Advocates for valley fever research give California Assemblyman Rudy Salas (D-Bakersfield) an “A” for effort for what they call the most robust legislative effort to address the disease in California history. But public health officials and disease experts are split on whether the remedies proposed by Salas will bring improvements.
Salas’ package of bills takes aim at disease reporting standards, physician training and workplace safety with promises of a budget resolution to bring more funding to the disease. Experts are happy about the money and attention valley fever is receiving, but are divided about one of the four bills Salas introduced.
That bill, AB 1788, would change how public health officials must count cases and report on the disease, which is endemic to the San Joaquin Valley.
The current standard for disease reporting for valley fever requires a detailed, resource-intensive process designed to avoid errors. But because county health departments don’t have the resources to go through the two rounds of verification required for each case, they often fail to account for cases altogether.
The bill aims to create a streamlined reporting system that delivers statewide case counts faster. To do so, Salas has eliminated a time-consuming step in counting cases to increase the likelihood that cases are recorded at a time when valley fever is on the rise. The legislation also would bring California in line with the practice in Arizona, another state where valley fever is widespread.
Skeptics say the proposed reforms could inadvertently reduce the chances of local health departments spotting outbreaks by trading accuracy for speed.
“I think it would be chaos,” said Jeff Engel, the executive director of the Council and State of Territorial Epidemiologists, the nonprofit group that wrote the current state guidelines.
Meanwhile, those supporting the legislation say the state should assume new responsibilities now left to cash-strapped county health departments.
“There’s nothing wrong with doing surveillance. It needs to be done. But why not at the state level in occupational health since they’re compiling and scrubbing the data?” asked Rob Purdie, vice-president of the Bakersfield-based Valley Fever Americas Foundation.
Salas said underfunded public health departments in endemic areas don’t have the resources to investigate cases under the current standard. As a result, cases are sometimes marked as “probable” or “suspect” and not counted by the state, he said. Streamlining the process of verifying cases, he said, would increase the case count and raise the disease’s profile.
“If I go to the governor and ask him for additional resources, he’ll say there’s not many affected — (but) I can say there is,” Salas said. “He’s going to want the numbers.”
With his legislation, Salas aims to address an undercount that makes it harder to shake loose government funding for treatments and a vaccine under development. Despite federal data showing that cocci have never infected more than 23,000 people, valley fever researchers estimate that more than 150,000 annually get valley fever in the United States. Cases have been increasing to epidemic proportions this year in California, prompting the state health officer to issue warnings as the disease sprawls outside of its traditionally endemic regions.
Valley fever, or Coccidioidomycosis, is caused by the Coccidioides fungus, which grows in the loamy soil of the southwestern United States. When disturbed, often through agricultural tilling, construction and high wind, microscopic fungal spores can become airborne and, once inhaled, cause valley fever. Most people are asymptomatic, but others develop flu-like symptoms, including fever, cough, headaches, and chills. In some cases, when left untreated, the fungal spore can spread throughout the body and cause a lifetime of health issues, and in rare cases, death.
Valley fever is already seen as an orphan disease that is found only in a narrow band of states. Yet public health officials cannot grasp the full scale of the disease in endemic regions because of the need for a more robust count.
Under current state standards, before public health agencies can report a valley fever case to the California Department of Public Health, they confirm it through a laboratory process and a clinical follow-up with physicians to determine symptoms.
Many cases are not counted, however, because cash-strapped health departments don’t have the time to conduct clinical confirmations, a process that requires epidemiologists, at a minimum, contact doctors to ensure it’s a cocci case and not a misdiagnosis.
The Center for Health Journalism Collaborative surveyed seven counties in the San Joaquin Valley and along the coast and found a lack of consistency in how cases are reported. Kern, Tulare, Stanislaus, and San Joaquin counties do not conduct any clinical confirmation for valley fever. Merced, Monterey and San Luis Obispo counties do.
Even before the legislation, state public health leaders seem to be backing away from the more rigorous verification process.
“Local health departments in California are not required to review clinical information when confirming cases of valley fever. Local health departments can adopt their own practices to determine which cases they consider as confirmed,” California Department of Public Health officials said in a statement.
State Public Health officials added that there’s a workgroup of local health officials working to standardize reporting practices.
