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In West Virginia, an Outbreak and Few Answers



High-risk factors for hepatitis A include those experiencing homelessness or who are transient, those who have been incarcerated within the last 6 weeks, and people who use illegal drugs. Those experiencing homelessness are at risk because of the difficulty maintaining hygiene on the streets. Photo:
This article was originally published by Rewire.News. 

Opioids and a rise in people experiencing homelessness have been blamed for a hepatitis A epidemic in West Virginia. But advocates for the homeless say the local census doesn’t support that.

West Virginia has been struggling with an outbreak of hepatitis A, according to local public health officials.

The most populous county in the state found itself the “major epicenter of a major hepatitis A outbreak,” said John Law, a public information officer at the Kanawha-Charleston Health Department (KCHD). Since March, West Virginia’s Department of Health and Human Resources (DHHR) has reported nearly 1,400 new cases of hepatitis A, an unprecedented increase. According to DHHR, the majority of the hepatitis A cases have been in Kanawha, Cabell and Putnam counties. Two cases have been reported in a northern West Virginia jail, and there have been at least two confirmed deaths.

Police and health officials say that the epidemic may be linked to a possible rise in people experiencing homelessness in West Virginia. But advocates for the homeless say the local census of people experiencing homelessness doesn’t support that theory. Others blame opioid usage for the state’s surging rates of hepatitis A.

Hepatitis A is a contagious disease often transmitted by food or water contaminated by fecal matter. People who are homeless or transient, those who don’t have access to proper sanitation, drug users, and the recently incarcerated may be at high risk, as well as anyone who has contact with higher-risk individuals. Symptoms of hepatitis A include whole body fatigue, fever, loss of appetite, diarrhea, nausea, and vomiting, as well as abdominal, joint, and muscle pain. Dark urine, itching, weight loss, and yellow skin and eyes (jaundice) are also common symptoms of infection.

The jump in West Virginia cases is alarming because, nationally, annual reports of hepatitis A cases have remained relatively stable, with a 95 percent decline since a vaccine became available in 1995, according to the Centers for Disease Control (CDC). Until this year, West Virginia reported an infection rate lower than or comparable to many other states. According to Janet Briscoe, the KCHD director of epidemiology, in an interview with local News Channel 3 WSAZ: “Before the outbreak, hepatitis A cases were rare in our region.” In 2010, previously the most recent year with the highest number of new cases, the state reported only 16 new cases.

Currently in West Virginia, “we are seeing it particularly in our homeless population. Maybe not the traditional on-the-street population, but the itinerate homeless—couch surfers,” Law of the DHHR said in an interview with Rewire.News. Those experiencing homelessness are at risk of hepatitis A due to the difficulty maintaining hygiene on the streets or without a permanent home.

Spotlight on Poverty and Opportunity, a nonpartisan forum on issues surrounding poverty in the nation, reports a total of more than 1,300 people experiencing homelessness in West Virginia, though it’s unclear how their count defines homelessness. An accurate, current count for both West Virginia and its capital proves hard to find because different agencies define homelessness differently.

As defined in a report from the Substance Abuse and Mental Health Services Administration, the point-in-time (PIT) count from the Department of Housing and Urban Development (HUD): “tallies the number of people in a community who are experiencing homelessness on a single night.” The PIT count taken in January for the entire state of West Virginia, according to the Western Virginia Continuum of Care, was higher than in years past, up by 9 percent, totaling 304 persons (including children) experiencing homelessness. But because of rural terrain and the difficulty reaching or finding many unknown people, this count may be low.

As reported in the Charleston Gazette-Mail, Charleston, West Virginia, Police Chief Steve Cooper stated last January there had been an influx of “several hundred” homeless people in the city and that homelessness in West Virginia is difficult to quantify.

This also makes linking the hepatitis A outbreak to homelessness difficult.

