, the amount and duration of individual's exposure to mold parts or products, and the specific susceptibility of those exposed. Health effects generally fall into four categories. Allergy, Infection, Irritation, Toxicity Toxicity Molds can produce other secondary metabolites such as antibiotics and mycotoxins. Antibiotics are isolated from mold (and some bacterial) cultures and some of their bacteriotoxic or bacteriostatic properties are exploited medicinally to combat infections. Mycotoxins are also products of secondary metabolism of molds. They are not essential to maintaining the life of the mold cell in a primary way (at least in a friendly world), such as obtaining energy or synthesizing structural components, informational molecules or enzymes. They are products whose function seems to be to give molds a competitive advantage over other mold species and bacteria. Mycotoxins are nearly all cytotoxic, disrupting various cellular structures such as membranes, and interfering with vital cellular processes such as protein, RNA and DNA synthesis. Of course they are also toxic to the cells of higher plants and animals, including humans. Mycotoxins vary in specificity and potency for their target cells, cell structures or cell processes by species and strain of the mold that produces them. Higher organisms are not specifically targeted by mycotoxins, but seem to be caught in the crossfire of the biochemical warfare among mold species and molds and bacteria vying for the same ecological niche. Mycotoxin Effects - The class of small fungal secondary metabolites which has been given the name " mycotoxins " is definitely known to include many compounds which are highly toxic to vertebrates (such as humans). Most of the well characterized toxic effects are from animal feeding situations, either natural mycotoxicosis outbreaks caused by contaminated animal feed, or laboratory experiments based on feeding (or connected artificial experimental situations such as parenteral injection of purified toxins into experimental animals). Ingestion of mycotoxin-contaminated foods by humans results in similar symptoms. Toxic effects have also been found in laboratory experiments in which animals are exposed to mycotoxins via the respiratory tract. In cases involving humans and airborne exposure, the most suggestive of a direct mycotoxin effect are those in which heavily mold-exposed workers develop severe symptoms reminiscent of animal mycotoxicoses or contaminated-food mycotoxicoses. Common Symptoms As another example, classic stachybotryotoxicosis, described mostly from agricultural workers who handled or disturbed large quantities of material (usually hay or straw) contaminated by Stachybotrys chartarum, was characterized by (1) " Cough, rhinitis, burning sensation in the mouth, (throat) and nasal passages, and cutaneous irritation at (points) of toxin contact " (2). Nosebleeds were also common, and tracheal bleeding was occasionally reported. Whether such mycotoxin effects explain the symptoms seen in common building exposures has been disputed. It has been pointed out that, although the mycotoxins are often associated with disseminating fungal conidia, the quantities present may not be sufficient to explain the effects observed (3), at least not in terms of classic toxicosis. A number of mycotoxins or conidia of mycotoxigenic fungi, however, have also been shown to have effects such as activation of pulmonary alveolar macrophages (PAMs), DNA fragmentation in PAMs, inhibition of the oxidative burst killing mechanism in PAMs, and slowing of respiratory ciliary beat (e.g., 4). Such interactions with immune mechanisms may explain some symptoms not explained by toxicosis. Careful study of occupants of contaminated buildings suggests an association between inhalation of toxigenic fungi and nonspecific respiratory symptoms (5) Moldy Odors are released from actively growing fungi may also pose a health risk. Not all molds produce mycotoxins, but numerous species do (including some found indoors in contaminated buildings). Toxigenic molds vary in their mycotoxin production depending on the substrate on which they grow (Jarvis, 1990). The spores, with which the toxins are primarily associated, are cast off in blooms that vary with the mold's diurnal, seasonal and life cycle stage (Burge, 1990; Yang, 1995). The presence of competitive organisms may play a role, as some molds grown in monoculture in the laboratory lose their toxic potency (Jarvis, 1995). Until relatively recently, mold poisons were regarded with concern primarily as contaminants in foods. More recently concern has arisen over exposure to multiple mycotoxins from a mixture of mold spores growing in wet indoor environments. Health effects from exposures to such mixtures can differ from those related to single mycotoxins in controlled laboratory exposures. Indoor exposures to toxigenic molds resemble field exposures of animals more closely than they do controlled experimental laboratory exposures. Animals in controlled laboratory exposures are healthy, of the same age, raised under optimum conditions, and have only the challenge of known doses of a single toxic agent via a single exposure route. In contrast, animals in field exposures are of mixed ages, and states of health, may be living in less than optimum environmental and nutritional conditions, and are exposed to a mixture of toxic agents by multiple exposure routes. Exposures to individual toxins maybe