The Killer in the Kitchen Counter- Crystalline Silica with Dr. Jeremy Hua

Last month we heard from Dr Drew Harris about the ongoing death and disease from coal dust exposure in both miners and the community surrounding mines. We also discussed the particular danger of silica which is leading to a dramatic rise in the dreaded disease of progressive massive pulmonary fibrosis. One hope for coal workers and their communities is that, with the transition to cleaner energy, we can hope that the death and disease caused by extracting coal will decrease. However the risk of silica remains very real and is increasing dramatically in other industries intimately involved in our everyday lives, and silica is sickening and killing those often in a poor position to advocate for themselves.

Fortunately there are measures that can be taken to protect workers. For today’s post and episode, I interviewed Dr Jeremy T. Hua MD, MPH, a lung doctor at National Jewish Health in the Division of Environmental and Occupational Health Sciences. He specializes in patients who get sick from where they work and how we can help keep them healthy. His research helps us understand more about crystalline silica, who may be vulnerable to it, and what steps we may begin to take to protect our communities.

We discussed not only the vulnerable coal miners covered in last month’s post and podcast, but also the dramatic rise in crystalline silica exposure with the exploding industry of engineered stone, for example in manufacturing quartz countertops, in which 90% of the material may be silica. These are often small employers who may be unaware of OSHA standards or with limited resources to implement them without competitive disadvantage. Many young people are getting progressive massive pulmonary fibrosis, a progressive disease without treatment. They are also dying at young ages from manufacturing material widely used in homes throughout the world.

How common is disease in those working on cutting engineered stone? The Australian states of Victoria and Queensland began mandatory medical surveillance of this after alarming severe silicosis outbreaks. They found around 25% of 1800 engineered stone workers in surveillance had silicosis and 15% of those had progressive massive fibrosis, the devastating and feared complication that turns the lungs to scar, unable to adequately bring oxygen into the body, often trapping people at home with limited ability to work, requiring oxygen, and often progressing to death. A very scary element is that this disease progresses even after the exposure is removed, so overall these are likely low estimates of the total who will end up with progressive massive fibrosis.

A case series in California found 52 men with silicosis working in engineered stone. Their average age was 45, and 51 of them were Latino immigrants. Almost half initially came to an ER for how sick they were. 38% of them had progressive massive fibrosis at the time of their diagnosis with severe lung impairment. 10 of the men (around 20%) died of the condition – dying between the ages of 38 and 51 years of age. Only 2 of the 11 patients referred for lung transplant received it and survived. 7 were declined, and 6 of those seven died of the disease. They had been working for 15 years on average, with a range of 10-20 years, and about half reported that water suppression was in use at their workplace.

This is such a hard topic and is a clear example of all the different ways people may be exposed in their workplace to things that are harmful. In making this episode, I watched several videos with testimonials from gentlemen who had worked in these conditions. One of them mentioned how much the engineered stone cutting caused his nose to sting compared to cutting other materials. It made me think about what Dr Hua said in our interview about the inflammatory nature of crystalline silica when it is inhaled.

Like many in the United States, I am a descendant of immigrants and have many immigrants in my family. immigrants face significant barriers at times to receiving healthcare, to navigating work places, starting businesses and more. That is why the story of silica and cutting engineered stone, like the beautiful quartz countertops that many of us have in our homes, is so devastating. The crippling health cost of manufacturing these materials falls disproportionately on the most vulnerable, and our current workplace safety measures are insufficient.

One of the most heartbreaking elements of that California engineered stone-workers study was that in 52 patients who were found to have silica lung disease from their work, nearly half of them continued to fabricate stone after being diagnosed with silicosis. That speaks to how trapped vulnerable workers often feel in their jobs. I can tell you I have had many patients who feel trapped in a job that is harming their health. Even when they know their job is making them sick, they are willing to sacrifice their health to keep bringing home income for their families and can’t see how they could change jobs and keep making the same wage. We need to make sure all jobs are safe for those working them.

To Do

Learn more about silicosis from the American Lung Association or at the post for this episode.
When considering a kitchen upgrade or other changes, consider avoiding engineered stone unless you know it has been made with high safety standards in place.
Write to your members of Congress to encourage robust funding and staffing of OSHA and MSHA.
Listen to last month’s podcast episode about coal mining and silica with Dr. Drew Harris to learn more about how to support miners.
Consider a donation to the American Lung Association, who advocates for patients with lung diseases including Silicosis.