The outbreak in West Virginia “has been connected with the outbreaks in both California and Kentucky,” Law said. Though the original source of the infection remains unknown, researchers speculate that it first began in California, then spread. In addition to West Virginia, this year has seen newer outbreaks in Massachusetts, Missouri, Ohio, Arkansas, and Nashville, Tennessee.

According to Ellen Allen, executive director of Covenant House, a continuation of care site in Charleston that seeks to help the homeless through long-term support, PIT numbers have changed very little in the last five years—despite what is being claimed by the Charleston police department and mayoral office. “That’s not accurate at all. They know the homeless population has not tripled. This has been a point of contention with them,” she said in an interview with Rewire.News. She noted that local law enforcement have participated directly in the PIT count each year, which has stayed around 300 for Charleston.

Last month, a segment on News Channel 3 WSAZ ascribed an increase in the Charleston homeless population to people from out of state. According to Ronald Chandler, a man experiencing homelessness interviewed by WSAZ, many of these out-of-state individuals found their way to West Virginia after other states began to “crackdown” on the population.

Allen disagrees, saying Covenant House sees many in the new homeless population coming from rural parts of West Virginia itself. “We’re not seeing them come from all over the country. We’re seeing them from areas like the devastated coal communities,” she said, noting Boone County as an example.

Nationally, numbers of people experiencing homelessness have been on the rise, with a 9 percent increase specifically in “unsheltered homelessness” in 2017 and 12 percent in “chronic homelessness” in 2017.

For Allen, community resources such as shelters serve as gatekeepers for the health of the high-risk population, offering access to resources like vaccines that some would not be able to easily obtain otherwise. “We try to respond collectively as a community, to get everyone immunized that we can,” Allen said. “We also know [the hepatitis A outbreak] is being driven by opioid addiction and we are arguably the epicenter of that as well.”

As of September 28, among the 1,395 hepatitis A cases in West Virginia, 76 percent report drug use, and 11 percent of the total number of people infected are considered homeless.

When it comes to individuals experiencing homelessness, “That particular population is sometimes difficult to access and make realize they need to be vaccinated and tested,” said Law. “We are reaching out to them in as many ways as we possibly can. For instance, we have provided vaccinations at shelters and soup kitchens.”

Because hepatitis A is a virus, treatment only addresses symptoms until the virus has run its course. The CDC, DHHR, and Law all urge those who qualify to prevent contracting the virus by getting vaccinated—though it’s a little more complicated than simply getting a shot, according to Law. “With hepatitis A, if you are vaccinated within two weeks of exposure, you will most certainly be protected against it. The dichotomy there is that you sometimes don’t manifest any symptoms until well after that two-week window.”

On August 25, the CDC distributed information to all state and local health departments about an investigation into hepatitis A infections specifically in people who are experiencing homelessness or who use illicit drugs.

At the end of August, West Virginia Public Broadcasting reported that at Gov. Jim Justice’s (R) request the CDC assigned six “subject matter experts” to “manage the outbreak,” assisting with technical tasks such as data management and case investigation strategies and procedures. The CDC’s Division of Viral Hepatitis has been monitoring and assisting many states since March 2017. The CDC did not respond to multiple requests from Rewire.News for comment.

“This outbreak is continuing; we have seen it across the country,” Law said. “The best thing is you can do, certainly, is to get vaccinated.”

According to a KCHD press release, in West Virginia “most adults have not been vaccinated for Hepatitis A.” Though beginning in 2006 the vaccine did become recommended vaccine, it is required only for children attending state preschool in West Virginia.

“The numbers we are seeing [of hepatitis A] have been lab-confirmed numbers. There is probably a larger number out there,” Law said. “These are the people who are sick enough to go to a health-care provider or hospital.”


Air Pollution Continues to Decline, Smog Remains a Problem



Mt. Storm Power Plant in West Virginia. Photo: Cecilia Mason/WVPB

A new report released this week by the American Lung Association finds fine particle, or soot, pollution continues to improve across West Virginia, but smog pollution remains a challenge.

