Hep
C is deadly: Many emergency workers around country afraid to
be tested or treated
by: Julie Knipe Brown
Reprinted Philadelphia Daily News
SAN FRANCISCO
- John Parent was buried in a coffin carved by his two brothers
from a California redwood tree.
It
was two days before last Thanksgiving, two months after he had
been scuba diving in Mexico, a month after
he and his wife, Jeanne, bought a time-share condo in Cancun.
Parent didnt think he was going to die.
As
a San Francisco firefighter for 32 years, he had learned to respect,
but not fear, his own mortality.
He
had survived gas explosions, wildfires and earthquakes. He had
rescued victims from collapsed apartment
buildings and burning skyscrapers. And like most firefighters,
he had mastered the fine art of fighting fires on the
steeply pitched roofs of million-dollar townhouses perched high
above the Pacific Ocean.
So
when doctors told him two years ago that he had hepatitis C, 50-year-old
Parent couldnt fear that the
disease would kill him any more than he could fear climbing into
a teetering building or jumping into San
Francisco Bay to save someone from drowning.
"Firefighters
think they are indestructible", said his friend, John Hanley,
president of the San Francisco
firefighters union. "They dont want to think
about their mortality, and they dont want to think about
a disease
that could kill them."
But
firefighters and paramedics in San Francisco and across the country
have been forced to face a new
threat, one that some fear may be far more deadly than anything
theyve encountered in the line of duty.
The
enemy this time is hepatitis C, a disease that has infected an
untold number of firefighters and medics
nationwide. Some health experts suspect the firefighters may
have been unknowingly infected with the virus over
the past two decades through contact with contaminated blood
during rescues and medical calls as hepatitis C
has spread through the general population.
Propelled
by concern over an epidemic among firefighters and paramedics
in Philadelphia that has claimed at
least three lives, fire departments across the nation are costing
out hepatitis C testing kits and lobbying for
legislation to help pay for education and screening.
The
International Association of Firefighters is getting deluged with
requests for a hepatitis video they
produced more than a year ago - a video that just six months
ago no one even wanted.
"This
is more complex than the numbers and it goes beyond Philadelphia,"
said the IAFFs Rich Duffy.
Meanwhile,
Philadelphia numbers continue to grow. At least 10 more firefighters
have been diagnosed with
the hepatitis C virus since December when the results of testing
for half of the departments 4,000 active and
retired members showed 130 firefighters, or 6 percent, had tested
positive - three times the national average.
So
far, 10 to 15 San Francisco firefighters have been diagnosed with
hepatitis C, Hanley estimated, but that
number, he fears, may only be the beginning. "We havent
reached the traumatic proportions in Philadelphia,"
said Hanley, whose union represents 1,800 firefighters and medics.
"But because of the awareness of
Philadelphia, we started asking our members and we had 10 people
come forward without even doing any formal
testing."
In
San Francisco, Atlanta, Miami-Dade County, Hawaii and elsewhere
across the country, firefighters,
emergency medical technicians and paramedics are pushing for
testing.
In
Chicago, the nations second-largest fire union is in panic
mode. "Its very serious. We think we have a lot
more people than Philadelphia or anybody else," said Bill
Kugelman, president of Local 2, which represents
4,600 active firefighters, EMTs and paramedics. "I want
everybody tested. Ive made that clear to the city. Our
negotiations can drag on, but this is not negotiable."
"Philadelphia
has led to a lot of awareness around the country," said Dominick
Barbara, president of the
Dade County Association of Firefighters, where 1,500 members
began hepatitis C screening earlier this month.
"Everybody
knows its out there now, and I think youre going to
find more departments do testing."
Yet
despite the alarm, theres debate about whether there is
cause for panic. Few departments other than
Philadelphia have conducted testing or have numbers that are
above the national average. Some fire
departments, like Baltimores, say they dont even
think testing is necessary, citing a Centers for Disease
Controls recommendation against routine testing of health
care workers and firefighters.
"We
have cases of hep C and were concerned. But is it rampant?
I dont think its rampant," said Pat
Bahnken, president of New Yorks paramedic union, which
has 2,600 members.
Still,
the IAFF is fighting for legislation to provide money for testing,
education and training for firefighters and
medics around the country and has asked that the National Institute
of Occupational Safety and Health
investigate the Philadelphia epidemic.
The
IAFF believes that firefighters who do rescue work and medical
runs, as well as EMTs and paramedics,
are at greater risk of contracting hepatitis C on the job because
the virus is spread through direct contact with
infected blood.
"Were
the first on the scene. Before we wore gloves, we never thought
twice about getting blood on us. It
was just something we had to do," said 44-year-old San Francisco
firefighter Bobby Jackson, who believes he
contracted hepatitis C when he was cut during a rescue more than
five years ago.
Unlike
Philadelphia, where firefighters were forced to wage a public
campaign to embarrass the city into
supporting them, firefighters in San Francisco have been backed
by the city.
Jackson
underwent painful Interferon treatment, and was unable to work
for a year. He was never in danger of
losing his job, and was covered by state Workers Compensation,
in part because he was able to document
exposure to blood.
Hepatitis
C, called the "silent epidemic," affects an estimated
4 million Americans, most of whom arent even
aware they have the disease because symptoms can take 10 to 30
years to develop.
The
primary method of transmission is through intravenous drug use,
but the virus was also spread in blood
transfusions given before the early 1990s, when blood banks began
screening for it. There is no cure or vaccine,
but hepatitis C can be brought into remission with drugs if caught
early. Like firefighters in Philadelphia, San
Francisco firefighters spend far more time on medical runs than
fighting fires.
