It's 2018 and black lung disease seems to be on the rise

You probably realize that inhaling coal dust would be bad for you. But for the people who spend long shifts working in mines to extract the stuff, it’s a tangible occupational hazard. Even with protective gear and federal regulations on dust exposures, tiny particles of dust can enter miners' lungs, causing a plethora of respiratory diseases.

For the last few decades, it looked like mining conditions were improving, along with the health outcomes among most miners. In 1970, the federal government implemented the Federal Coal Mine Health and Safety Act, which created the first national standard for safety regulations, including limits for the amounts of dust that coal miners could be exposed to. The Act mandated annual inspections at all underground coal mines, and introduced steep penalties for violations. It also provided health benefits and compensations for miners afflicted with fatal lung diseases like Progressive Massive Fibrosis, or black lung.

The Coal Workers’ Health Surveillance Program, also implemented in the '70s, provided access to healthcare and preventative care for these types of diseases, and it worked—from 1970 to around 1990, miners who participated in the program rarely got black lung. But a research letter recently published in the Journal of the American Medical Association finds a disturbing reversal of that trend. Since the early 2000s, black lung has been on the rise again, and the cluster of more than 400 cases centers around Kentucky and Virginia.

“It never really went away,” says David Blackley, a researcher at the Centers for Disease Control. “We used to see it in the '70s and '80s, and it was more common among miners in their forties and fifties.” Of the new set of reported black lung cases, the majority of miners are older or retired, but a greater proportion of miners than before are younger and have worked in mines for less than 20 years. It’s the largest cluster of black lung ever identified, and the years spent tracking the disease make it unlikely factors like higher reporting rates or better detection are to blame.

The disease gets its name because dust inhalation causes scarring in the lung tissue, which turns black as the condition worsens. It becomes harder and harder to breathe, until, as one miner told NPR, “You literally suffocate because you can’t get enough air.”