The American Lung Association’s 20th annual “State of the Air” report analyzed air quality data collected by federal, state and local air monitoring devices between 2015 and 2017, the most recent data available. Data is collected in just 10 of West Virginia’s 55 counties.

The Lung Association’s 2019 report found fine particle pollution continued to improve across the state. All counties with data earned an “A” grade.

Soot pollution is expelled from sources like exhaust pipes or industrial plants. It’s the fine, microscopic dust sometimes small enough to pass directly into the blood streams through the lungs. Not only can it exacerbate respiratory health problems, but fine particle pollution is also linked to heart problems.

Cabell and Kanawha counties had zero unhealthy days of short-term spikes in particle pollution for at least the fifth consecutive year, listing them among the nation’s cleanest counties for soot pollution, the report stated. The area ranked 89 worst in the country.

It was a different story, however, for ozone pollution. Ozone is a powerful lung irritant that exacerbate asthma attacks and negatively impact those with other lung diseases. The new report showed West Virignia counties had similar levels of unhealthy days of high ozone as last year’s report.

Cabell, Kanawha, Ohio and Wood counties all earned “C” grades and had four or more days with unhealthy ozone levels.

The American Lung Association said a warming climate may help explain the boost in unhealthy ozone pollution levels. Ozone levels increased in most cities around the country during the three-year period, which were also some of the warmest on record.

The report also highlighted a series of federal environmental laws that have been rolled back — from methane standards for oil and gas wells to car pollution standards — that may be negatively affecting air quality.

Nationally, the report found ozone and short-term particle pollution worsened in many cities. More than four in 10 Americans, or about 43 percent of the population, live in counties that have monitored unhealthy ozone and/or particle pollution.

This article was originally published by West Virginia Public Broadcasting.

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Serving Survivors: In Rural States, Telemedicine Brings Treatment For Sexual Abuse



“Open plains and lots of antelope,” Matt Gray describes the Wyoming landscape. Photo: Mary Meehan, Ohio Valley ReSource

Gillette, Wyoming, isn’t the kind of place you just happen to come across.

“It’s about a four hour drive through vast, unimpacted, wide, sweeping plains,” said Matt Gray, a professor at University of Wyoming in Laramie, explaining the trek from his office to his clients.

Plains, he said, “and lots and lots of antelope.”

For the last decade, Gray and graduate students have bridged the space across the high plains with a digital connection in order to serve survivors of domestic violence and sexual abuse.

The university town of Laramie connects with the boom and bust energy town of Gillette near the South Dakota border providing specialized trauma counseling. Without that link no such service would be available.

Graphic: Alexandra Kanik, Ohio Valley ReSource

AMargie McWilliams is director of what is officially called the Gillette Abuse Refuge Foundation and unofficially called GARF. In her estimation the therapy program has been invaluable.

“Honestly, it has saved a lot of lives.”

Since the #MeToo movement started a national conversation about sexual violence, the scope of the discussion continues to grow from exposing the issue to exploring how to best help survivors. Those include rural women who are often underserved and overlooked. Each place is different but many rural communities, including those in the Ohio Valley, share the challenge of providing services when there are lots of miles between people and providers.

Underserved, Overlooked

Historically, much of the research on domestic violence and sexual assault has centered on urban areas. But a study published in the Journal of Women’s Health shows that women in rural areas suffered a higher rate of intimate partner violence than their urban counterparts.

Not only is there more violence, it is less frequently reported. A 2016 report from the Justice Department noted that in rural areas only 41 percent of violent crime and 47 percent of serious violent crimes (defined as rape or sexual assault, robbery, and aggravated assault) are reported to the police.

An earlier study explored reasons that people did not report these crimes: it was considered a personal matter; such an assault was not considered important enough to report; victims felt the police would not or could not help; and victims fear of reprisal or getting the offender into trouble.

These findings are not news to McWilliams or Gray, who between them have nearly 50 years of experience in dealing with domestic violence and sexual assault in rural communities.

