By Twilight Greenaway, Civil Eats
This story was produced in partnership with Civil Eats, a nonprofit news organization focused on the American food system.
LAMONT, Calif. — Victor Gutierrez contracted valley fever, an illness caused by a soil-borne fungus, and he thinks he got it in the summer of 2011 when he worked in the nectarine orchards of California’s dry, dusty Central Valley.
“The wind was really strong, and we were almost falling off our ladders,” Gutierrez said. “The dust would rise up in the fields and we would get lost in [it].”
Then again, he might have contracted it during that year’s grape harvest. “We would walk out of the vineyard with our faces full of dirt. Only our eyes were visible,” Gutierrez said. When he showered at night, he could see the layer of soil washing off his body.
Ultimately, he doesn’t know exactly when he contracted valley fever, a dangerous fungal disease. Gutierrez just knows that late that summer, he started experiencing flu-like symptoms — coughing, night sweats, exhaustion, and a strange feeling that he was burning up on the inside. The father of three ignored it and kept working for fear of losing his job. But when the illness got to the point where he was struggling to breathe, he went to see a doctor, who gave him a dose of antibiotics and told him to buy a humidifier.
Tracking Valley Fever, the mysterious illness affecting farm workers
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The next day, Gutierrez’s lungs filled up with fluid and he felt so unwell that he went to a local clinic. This time, they tested him for valley fever, and it came back positive.
“The nurse called me and told me to rush to the clinic because it was an emergency,” he said. Gutierrez, who was 33 at the time, had never heard of valley fever and was told he might only have six months to live.
While Gutierrez managed to beat those odds by taking the antifungal medication fluconazole for more than a year, he has seen valley fever kill many other people he’s known. Of the five people he recalls seeing diagnosed with the fungal infection on that day in 2011, he said he’s the only survivor.
Still, valley fever remains dormant in his body — and it could come back at any point. Gutierrez still struggles with regular pain in his lungs and when he gets a cold or flu, he’s in bed for weeks.
Years of climate change-fueled drought appear to have led to a swift rise in the number of people diagnosed with the illness across the Southwest.
Coccidioidomycosis or cocci (pronounced “coxy”), the fungus that causes valley fever, thrives in dry, undisturbed soil. It becomes airborne when that soil is disturbed — whether it’s by dirt bikes, construction crews, or farmers putting in new fruit or nut orchards. It can travel on the wind as far as 75 miles away. Years of climate change-fueled drought and a 240 percent increase in dust storms appear to have led to a swift rise in the number of people diagnosed with the illness across the Southwest.
In California, rates of new cases rose 10 percent between 2017 and 2018, according to the California Department of Public Health, at what will likely be a sizable cost to the state. The state budgeted $8 million for valley fever research in 2018, and about $3 million will go toward the expansion of the Valley Fever Institute at Kern Medical hospital. Three new laws address valley fever reporting, testing, and education in the state. In 2011, California spent approximately $2.2 billion in valley fever-related hospital expenses.
Misdiagnosis and the role of race
Getting an accurate count of the number of people affected by valley fever is a challenge because the majority of those who are infected never know they have it. However, new cases are especially concentrated in the San Joaquin Valley, home to the farms that produce two-thirds of the nation’s fruit and nuts and one third of its vegetables. The region is also home to the two cities with the worst particle pollution in the U.S. and most of the state’s farmworkers.
In 2017, the Centers for Disease Control and Prevention said 14,364 cases of valley fever were reported nationally, but that “tens of thousands more illnesses likely occur and may be misdiagnosed because many patients are not tested for valley fever.” On average, there were approximately 200 deaths associated with the illness each year in the U.S. from 1999 to 2016.
Dr. Royce Johnson, director of the Valley Fever Institute and professor of medicine at the University of California, Los Angeles, said 60 percent of valley fever cases are misinterpreted as the flu and go undiagnosed. Johnson, who has been working with valley fever patients for more than 40 years, says the remaining 40 percent tend to experience symptoms that are similar to and often confused with a serious case of pneumonia. From there, a small percentage — around 1 percent of the total people infected — see the disease spread to other parts of the body, including the brain and the skin.
“People with relatively uncomplicated [respiratory valley fever] will usually think this is the worst illness they’ve ever had,” Johnson said, adding that the symptoms can get quite a lot worse in cases where it spreads. Patients are treated for between three and 12 months and then tracked for an additional two years to make sure the disease doesn’t come back or spread.
“A lot of people don’t understand how manifold and complicated valley fever can be,” Johnson said.
The infection is not passed from person to person, but epidemiologists are still trying to determine what exactly puts people at risk, aside from simply being outside, said Stephen McCurdy, who serves as a professor in the Department of Epidemiology and Preventive Medicine at the University of California, Davis, which created the California Center for Valley Fever in 2016.
Farms in California’s Central Valley, such as this pistachio orchard, contribute to arid conditions and dust problems, according to scientists.Nirma Hasty / NBC News
Immune function is one key factor, putting pregnant women, some diabetics, people with HIV, the elderly, and those who are on immunosuppressant drugs or have had organ transplants at elevated risk. Race appears to be another factor, McCurdy said. “It seems that darker-skinned people are more likely if they contract valley fever to get a more severe case of it. In the majority of cases, people knock it back themselves [like a typical flu]. People with darker skin seem to be less able to do that.”
It’s not entirely clear just why that is. “I’m sure it’s related to whatever genetic resources those groups have compared to others,” he said.
According to a study by the California Health and Human Services Agency, African Americans and Hispanics in California are more likely to be hospitalized with valley fever than whites.
“A contributing factor to this finding may be the large populations of Hispanics living and working in the endemic region counties of California,” wrote the study’s authors, who added that the connection between race and risk for the disease “is not well understood and may be attributable to variations in genetic susceptibility.”
Another challenge with gathering data, said Carol Sipan, a public health lecturer at the University of California, Merced, is the fact that, “many [farmworkers] would go back to Mexico if they got really sick.” In Mexico, she added, valley fever is not a reportable disease.