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black-lung-silicosis Getty Images
Light micrograph showing a human lung affected by a severe silicosis. The normal structure of parenchyma has disappeared and has been replaced by fibrotic areas and deposits of anthracotic pigment.

Alarm Sounds Over Resurgent Black Lung Disease

Rock particles in coal dust create a form of silicosis not yet regulated by the government.

Once thought to have been nearly eradicated, a new epidemic of an even more vicious black lung disease is rampaging through the thinning ranks of coal miners. The slow development of knowledge about the true nature of the illness and confusion over how to prevent it has provoked a new round of finger-pointing by the mineworkers union and other mining industry critics.

It was relatively recently that research uncovered how widespread is the new black lung. It is different from the older disease, which struck miners because of their exposure to coal dust in underground mines. The newer form strikes more quickly and devestates miners’ lungs earlier because the disease they are suffering from is in reality a form of silicosis.

It is believed that the new disease arose after many of the seams of pure coal ran out and operators began mining thinner seams running through rock, primarly sandstone. The mining process involved grinding up rock along with the coal, spreading fine silica dust everywhere, leading to this new form of black lung called progressive massive fibrosis (PMF), which is just as bad as the name sounds.

The results are horrifying, as was depicted in a PBS “Frontline” documentary first broadcast last December, which was a follow-up to a 2016-17 investigation by NPR. An article in the May 2017 issue of Smithsonian Magazine also explored many of the same issues.

PMF is worse than the kind of black lung that arises primarily from exposure to coal dust. The silica particles from the ground-up rock trigger the body’s immune response which, when it cannot neutralize or expel the silica from the lungs, then destroys healthy tissue and forms hard nodules in the upper lungs.

Miners contract PMF younger—in one case the miner was just 29—and they die sooner and in a great deal of pain. While the mine union and other critics blame mine operators and the Mine Safety and Health Administration (MSHA), thorough research into the new form of black lung is only in its early stages.

One reason suggested for why miners have been getting the disease earlier than they contracted black lung before is that because of a decline in the workforce in recent decades, fewer miners are working longer shifts, sometimes reported to be 70 to 80 hours a week.

To make matters worse, anecdotal evidence suggests that conventional coal dust abatement techniques may not be effective in protecting workers when it comes to silica dust generated during underground mining. Research shows the dust generated in recent years is much finer in consistency than it was in the past. This also may alter the mineralogic characteristics of the dust. As a result, it is possible that some of the abatement techniques used to protect miners in the past don’t appear to be effective in preventing PMF.

Some of the techniques used to protect workers from silica dust in above-ground manufacturing and other processes are not practical for use in mines. Miners also have noted that it is impossible for them to wear the assigned masks throughout the entire time they are in the mines because of the way they interfere with breathing.

Also, the fine, powdery nature of the silica-laden coal dust, which coats personal clothing and equipment, means the miners probably are dosing themselves when they are above ground and remove personal protective equipment and clothing.

Numbers Tell the Story

U.S. Department of Labor (DOL) data gathered between 1970 and 2016 found a total of 4,679 cases of PMF among miners. Keep in mind that in the 21 years between 1996 and 2016 a total of 2,374 cases were recorded—more than the 2,205 cases that were found during the 26 years prior to 1996. The increase occurred in spite of the fact that the total number of coal miners employed in the United States decreased by more than two-thirds between 1979 and 2016.

In addition, the PMF trend largely went unnoticed because individual cases found at clinics throughout coal country had not been linked together until recent years.

Following enactment of the 1969 Coal Mine Health and Safety Act, the number of American miners suffering from black lung disease dropped by about 90%, leading many in the industry to believe black lung was on its way to being wiped out. However, the speed of the PMF version’s progress and the eventual gathering of data from clinics across coal country made the scope of the newer disease fully evident.

A report unveiled by the National Institute for Occupational Safety and Health (NIOSH) and other health researchers at a medical conference in mid-2018 showed that 84% of PMF cases reported from 1970 to 2016 were found among miners working in central Appalachia. Of the total cases found, 28.4% of them were found in West Virginia, 20.2% in Kentucky, 20.0% in Pennsylvania and 15.3% in Virginia. The biggest increase in PMF cases by state occurred in Virginia, with an average rise of 31.5% annually over the 46-year study period. The miners and former miners who reported PMF ranged from 27 to 93 years old, with the average age of 61.

However, while there is still a great deal that we don’t know about the disease and its extent, much information has been gathered over the last three years. This is why there have been demands for faster action by the industry and regulators who are waiting for that research to be completed.