Rural Similarities

Eileen Recktenwald is executive director of the Kentucky Association of Sexual Assault Programs. She said access to quality care has been an issue for the 35 years she has been an advocate. She said she could see a telehealth program working in the Ohio Valley.

Already, she said, younger people, especially ages 18 to 24, are seeking services in a different way. “They are much more electronically inclined and access services via chat or the internet,” she said.

Eileen Recktenwald of the Kentucky Association of Sexual Assault Programs. Photo: Mary Meehan, Ohio Valley ReSource

Rural communities don’t all look the same. Wyoming’s wide open spaces, as people there like to say with some pride, make it one of only two states determined to be not only rural but uber-rural, or “frontier.”  (The other frontier state being Alaska.)

But there are similarities between the plains in the west and rural parts of Kentucky, West Virginia, and Ohio.

Recktenwald said most rural parts of America share some common traits. They also have similar barriers to mental health care because they lack services and providers, face transportation barriers, and have cultural factors that can cause social stigma to be amplified.

Graphic: Alexandra Kanik, Ohio Valley ReSource

Telemedicine, as a whole, is becoming a routine part of healthcare. According to a recent report from the American Hospital Association, 76 percent of hospitals offer some kind of telehealth service. Last year, the Veterans Association launched a telehealth initiative for service members with PTSD.

But as Gray points out, the best ways to approach rural women and combat veterans are not the same. And, he said, there are other things to consider.

Why Wyoming

Gray went to college to be a dentist but soon found a passion for psychology and has specialized in sexual abuse and domestic violence for more than 20 years. With a dark beard and an easy smile, he’s the kind of guy who frequently says, “that’s a great question,” yet manages to always sound sincere.

Matt Gray, a professor at the University of Wyoming in Laramie. Photo: Mary Meehan, Ohio Valley ReSource

The university’s information technology department first brought the idea for a telehealth clinic to him. They had received grant money for telehealth but couldn’t find the right focus.

Gray said he was a little worried at first that he wasn’t tech savvy enough to oversee a digital operation. Now he rolls with the lingo.

“It was a matter of having them help set up a polycom unit that is secured and encrypted video conferencing at the distal site,” he said.

Translated, that means there is a secure computer in one place that connects to the same in the other. Those computers can only talk to each other and no one else can listen. Securing privacy is a key element given the subject of the conversations that will take place on these links.

The first clinic was in Rawlins, a town of just under 9,000 people. Rawlins already offered domestic abuse services but not therapy. Gray said only one or two clients in Rawlins access telehealth each year. Some clients come from the state’s biggest city, Cheyenne, but most come from Gillette.

Gray said he had some reservations in the beginning as to whether the person-to-person experience of counseling could be replicated in a remote and mediated setting. His research shows the clients are often more satisfied with their experience than are the therapists.

“The baseline is different because the client isn’t comparing the telehealth experience to previous counseling,” he said. For them, he said, “it’s how does this compare to getting nothing at all, which would be the only alternative.”

Student Help

Another important piece is the graduate students who make up the therapy team.

Two current team members are Kendal Binion from Georgia and Stephanie Amaya from Los Angeles.

Kendal Binion, part of the graduate student therapy team. Photo: Mary Meehan, Ohio Valley ReSource

After working together closely for two years, they frequently laugh in unison and finish each other’s sentences. It is a bound forged, they said, in doing the difficult work of providing therapy to rural survivors of sexual assault and domestic violence.

Binion said she applied to the program while working as a hospital advocate where she helped connect clients to services but didn’t provide therapy.

“What I saw was a lot of victim-blaming from not only medical providers and police officers, but from family and friends,” she said. “And I really wanted to reach out and go beyond advocacy.”

Binion gets tears in her eyes as she talks about one Wyoming client who made a lasting impression. The woman had kept the secret of her assault to herself for decades, telling no one.

