This story was produced in partnership with NBCNews.com.
Victor Gutierrez does not know when he contracted Valley fever, a disease caused by a soil fungus, but reduced it to a few possible jobs in the summer of 2011.
Gutierrez recalls in the nectarine orchards: "The wind was very strong and we were almost falling off our ladders. Dust would go up in the fields and we would get lost in [it]. "This year's harvest has not been better. "We came out of the vineyard with a face full of earth. Only our eyes were visible, "he said. When he was showering at night, he could see the layer of earth that was cleaning his body.
At the end of the summer, Gutierrez began to present symptoms resembling those of the flu: coughing, night sweats, exhaustion and strange feeling of burning in the interior. Gutierrez ignored him and kept working for fear of losing his job. But when he had trouble breathing, he went to see a doctor who gave him a dose of antibiotics and told him to buy a humidifier.
The next day, his lungs filled with fluid and he felt so bad that he went to a local clinic. This time, they tested it for Valley Fever, and he came back positive.
"The nurse called me and told me to rush to the clinic as it was an emergency," he said. Gutierrez, then 33 years old and father of three, had never heard of valley fever. He was told that he would only have six months to live.
While Gutierrez managed to overcome these obstacles by taking fluconazole, an antifungal for over a year, he saw the valley fever kill many other people he knew. Of the five people he remembers diagnosing with the fungal infection that day in 2011, he said he was the only survivor.
Nevertheless, the valley fever remains dormant in her body – and she could reappear at any time. Gutierrez still has lung pains and when he has a cold or flu, he stays in bed for weeks.
coccidioidomycosis or cocci (pronounced "coxy") develop in dry, undisturbed soil; it takes flight when the ground is disturbed, be it off-road motorcycles, construction crews or farmers developing new orchards of fruit or nuts. It can travel in the wind as far as 75 miles. Years of drought caused by climate change and a 240% increase in dust storms appear to have resulted in a rapid increase in the number of people diagnosed with the disease in the southwest.
According to the California Department of Public Health, new cases in the state have increased by 10% between 2017 and 2018. California has budgeted $ 8 million for Valley Fever Research in 2018, and approximately $ 3 million will be spent on expanding the Valley Fever Institute at Kern Medical Hospital. . Three new laws also deal with the reporting of valley fever, testing and education in the state. In 2011, California spent about $ 2.2 billion on hospital expenses related to Valley Fever.
The summit of the iceberg
Getting a precise count of the number of people affected by valley fever is a challenge, as the majority of people infected never know they have it. However, new cases are concentrated in the San Joaquin Valley, where farms produce two-thirds of the country's fruit and nuts and one-third of its vegetables; the two most polluted cities in the United States; and most agricultural workers in the state.
In 2017, the Centers for Disease Control reported that 14,364 cases of Valley Fever had been reported nationally, but that "tens of thousands of additional diseases could occur and could be misdiagnosed as many patients are not not tested for valley fever ". 200 deaths related to the disease each year in the United States between 1999 and 2016.
Dr. Royce Johnson, director of the Valley Fever Institute and professor of medicine at the University of California at Los Angeles, said that 60% of valley fever cases are misinterpreted as flu and are not diagnosed . Johnson, who has been working with patients with valley fever for more than 40 years, said the remaining 40% tended to have similar symptoms and often mistaken for a severe case of pneumonia. From there, a small percentage – about 1% of the total number of people infected – sees the disease spread to other parts of the body, including the brain and skin.
"People with relatively uncomplicated [respiratory valley fever] will usually think this is the worst disease they have ever had, "said Johnson, adding that the symptoms could get worse in many cases. Patients are treated for between three and 12 months, then followed for another two years to prevent the disease from returning or spreading.
"Many people do not understand how much valley fever can be multiple and complicated," said Johnson.
Valley fever is not passed from person to person, but epidemiologists are still trying to figure out what is really putting people at risk, in addition to being outside, said Stephen McCurdy, Professor of Medicine at the Department of Epidemiology and Preventive Medicine at the University of California Davis, who created the California Center for Valley Fever in 2016.
Immune function is a key factor, putting at high risk pregnant women, some diabetics, people living with HIV, the elderly and people on immunosuppressive or organ transplant patients. The breed seems to be another important factor, said McCurdy. "It seems that people with darker skin are more likely, if they contract the fever of the valley, to contract this syndrome more severely. In the majority of cases, people reject it themselves [like a typical flu]. People with darker skin seem to be less able to do so. "
It's not entirely clear why. "I'm sure this is related to the genetic resources that these groups have compared to others."