much lower than those required to elicit an adverse reaction in a small controlled exposure group of ten animals per dose group. The effects from exposure may therefore not fit neatly into the description given for any single toxin, or the effects from a particular species, of mold. Few toxicological experiments involving mycotoxins have been performed using inhalation, the most probable route for indoor exposures. Defenses of there respiratory system differ from those for ingestion (the route for most mycotoxin experiments). Experimental evidence suggests the respiratory route to produce more severe responses than the digestive route (Cresia et al.,1987). Effects from low level or chronic low level exposures, or ingestion exposures to mixtures of mycotoxins, have generally not been studied, and are unknown. Effects from high level, acute sub-acute and sub-chronic ingestion exposures to single mycotoxins have been studied for many of the mycotoxins isolated. Other mycotoxins have only information on cytotoxicity or in vitro effects. Effects of multiple exposures to mixtures of mycotoxins in air, plus other toxic air pollutants present in all air breathed indoors, are not known. Effects of other biologically active molecules, having allergic or irritant effects, concomitantly acting with mycotoxins, are not known. Measurement of mold spores and fragments varies, depending on instrumentation and methodology used. Comparison of results from different investigators is rarely, if ever, possible with current state of the art. While many mycotoxins can be measured in environmental samples, it is not yet possible to measure mycotoxins in human or animal tissues. For this reason exposure measurements rely on circumstantial evidence such as presence of contamination in the patient's environment, detection of spores in air, combined with symptomology in keeping with known experiment allesions caused by mycotoxins, to establish an association with illness. Response of individuals exposed indoors to complex aerosols varies depending on their age, gender, state of health, and genetic make-up, as well as degree of exposure. Microbial contamination in buildings can vary greatly, depending on location of growing organisms, and exposure pathways. Presence in a building alone does not constitute exposure. Investigations of patients' environments generally occur after patients have become ill, and do not necessarily reflect the exposure conditions that occurred during development of the illness. All cases of inhalation exposure to toxic agents suffer from this deficit. However exposures to chemicals not generated biologically can sometimes be re-created, unlike those with active microbial growth. Indoor environments are dynamic eco systems that change over time as moisture, temperature, food sources and the presence of other growing microorganisms change. Toxin production particularly changes with age of cultures, stage of sporulation, availability of nutrients, moisture, and the presence of competing organisms. After-the-fact measurements of environmental conditions will always reflect only an estimate of exposure conditions at the time of onset of illness. However, presence of toxigenic organisms, and their toxic products, are indicators of putative exposure, which together with knowledge of lesions and effects produced by toxins found, can establish association. Field exposures of animals to molds (in contrast to controlled laboratory exposures) show effects on the immune system as the lowest observed adverse effect. Such immune effects are manifested in animals as increased susceptibility to infectious diseases. It is important to note that almost all mycotoxins have an immune suppressive effect, although the exact target within the immune system may differ. Many are also cytotoxic, so that they have route of entry effects that may be damaging to the gut, the skin or the lung. Such cytotoxicity may affect the physical defense mechanisms of their respiratory tract, decreasing the ability of the airways to clear particulate contaminants (including bacteria or viruses), or damage alveolarmacrophages, thus preventing clearance of contaminants from the deeper lung. The combined result of these activities is to increase the susceptibility of the exposed person to infectious disease, and to reduce his defense against other contaminants. They may also increase susceptibility to cancer (Jakabet al., 1994). Because indoor samples are usually comprised of a mixture of molds and their spores, it has been suggested that a general test for cytotoxicity be applied to a total indoor sample to assess the potential for hazard as a rough assessment (Gareis, 1995). Animal experiments in which rats and mice were exposed intranasally and intratracheally to toxic strains of S. chartarum, demonstrated acute pulmonary hemorrhage (Nikkulin et al. 1996). A number of case studies have been more recently published. One involving an infant with pulmonary hemorrhage in Kansas, reported significantly elevated spore counts of Aspergillus/Penicillium in the patient's bedroom and in the attic of the home. Stachybotrys spores were also found in the air of the bedroom, and the source of the spores tested highly toxigenic. (Flappan et al., 1999). In another case study in Houston, Stachybotrys was isolated from bronchopulmonary lavage fluid of a child with pulmonary hemorrhage. (Elidemir et al., 1999), as well as recovered from his water