“All of these cases are hard, but to have someone who had the added pain of no support,” Binion said, “it was also exceptionally hard to hear that it was for 40 years.”

Amaya said she’s been inspired by her clients. “They are the ones making those steps first,” she said.

Those first steps involve escaping the extensive control exerted by the partner. That can include, she said, the lack of access to money, the lack of the ability to leave the house, threats to take away children, and the very real possibility of additional physical or sexual violence.

The geographic isolation of a rural setting can compound those effects, she said.

“Part of that cycle of violence is isolation that the perpetrator tries to inflict on the victim, whether that be from family or from resources,” Amaya said. “And geographic isolation just really fits perfectly into that model.”

But she said therapy can work even if it is happening across a computer network instead of across the room.

“I found that human connection is transcendent,” she said. “It doesn’t depend on proximity. It depends on empathy, and a willingness to share and to open up and to support someone who needs that support.”

Finding Funding

Telehealth is not the perfect solution in rural areas, Gray said. First, there’s the question of funding.

“It goes without saying that in terms of getting dollars in resources for sexual assault and domestic violence, no matter what kind of service you’re trying to provide, that’s a really hard thing to do,” he said.

Matt Gray,
left, and trauma treatment students on a hiking field trip. Photo: Courtesy Univ. of Wyoming

Plus, he said, most available grant money is tied to innovative uses of technology for a limited number of years. There is less funding available to sustain the work of treating trauma.

There are plenty of other rural communities that would benefit from such a program, he said. But there is also a limited number of appropriate therapists-in-training. His program can serve about 20 to 25 clients at a time. Those clients receive, on average, 12 to 15 sessions.

What you don’t want to create, he said, is a service with a far reach but a long wait time.

He said that to tell a domestic violence or sexual assault victim “’we can get you but it is going to be two or three months’ is highly problematic.”

The goal of the current team is to contact a client within the first 48 hours after the first report and to have the first session with the client within 96 hours.

The need for more services, he said, is always there. “Unfortunately up until very recently mental health services has been deemed kind of a luxury,” he said.

Even the rate of sexual assault and domestic violence is not well understood in the broad community, Gray said.

He conducted a study of 2,000 University of Wyoming students on incidents of sexual misconduct, partner violence, domestic violence, sexual harassment, and stalking. The study found 27 percent of students had experienced sexual abuse. People outside of the field of study might find the results “eye popping,” he said, but “while they are tragic, they are not atypical.

“So, I do think we still have this disconnect between people who recognize how common this is — and that’s been replicated again, and again, and again — versus people who are just finding out about the magnitude of this problem for the first time,” he said.

Margie McWilliams,
left, and Shawna McDonald seen
on a telemedicine link. Photo: Mary Meeha, Ohio Valley ReSource

A #MeToo Effect

McWilliams has been at the Gillette Abuse Rescue Foundation for most of its three decades. Shawna McDonald has worked there for 15 years.

The two women are self-described left-leaning advocates in a deeply red community. They are carrying on work that began when “host families” took in victims of domestic violence in private homes back in the 1970s.

They said getting survivors into the building so they can use the telehealth service involves pushing back against cultural norms that encourage silence.

Gillette is a boom town dependent on the cyclical nature of the energy business. Because of that, the locals welcome outsiders out of economic necessity. But that has its limits, McWilliams said.

McDonald said the families that came to the region generations ago, called the “homesteaders,” still hold political sway.

“We always we call it the Good Ol’ Boy system here because, you know, men run our government.”

She said when a female GARF board member recently talked about running for a county office, one male elected official told her “we won’t be letting any little ladies” win elections.

But, they said, #MeToo is having an effect, even out on the high plains. McWilliams said they are seeing more young people seeking help.

There is something else, a cultural shift that is both quiet and broad. In January about 60 people turned out for a Women’s March in Gillette. McWilliams and McDonald said that kind of support matters.

