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Pandemic

Libby, Montana: Where Asbestos Exposure and COVID-19 Mingle

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Libby, Montana has fought lung diseases due to asbestos for over a century; but now the effects of asbestos exposure and COVID-19 are giving residents of Libby a new worry.

History of Libby asbestos exposure

This combination of silent killers increases the medical fears that have long plagued the area. For generations, Libby, Montana has fought serious lung diseases due to large exposures to asbestos posed by asbestos contaminated vermiculite mined from nearby Zonolite mountain. Asbestosis, lung cancer, and mesothelioma – a deadly disease – have led to hundreds of deaths and many residents with scarred and damaged lungs.

Asbestos exposure and COVID-19 threats

Now coronavirus disease 2019 (COVID-19) and the ensuing pandemic, has left Libby with additional medical worries. COVID-19 is especially dangerous for older people and those with lung or heart conditions, severe obesity, diabetes, and weakened immune systems. Today, 1 in 10 residents are diagnosed with some form of asbestos disease. Since generations of residents lived with the horror of asbestos exposure, this new threat is just one more blow.

Deception leads to distrust

National Public Radio (NPR) reports trusting authorities can be difficult for some individuals who lived through deceptions about asbestos – not knowing that the mines and piles of mine waste that abounded in the area were toxic to them. But W.R. Grace and Company knew and kept it secret for decades. Eventually the EPA came in during the 1990s, helped clean up the town and made the former mine a super fund site. 

Turning to today, COVID-19 is a potentially deadly virus.  Local, state and federal health officials warn that masks should be worn and contacts limited.  But as NPR reports, mistrust in state and local authorities from their initial handling of asbestos disease issues from the mines makes it difficult for some in Libby to know what to do with the new silent health threat posed by COVID-19.  Some just want to get back to work and to their lives. This area of Montana is beautiful – leading the town to rely on the visits of tourists. Yet, tourists could bring more of this new health threat into their town. This conundrum leads to varying opinions among residents on how to protect while keeping livelihoods.

Cancer Diagnoses Declining as COVID-19 Fears Rise

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Generally, to find cancer diagnoses declining would be good news, but this decline is due to fewer people willing to risk COVID-19 for a doctor visit. Six common cancers and their diagnoses were studied: breast, colorectal, lung, pancreatic, gastric and esophageal. A 46% decrease was found between March 1 and April 18 – the same time period the public was warned to stay away from doctors’ offices and emergency departments unless it was a true emergency.

safe doctor office practices to change cancer diagnoses declining

Since that time, safety procedures were put in place that lessened worry about these visits. Even though the warnings about visits are much fewer, the initial fear of visits – leading to diagnoses – are still less than pre-Pandemic.

How was the study conducted?

Quest analyzed tests ordered by doctors who entered the code for ‘new cancer diagnosis’. They began with a baseline covering January 2019 through February 2020. In the following seven weeks, March 1 through April 18, the mean weekly number for all six types of cancer diagnoses decreased 46.4% for those newly diagnosed with cancer. Quest found that in the baseline and pandemic studies, women with a mean age of 66 comprised 75% of their patients.

What does cancer diagnoses declining mean to patients?

Ned Sharpless, director of the National Cancer Institiute, stated this delay of diagnoses could mean 10,000 unnecessary deaths from breast and colorectal cancer over the next ten years. He also said, “We’re very worried about the consequences of … delaying therapy on our patients. We can’t delay cancer care forever.” This could be trading the COVID-19 crisis for a late cancer diagnosis crisis. The United States now has 163, 651 deaths from COVID-19 as of August 11, 2020. This is a huge number.

Other effects of COVID-19

The purpose of the National Syndromic Surveillance Program (NSSP) is to collect electronic health data in real time. They found that visits to emergency departments declined by 42% comparing March 31 – April 27, 2019  to March 29 – April 25, 2020.  This data covered visits from a subset of hospitals in 47 states. This led to acquiring data from approximately 73% of emergency department visits in the United States.

This demonstrates that patients afraid of going to the doctor’s office, also were slow to go to the emergency room. A person with arm or chest pain may decide it’s better to wait and see what happens than go to the emergency room, leading to a potential heart attack. Visits for nonspecific chest pain decreased by over 24,000 during the early pandemic.

They may try to ignore a severe headache and treat with OTC remedies when it could be a treatable stroke. They also may hesitate to go with abdominal pain, musculoskeletal pain, high blood pressure, and nausea and vomiting, respiratory infections – as well as sprains and strains. While some of these might be minor, others could lead to serious illness or death.

Those who use emergency departments as their primary healthcare – usually because of lack of access to primary care – may be significantly affected, leading to avoidance of their normal safety net.

What to do?

Authorities, and the media, must stress doctor visits, regular checkups and needed tests are still necessary to stop the number of cancer diagnoses declining. They must also reassure the public that health facilities have guidelines in place for monitoring entrance to facilities, mandatory face masks, and social distancing. All facilities need frequent access to approved hand sanitizers and hand washing stations. Good use of phone and video calls for triage can quickly assess emergency situations and limit crowds. For those afraid that telemedicine may not be covered with their insurance, check with providers. Currently, because of the emergency status, most insurances are paying as if in-person. In most cases, that also includes Medicare.

While COVID-19 is serious and can be deadly, so can ignoring early detection of cancer and other health risks.

Cancer diagnoses declining is the canary in the mine warning everyone that this is not a time to neglect health care.