damaged-home. The patient recovered upon removal and stayed well after return to a cleaned home. Another case study reported pulmonary hemorrhage in an infant during induction of general anesthesia. The infant was found to have been exposed to S. chartarum prior to the anesthetic procedure (Tripi et al., 2000). Still another case describes pulmonary hemorrhage in an infant whose home contained toxigenic species of Penicillium and Trichoderma (a mold producing trichothecene poisons similar to the ones produced by S. chartarum) as well as tobacco smoke (Novotny and Dixit, 2000) Toxicologically, S. chartarum can produce extremely potent trichothecene poisons, as evidenced by one-time lethal doses in mice (LD50) as low as 1.0 to 7.0 mg/kg, depending on the toxin and the exposure route. Depression of immune response, and hemorrhage in target organs are characteristic for animals exposed experimentally and in field exposures (Ueno, 1980; Jakab etal., 1994). While there are insufficient studies to establish cause and effect relationships between Stachybotrys exposure indoors and illness, including acute pulmonary bleeding in infants, toxic endpoints and potency for this mold are well described. What is less clear, and has been difficult to establish, is whether exposures indoors are of sufficient magnitude to elicit illness resulting from toxic exposure. The toxic mold environmental risk may be one of the next major real estate " due diligence " concerns, especially in property development areas where major flooding has occurred. The problem is that this not only includes known residential and commercial flood areas incidents, but also numerous minor water releases due to plumbing failures, conductive condensation, house water leaks and accidents. The toxic mold concern could also be a problem where fires occurred at residential properties. The second major concern is that one might not be able to permanently eliminate the entire toxic mold from the structure. There also remains a great propensity for future reoccurrence. The health risk/hazard could be back again. Therefore, we must recommend that great care be exercised to remove and dispose of all products, which have been contaminated by the toxic mold contaminated. The Department of Health Administrations in many states supports this recommendation. The third concern is that States' Health Departments will consider ambiguous and genetic disposition as a response to the publics' inquiries. There will be some people, especially children, that will exhibit more adverse reactions, including death, lung tissue damage, and memory loss, than other persons exposed to the toxic mold. This may depend on the chemical sensitivity, genetic disposition, predisposing health history (such as allergies, asthma, smoking, etc.). For some, the exposure to the toxic mold spores may just be a " health risk " and to others, it may be a real " health hazard " (potential life-threatening and loss of " quality of life " .) Whether a potential liability concern is a risk or hazard will be paramount in defining the critical level of due diligence and disclosure response by responsible parties. There are already several major lawsuits concerning toxic mold exposure in residential and commercial buildings throughout the United States. Currently, most health organizations consider exposure to Stachybotrys mold as a health hazard. Also, keep in mind that most responses leading to testing, investigations, and abatement of the Stachybotrys toxic mold are due directly to occupant complaints or documented detrimental health effects. Stachybotrys mold may evolve to a point where it is regarded with the same cautions, response and liability concerns as those attributed to lead-base paint and asbestos. Health hazards and risks associated with concern to exposure to Stachybotrys are currently considered as short-term effects. Exposure to radon gas in houses is considered a long-term health risk and is not considered a short-term hazard. Mold & Mildew: A Creeping Catastrophe In February 2000, a Texas grand jury found reason to continue a criminal investigation of child endangerment charges against an insurance company for its handling of a water damage claim. This investigation was prompted by a criminal complaint filed by the policyholder and follows the filing of a $100 million lawsuit in 1999 against the same insurance company for its handling of the claim. The policyholders say that the insurance company did not act properly or in a timely manner following the water damage claim. The allegation is that the house is now uninhabitable. The family claims that, following the water damage, and while they were still living in the house during repairs, they were coughing up blood. The husband, the family claims, is now suffering from a cognitive dysfunction, among other injuries. The problem? Mold. Stachybotrys chartarum (a.k.a. atra) to be specific. The mold developed following a water damage loss in 1998. The policyholders allege that neither the insurance company nor the company's expert informed the family that the home contained the deadly mold until their health was irreversibly damaged. Is the Texas case merely an extreme example? Or is it a harbinger of things to come? Many lawsuits have been filed and are being filed around the country involving the improper handling of covered water damage losses that have resulted in mold growth so extensive and severe as to present potentially serious - and in too many cases, actual - health hazards, not only to the occupants of the building involved but possibly to anyone who unwittingly enters the structure. Furthermore, mold growth can cause damage to building materials, such as paper and wood products. Mold contamination and growth may also pose a disclosure issue during a real estate transaction. According to the Insurance Information Network of California and the Western Insurance Information Service, both sponsored by insurance companies, water damage from frozen and broken water pipes ranks second, behind hurricanes, in terms of the number of homes damaged and the amount of claim costs in the U.S. Damage from water is the most prevalent, yet least recognized, catastrophe. In addition to broken and frozen water pipes, we have to include losses from flood, rain, leaks and surface water, as well as water damage from putting out fires. Some of these losses are covered, some are not. If the water damage is the result of a covered loss, the resultant damage, mold (including fungi, mildew, etc.), is probably also covered and must be considered in preparing the scope of damages and costs of repair. The consensus of opinion from the EPA, FEMA, the Centers for Disease Control (CDC), mycologists and microbiologists is that mold may start to grow and spread within 24 to 48 hours in structures damaged by water. Mold can grow exponentially, given the right conditions of temperature, moisture and food sources, such as sheetrock. Know your enemy. Fungi are a group of organisms with nuclei and rigid cell walls, but without chlorophyll. They may be unicellular or in multicellular filaments. The filaments are called hyphae. A fungus may produce a system of branching filaments, called the mycelium. The filamentous fungi are sometimes called molds. Unicellular fungi are often called yeasts. Some fungi may produce both yeast and mycelial mold phases. Mildew, in layperson's terms, describes the staining, and likely the degradation of the materials, caused by fungi or molds. Mildew is also used by plant pathologists to identify plant diseases, such as " powdery mildew, " caused by fungi. or molds. Mildew is also used by plant pathologists to identify plant diseases, such as " powdery mildew, " caused by fungi. Mold, mildew and fungi are hardly new problems. In the book of Leviticus, chapters 13 and 14, there is reference to a plague, also called mildew in some translations. The description seems to fit that of a toxic mold. In Leviticus, the solution was to try cleaning: " Watch the plague and if the plague spreads, the unclean item or property must be removed and destroyed. " Stachybotrys chartarum was first identified and described by a scientist from wallpaper collected in a home in Prague in 1837. The toxic effects of Stachybotrys have been reported as early as the 1920s. Reports and surveys on mold in homes have been published since at least the late 1970s. In 1986, the injurious effects of trichothecenes - a mycotoxin produced by Stachybotrys chartarum and a few other molds - were reported from a study of a family in Chicago. That report, by W.A. Croft, said that Stachybotrys could be commonly found in homes with water damage, could grow undetected behind walls and could grow profusely on sheetrock. In 1993, the New York City Department of Health's Bureau of Environmental & Occupational Disease Epidemiology convened a panel of experts to study a growing and noted problem. Their report, " Guidelines on Assessment and Remediation of Stachybotrys Atra in Indoor Environments, " was issued in 1994. An updated report, " Guidelines on Assessment and Remediation of Fungi in Indoor Environments, " was issued in April 2000. The scope of the report was expanded to include all mold or fungi. These guidelines serve as the accepted standard on how to deal with mold. The initial 1994 report focused on Stachybotrys, but was revised in 2000 to include all mold (fungi). The authors highly recommend that concerned readers download and print out copies for reference, which run about 17 printed pages. (For more information, contact he N.Y.C. Department of Health at (212) 788-4290.) Mold & medical problems A wide variety of symptoms have been attributed to the toxic effects of different molds. The medical problems may be caused by toxic gases produced by the molds or by reactions to the mold particles themselves. Many allergies are also attributable to mold and fungi. Commonly reported symptoms include runny noses, eye irritation, congestion, and aggravation of asthma, headaches, dizziness and fatigue. More severe symptoms may include reports of profusely bloody runny noses, the coughing up of blood, severe headaches, fibrous growth in the lungs and - at least in one reported instance - cognitive dysfunction and loss of memory. In the previously described water damage and mold claim in Texas, a mold expert in the case underestimated the danger involved. The expert found himself throwing up for hours after spending just 30 minutes in the house. He has a severe hearing loss in one ear from his exposure to the mold. In 1993 and 1994, a doctor from the Cleveland area attributed 37 cases of pulmonary hemorrhage and hemosiderosis in young infants to Stachybotrys. Twelve of the infants died. A recent CDC report questions the scientific validity of the doctor's conclusions and the causal linkage of the infant deaths to the toxic effects of Stachybotrys. However, the CDC does