By Maria Telesco
At the time of this writing, a serious medical crisis is looming in two California prisons. Valley fever, which is caused by the sometimes-lethal aspergillus fungus, may be threatening 2,000–3,000 men at Pleasant Valley (Coalinga) and Avenal state prisons. The federal government’s Centers for Disease Control (CDC) reports that valley fever increased nationwide by 850% between 1998 and 2011. The largest increase of the disease has occurred in the region where the two prisons are located: Coalinga, in Fresno County, and Avenal, in Kings County, about 60 miles southwest of Fresno, and about 10 miles apart from each other, in an area where the fungus is endemic.
Media sources report that since 2006 there have been about 36 inmate deaths and “hundreds of hospitalizations” of men incarcerated at Avenal and Pleasant Valley with valley fever. Wind stirs up dusty desert dirt and releases the fungus, lying in wait beneath the surface, eager to smother its victims. Aspergillus is only one of several organisms that can cause the disease, but it has been identified specifically as responsible for multiple California prison deaths.
Valley fever, which is caused by fungi such as aspergillus and coccidioidomycosis, usually attacks the lungs but can affect bones, eyes and other body parts as well. Hardy forms of the fungus can survive for a long time in environments of extreme heat, cold and drought; it spreads through spores in the air when the dirt is disturbed. Federal government statistics say that hundreds of thousands of aspergillus and coccidioidal infections occur each year in the United States, although more than half of these infections do not produce symptoms. Not everyone who encounters the fungus gets sick, but those relatively few who do get sick can get very sick.
When dirt containing the fungus is dislodged by digging, construction work or strong winds, and airborne dust particles containing fungal spores are inhaled, construction and farm workers, military personnel, archaeologists and others in the area become vulnerable. They cannot catch it from anyone who has the disease; if they’ve had it and survived, they cannot get it again.
Valley fever is difficult to prevent. There is currently no vaccine; efforts to develop a vaccine are ongoing. Persons at risk of valley fever should avoid exposure to dusty air in locales where the disease is common. Those exposed to dust during their jobs or outside activities in these areas should consider respiratory protection, such as a mask, during such activities.
Medical authorities say African-Americans and Filipinos are most likely to be affected, along with others whose immune systems are compromised. There has been talk about transferring men who are vulnerable to the disease to other prisons. Due to various delays, only a few transfers have taken place so far.
However, help and hope may be on the horizon. Federal Judge Thelton Henderson, who oversees prison health issues (while many others overlook them), ruled on June 24 that the California Department of Corrections and Rehabilitation (CDCR) must transfer men from locations where the sometimes deadly aspergillus fungus is endemic to areas where it’s absent. The ruling applies specifically to inmates who are at risk for getting valley fever from the organism. He ordered the CDCR to start moving the men within seven days and complete the moves within 90 days. On July 2, CDCR officials stated they will comply with Judge Henderson’s order.
Associated Press reported on July 13 that some paroled prisoners who contracted valley fever while in prison are suing the state for lifetime medical care. While many cases of this fungus-caused disease have few or no symptoms, some are life-threatening and may be lifelong. Those victims of the disease might recover with or without medication and could be immune for life. Others, with more serious cases, remain sick for life; they require medication for their entire life and would likely die without it.
The state’s policy is to release seriously infected parolees with a one-month supply of medication. After that, the parolee is responsible for providing his own medications. There are few medications that can control the fungus in the patient and even fewer that can cure the patient by killing the fungus entirely.
Diflucan (generic name Fluconazole) and Sporanox or Onmel (generic name Itraconazole) may be taken by mouth in pill form. Depending on the amount of the drug needed and where purchased, the cost of these might be up to about $10 a day. For patients who have a worse condition and need a stronger drug, there’s Amphotericin B (generic name), brand named Abelcet or Amphotec, which is known in the medical profession for its many unpleasant side effects. This must be taken intravenously daily, and the cost can run up to more than $2,000 per month.
Months ago, lawyers for the CDCR wanted to postpone the transfers until the CDC and the National Institute for Occupational Safety and Health conduct a study. The CDC says the study should be completed by December. Henderson’s order and the CDCR’s compliance agreement would probably void that request. Governor Jerry Brown has said it would be “impractical” to move about 3,000 men. Others say it’s “inhumane” not to transfer them away from the killer fungus that has already claimed too many lives.
It’s going to take a lot of work to transfer about 2,600 prisoners out of various facilities in order to transfer 2,600 others in. But it can be done. I recall a few years ago when I visited Angola, Louisiana’s Level Four men’s state prison. Everyone was still talking about the recent flood. There had been hurricanes, and the Mississippi River, which forms one “wall” of the prison, flowed over into Angola. It also flooded nearby men’s and women’s prisons.
It didn’t take long for Angola inmates and staff, working together, filling sandbags, and opening up some old buildings in a relatively dry area of the large facility, to make the yards habitable. Within hours, they managed to bring in hundreds of inmates from two other prisons, put the women into a safe area and put everyone to work. And they did this with no fights, no rapes, no escapes, just people helping each other to survive. We can do that here, too, if necessary.
