Monterey County becomes 'major epicenter' for Valley Fever with tenfold uptick

Chelcey Adami
The Californian

Rogelio Jacinto doesn't know if he can sing anymore — it's a struggle just to breathe.

The Salinas resident loves to belt a good song and sang in area churches and at community events for decades. He has also advocated for better conditions for farmworkers alongside Cesar Chavez, served as a board member for the Clinica de Salud system, and worked with five youth soccer teams.

At 68, a Valley Fever diagnosis abruptly changed his life.  

"Every night I pray and ask my God, please let me wake up," he said. "I still don't believe I have Valley Fever."

At first, doctors thought he had bronchitis or pneumonia, telling Jacinto that his lungs "sound awful." His doctor later confirmed that he had coccidioidomycosis, an infection caused by the fungus Coccidioides — commonly known as Valley Fever.

Salinas resident Rogelio Jacinto has been diagnosed with Valley Fever. He already lost his brother-in-law to Valley Fever and the news of his diagnosis has weighed on him.

The news scared Jacinto, who lost his brother-in-law to Valley Fever in 2001. His brother-in-law lived in the San Fernando Valley.

“I never heard that Valley Fever was in this valley," Jacinto said. "I’ve heard of it in Arizona and the desert…. I never heard of it here."

'Profound increase' 

In fact, cases of Valley Fever in Monterey County have skyrocketed over the last few years, prompting county health officials, medical providers, employers and residents to take safeguards.  

More:Valley fever: Why the CDC calls this little-known disease a 'silent epidemic'

"We’ve seen, over the last three to four years, a profound increase in the number of cases of Valley Fever in our community," said Dr. Allen Radner, chief medical officer of Salinas Valley Memorial Healthcare District and an infectious disease specialist. 

In 2008, just 30 cases of Valley Fever were reported, according to the Monterey County Health Department.

That number began creeping up over the next few years — with 80 cases reported in both 2011 and 2012 — before dipping down to 24 cases in 2014.

Then it spiked to 80 cases in 2016 and more than doubled to 200 cases in 2017. Last year, there were 240 Valley Fever cases reported in Monterey County. 

"It's a significant increase in the number of cases," said Dr. Edward Moreno, Monterey County health officer and director of public health.

The fungus that causes valley fever is known to live in soil in the U.S. Southwest, Mexico, Central and South America. The majority of Valley Fever cases are in California and Arizona, Radner said. 

"Everyone has seen a big increase, particularly in California, and it has happened three years running ... Monterey County has really kind of surpassed lots of other counties," Radner said. 

South County has been hit the hardest, with a rate of 117.3 per 100,000 people, compared to Salinas at 37.4 at the next highest rate, according to 2016-2018 county data. 

The range of the fungus, Coccidioides immitis, that causes valley fever.

While Monterey County used to be more "middle of the road" in the number of Valley Fever cases, it has risen to be one of the counties with the highest incidence rates in the state. 

Counties with the highest statewide incidence in 2017 according to the California Department of Public Health (CDPH):

  • Kern (305.7 per 100,000; 2,748 case-patients)
  • Kings (172.7 per 100,000; 260 case-patients)
  • San Luis Obispo (150.4 per 100,000; 419 case-patients)
  • Fresno (82.4 per 100,000; 824 case-patients)
  • Tulare (58.2 per 100,000; 275 case-patients)
  • Madera (41.3 per 100,000; 65 case-patients)
  • Monterey (41.1 per 100,000; 182 case-patients)

"Monterey County has become one of the major epicenters," Radner said "Everyone is seeing an increase, but we’re seeing a disproportionate increase.”

In 2017:State: Businesses cited after workers contract Valley fever in Monterey Co.

'...it can go to virtually any part of the body'

People can get Valley Fever from breathing in airborne microscopic fungal spores which start to grow in the ground during the rainy season. 

The earth dries up and the wind comes in and blows dirt into the air, Moreno said. Outbreaks of Valley Fever are known to occur after dust storms. 

A tractor sends up plumes of dust as it plows in bone-dry fields off Old Stage Road on Wednesday in Salinas during the early September heat wave.

Once a person is exposed to the spores related to Valley Fever and following an incubation period, the fungus starts to grow in lungs. Symptoms include a cough, fatigue and weight loss and may initially look like pneumonia, Moreno said. 

Most people exposed never have symptoms. Others may experience flu-like symptoms that go away on their own. It is not contagious.

"They think they have a cold for a few days. They get better, they never see a doctor, and they're never diagnosed ... Everyone who breathes this in doesn't necessarily get very sick," Radner said.

However, 5 to 10% of those who get Valley Fever develop serious or long-term lung issues.

And about 1% of those who get Valley Fever will have it spread to other parts of the body, which can be very serious and sometimes fatal. 

"The body can't contain in the lungs, and it can go to virtually any part of the body," Radner said. "It can go to the brain, it can go to the eyes. it can go to the liver. It can go to joints, and once it does that, it's a real serious problem."