recognize that moldy homes are unhealthy for human occupancy. Other reports claim to confirm the linkage of Stachybotrys to instances of infant deaths in other locations. Some of the most extreme cases of mold-related health problems, the so-called " yellow rain " attacks in Southeast Asia during the late 1970s, and the Iraqi attacks on some Kurd villages in the 1980s and 1990s have been attributed to use of mycotoxins produced by molds. The conclusion to be reached from all of these dramatic cases is that molds are potentially dangerous and cannot be ignored. All molds should be removed. If the mold is attributable to a covered loss, it is the responsibility of the adjuster to include removal of the mold as part of the loss. Immediate response required While all claims should be responded to and handled promptly, timeliness on covered water damage claims is especially critical. A prompt response and an immediate commencement of cleanup and drying is essential in reducing or eliminating further damage, particularly by mold. The sooner the water is removed and the property properly dried out, the less property damage there will be and any related claim will also be correspondingly minimized. Water damage that is not addressed within 24 to 72 hours may result in the growth and spreading of mold which could be toxic. (See " Wringing Out Excess Costs From Water Damage Claims " for proper drying procedures.) A visual inspection is the most important step in identifying possible mold contamination. The inspection should include any areas damaged by water, e.g., behind cabinets, in attics, under carpets, inside wall cavities and any area with porous material or soft goods exposed to high humidity (over 60 per cent) or water for a period in excess of 72 hours. The general rule of thumb is very simple: If you can see mold or smell mold, you have to remove it. Once you find and start removing the mold-damaged or contaminated materials, such as sheetrock, you should keep on removing the material until you find no more mold, either on the face of the sheetrock or on the back side of the sheetrock next to the studs. If the studs have mold contamination, you must consider the edge of the stud on which the other or exterior wall is attached. Since the N.Y.C. Department of Health's panel of experts concluded that it was not possible to determine safe or unsafe levels of exposure for people with varying degrees of susceptibility, the guidelines essentially call for the removal of all visible mold. The New York City guidelines state that in looking for mold following water damage, bulk sampling or air monitoring is not required. Remediation of all visibly identified mold contamination should proceed without further evaluation. However, if mold is not visible but is suspected because of circumstances such as water damage and unexplained illness, it may become necessary to test in order to rule out mold or to verify its presence. Porous materials, such as ceiling tiles, insulation and wallboards, with more than a small area of mold contamination should be removed and discarded. A small isolated area is defined as 10 square feet or less. A small area may be cleaned safely if done properly, without problems, and a check reveals no more mold. Removal of the mold-contaminated material is only the first step. A certified mold remediation specialist should then remediate or decontaminate the structure and personal property involved. Depending on such variables as the length of time from the initial water damage, the amount of water in the structure, the cleanliness of the water and the type of property involved, it may be necessary to remove carpets, pads and any other wet items (especially clothing and other soft goods) from the premises for proper drying, cleaning and treatment. Damp or wet carpets, pads or other items may provide a medium for potentially dangerous mold growth. Flooding of property, pipe breaks in ceilings or walls, or standing water necessitates removing sheetrock that has been water-damaged, up to at least a foot or more above the high-water mark. Removal of at least some sheetrock may also be necessary to allow the wall cavities to drain and dry properly. Wet insulation, in the ceiling or walls, must be removed and replaced. Wet or damp insulation, especially in dark places like wall cavities is a breeding ground for mold. The insulation value is also reduced. Prompt response and appropriate action is necessary to minimize damage in a water loss. A quick response will also allow the adjuster to determine if the mold is pre-existing or a result of the water damage. If the adjuster can inspect the loss within 24 or 48 hours of the initial damage, it is likely that any visible or detected mold may be the result of a pre-existing water problem, possibly a long- term leak. However, if the loss is not inspected or properly dried within 72 to 96 hours, it may be more difficult to determine if the mold was a pre-existing problem or a result of the covered loss, and thus also covered. The longer the delay in inspecting the loss, the more difficult it becomes to prove the mold was not caused by the covered loss. Roles of adjusters, experts As the expert in claims handling and policy coverages, it is the adjuster's responsibility to seek out and identify any and all damage covered in the loss - either alone or with the assistance of the contractor - and then to extend to the insured any and all benefits available