I wouldn’t wish valley fever on my worst enemy. About a dozen years ago, my brother was gardening on a windy day. A few days later, neighbors found him on the ground, barely breathing, and rushed him to the hospital. He was on life support, a machine breathing for him through a tube, for several weeks. Doctors told us he would probably die, but miraculously, he survived. He had aspergillus pneumonia. The fungus in his small home garden got into his lungs and caused the infection. It took months before he could resume normal activities, and he still suffers from ongoing respiratory problems.
My turn came about five years ago. I was having terrible headaches, pains in my eyeballs and couldn’t breathe through my nose; I breathed only through the mouth. I was diagnosed with aspergillus sinusitis, a dangerous infection caused by the microorganism. I had to undergo sinus surgery to “roto-root” out the nasty fungus from my sinuses. The doctors told me that sometimes the fungus gets “aggressive” and wiggles its way through the extremely thin bones between the sinuses and the brain, then attacks the brain, causing death.
Here in the Valley we definitely have the fungus among us. So why do the powers-that-be drag their feet, dawdling about getting those at-risk prisoners somewhere else, out of harm’s way, to prevent God-only-knows how many more deaths or hospitalizations? We can pack up and leave, go to a safer location; they can’t.
When we don’t get an acceptable answer, or can’t figure one out, it’s easy for prisoners, and those of us who advocate for them, to hurriedly blame “The Department.” But the CDCR is people who, like most of us, are just trying to do their jobs. The men and women who constitute the CDCR are powerless to act if the politicians and bureaucrats in the ivory towers refuse to acknowledge a problem exists, thereby withholding the funds and authority needed to fix it. Those two prisons definitely have a problem that needs fixing.
Our national culture has popularized a false concept that prisoners—one percent of our total national population—are subhuman critters who don’t deserve even the minimum of anything. Every day letters to the editor are full of comments like “So let them die, they don’t deserve medical care” or “Let them starve to death.” We are better than that. We need to follow up on this problem and be ready to deal with the politicians and bureaucrats if they don’t do what’s right to save the lives of these prisoners. Stealing a car or robbing a bank does not warrant a death penalty.
Maria Telesco is a retired registered nurse who has volunteered in various aspects of prison ministry for more than 25 years. Contact her at firstname.lastname@example.org.
Valley Fever–Related Glossary
Allergy is a hypersensitive disorder of the immune system. Allergic reactions occur when a person’s immune system reacts abnormally to what are usually harmless substances, like certain foods, animals or pollens in the air. The immune system mistakes these substances as “dangerous” to the allergic individual, and tries to eliminate them, causing discomfort like itching or sneezing.
Aspergillosis is aspergillus present in your body, without being sick from it, although you may be allergic to it. The suffix “osis” refers to conditions that are not infections.
Aspergillitis is having an infection caused by aspergillus. The suffix “itis” refers to infections.
Bacteria (plural, bacterium singular) are the tiny, invisible microscopic “bugs” that are present in and on everyone and everything. Most are harmless. Some are useful, for example, they may help digest food. Others are dangerous and cause diseases.
Disease transmission is how contagious, pathogenic microorganisms spread from one person to another, by way of sexual contact, nonsexual personal contact, air, insect or animal bites, dust, dirt, food and many other types of contact between the organism and humans and/or animals.
Endemic means something native or normal to an area or environment. For example, the common cold is endemic.
Epidemic occurs when a disease affects many persons at the same time, spreading from person to person, in the same locality.
Fungus is another kind of microorganism. “Good” fungi (plural) can be found in foods like yeast and cheese. “Bad” fungi can cause minor annoyances like “smelly feet,” as well as the deadly valley fever.
Immune System is a biological system that protects against disease. The functional immune system must detect a wide variety of agents, from viruses to parasites, and distinguish them from the organism’s own healthy tissue. Sometimes the immune system makes a mistake, and we get allergies and other self-destructive conditions of the body.
Infection is the invasion of body tissues by disease-causing organisms like bacteria, fungi or viruses. They multiply and produce toxins, which act like poisons in the body. The immune system can help the body fight infections; sometimes medicines like antibiotics are needed. Antibiotics are not given for infections caused by viruses, and some caused by fungi, because the organisms do not react to them.
Pandemic is an epidemic of enormous proportions, of an infectious disease that has spread through human and/or animal populations across a large area, even an entire country or continent.
Pathogenic means anything capable of causing disease, such as a virus, bacteria or fungi.
Sinus cavities are natural formations that occur in the bones of the face and nose to aid in breathing.
Spore is a one-celled unit that enables microorganisms to reproduce alone, without contact with another organism.
Virus is a small infectious agent that can reproduce only inside living cells. Viruses can infect all types of organisms, from people to animals and even plants. They are hard to cure because they live inside other living cells and do not respond to antibiotic medicines. The common cold is caused by a virus. So is HIV and other diseases that can kill if not treated properly.