In a city already plagued with high rates of childhood asthma, Hurricane Katrina changed the landscape of the disease in New Orleans. Major flooding led to mold, which led to a significant number of children developing asthma symptoms for the first time.
Yesterday I talked with Dr. Floyd Malveaux, executive director of the Merck Childhood Asthma Network, Inc. (MCAN) and the former dean of the College of Medicine and professor of microbiology and medicine at Howard University. MCAN collaborated on a project called Head-off Environmental Asthma in Louisiana (HEAL), created to study how mold and other allergens affect children with asthma in post-Katrina New Orleans.
You’re studying asthma in children, which is on the rise in urban areas across the nation. Why are you specifically looking at cases in post-Katrina New Orleans?
I was studying asthma in academics most of my professional life and decided to pursue it in a different vein. It’s really a public health problem and has become epidemic. When the opportunity presented itself at MCAN, I thought this would be a good way to take lessons learned and actually apply it. I started August 15, 2005, and hurricane occurred two weeks later.
So what were you thinking—about asthma--after you realized the implications of the hurricane?
I’m a native of Louisiana, so my first thought was that I wanted to go down there and give help. [Regarding the asthma], it was obvious. With the flooding there would be a tremendous increase of mold in the air. We expected asthma to get worse. We knew that respiratory problems would be big, and those with a genetic propensity to develop asthma would experience symptoms for the first time. Even before the hurricane, I knew children had worse asthma in New Orleans than children in may other parts of the country.
What did you find in your research?
It confirmed what we knew: that the mold concentration increased tremendously—in homes and throughout the indoor and outdoor environment.
Many children left the area, which was quite fortuitous. Those who did stay, we worked with them and tested them. We found about 78 percent of those who had asthma were sensitive to molds. It’s 50 percent in major urban areas around the country. That was shortly after Katrina. I don’t think it’s a lot different today, because once you’re sensitized you don’t lose your sensitivity.
Why is the environment in New Orleans especially bad for those prone to asthma?
This is a problem because New Orleans is already below sea level, but it was made extremely worse by the flooding and the water. Over 80 percent of the city was flooded.
Mold is just one of the things that individuals can be allergic to. Cockroaches can make asthma worse, as can pollen, ragweed, dust mites. But we find that in our urban areas, we’re dealing primarily with indoor allergens that seem to be the most important types of things that children react to. If you’re in an environment that’s quite humid, like New Orleans, there is already a lot of mold in the air. With the flooding, when there was up to eight to 10 feet of water, you’re creating a very moist environment. It becomes a big soup, where microorganisms grow. The mold remains in the walls, carpeting and just takes over the entire environment.
How did you manage the increased cases?
We discovered an environment where it was difficult to come in and implement programs that you know work, because it’s a disrupted environment. We thought there were two major needs: case management and environmental management. As a result of that, we were able to assist the children, so the symptom levels declined very dramatically. We partnered with NIH and were able to work with about 184 families in a little over two years.
After the [HEAL] program ended in 2009 the NIH decided it would not continue the study. But we always felt we would not implement the program and walk away. We wanted to see a program institutionalized and see this incorporated into the health care system.
We made about a $2 million investment with Xavier University to sustain this program [through their Center for Minority Health and Health Disparities Research and Education]. We’re now going to help centers throughout New Orleans implement the program among their children who have asthma and see if we can make it a part of the health care system.
You have asthma counselors. What do they do?
They go into the homes and will sit with the family and educate them on how to manage it, how to take the medications, why it’s important to go to the doctor on a regular basis. They will inspect the home and identify where there may be mold.
Is it all about treating the asthma, or can things be done to prevent it?
The preventative work is environmental to a great extent. If there’s dust mites, you give them encasements that go around mattresses. You talk about not leaving water and food out, which attracts cockroaches. You talk about eliminating leaks where you have dampness and mold. You talk about not smoking in the home and about taking medication. You avoid the triggers, you go for lung testing at specific intervals, and if you do have symptoms, the asthma counselor teaches you how to manage it.
What’s the situation there today?
There are still a number of issues. Having access to health care is still a major issue there, and there are still a number of children not enrolled in Medicaid. Then once you have insurance you have to have access to the health care system, which isn’t the same thing. I don’t think there are a sufficient number of asthma specialists, and many of the children are still using the ER as a primary source of care, and that’s not appropriate. There’s no hospital on the east side of New Orleans at the present time. These children lost their safety net—Charity Hospital—which closed after Katrina when the first floor flooded. It never opened again.
Have mold levels gone down?
They have gone down. I don’t know if they’re at pre-Katrina levels, but they have dropped a very significant amount.
Five years later, what have you learned?
We’ve learned some very important lessons. Certainly among the 184 children--they’re doing better. But it’s a fraction. That’s why it’s so important to sustain the program and expand the effort, to reach out to the community health centers and the state and to say, with this program, we can control asthma in New Orleans.