under the policy. This responsibility means including in the scope of damage any visually identifiable mold in a covered loss as possibly a part of the loss. Unless the adjuster can determine that the mold in a covered loss either pre-existed the loss or is not a result of the covered water damage, the mold has to be considered as part of the loss. Denial of the mold contamination as being excluded under the policy, either subject to the standard mold exclusion or as not being part of the covered loss itself, requires that the adjuster prove and document the basis for the denial. Relative to the insured, the adjuster is operating from a position of superior knowledge on what should be expected in the way of damage, and what damage is or is not covered under the policy. Many adjusters see water damage claims on a frequent basis and have a much better idea than the insured on what might be damaged and where to look for hidden damages. If the adjuster is in doubt or lacks sufficient experience, he or she should work closely with the insured's contractor and make sure the scope of damage is complete. If the water damage is more than a few days old, be sure and check for mold as a possible hidden damage in wall cavities or other areas damaged by water. Adjusters are not expected to be experts on determining whether or not the mold is dangerous; however, an adjuster is expected to detect visible mold, to look for mold in certain areas (such as water-damaged wall cavities), to include the mold in the scope of damage and to call in the appropriate experts to assist and advise. The job of the experts is to advise the adjuster concerning the mold and how to handle the mold. A professional restoration consultant should be contacted when more than a small area of mold contamination is involved. Even a mid-sized isolated area - say, 10 to 30 square feet - requires special handling. Areas of 30 to 100 square feet require professionals, preferably certified in mold remediation and trained in handling hazardous materials. Areas of more than 100 square feet require special containment procedures and negative pressurization. Such areas may require asbestos-like remediation procedures; the removed material must be treated as hazardous waste. During and after removal or remediation of the mold, it may be necessary to conduct sampling to determine if remediation has been successful. The future of mold claims The Cleveland Plain Dealer, in August 1998, quoted Dan Zielinski, of the American Insurance Association, as saying, " Insurance companies will not take note of [stachybotrys atra] until they are faced with numerous losses because if it. " One of the reasons may be the high cost of mold remediation, which should be done only by trained and experienced professionals. Some studies have shown that proper remediation and removal of contaminated building materials is about 10 times as expensive as regular tear-out and replacement. In some cases the remediation cost is more than $150 per square foot. Insurance companies and adjusters should, however, be taking note of the dangers of mold contamination now. The insurance industry is being faced with numerous losses and lawsuits, some of them far more expensive than any remediation cost. In the last seven years in California, there have been a number of lawsuits involving mold following water damage. Many have settlement figures of more than $500,000. In one suit, the policyholder recovered more than $2.5 million. In another, the policyholder recovered over $9 million. The case in Texas was filed demanding $100 million. Hardly a figure to sneeze at. The examples cited above do not even touch on the liability, construction defect and " sick building syndrome " cases. In 1992, for example, a courthouse in Florida developed mold problems due to construction defects. A jury recently awarded more than $40 million in personal injury claims. There were over 200 workers' compensation claims and at least 180 separate lawsuits. In New York City, more than 300 tenants in an apartment complex with mold problems have filed a class action lawsuit in excess of $10 billion. Previously, such lofty figures were seen only in asbestos or drug- related class actions. Now, we are starting to hear 11-digit figures mentioned in litigation concerning the lowly mold fungi. While mold does not develop in every water damage loss, the adjuster must be aware of the potential for mold and its inherent costs. The adjuster must look for mold when the circumstances warrant and must call in appropriately qualified experts for guidance as needed. Mold remediation may be expensive, but failure to remediate a covered damage may be even more expensive, in terms of health as well as dollars. Combating Mold In Your Home What's wrong with a little mold and mildew? As long as they stay put behind the laundry tub, out of sight under the basement carpet, or only peek around the edge of the bathroom wallpaper, who cares? Well, YOU should, because they're not only eating away at your house, they could be eating away at your health, too. Here we'll take a look at what mold and mildew are, how they affect the health of you and your house and, finally, how you can prevent their growth and get rid of the stuff. MOLD AND MILDEW--BIG-TIME CONSUMERS Though there are thousands of different types of mold and mildew, they all have two things in common: The first is that their mission on Earth is to digest the organic world