Jimmy Moore barely leaves the house. When he does, the 74-year-old is usually parked outside his local pharmacy in Dorton, Kentucky, until someone brings out his regular meds. As soon as Moore arrives home, he changes his clothes and washes his hands. Religiously. This wasn’t his routine before, but Moore can’t take any chances with the coronavirus.
Moore mined the coalfields of Appalachia for 22 years. He has both diabetes and black lung, which covers a range of lung diseases that makes breathing difficult and damages the lungs. His 51-year-old son who followed him into the mines is also dealing with black lung, which is a common malady for patients exposed to coal and silica dust. That’s why black lung is formally known as coal workers’ pneumoconiosis. Physicians and researchers are warning that these former coal miners are at particular risk during this pandemic. As president of the Southeastern Kentucky Black Lung Association, Moore is also telling members to stay home and stay safe.
“It’s a scary time right now,” Moore told Earther. “We try to be extra careful, [but] I don’t know how careful you can be with this virus. I’m just praying it don’t come into eastern Kentucky.”
Covid-19 is especially deadly to those above the age of 60 and those already suffering from heart disease, lung disease, and diabetes. Once the virus infects someone, it attacks the respiratory system. For those with an already weakened system, that damage can prove deadly.
Unfortunately, many individuals with black lung are in a dangerous demographic, as they tend to be older in addition to having respiratory issues. Deaths from the disease were already on the rise pre-coronavirus. Adding in a new, dangerous disease will only raise the risks of more deaths.
“The secondary insult from the infection can take an already borderline situation and quickly make it more severe,” Anna Allen, an associate professor of occupational hazard assessment at West Virginia University who is a federal black lung examiner, told Earther.
If black lung progresses, the lungs scar. As tissues stiffen, the lungs struggle to inflate and deflate properly, which is essential to letting air in. This is before any exposure to infection. Once an infection—such as covid-19—enters the equation, the lungs lose even more function. For some individuals, that can be the difference between breathing or not.
Black lung patients also typically experience other health issues as well, with diabetes and heart disease among them. The Centers for Disease Control and Prevention has even previously referred to Appalachia as the “diabetes belt.” That’s unrelated to the coal mining, though; these diseases result from the socioeconomic problems entrenched in Appalachia, including less access to healthcare, higher poverty, and rural isolation.
“You have a large population that is on Medicaid or Medicare, and that does not cover the cost of a lot of hospitals,” Allen said.
Plus, hospitals with critical care units may not be a simple 10-minute or even 30-minute drive away. All this can further complicate the region’s covid-19 response. That’s a large part of the concern. Just as outbreaks are overwhelming the healthcare systems of metropolitan areas, such as New York City and Seattle, a similar situation would devastate this rural region.
“If a healthcare worker gets sick, for example, the impact is going to be greater in a community with fewer healthcare resources than in a larger city with many hospitals,” Leonard Go, a research assistant professor of environmental and occupational health sciences at the University of Illinois at Chicago, told Earther. “Prevention is really the name of the game here.”
West Virginia, for one, ain’t playing. Governor Jim Justice already shut down nonessential businesses and ordered residents to stay home earlier this week despite having only 39 confirmed cases of the coronavirus as of Wednesday. For comparison, New York didn’t issue a similar order until the state saw its cases shoot past 7,000. In Kentucky, Governor Andy Beshear has also ordered the closure of nonessential businesses. The governor has already received praise for his handling of the situation, including from Moore, who always tunes into Beshear’s daily televised briefings.
“I think Beshear is doing a fine job,” Moore said, highlighting what he’s learned from the governor, such as to avoid the hospital if you’re sick but able to recover at home. “I watch him every evening,”
What makes this whole situation all the more tricky is that in West Virginia, at least, coal mining remains ongoing as an essential business. The United Mine Workers of America supports this, Phil Smith, its director of communications and governmental affairs, told Earther—that is, so long as workers have the proper protections in place. That means wipes to clean off equipment, proper protocol to keep workers six feet apart in the mines, and allowing sick workers to stay home.
“We think [coal mining] is an essential industry, but we think it’s incumbent upon the companies and the government to make sure that these people can work safely,” Smith said.
Though the mines remain open, some health centers for retired coal miners in the region are slowly starting to pause rehabilitation services for black lung patients in order to protect them.
New River Health in Scarbro, West Virginia, typically sees some five to eight patients (most of whom have black lung) on a regular day. Some days, patients come in for pulmonary rehabilitation, which involves supervised exercise and educational sessions on how to live with the disease. Other days, another group of patients comes in for pulmonary maintenance, where they exercise to prevent further lung decline. These individuals get access to treadmills, exercise bikes, vital health information, and, most importantly, one another. As of March 18, all that had to end for their safety.
“Everyone almost simultaneously at the ground judged that the risk of them coming in and being exposed to us and each other was greater than the benefit of being there,” Daniel Doyle, a family physician and medical director of the Breathing Center for Black Lung with New River Health and Cabin Creek Health Systems, both of which have multiple sites throughout the state, told Earther. “So we said, ‘Stop coming.’”
The facility remains open for individuals who need medical attention for any respiratory issues, but the team is being incredibly vigilant to screen every patient before allowing them inside. If patients exhibit symptoms related to covid-19—fever, dry cough, shortness of breath—then they must wait in their vehicles until a physician can come out and examine them in full protective equipment.
This is life in Appalachia under the coronavirus. Doyle remembers thinking his black lung patients weren’t worried enough about the virus. Perhaps they were looking to him and his colleagues to tell them when to worry. Either way, the time to worry has come.
But worrying isn’t going to save anyone. Proper government action to keep people at home will. These coal workers have suffered enough from their contribution to the U.S. energy economy, and it’s incumbent on not just state but also the federal government to care for them. They won’t become a sacrifice, as some Republicans have suggested.
Moore expects black lung to kill him one day. His breathing has diminished in recent years. He can’t go on raccoon hunts anymore. He can’t fish. That doesn’t mean, however, covid-19 should cut his life any shorter.