Critics argue that MSHA, which like the Occupational Safety and Health Administration (OSHA) is an agency of DOL, has not been doing enough to help miners. In a January phone meeting with stakeholders, MSHA chief David Zatezalo revealed that inspectors have increased dust sampling in the field, and he asserted that overexposure readings have decreased.

“The system has changed and it has increased sampling a lot,” Zatezalo said,.“We sample over twice as much as we used to.” He also cited actions taken under strengethed standards for dust exposure and the introduction of Continuous Personal Dust Monitor (CPDM) equipment that were adopted in 2014. “That CPDM has lowered miners’ exposures and we have proof of that,” he added. What he didn’t mention is that the CPDM equipment is not designed to monitor specifically for dust from silica.

Zatezalo, who is a former mining company executive, also said the number of incidents where samples found the dust standard being exceeded is now one-third or one-fifth of what it was before the 2014 monitoring standards were implemented.

In terms of possible new rules,, MSHA published a Request for Information (RFI) last July to gather comments, data and additional information about its dust regulations. The RFI also seeks information and data on engineering controls and best practices that can lower exposure to respirable coal mine dust. The comment deadline is July 9, 2019.

In June 2018, a National Academies of Sciences panel report sponsored by NIOSH stated that further research and development efforts are needed for better understanding of relationships between miners’ exposures and disease, including studying effects of changes in mining methods, improving monitoring approaches, and increasing participation in medical surveillance programs.

Calls for Action

Last November, the DOL Inspector General’s annual report said MSHA should take action to ensure mine operators comply with its Respirable Coal Dust rule. This includes reviewing the quality of coal mine dust controls in mine ventilation and dust control plans; analyzing sampling data quarterly; and monitoring operator sampling equipment.

The Inspector General added that MSHA needs to re-evaluate the Respirable Coal Dust rule in light of new information and increase testing and enforcement for other airborne contaminants.

Following the PBS/NPR broadcasts, United Mine Workers of America (UMWA) International president Cecil E. Roberts didn’t hesitate to blame mine operators for the new as well as the old black lung epidemics. He said the PBS/NPR documentaries failed to drive home who the real culprits are: the coal companies, he charged, had been breaking the law and ignoring respirable dust standards for the last 30 years.

“The fact that younger miners are getting this disease is especially damning to the industry, because it shows that even in the last decade or less, a large number of coal operators chose to put their employees’ lives at risk simply to be able to mine coal faster,” Roberts argued. “That is criminal, and the perpetrators of this crime should be locked up.”

The National Coalition of Black Lung and Respiratory Disease Clinics reacted to the PBS/NPR broadcasts by stating that MSHA has “more than enough data demonstrating the risks associated with current mining practices to implement new measures.” Specifically, the coalition asks regulators to enact a standard to control the dust generated when mining equipment cuts into rock containing silica.

Roberts also pointed out in his December 2018 statement that the contributions mining companies make to the Black Lung Disability Trust Fund were to be cut by more than half at the end of 2018, which took place. “This will cause the deficit in that fund to skyrocket, sticking taxpayers with a bill that the companies should continue to be responsible for,” Roberts observed.

The Black Lung Disability Trust Fund was established by Congress in 1977 to help out afflicted miners with benefits of between $650 to $1,300 per month when their former employers are bankrupt or are otherwise unable to pay.

In 1986 mine operators were assessed a $1.10-per-ton tax on coal from underground mines and 55 cents-per-ton for coal from surface mines. The fees were never enough to meet all the needs, and taxpayer money was used to make up the difference. Congress forgave $6.5 billion of the fund’s debt in 2008, and enacted a sunset provision that dropped the coal tax rates by half at the end of 2018, apprently because of the widespread belief that black lung was on its way to being eradicated. As a result of the new wave of claims, the fund’s debt has climbed to $4.3 billion.

“No coal company has gone out of business because it pays an extra 55 cents in contributions on every ton of coal it mines to that fund,” Roberts added in December. “It is clear that the need for this fund will be long-lasting as younger miners are afflicted with black lung because their employers chose to not follow the law. Now is not the time to cut back on coal company contributions to this fund.”

In March 2018, a bipartisan coalition of members of Congress spearheaded legislation that increased funding for 28 black lung clinics in 15 coal mining states from $2.7 million to $10 million.

Following the PBS/NPR broadcasts, Rep. Bobby Scott (D-VA), who is now chairman of the House Education and Labor Committee, announced that he intends to schedule congressional hearings focusing on the new black lung and the charges of regulatory failures.

“Congress has no choice but to step in and direct MSHA and the mining industry to take timely action,” Scott declared. He added that the hearings should create a foundation “to forge legislative solutions so that we can prevent the physical, emotional and financial toll of this completely preventable disease.”

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