When the fungus gets outside of their lungs, patients generally have to be on treatment for the rest of their lives, he said.

More:Take It Outside Salinas seeks to connect residents to open space, community resources

Radner is also the medical director at the Natividad Outpatient Infectious Diseases Clinic and says the clinic is following nearly 400 patients who have Valley Fever fungus outside their lungs. 

“This is a huge problem in our county and I don’t think there’s a real appreciation of that from a provider standpoint and patient standpoint," Radner said. 

If infected, some people also experience Valley Fever far more severely. Those include people with weakened immune systems, pregnant women, and people of color, particularly black, Hispanic or Filipino.

"There's a whole subgroup of people who, if they get infected, they get much, much sicker," Radner said. 

Dust in the wind

Even experts aren't sure what's driving the local increase in Valley Fever cases.

However, the area uptick is most likely related to atmospheric conditions and the weather over the last few years, Moreno said.

Thereby, some believe climate change is a root cause.

Ian McHardy, co-director of the Center for Valley Fever at the University of California, Davis, told CALmatters last fall that, “We know there’s a direct correlation between these dust storms and Valley Fever, and we know climate change is increasing the extreme weather patterns here, including the dust storms.”

Observers have also discussed farming trends as a factor, such as the increased popularity in almond farming that generates a lot of dust, Radner said. 

“There’s all kinds of theories out there and again, it’s not just a local phenomenon …This organism, it’s the fungus that lives right under the soil, and the soil is disrupted and then there’s a windy period," Radner said. "It gets into the air and people breathe it in. So is there some climate change (involved)? We don’t really know."

Also, South County is great for growing pinot noir but it may come with an unforeseen cost.

Natividad Infection Preventionist Drew Massengill said that anytime fields are plowed deeper, the soil born organisms causing Valley Fever are liberated. One trend he's noticed is whenever new vineyards are planted, more cocci (short for the Valley Fever causing fungus Coccidioides) is stirred up. 

Wildfires that expose top surface soil, often accompanied by winds, also may be contributing to the Valley Fever increase, he added.

Greater risk

Just going to work creates risk for many in the Salinas Valley.

Certain jobs are considered at higher risk: agricultural workers, construction workers, military personnel, and wildland firefighters, according to a Monterey County health advisory on Valley Fever last year.

"We have a lot of people working in the dirt in South County ... Anyone in construction, grading and leveling in South County are believed to be at greater risk of getting sick,' Moreno said. "And ag workers."

In this June 19, 2007 photo, wheat straw and dust blow from the back of a combine harvesting the grain in a field near Mullinville, Kansas.

In January 2017, three workers building a solar farm in southeastern Monterey County were diagnosed with Valley Fever.

CDPH collaborated with Monterey and San Luis Obispo county public health departments to conduct an investigation. Results later revealed nine confirmed cases of Valley Fever among 2,410 solar farm employees — an incident rate substantially higher than county rates. This suggested the illness was work-related.

"I think that the variety of projects that go on in the South Salinas Valley that would contribute to higher rates we’ve been seeing," Moreno said. 

The Monterey County Health Department has also been conducting outreach in South County — specifically in areas where the department knows there will be construction and heavy equipment moving — to communicate that there's potential increased exposure to dust that could lead to Valley Fever.  

Employers have been told that moving dirt puts employees at greater risk, and that masks or respirators should be provided. The California Division of Occupational Safety and Health requires all employers to identify risk of injury or illness to their employees in the workplace, which may include use of masks to prevent exposure to infectious agents, according to county officials. 

If an employer is asking someone to wear a respirator, the worker should see an occupational health nurse and be fit tested to ensure that mask is filtering out small particles and functions as it's designed, Massengill said. As part of that fit testing, there is a health assessment that screens people for heart or lung disease as well as any other issues that would make it hard to breathe while wearing a mask.

It's also important for farmworkers who have cuts — such as on their hands, legs or arms — to make sure their wounds aren't open to air when around dust or debris, he said, since it could cause a subcutaneous infection. 

Those who drive heavy machinery should work within a completely enclosed cab with air conditioning. Massengill said he always recirculates air in his own car, especially when driving through an area with fields and tractors out. 

"It's something I do to protect myself," he said. 

Sick behind bars

With most California prisons located in rural, dry and dusty Central California, where Valley Fever is endemic, inmates have been even more susceptible.

In Monterey County, the Correctional Training Facility prison and Salinas Valley State Prison in Soledad are "right in the middle of where we think cocci comes from because it's the driest area," Radner said. 

Salinas Valley State Prison

An "enormous number of the patients we've seen ... are people coming in here from prisons," Radner said. "And your likelihood of getting cocci in prisons is very high."

In response, the California Department of Corrections and Rehabilitation started a medical classification of inmates to place prisoners based on medical risk, which specifically includes Valley Fever restrictions. 

