Doctors link valley fever wave to Thomas Fire

The Thomas Fire that burned 282,000 acres and replaced brush-covered hillsides with blackened, barren vistas is likely contributing to growing waves of valley fever disease in Ventura County, said area lung and infectious disease specialists.

In January alone, 55 possible cases of the fungal disease with symptoms that can mimic the flu were reported in Ventura County, according to provisional data from the California Department of Public Health.

Nicole Sadowsky, a Camarillo teacher, was diagnosed with valley fever. Her doctor thinks the cause was the Thomas Fire.

The disease was on the rise before the December fire. But January’s tally — the fifth highest in California — is on a pace that dwarfs the 231 cases reported in all of 2017. Because the numbers are provisional, they could change.

In 2015 and 2016 combined, there were 159 cases in the county.

Pulmonologists and infectious disease specialists predict the surge will continue, citing the fire and the wind that came with it.

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“You burn everything down and now you just have bare ground,” said Dr. David Mescher, an Oxnard and Camarillo lung and internal medicine physician. “You start getting a lot more dust blowing around. The fungus gets blown around with the ash and soil.”

The disease can’t be spread from person to person, but is activated when spores from a fungus called coccidioides are swept from the soil into the air and then inhaled.

Although valley fever often produces no signs of illness, it can in rare instances trigger fatal complications and is believed to have contributed to five deaths in Ventura County over four months ending in January.

“There’s part of me that worries about the what-ifs,” said Nicole Sadowsky, a Camarillo fourth-grade teacher who was diagnosed in January with her infectious disease doctor pointing blame at the fire. “What if I have permanent scarring on my lungs?”

Public health officials are cautious about causes of the disease’s rise.

Dr. Robert Levin, Ventura County public health officer, cited a November news release in which California Department of Public Health officials said they couldn’t pinpoint reasons for an already apparent increase in valley fever. Other observers theorized heavy rains a year ago played a role.

This week, Levin said he doesn’t have the proof to conclusively draw a line linking new cases of the disease to the fire, noting only that it is possible.

Avoiding the disease

  • Stay inside with doors and windows closed during strong winds in areas where the disease is common.
  • Keepcar windows closed when driving and use recirculating air condition.
  • If you must go outside during strong winds, consider using an N95 mask or respirator.

Source: California Department of Public Health

“It’s hard for me to say definitively there is a connection,” Levin said, noting that while the exact cause may be debatable, the increase in incidence is not.

Ventura County provisional data shows 362 possible cases of valley fever — also known as coccidioidomycosis or cocci — in a five-month period ending Jan. 31. That’s more than three times higher than the 109 possible cases over the same time frame a year earlier.

Of the five deaths in Ventura County, all involved people 65 and older. The surge in cases pushed public health officials to send an alert to doctors, telling them to be vigilant in looking for the disease.

But the diagnostic search can be difficult. The disease often does not trigger any symptoms. Other times, it can create fatigue, fever, night sweats and a rash on the upper body.

The generic signs mean the condition is often misdiagnosed as pneumonia or flu. Because it can cause a fungal mass in the lungs, the symptoms can trigger cancer concerns.

“They may think they have a malignancy when in fact they have an infection that we can treat,” said Dr. Glen Abergel, an Oxnard infectious disease and lung specialist.

Sadowsky’s symptoms emerged in mid-December. She felt tired all the time. It was hard to breathe.

“I had pain in my chest when I would take a deep breath,” she said.

A doctor suggested her asthma might be flaring. That kicked off two weeks of possible diagnoses — upper respiratory infection, pneumonia, maybe a blood clot — and medications that didn’t seem to help.

Finally, an emergency room doctor suggested she might have valley fever and referred her to Abergel. He performed the blood test that confirmed the diagnosis.

“He said, ‘Congratulations, you have valley fever,’” she said, noting the manner of the announcement puzzled her. “He said, ‘You have a mass sitting on your lungs. Would you rather it be something else?’ I said, ’Good point.’”

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Sadowsky was told the fire was the most likely cause of her condition. She remembered visiting her mother in Ventura immediately after the fire and going outside in Camarillo on an especially smoky day.

“I wasn’t out in the air that long,” she said.

Abergel said he believes the fire played a role in Sadowsky’s illness, calling the blaze and accompanying winds “a perfect storm.”

“The landscape is gone,” he said. “Anytime we have winds, there are more of the organisms being uplifted from the soil. Until ground cover is replenished, we’re going to see a lot more cases.”

While the disease has surged in Ventura County, public health officials in Santa Barbara County say they haven’t seen any increase. Provisional state records show 11 possible cases of valley fever in January in the county and 92 throughout all of 2017.

In a news release, public health officials said only one confirmed case had been reported in southern Santa Barbara County since the Thomas Fire started on Dec. 4. They said much of the public concern surrounded the idea that spores could come from the dust emitted by drying mud.

“The risk of acquiring cocci is low, though not zero, in southern Santa Barbara County,” said county health officer Dr. Charity Dean.

State provisional data shows far less incidence in Santa Barbara County than in the Ventura area, with 172 possible cases from 2015 to 2017, compared to 390 cases in Ventura County.

Five different doctors in Ventura County said the fire likely increases risks of the disease locally. Mescher said he had seen patients with the condition from several places in and near the fire zone including Ventura, Ojai and Fillmore.

In as many as 60 percent of the cases, there are no signs of illness. But in other cases, cocci can trigger pneumonia or other complications. In the rare cases that spawn much of the alarm surrounding the disease, it can spread to the spine and the brain, causing meningitis.

Groups at increased risk of severe illness include Filipinos and African-Americans. People may also be at higher risk if they are 60 and older or pregnant or diabetic.

Sadowsky’s breathing has improved but she still gets winded at times. She struggles with headaches.

She worries about her health but feels relieved that at least she knows what she has.

“I’ve done a lot of reading, a lot of question asking,” Sadowsky said, noting she takes anti-fungal medications and continues to see an infectious disease specialist. “They’re just going to monitor me now for the next two years.”

Valley fever by the numbers

  • 55 cases in January 2018 in Ventura County
  • 66 cases in all of 2016
  • 231 in all of 2017

Provisional numbers from the California Department of Public Health