Wildland firefighters face another danger—an increased risk of long COVID

Wildland firefighters face another danger—an increased risk of long COVID
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This article originally appeared on High Country News .

The heat was in triple digits by the time Lea Bossler, her U.S. Forest Service engine crew, reached the blaze in a canyon outside Nogales in Arizona. With her shovel-like rhino tool, she climbed up a hill, where flaming barrels of cacti tumbled down, sparking more burning fuels. Despite the heat, a 45-pound pack and little sleep, Bossler felt strong and capable, mopping up the edges of the fire, extinguishing collapsed cactuses that smoldered like burnt rubber. She was on her third season as wildland firefighter and was well on her path to becoming an incident commander.

Editor’s note: This story includes a graphic description of the loss and grief that comes with the death of a child.

After the fire was contained Bossler and her team drove home to Missoula in Montana, where they had completed a two-week-long roll in the Southwest. It was early July 2020, the middle of a record-breaking fire season that would burn over 10 million acres across the country, and Bossler was resting before her next assignment. There was a coronavirus outbreak at her partner’s workplace, and just a couple of days after she came home, she caught a debilitating case of COVID-19. Now, more than two years later, the 32-year-old still hasn’t recovered. Long COVID has not only affected her health but also forced her to quit her career as a firefighter.

Currently, over 19 million people in the United States — 1 in 13 adults — are living with long COVID, though some estimates place the number as high as 23 million. Long COVID can affect all ages and involve multiple organ systems. It’s diagnosed weeks or months after a COVID-19 infection. Some of the symptoms include cognitive dysfunction, respiratory and cardiovascular problems and extreme fatigue, though roughly 200 other symptoms are recognized, and some can linger for years. Many patients also meet the criteria for other diagnoses. These include postural orthostatic Tachycardia Syndrome, which causes extreme dizziness and headaches, and myalgic Encephalomyelitis (ME), sometimes known as chronic fatigue syndrome. This is a disabling neurological condition that has been neglected for many decades.

A World Health Organization official warned recently that repeated infections could increase the risk of developing long-term COVID. A recent U.S. Census Bureau survey analyzed by the National Center for Health Statistics showed that as many as 1 in 5 adults who were infected with COVID-19 now have symptoms of long COVID.

While the number of U.S. wildland firefighters affected is unknown, the workforce is considered at high risk of contracting COVID-19: In 2021, the leading cause of line-of-duty deaths in wildland firefighters was COVID-19. Firefighters are already stretched thin due to the prolonged and intensified fire seasons caused by climate change. Long COVID can not only affect firefighters’ lives and livelihoods but it could also severely hamper their ability to respond to the growing crisis.

Firefighters are a strikingly transient workforce, making them more vulnerable to catching and spreading COVID-19. Matthew Thompson, a Forest Service research forester, said that firefighters and other fire personnel travel from all over the country in order to arrive at a common location.

The lack of sanitation and privacy at the camps, along with fatigue, heat and other factors, add to that vulnerability, according the National Wildfire Coordinating Group. This group provides leadership for wildland fire operations between federal, state, tribal, and territorial partners. One of the largest COVID outbreaks at a fire camp occurred during the 2020 Cameron Peak Fire in northern Colorado, with 79 positive cases and 273 close contacts who were quarantined. A Forest Service press officer emailed that among nearly 11,000 permanent and temporary agency firefighters, there were 1,847 reported cases of COVID-19 within the past 12 months.

In a recent modelling study , Thompson with his co-authors discovered that social distancing from the public and vaccination reduces outbreaks in fire camp camps. However, their study didn’t assess long COVID and the highly contagious Omicron variant. (According to a 2022 study in the journal Nature Medicine, vaccination may only slightly reduce the risk of long COVID.) Thompson’s study also showed that firefighters were more likely to become infected outside of fire camp than inside it. This means that they are at greater risk for long-term COVID as the U.S. relaxes their preventive measures.

“It’s not only the risk of transmission or getting COVID. It’s also the severity of outcomes.”