Due to particular risk at Avenal State Prison and Pleasant Valley State Prison, in 2013 a federal judge ordered CDCR to not house prisoners who are more susceptible to Valley Fever, such as those who are black or Filipino, there. The state had to move thousands of inmates out of the facilities.

A triple fence system surrounds Salinas Valley State Prison.

In February, in a decision throwing out inmates' lawsuits, a U.S. appeals court said California prisoners cannot hold state officials liable for contracting Valley Fever in the prison system.

At the time, Ian Wallach, an attorney for some of the inmates, said the ruling was devastating.

"The families of over 40 inmates who died and 100 who got infected and require lifetime medical care are left to fend for themselves," he said, according to the Associated Press.

Signs of trouble

Identifying Valley Fever early is key to fighting it.

In 2018, there were nine confirmed deaths related to Valley Fever in Monterey County, Massengill said. In comparison, there were three Valley Fever-related deaths in 2015-2017 combined.  

In February 2018, Moreno issued a health advisory regarding the high number of Valley Fever infections, noting that "In several instances, patients were misdiagnosed and appropriate treatment was delayed, contributing to severe complications."

When evaluating patients with a persistent cough and progressive respiratory illness, Monterey County Public Health officials have urged medical providers to include coccidioidomycosis in their possible diagnoses.

"It's an opportunistic organism that wants to keep growing, and they see our lungs and other tissues as a food source," Massengill said. 

Locally, the county health department has been working with infectious disease doctors at Natividad and Salinas Valley Memorial Healthcare District to ensure they provide adequate early diagnosis and treatment. 

Once patients are diagnosed or there's suspicion of the infection, they can get started on antifungal medications, Massengill added. 

"It's very important to get these people in right away and started on the right treatment," he said.

A flurry of legislation regarding Valley Fever was passed last year, and the state budget included $8 million for research and education.

AB 1787 established a yearly deadline for health departments to report cases to the state; AB 1788 allowed lab tests, as opposed to physical findings, to confirm infection; and AB 1790 required the state health department to develop a valley fever education program for doctors and patients.

Salinas resident Rogelio Jacinto has been diagnosed with Valley Fever. He already lost his brother-in-law to Valley Fever and the news of his diagnosis has weighed on him.

Field to field

Since his diagnosis, Jacinto said he has changed the way he interacts with his loved ones. 

"I tell my grandkids, 'Remember all of your life that I love you and I'm not only your grandpa, your abuelo, but your friend,'" he said. "...Now I call my daughters and sons every night. I tell my wife and my kids every night I love them. This (diagnosis) makes you feel weird things."

Jacinto has been married for 47 years and has four children, five grandchildren and one great-grandchild.

"It's a beautiful life I have with all the love around me," he said.

Salinas resident Rogelio Jacinto has been diagnosed with Valley Fever. He already lost his brother-in-law to Valley Fever and the news of his diagnosis has weighed on him. Here, he poses for a photo with two of his grandchildren, Jacob Christian Jacinto, 9, and Rogelio "Kike" Jacinto III, 12.

He hopes those most at risk of Valley Fever, such as fieldworkers, are adequately warned so they can safeguard themselves as much as possible. 

"People need more information and people need information straight in the field. People see it on the TV but they don’t pay attention," he said. "…They need straight information in the fields. People going field to field, informing."

Be proactive

The Monterey County Health Department advises that the best way to reduce risk of Valley Fever is to avoid breathing in dirt or dust in areas where it's common. 

When it's windy, especially during dust storms:

  • Stay inside and keep windows and doors closed.
  • While driving, keep car windows shut and use “recirculating” air conditioning if available.
  • If you must be outdoors in dusty air, consider wearing an N95 mask or respirator. N95 masks are available at drug and hardware stores To be effective, N95 masks must be fitted properly. Consult an occupational health professional.

When working or playing in areas with open dirt:

  • Wet down soil before disturbing it to reduce dust.
  • Consider wearing an N95 mask or respirator.

Other things you can do:

  • Cover open dirt areas around your home with grass, plants, or other ground cover.
  • After work or play, change out of clothes if covered with dirt.
  • Take care not to shake out clothing and breathe in the dust before washing. Warn the person washing these clothes if you are not washing them yourself.
  • Carry a couple of N95 masks or respirators in the car in case they are needed.

If you work in a job where dirt or soil is disturbed in a place where valley fever is common, you and your employer may want to review the California Department of Public Health website for preventing work-related valley fever.

The most common symptoms include:

  • Fatigue (tiredness)
  • Cough
  • Fever
  • Shortness of breath
  • Headache
  • Night sweats
  • Muscle aches or joint pain
  • Rash on upper body or legs

If you think you have Valley Fever, visit your healthcare provider. Also, report symptoms to your employer. For more information, visit http://bit.ly/ValleyFeverWork or call the CDPH Workplace Hazard Helpline at (866) 282-5516. 

Chelcey Adami is the local content editor for The Salinas Californian. She can be reached at cadami@thecalifornian.com and 831-277-8763. To support this work, subscribe here.

The Associated Press contributed to this report. 

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