around them. The second is that they all need moisture so their little digestive enzymes can go to work. There are differences between mold and mildew, but for our purposes, we can call the entire gang mold. Molds are neither plants nor animals. They're microscopic organisms containing enzymes (responsible for digesting and decomposing) and spores (in charge of reproduction). Mold dwells within the fungi kingdom: a realm includes mushrooms, yeast and other seemingly unsavory characters. But the truth is, these decay organisms aren't unsavory at all. Without them, toppled trees, dead animals and fallen vegetables wouldn't decompose. Our land would get piled higher and higher with dead stuff. We wouldn't have foods and medicines like cheese and penicillin. The problems arise when mold starts chomping away at things we don't want them to--affecting the look, smell and structural integrity of your house. IT'S DOING THAT TO MY HOUSE? Mold needs to consume something to survive, and it's perfectly happy eating your house if you let it. Some molds and mildews are fond of the cellulose in the paper backing on drywall, insulation and wallpaper. Others have a ravenous appetite for the glues used to bond carpet to its backing. Left unchecked, mold eventually destroys the parts of the drywall, wallpaper and carpet it attacks. But many molds just like to feast on the everyday dust and dirt that gather in the perpetually moist regions of your house. They won't destroy your house, but they can sure make it look, feel and smell bad. Mold can mar your walls with white spider web-like growths or clusters of small black specks. It creates the smell we often refer to as " musty. " It can be slippery and dangerous when it grows on damp basement stairs. Molds rarely go so far as to rot wood or do structural damage-- they'll leave that to their fungal cousins--but they can wreak plenty of havoc. We can't overemphasize that mold needs moisture to get established, grow and reproduce. Mold problems and longstanding moisture or high humidity conditions go hand in hand. To conquer mold, you must also conquer moisture problems. Fig. B shows common hangouts for mold and some steps you can take to minimize its growth and the damage it inflicts. 13 common breeding grounds for mold and mildew Problem #1 Leaky air-conditioning duct joints, especially those running through a hot attic, create a moist environment for mildew. Solution: Seal all duct joints with the special flexible mastic available heating and cooling supply stores. Problem #2 In warm environments, impermeable vinyl wall coverings can trap moisture-laden air as it moves from the warm exterior to the cooler interior. Mold degrades the drywall and adhesive behind the vinyl wall covering. Solution: Use paint or apply wall coverings with permeable paper backings that don't trap moisture on exterior walls. Problem #3 When washing machines in a room without a floor drain overflow or hose connections burst, water with no point of exit will soak into adjacent carpet, drywall and insulation. Solution: Always provide a floor drain near the washing machine. Install an overflow pan directly under the machine or install a 1-in. lip at the doorway to contain overflows in main-level or second-story laundry rooms. (An overflow pan is available for about $125 plus shipping from AMI, 800-929-9269.) Problem #4 Water-resistant drywall used as a backer quickly degrades once subjected to moisture. Solution: Install cement backer board, which will remain structurally sound even if repeatedly subjected to moisture. Problem #5 Poorly ventilated bathrooms allow surface mold to grow. Solution: Install a bathroom fan (or at least, open a window) to exhaust moisture. Remove surface mildew by scrubbing the area with a 1/2 percent bleach solution. When the area is dry, prime it with an alcohol-based, white-pigmented shellac, such as Zinsser Bullseye, and use a paint containing mildewcide. Problem #6 Poorly constructed crawlspaces promote mildew growth. Bare earth floors transmit huge amounts of moisture. Solution: There are many regional differences and solutions. Cover bare earth with 6-mil poly sheeting. Heat, cool and humidify the area the same as the rest of the house. Problem #7 Freshly cut firewood stored indoors emits huge amounts of moisture. Solution: Store it outside. Problem #8 Humidifiers (especially reservoir-type central units and portable units) provide both a growth medium and a distribution system for mold and mildew. Solution: Clean and treat the reservoir often with an antimicrobial solution, available at most hardware stores. Problem #9 The condensation pan directly under the coil of your central air conditioner can harbor mold. Solution: Before each cooling season, clean the pan with a 1/2 percent bleach solution and make sure the continuous drain is working. Problem #10 Finished concrete basements that haven't been thoroughly waterproofed from the outside are problematic. When moisture migrates through the earth and non-waterproofed concrete walls, it can get trapped behind vapor barriers, carpet, layers of insulation and drywall. Solution: Thoroughly waterproof the exterior of concrete walls before backfilling. Install 6 in. of gravel under concrete floors during construction to prevent moisture from wicking up through concrete floors and into floor coverings. Problem #11 Yards that slope toward foundations invite water to enter basements and crawlspaces. Solution: Regrade