All of the counties the Collaborative surveyed said they struggle to conduct these types of investigations. That’s because departments have been given no additional resources to tackle counts even as valley fever cases have been rising.
“It’s very research intensive to call every patient and ask these questions,” said Kern County Epidemiology Manager Kim Hernandez, whose county recorded 2,310 cases in 2016. “For us, we can’t sustain that, and other counties are finding with these increasing cases that they can’t sustain it, either.”
Some counties, during this process, also investigate cases to determine where the patient was exposed to the fungal spore, whether they had been treated, and perhaps most importantly, their occupation.
“What they do for a living has led us in the past to at least three outbreaks associated with a work site,” said Ann McDowell, an epidemiologist at San Luis Obispo County Health Department.
In one case, 11 of 12 crew members replacing a busted water pipe in 2007 at Camp Roberts, a California National Guard military base, got sick. Public health nurses spotted the cluster during the clinical confirmation process and found that none of the workers were using respiratory protection. They also found during the investigation that a military instructor working on base was exposed to fungal spores and got sick.
Those investigations helped spur the department to work with their local building departments to ensure that contractors provide valley fever education to workers before issuing a permit.
Just two months ago, Monterey and San Luis Obispo public health officials spotted a cluster of cases at the California Flats Solar Project in Cholame Hills, which straddles the two counties. The departments, working with the California Occupational Safety and Health Administration, found that six construction companies were not protecting workers from the risk of valley fever by taking common-sense prevention measures, including soaking soil before digging and ensuring workers wore respirator masks. One company, Papich Construction, was a repeat offender. The six were fined a combined $240,000.
“We feel that clinical investigation helps us if there’s a problem with a work site,” McDowell said. “Doing away with it would probably not get us as much visibility on some of these sites.”
Still, she acknowledges that public health departments have fewer resources and less time to carry out valuable investigations. San Luis Obispo had 330 confirmed cocci cases in 2017, with scores more still under investigation. Two years earlier, they had fewer than 49 cases.
“It’s been a very busy year for valley fever and it’s really stressed our nurses to have to do these clinical investigations,” McDowell said.
A lack of resources, however, is no reason to change the state standards for verifying cases and tracking the disease, said Engel, the nonprofit director.
“If the problem is resources at the local health department, then California legislators should be focusing on making sure that they’re adequately resourced for the burden of disease,” Engel said. Reforms “could provide misleading data that would harm surveillance efforts.”
But Arizona officials have conducted studies after changing their standards and have found a slim margin of error — less than 3 percent.
Dr. John Galgiani, executive director of the Valley Fever Center for Excellence at the University of Arizona, considered the nation’s top valley fever researcher, said he’s willing to accept that margin for a more cost-effective data reporting method.
Kelsey McNary was one of more than 650 high school cheerleaders and dancers from across the U.S. who represented Varsity Spirit in the London New Year’s Day Parade.
McNary, a senior at Sierra Pacific High school and cheer captain, said she went to cheer camp over the summer and tried out to become an All-American cheerleader and was accepted.
All of the individuals invited to perform in the parade qualified for the trip after being selected as an All-American at the summer camp hosted by one of the Varsity Spirit camp brands.
According to a press release from Varsity Spirit, All-Americans are selected to try out based on superior cheerleading, dancing and leadership skills at camps across the country.
The press release also said only the top 10 percent of the more than 325,000 cheerleaders and dancers who attend the 5,000 Varsity Spirit summer camp sessions earn the chance to march in the parade.
McNary was among parade performers from all over the world.
“I was super excited,” McNary said. “It was my first time traveling far from home, so I was a little bit nervous as well. But I was mostly grateful for the amount of support from friends and family that helped raise the funds for me to go.”
The theme of this year’s parade was “Showtime!”, and celebrated the greatest shows on earth. Cheerleaders, dancers, marching bands, acrobats and more made up the 10,000 performers representing 20 countries worldwide in the 2018 parade.
Established as one of London’s biggest events, the parade is seen by nearly 300 million people around the world.
McNary said her favorite part of the experience was definitely the parade.
“It was so cool to see how many people got excited when they saw us perform and it was fun because I got to talk to lots of girls from all over the U.S.” McNary said.
In addition to cheering in the parade, McNary got the chance to tour some of London’s most historic sites during her stay, including the Tower of London, London Eye, Westminster Abbey, Buckingham Palace and Windsor Castle.