The NWCG recommends COVID safety prevention practices for wildland firefighters based on guidance from the Centers for Disease Control. But a widely referenced CDC document about COVID and wildland firefighters doesn’t specifically mention long COVID.

In a review published last year, Kathleen Navarro, a researcher at the National Institute for Occupational Safety and Health, noted that particulate matter — including the hazardous mixture of small particles and droplets found in wildfire smoke — could contribute to a greater likelihood of COVID-19 infection in wildland firefighters, as well as more severe illness. Navarro said that it’s not just the risk of getting COVID or transmission.

But firefighters face a risk of long COVID, no matter the severity of their acute case: A 2022 white paper stated that nearly 76% of those diagnosed with long COVID have not been hospitalized.

Bossler returned to work after her 14-day quarantine despite not feeling fully recovered. She said, “I went back hoping that I would return to normal.” “But I didn’t. It was a tough situation, but I persevered because there were no other opportunities for female firefighters.” She felt like she was in a coma as she continued fighting fires across Montana throughout the summer.

“There is a mindset among firefighters that you can’t quit for nothing,” she stated.

Advocates for those with chronic illness warned of the possibility of complex chronic illness following COVID-19 in the beginning of the pandemic, but the federal government’s public health apparatus did not amplify these messages and still doesn’t consistently emphasize the risk of long-term health effects following an initial case. She stated that she could only conclude that she did more harm to herself. “I believed that I was healthy and young, so I would be fine. But deep down I knew there was something wrong with me

“I worked through it because you just don’t pass up opportunities as a female firefighter.”

A growing number of doctors warn that if a person is not fully recovered, he or she may be more likely to develop COVID. Many Americans continue to work despite their illness, despite financial hardships, inadequate sick leave, and other pressures.

Bossler continued working with her crew throughout the summer, despite persistent symptoms. In late August, she discovered she was pregnant. She said she likely conceived around the time she first contracted COVID-19 in early July 2020.

In a joint decision made with her superiors, Bossler was transferred from the engine crew into a timber striker team for the remainder of the season. She was due in May. She planned to get a job as a Forest Service officer that summer and return to firefighting the following season, assuming she recovers from long COVID. But these plans were put on hold in January when she gave birth to her daughter, Maesyn, prematurely, at only 25 weeks. Due to her maternal history of COVID, her baby was diagnosed with fetal inflammation response syndrome. Bossler’s placenta contained blood clots which contributed to abruption and placental failure. Bossler explained to me that a COVID-affected baby looks like a roadkill deer. She then took out the liver and shot it with a shotgun several times.

When she first went into the hospital at 23 weeks with contractions from early labor, Bossler was told there was only a 30% chance of her baby surviving. Her daughter weighed just 1 pound and 6 ounces at birth when she arrived two weeks later and gained only 5 more pounds during her 115 days in the Neonatal Intensive Care Unit. She died on May 14, 2021, close to her original due date. Bossler was able, in Maesyn’s final moments to take her daughter outside the NICU to view the sky for the very first time. Maesyn passed away in the spring sunshine, in the arms and hands of Bossler, her partner Marcus Cahoon.

Now that it has been over two years since her first diagnosis of COVID, Bossler still experiences debilitating long-term COVID symptoms. She can’t walk more than half a kilometer without feeling tired and has trouble paying attention. She complains of chest pain that has gotten worse since June, when she was re-infected. Bossler believes that her pregnancy complications made it more aware of her illness. She might not have been as stubborn to admit it otherwise. “I know of people who have COVID for a long time and are still trying to become firefighters,” she said. “But I don’t think that they have the same understanding of it or recognition as I do.”

” I believe all employers of wildland firefighters would do a huge disservice for their employees if they didn’t recognize long COVID, and the mental health problems that it causes,” Bossler stated. In August, I contacted the Forest Service to inquire about their approach to long COVID education. I was directed to the United States Office of Personnel Management (OPM), which oversees all federal employees. The Interior Department, which employs over 5,000 temporary and permanent wildland fire personnel, wrote that it develops policy based on recommendations from the CDC and Safer Federal Workforce Task Force, which is led by the White House COVID-19 Response Team, the General Services Administration and the OPM — none of which offer publicly available guidelines on long COVID. The Office of Personnel Management responded to our request for comment with a written statement, but did not provide any details about its policies regarding long COVID.