yard surrounding house so it slopes away at a rate of 1 in. per foot. Problem #12 Improperly flashed or caulked windows (and those with large amounts of surface condensation) let moisture seep the surrounding wood, drywall and insulation. Solution: Properly flash and caulk windows during installation; minimize condensation with good ventilation and airflow. Problem #13 Leaky flashings and shingles allow rain to infiltrate attics, insulation, eaves and other areas that can trap moisture and be difficult to inspect. Solution: Perform yearly roof inspections--even if you do it from the ground with binoculars. IT'S DOING THAT TO MY HEALTH? Besides damaging your house, mold can cause severe health problems. One consultant we interviewed confessed he crawls around in moldy places day after day, month in and month out, and never suffers ill effects. Others--some estimate about 10 percent of the population-- are severely allergic to mold. It's primarily the dinky reproductive spores that people react to. Twenty of them sitting side by side could fit across the period at the end of this sentence. That means they're hard to filter out. The spores also have an incredible " hang time " (as my teenage son would say); they're able to stay suspended in midair for hours on end. That means they're easily inhaled. With even slight exposure to molds and spores, sensitive people may experience headaches, runny noses, skin rashes, nausea, sinus problems, memory loss and coughs. They may feel listless for long periods of time. In short, they feel as though they have a perpetual case of the flu. Newborns, the elderly, the sick, and those with compromised immune systems can be affected severely, even fatally. Babies and toddlers, who love to crawl around on possibly moldy carpets and stick possibly moldy things in their mouths, also are highly vulnerable to mold-induced illnesses. Super-sensitive people often go to extremes to rid their houses of the materials that harbor the dirt and dust that molds feed on. They'll replace soft, textured materials with smooth, hard surfaces that are easier to keep clean and less likely to trap debris and moisture. Out go the carpets and draperies; in come hardwood floors and metal window blinds. Out go the cushy couches; in come the vinyl chairs. Tightly sealed newer houses may be better at holding in heat, but they're also more likely to trap moisture and spores. Mechanical ventilation, like an air-to-air heat exchanger, is critical for healthy air quality in tightly sealed new homes. In truth, most of us fall somewhere between the two extremes of invincibility and super sensitivity. But even " normal " folks will react to unusually high concentrations of mold and spores. And the time you're most likely to stir up spores and inhale and ingest them is the very time you're trying to get rid of the stuff. That's when you need to be the most careful. DISPOSE OF IT CORRECTLY OR YOU'LL JUST MAKE MATTERS WORSE Step one in getting rid of mold is to fix the moisture problem that's setting the stage for its growth. This is key. You can scrub, dispose of and replace moldy materials, but until you fix the problem, mold will keep returning. The fix can be as simple as sealing up leaky air- conditioning ducts (Fig. or as daunting as re-shingling a leaky roof or re-grading your yard so water runs away from, rather than toward, your foundation. Sewer backups and floods also set up ideal environments for mold and mildew growth. Once the moisture problems are fixed, get rid of the moldy materials carefully. Rough handling of damaged materials will not only stir up spores and spread them even farther around your house but also launch zillions of spores into the air, where you'll inhale them. One square foot of moldy drywall can harbor more than 300 million mold spores; slam-dunk that onto the basement floor and you're just opening another Pandora's box. Even dormant spores inhabiting dried-out materials are irritating to inhale, and if they find moist environs again, they can zip back to life and establish new colonies. The smart way to get rid of moldy building materials THE KEY TO REMOVING MOLDY MATERIALS is containment and thoroughness. Seal off the area. Create a crude " air lock " door to contain spores and dust by covering the opening with a sheet of poly slit in the center, and then cover that with another sheet or flap. Wear a respirator and work slowly and surely. Double-bag or wrap all materials, then wash all remaining hard surfaces with a 1/2 percent bleach solution and let dry. * Wear a good cartridge-type respirator, available through a medical or safety equipment supplier. One good mask is a Willson triple-seal respirator (No. 03711; $30.75, plus shipping) with a P100 filter cartridge ($52 for a carton of 10) available from Direct Safety, (800) 528-7405. A simple dust or particulate mask doesn't offer adequate protection. Wear gloves and goggles if you're scraping. * If your basement or main floor has flooded, get it as dry as possible within the first 72 hours, before mold and mildew can get established. Drill holes in drywall or remove lower sections of it to let the inner wall and insulation dry out. * Close off any ventilation grilles with polyethylene sheeting and duct tape. Shut down your furnace so the blower doesn't spread spores and dust throughout the house. * Remove everything--furniture, pictures, and lamps--from the room. 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