HANFORD — Students, educators, elected officials and community members gathered Friday to celebrate the ribbon cutting for the new Hanford agricultural school farm and learning laboratory.
Combined, Hanford High School, Hanford West High School and Sierra Pacific High School have over 900 students in agricultural programs, making it one of the largest in the nation. Of all the Future Farmers of America programs in the state, Hanford was one of only two programs that didn’t have a school farm.
Now all that has changed.
The farm sits on a 3.9-acre site behind Sierra Pacific High School, near the intersection of Centennial Drive and Greenfield Avenue.
The farm includes a 8,621 square-foot sheep and cattle building, a 3,442 square-foot swine building, a 10,268 square-foot arena building and a 2,521 square-foot small animal building.
LEMOORE — After an initial discussion ended with an impasse, the Lemoore City Council decided at its meeting Tuesday night to rekindle the city’s partnership with Kings Economic Development Corporation.
At the Oct. 17, 2017, meeting, a memorandum of understating between the city and Kings EDC was brought before Council. Council debated the issue and in the end, there was no motion to accept the contract.
Since then, Interim City Manager Nathan Olson said multiple Council members had asked that the issue be brought back before them, which is allowed because no action was taken the first time.
Councilwoman Holly Blair, who was critical of Kings EDC at the October meeting, said she was not happy about the issue being brought back again. She was especially confounded because she believed there was a consensus from council in October that the city would not move forward with any contract, yet the item came back on the consent calendar, where items are usually not discussed because they are considered routine.
“We’ve already had this discussion once before, and I personally don’t like the precedent being set that we, as a council, decide one thing and they can just continue to come in and badger and hopefully get it on the consent calendar and passed and nobody notices,” Blair said.
When John Lehn, president of Kings EDC, spoke later during the meeting, he clarified that no one from the organization asked that the contract be put on the city’s agenda again, though he was glad that it was reconsidered.
Mayor Pro Tem Eddie Neal, who was also unconvinced of Kings EDC’s promise in October to bring growth to Lemoore, changed his tune Tuesday night and said he believed the organization would work to live up to its promises and was willing to give it a second chance.
Councilman Dave Brown gave his take, saying he was willing to give Kings EDC another chance if it meant bringing more economic development to Lemoore. He said the organization is contracted to meet several requirements, and if it doesn’t meet expectations, then council could reconsider the partnership once again.
“I would like them to be out there beating that drum for us,” Brown said. “I really want to give them a chance and go forth and see what’s going to happen.”
Councilman Jeff Chedester and Mayor Ray Madrigal both agreed, with Madrigal saying he thought Kings EDC’s expertise, knowledge and contacts across the state would strengthen the city.
Lehn was finally given the chance to speak on behalf of his organization’s merits, and he reminded Council that projects don’t come around overnight, sometimes taking years to come to fruition.
“If we’re skipping down that road arm in arm, I think we’re going to get a lot done,” Lehn said, adding he believes the contract outlines the right strategies for Lemoore to succeed.
Blair was unconvinced and said there was nothing to show for the 45 years the city partnered with Kings EDC, which ended in 2014. She asked for a guarantee that something would come from the partnership, but said she knew nothing would change.
After some more back and forth discussion, Neal moved to approve the one-year $20,000 contract with Kings EDC. It was a 4-1 vote, with Blair being the only “no” vote.
Reached by phone on Friday, Blair said she was still skeptical that the contract was awarded based solely on promised outcome. She said she didn’t see anything new in Kings EDC’s promises of “deliverables.”
She said after talking with several constituents, she believes the community is ready to see changes that are not being reflected through council actions.
“Things won’t change if we keep doing the same things over and over,” Blair said.
Lehn, on the other hand, said on Friday that Kings EDC is “extremely pleased” to partner with Lemoore in a formal way once again.
“Contributions of the Economic Development Corporation on a countywide basis have continued to be strong and significant over the last several years” Lehn said, adding every nearby community benefits in some way from the services the organization provides, even if they are not strictly members.
Lehn said Kings EDC received a lot of support from Lemoore city staff and he’s pleased a majority of the Council recognize the city’s need to diversify its economy and attract more businesses.
“We look forward to a positive relationship and working with businesses to ensure they remain profitable and growing,” Lehn said.