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Coal mining in West Virginia and Appalachia
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Coal mining in West Virginia and Appalachia
The rocky landscape shows some of the last sections to be mined for coal at the Hobet site in Boone County, West Virginia, U.S. May 12, 2016. To match Special Report USA-COAL/HOBET REUTERS/Jonathan Ernst
A Caterpillar Inc. front loader scoops coal from a mound at the Arch Coal Inc. Sentinel Prep Plant in Philippi, West Virginia, U.S., on Wednesday, Jan. 13, 2016. Arch, the St. Louis-based holder of the second-largest reserve of coal in the U.S., filed for creditor protection Monday, with an agreement to erase $4.5 billion in debt. Photographer: Luke Sharrett/Bloomberg via Getty Images
Coal waits to be among the last shipments to be loaded on train cars to depart the Hobet mine in Boone County, West Virginia, U.S. May 12, 2016. Picture taken May 12, 2016. To match Special Report USA-COAL/HOBET REUTERS/Jonathan Ernst
Ice patches sit on a mound of coal at the Arch Coal Inc. Sentinel Prep Plant in Philippi, West Virginia, U.S., on Wednesday, Jan. 13, 2016. Arch, the St. Louis-based holder of the second-largest reserve of coal in the U.S., filed for creditor protection Monday, with an agreement to erase $4.5 billion in debt. Photographer: Luke Sharrett/Bloomberg via Getty Images
Coal spills out from a tower into a large pile at an Alpha Natural Resources Inc. coal preparation plant in Logan County near Yolyn, West Virginia, U.S., on Wednesday, Aug. 5, 2015. Alpha Natural Resources Inc. filed for bankruptcy in Virginia last week, becoming the latest victim of the coal industrys worst downturn in decades. Photographer: Luke Sharrett/Bloomberg via Getty Images
Radio channel signs are posted beside a large mound of coal at an Alpha Natural Resources Inc. coal preparation plant in Logan County near Yolyn, West Virginia, U.S., on Wednesday, Aug. 5, 2015. Alpha Natural Resources Inc. filed for bankruptcy in Virginia last week, becoming the latest victim of the coal industrys worst downturn in decades. Photographer: Luke Sharrett/Bloomberg via Getty Images
A mound of coal sits outside an Alpha Natural Resources Inc. coal preparation plant in Logan County near Yolyn, West Virginia, U.S., on Wednesday, Aug. 5, 2015. Alpha Natural Resources Inc. filed for bankruptcy in Virginia last week, becoming the latest victim of the coal industrys worst downturn in decades. Photographer: Luke Sharrett/Bloomberg via Getty Images
Views of a radically altered natural environment in southern West Virginia due to extensive mountain top removal coal mining and logging. (Photo by Andrew Lichtenstein/Corbis via Getty Images)
Views of a radically altered natural environment in southern West Virginia due to extensive mountain top removal coal mining and logging. (Photo by Andrew Lichtenstein/Corbis via Getty Images)
WISE COUNTY, VA - APRIL 16: A & G Coal Corporation surface mining operations continue in the Appalachian Mountains on April 16, 2012 in Wise County, Virginia. Critics refer to this type of mining as 'mountaintop removal mining' which has destroyed 500 mountain peaks and at least 1,200 miles of streams while leading to increased flooding. The Appalachians are some of the oldest mountains on Earth. (Photo by Mario Tama/Getty Images)
WISE COUNTY, VA - APRIL 16: A & G Coal Corporation surface mining operations are seen in the Appalachian Mountains on April 16, 2012 in Wise County, Virginia. Critics refer to this type of mining as 'mountaintop removal mining' which has destroyed 500 mountain peaks and at least 1,200 miles of streams while leading to increased flooding. The Appalachians are some of the oldest mountains on Earth. (Photo by Mario Tama/Getty Images)
UNITED STATES - AUGUST 16 : West Virginia Patriot mining operations at the Guston strip mine just outside of Starcity West Virginia on August 16, 2010. (Photo By Douglas Graham/Roll Call via Getty Images)
UNITED STATES - AUGUST 16 : West Virginia Patriot mining operations at the Guston strip mine just outside of Starcity West Virginia on August 16, 2010. Seen here is an example of land that has been reclamed and land that is still being mined. (Photo By Douglas Graham/Roll Call via Getty Images)
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In 2016, the Mine Safety and Health Administration started enforcing a new rule that lowered the allowed dust exposure in mines per each miner’s shift from two milligrams of dust per cubic meter of air, to 1.5 milligrams per cubic meter. Lower limits are almost always better, says Cecile Rose, a pulmonologist and the director of Environmental and Occupational Health Sciences at the National Jewish Health Center. But there’s a key flaw in the regulation: it takes into account the total mass of dust exposure, but not the proportion of specific particles like silica in that dust.

Whereas the Environmental Protection Agency individually specifies the acceptable concentration of hundreds of contaminants in drinking water (for example, there can only be .002 milligrams of mercury per liter), the Mine Safety and Health Administration only regulates the overall exposure to coal dust. So technically speaking, it doesn't matter if there’s a massive concentration of a particular toxin in coal dust, as long as that dust adds up to less than 1.5 miligrams per cubic meter of air. That would be similar to the EPA deciding that there could only be 2 milligrams per liter of any contaminant in the water you’re drinking. Our drinking water wouldn’t necessarily be safe, since some contaminants, like lead, are significantly more dangerous than others, like copper.

It may be the case that the overall dust limit isn’t as effective at preventing respiratory diseases among coal miners as a contaminant-by-contaminant approach. With better technology and techniques, mining companies have been able to profitably mine thinner seams of coal, which have more rock, or overburden. When that excess rock is broken and separated, particles like silicon dioxide and quartz, or crystalline silica dust, could be released at higher proportions.