“So to me that was a big thing that’s changed. We’ve never had that many people involved before. And of course, we got the trucks that drove by and you know flipping people off,” they recalled in unison. “But it was cool because nobody cared. We were just there for a reason and we have seen an increase in our services and sexual assault victims are coming in.”

People from more rural parts of the state came to the march. That included two moms who brought their daughters from the next town over, Sheridan. It’s 104 miles, one way.

Support for this story came from the Solutions Journalism Network. This article was originally published by Ohio Valley ReSource.

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West Virginia Coal Miners Rally For Black Lung Legislation



Photo: Perry Bennett, WV Legislative Photography

Miners and advocates rallied Wednesday at the West Virginia Capitol in support of a series of bills aimed at preventing and treating severe black lung disease.

Five bills introduced by lawmakers would make it easier to make qualify for state benefits and provide benefits to miners who have early-stage black lung.

The bills come at a time when the Ohio Valley is facing a surge in cases of severe black lung disease, also called Progressive Massive Fibrosis.

“We’re here because so many of the people that’s worked years and years years, 30, 35 years in the mines, and been exposed to coal dust their whole life and they fall through the cracks,” said Terry Abbott, president of United Mine Workers of America Local 8843, which represents miners in West Virginia’s Fayette and Kanawha counties.

A miner is tested for lung function and signs of black lung disease. Photo: Coal Miners Respiratory Clinic

We’re here to support all the miners that should be receiving compensation for the the years they put in the mines.”

Black lung is caused by exposure to coal dust and the debilitating and progressive disease has no cure. The state and federal government both have benefits systems that allow miners to make a claim against their employer for medical expenses and a small stipend.

Advocates and miners argue access to health and financial benefits increases the likelihood sufferers can seek medical treatment.

Getting those benefits through federal or state programs can be challenging, and recent changes on the state level has  made it tougher for miners to qualify.

Obstacles To Benefits

Kentucky lawmakers last year eliminated radiologists from the process miners use to qualify for benefits. In West Virginia, a decision by the state Supreme Court made it harder for miners to file a claim.

Now, advocates for black lung victims are rallying behind new legislation in West Virginia which they say can help sick miners. Kentucky representatives have also proposed a bipartisan bill that would repeal the state’s 2018 law that limits which doctors can evaluate black lung workers compensation claims.

One bill in West Virginia with bipartisan support is Senate Bill 260. Co-sponsored by two doctors, it would change the law to allow miners to receive partial disability awards if they are diagnosed with the disease. Miners diagnosed with early-stage black lung would qualify for 20 weeks of benefits.

Members of the Southeastern Kentucky Black Lung Association light candles in memory of those lost to the disease. Photo: Benny Becker, Ohio Valley ReSource

Miners would only have to have X-rays that show the presence of severe black lung disease, not a diagnosis that the disease has yet impacted their health.

Supporters of the bill argue that because black lung is progressive, there is no doubt symptoms will worsen. Providing some benefits to miners early on may boost their ability to seek treatment or assist in re-training to allow early career miners to find other employment and limit coal dust exposure.

Benefits Boost

Another bill, Senate Bill 144, would create a state black lung program that would provide $300 in monthly benefits for West Virginia miners with at least 10 years of coal dust exposure.

“We want to simplify the black lung program here in West Virginia, so the state can take care of its own, give them what they’re due, what they’re entitled to and what they’ve worked for,” said Charles Dixon, with UMWA Local 1440 in Matewan, West Virginia.

He was one of dozens of miners who rallied at the Capitol Wednesday in support of the black lung bills.

A third bill, House Bill 2588, would challenge the recent West Virginia Supreme Court decision that made it harder for miners to file a state workers’ compensation case. It stipulates a person seeking an evaluation from the state Occupational Pneumoconiosis Board can do so at any time regardless of the time limits set to file a claim and that insurance carriers must pay for the exam.

The bills have not yet advanced to a floor vote.

Dave Mistich of ReSource partner station WVPB contributed to this story. This article was originally published by Ohio Valley ReSource.

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