They
handled blood with their bare hands years before they began taking
precautions against HIV and other
infectious diseases, but cant prove they became infected
in the line of duty because they didnt keep track of
exposure to blood before the mid 1980s.
And
also like firefighters in Philadelphia, firefighters in San Francisco
are afraid of getting sick and being
unable to support their families. Many struggle to make ends
meet amidst the Silicon Valleys Internet gold rush.
Most cant afford to even live in the city they work to
protect, commuting as much as three hours a day. Even
rowhouses in rough neighborhoods here command a half a million
dollars, and many firefighters, though they
make salaries of $50,000 to $60,000 a year, work two jobs to
make ends meet.
"They
are pretty scared," said Jackson of his comrades who have
the virus. "They dont really know what it
is, and they dont want to talk about it because they dont
want to admit theyre scared."
John
Parent was among them. An active swimmer and hiker, he couldnt
face the fact that he had a serious
illness that needed treatment, said his wife. "He just didnt
want to go through the politics," Jeanne Parent said.
"The biggest thing with him is he knew the treatment would
make him sick and he would be off of work. The
doctors wanted him to do the treatment, but he didnt want
to be off of work."
Just
months before Parent died, Jackson finally convinced him to talk
to his doctor and the fire departments
doctor about getting treated. But by then it was too late.
The
San Francisco firefighters union is lobbying for laws that would
make it easier for stricken firefighters and
paramedics to get Workers Compensation.
Unlike
Philadelphia, where the fire commissioner and City Hall refused
to back firefighters claims until Mayor
Street intervened in January, San Francisco city government has
been supportive of the union.
The
fire departments physician, Dr. Deborah Owen, is pressing
for baselinetesting of all firefighters -
something the departments chief also supports. In the meantime,
the department has its firefighters take regular
physicals which include a test which shows whether their liver
enzymes are elevated - one indicator that they
may be carrying the virus.
"Hepatitis
C is on the front burner," Owen said. "Given the concern
over numbers in Philadelphia, it would be
better for the department to do baseline screening."
The
IAFFs Duffy, however, points out that hed be surprised
if infection rates are high in cities like San
Francisco, which has been proactive in its efforts to protect
firefighters from infectious diseases like hepatitis C
and HIV.
The
rates have been lower than the national average in cities like
Phoenix, Tuscon and Portland, he
theorizes, because they have an aggressive education, testing
and training programs.
Philadelphia,
he said, is quite the opposite.
"Philadelphia
hasnt even considered an infection control program,"
said Duffy. "I think the numbers speak for
themselves."
Unlike
San Francisco and other pro-active cities, Philadelphia doesnt
give its firefighters and medics annual
physicals. The disease has struck Philadelphia fire department
veterans the hardest, with firefighters ages 50 to
59 infected at a rate four times the national average for men
in the same age group, according to Casey.
The
crisis continues, Casey said, as many firefighters still refuse
to come forward for fear of losing their jobs.
While Street pledged to give the union $3 million a year to help
pay for treating sick firefighters, the union has yet
to receive the money. And the city is still fighting Workers
Compensa- tion claims, Casey said.
As
the debate continues over whether the disease is job related,
other experts point out that Philadelphia has
yet to adequately test all of its active and retired firefighters.
Only half of them have been tested - and the test
kits were donated by a private company.
Andi
Thomas, director of Hep C ALERT, a nonprofit agency studying hepatitis
C among firefighters and
medics in South Florida, and the American Liver Foundation believe
screening is necessary to help save lives.
"The
reality is firefighters and paramedics as a whole do not engage
in high-risk behaviors like intravenous
drug use," Thomas said.
But
Miriam Alter, a Centers for Disease Control epidemiologist, said
studies have shown that most hepatitis
C infections are the result of lifestyle, not job-related risks.
Intravenous drug use is still the No. 1 cause of
infection, she said.
"Im
not saying that none of the firefighters or first-responders [in
Philadelphia] got their infections on the job,"
Alter said. "What I am saying is in general, in the public
safety worker group, the majority dont tend to be the
result of occupational exposure."
However,
she said the CDC recognizes that anyone exposed to blood-borne
pathogens, through
needle-sticks and other sharp objects, are at increased risk,
but the risk is not high enough to merit screening.
The CDC has not studied firefighters or paramedics, and she admitted
that more research needs to be done.
When
asked whether the CDC would consider doing a study, Alter replied:
"The CDC has to be invited by
some other agency."
That
is of little comfort to John Parents widow, who is now selling
off her belongings because she wont be
able to make car or mortgage payments without her husbands
salary. These days, Jeanne Parent spends much
of her time on the phone, trying to work out payment arrangements
for the stack of medical bills that have been
pouring in regularly since John died.
Her
life will never be the same without her husband of 23 years.
"What
he loved more than anything else was the city. He loved San Francisco.
He grew up there and he was
a fireman there. He was proud of being a San Francisco fireman,"
she said.
Her
first Workers Compensation claim has been rejected, complicated
in part by the fact that John had been
an alcoholic most of his life. Though he quit drinking toward
the end, the alcohol may have been a co-factor in
the deterioration of his liver. But it didnt cause his
hepatitis - which was definitely a cause of death, according to
his doctor and lawyers.
His
wife believes more attention needs to be paid to how the disease
is affecting firefighters, to test them and
educate them about the disease.
"What
they need to know is if they dont, they could die,"
she said. "I hope with the other firemen, I hope they
know they can die too. I hope that they will talk about it and
do something so that it will save other lives."
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