“I think all employers of wildland firefighters would be doing a huge disservice to their employees to not recognize long COVID and the mental health challenges that come from it.”

“(First responders’) careers depend on our health and us being able to respond to a fire or an emergency at any point of time, despite how we feel,” said Karyn Bishof, the founder of the COVID-19 Longhauler Advocacy Project, a nonprofit advocating for education, research and patient welfare. She stated that many first responders, including wildland firefighters are afraid to talk about health issues, for fear of losing their livelihoods. “The flip side is that if they don’t seek treatment and care, they are not only risking themselves, but also the lives of their crews .”

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Bishof contracted COVID from an outbreak during her firefighter paramedic training at Palm Beach Gardens, South Florida. She said that she was later fired from her job as a Fire Rescue officer. In late 2020, Bishof was also denied workers’ compensation after a doctor diagnosed her symptoms as psychosomatic, a common experience for many patients with complex chronic illness. Since then, she has filed a discrimination suit against Palm Beach Gardens. My request for comment was not answered by the city.

Like other infectious diseases, including Lyme, mononucleosis and SARS-1, COVID-19 can develop into complex chronic illnesses. Researchers have repeatedly found a variety of abnormalities in long COVID suffers, including microclots, persistent virus reservoirs, and autoimmune reactions. The U.S. Department of Health and Human Services has recognized that the condition can be a disability, but in the fall of 2021, Bishof — like many long COVID patients — was denied Social Security disability benefits. She reapplied, but was denied again. She is now awaiting an appeal hearing.

Because there is no cure for long COVID, Bishof said that preventing COVID-19 and increasing public awareness of its long-term consequences are paramount, especially in protecting first responders. She is concerned that if COVID continues to be a problem for one in five people infected, it will eventually impact public safety. She asked, “What does it mean for emergency response times if we lose that percentage?” “What does that mean to wildfire response ?”

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Kati Bach, a senior fellow at Brookings Institution, testified before the Senate Subcommittee regarding the Coronavirus Crisis in July. She stated that policymakers must support better health care, sick leave and workplace accommodations for workers. Given that as many as 4 million long COVID patients are unable to work, Bach estimates a cost of as much as $230 billion in lost earnings alone, not including other costs, such as health care or reduced productivity.

The Forest Service and Interior Department offer sick leave for employees exposed to communicable diseases, like COVID-19, as well as disability accommodations that can include teleworking and more flexible work hours. According to an Interior spokesperson, federal firefighters who are unable to work because of long-term COVID may be eligible to workers’ compensation. According to the Office of Personnel Management guidelines, employees who are infected at work are not eligible for benefits.

Looking back at her experiences over the past two-years, Bossler believes that the Forest Service should develop policies to help firefighters avoid long COVID and provide support for those who are affected by it. When she entered early labor, she was forced to quit her job at Forest Service. She said, “It was a medically forced retirement.” She considered returning to the agency after her daughter’s birth. However, she was still grieving and could not work full-time because of her long COVID symptoms.

In the fall of 2021, she began working part-time as a health unit coordinator in the same neonatal intensive care unit that treated Maesyn. Like other first responders, many nurses at the unit also suffer from COVID. Bossler said to me, “I wanted work somewhere that would understand my needs.”

” I learned how to manage all these traumatic situations using the lessons from fire,” Bossler stated. Maesyn’s short life and tragic death had such an impact on Bossler, she feels compelled to tell her story and educate others about this chronic disease. “I think of other firefighters who lost their ability to do what they were trained to do.

” It’s more than your job. It’s your identity.

This story was supported by the journalism nonprofit the Economic Hardship Reporting Project.

Miles W. Griffis, an independent journalist, is based in Los Angeles. We welcome reader letters. Email High Country News at editor@hcn.org or submit a letter to the editor. See our letters to the editor policy.

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