Hep C is deadly: Many emergency workers around country afraid to
be tested or treated

by: Julie Knipe Brown
Reprinted Philadelphia Daily News

http://www.local1259iaff.org/hepc.html

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 didn’t 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 couldn’t 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 firefighter’s union. "They don’t want to think about their mortality, and they don’t 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 they’ve 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 IAFF’s 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 department’s 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 haven’t 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 nation’s second-largest fire union is in panic mode. "It’s 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. I’ve 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 it’s out there now, and I think you’re going to find more departments do testing."  Yet despite the alarm, there’s 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 Baltimore’s, say they don’t even think testing is necessary, citing a Centers for Disease Control’s recommendation against routine testing of health care workers and firefighters.  "We have cases of hep C and we’re concerned. But is it rampant? I don’t think it’s rampant," said Pat Bahnken, president of New York’s 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.  "We’re 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 aren’t 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 can’t prove they became infected in the line of duty because they didn’t 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 Valley’s Internet gold rush. Most can’t 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 don’t really know what it is, and they don’t want to talk about it because they don’t want to admit they’re scared."  John Parent was among them. An active swimmer and hiker, he couldn’t face the fact that he had a serious illness that needed treatment, said his wife. "He just didn’t 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 didn’t want to be off of work."  Just months before Parent died, Jackson finally convinced him to talk to his doctor and the fire department’s 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 department’s physician, Dr. Deborah Owen, is pressing for baseline testing of all firefighters - something the department’s 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 IAFF’s Duffy, however, points out that he’d 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 hasn’t even considered an infection control program," said Duffy. "I think the numbers speak for themselves."

Unlike San Francisco and other pro-active cities, Philadelphia doesn’t 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.  "I’m 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 don’t 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 Parent’s widow, who is now selling off her belongings because she won’t be able to make car or mortgage payments without her husband’s 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 didn’t 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 don’t, 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."