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Coal mining in America
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Coal mining in America
circa 1935: Two miners at work in an anthracite mine near Scranton, Pennsylvania. (Photo by MPI/Getty Images)
Blaine Sergent, coal leader, putting up his check at end of day's work. Lejunior, Harlan Co., Ky. Sept. 13, 1946. | Location: Lejunior, Kentucky, USA. (Photo by � CORBIS/Corbis via Getty Images)
Row of Coal miners shanties on Elk River at Bream, W. Va. Location: Bream, West Virginia (Photo by Lewis W. Hine/Buyenlarge/Getty Images)
A coal miner stands on his front porch with his wife and their two children, in Bertha Hill, West Virginia, September, 1938. (Photo via Smith Collection/Gado/Getty Images).
(Original Caption) One of the earliest battlegrounds in the current strike of Miners of the steel companies 'captive' coal mines is pictured here. The scene is the captive mine of the united States Coal and Coke Company in Gary, West Virginia. Various weapons were brought into play, as members of an Independent Miner's Union engaged in a free for all with striking United Mine worker's pickets who sought to bar their entry. Two men were shot here. A skirmish is shown in progress on the battleground, as the men in the center of the photograph are being wetted down by a stream of water from a fire hose directed from inside the building.
Group portrait of boys working in #9 Breaker Pennsylvania Coal Company, Hughestown Borough, Pittston, PA, 1908. (Photo by Lewis W. Hine/Buyenlarge/Getty Images)
Photograph of Breaker Boys and Woodward Coal Breakers, Kingston, Pennsylvania. Dated 1906. (Photo by: Universal History Archive/UIG via Getty Images)
UNITED KINGDOM - MAY 31: Photograph by Herbert William Hughes (d 1937). Hughes was elected a member of the Royal Photographic Society in 1893, and became a fellow two years later. (Photo by SSPL/Getty Images)
Coal Miners Using Automatic Conveyor (Photo by George Rinhart/Corbis via Getty Images)
(Original Caption) Coal mining: Young boys working in Pennsylvania coal mine before the introduction of the child labor laws. Photograph ca. 1895 shows them standing with horses at mine entrances.
Red Jacket, West Virginia. Miner and wife with 5 children outside of tent.
Three Coal Breaker Boys, Woodward Coal Mines, Kingston, Pennsylvania, USA, circa 1890. (Photo by: Universal History Archive/UIG via Getty Images)
(Original Caption) Mine 'Tipple Boy', West Virginia coal mine. Photograph by Lewis Hine, 1908. BPA 2 #3116.
Portrait of 15-year Old Boy Working as Trapper at Coal Mine, His only Job is to Open and Close the Door, West Virginia, USA, circa 1908. (Photo by: Universal History Archive/UIG via Getty Images)
Striking coal miners return to work at the Haveco Mine in West Virginia. (Photo by Library of Congress/Corbis/VCG via Getty Images)
(Original Caption) 12/29/1951-West Frankfurt, IL- Weary and covered with coal dust after spending eight hours in the New Orient mine at West Frankfort, IL, John L. Lewis, United Mine Workers' head, pauses to answer reporters' questions. Lewis and other investigators are seeking the cause of the blast which recently took the lives of 119 miners.
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“Silica is capable of entering the lungs in the way that other components of coal mine dust are not,” Rose says. The particles are smaller and can cause more damage than other components of dust when inhaled. “It is a very toxic dust, so if there’s an uptick in the percentage of the coal mine dust that’s silica, the lower standard may not protect people,” Rose says. In some preliminary research that Rose has worked on, biopsies of coal miners with black lung revealed very high levels of silica in the scarred tissue.

While further research on the impacts of silica and quartz is needed, a leading hypothesis in the scientific community is that the increase of silica is connected to more severe cases of lung disease. A 2011 Department of Health and Human Services report, for example, proposed the same idea. And in 1995, the National Institute for Occupational Health and Safety suggested a separate standard for crystalline silica (which was never adopted).

Even with better monitoring and detection—and better access to healthcare—there’s no cure for black lung. Miners who have evidence of the disease are legally allowed to request transfers to mines with dust concentrations even lower than the federal limit. But Blackley says miners who develop black lung will either die from it or with it—most likely from infections that target their weakened respiratory systems. Lung transplants are the last hope for many miners with the disease, but they're costly and dangerous. The only way to truly eradicate black lung would be to eliminate exposure to coal dust entirely. “It begins and ends with that dust,” Blackley says.

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