According to a California Health and Human Services Agency study, African Americans and Hispanics in California are more likely to be hospitalized than whites with a valley fever.
"The many Hispanic populations living and working in the counties of the endemic California region are a contributing factor to this discovery," wrote the authors of the study, which added that the link between race and the risk of contracting the disease "is not well understood and may be due to variations in genetic susceptibility. "
A 2011 study in Arizona found that Latin Americans and African Americans are also more likely to die without a diagnosis, and another study conducted in Kern County in the 1990s also found that The incidence of fever in the valley was higher among Latinos.
Carol Sipan, a lecturer in public health at the University of California, Merced, is another challenge related to data collection. [farmworkers] would go back to Mexico if they got really sick. In Mexico, she adds, valley fever is not a reportable disease.
Farmers in the line of sight
Like many farm workers who contract the disease, Victor Gutierrez has found the cost of antifungal drugs needed to treat valley fever. At the peak of the disease, the pills cost 1,200 US dollars for two months of treatment because he had to take two to three times more than one while he was treating a typical Candida infection.
He did not have insurance at that time and said that his family often had to choose between food and his medication. He is still unable to work regularly and the family of three depends mainly on the money his wife, Maria, earns in the fields to survive.
"It changed my life a lot," said Gutierrez. When I worked, I always had money at home – to eat, to buy clothes for my children, for everything. But for now, I have debts, "he said.
Like 68% of 800,000 farm workers in California, Gutierrez was born in Mexico. It is estimated that 49% of state farm workers do not have work permits and most live below the federal poverty line in unincorporated communities with few public services.
Meanwhile, the long harvest season in the Central Valley brings long hours, extreme heat and other harsh conditions. At home, these workers have limited access to health and education, a range of mental health issues and high rates of food insecurity. Valley fever only adds to these challenges.
Isabel Arrollo-Toland intimately knows both sides of this story. She is the daughter of a former farm worker who runs a small non-profit organization, El Quinto Sol of America, which trains farm workers and other recent immigrants to citizenship in a handful of non-farming communities. formed in Tulare County, one hour south of Fresno.
Arroyo-Toland was diagnosed with Valley Fever in 2007 and again in 2008, an infection that then spread to the skin. Both times she endured months of misdiagnosis. Then, in 2012, she was told that her kidneys were suffering from kidney failure because of the valley fever and the medications she was relying on to treat her. Since then, she has been doing peritoneal dialysis for 10 hours a night. She is currently on the donor list for a kidney.
Arrollo-Toland makes it a point to advise workers that she knows to be tested for the disease at the first signs of a cold or flu. "Sometimes I'll talk to a farm worker and they'll say to me" Oh, I have these symptoms … "And the first thing to do is," You should be tested for Valley Fever. "
It also highlights the many challenges that farm workers face in staying healthy – from regular exposure to pesticides and dust clouds to lack of fresh produce and safe water – a growing challenge to many inhabitants of undeveloped areas.
"It's very difficult to say that you have to maintain your immune system 100% because your environment does not provide you with it," said Arrollo-Toland. "Seeing the doctor for prevention is another problem, because you have to go to the clinic, which is probably 30 minutes … and still full."
Several studies have shown that farm workers suffer from high levels of chronic stress and anxiety, two other factors related to the suppression of immune function.
In U.C. Recent research of Professor McCurdy Davis, he found that "[The people who reported having valley fever] McCurdy is currently collaborating with other researchers in two studies of farm workers and valley fever, including one that interviewed about 120 Latinx workers in two Kern County Migrant Worker Centers.
The role of agriculture
While pesticides do not play a direct role in the spread of valley fever, Antje Lauer, a microbial ecologist at California State University, Bakersfield, who has received funding from NASA, the US Department of Defense and the US Department of Defense. Bureau of Land Management to study Valley Fever in the ground, sees that some forms of agriculture are a potential part of the problem.
Lauer links the perpetual haze around the main cities of the Central Valley to the way the region is exploited. "The pollution is in fact homemade," said Lauer. "Most of the agriculture we have here in the valley contributes to the poor quality of our air … Once the agricultural season begins with the plowing and planting of new orchards, we have an increase of particles fines. "
Research has shown that the cocci fungus does not tend to thrive in irrigated farmland, mainly because moisture allows other types of soil fungi to grow. However, Lauer said that the jury still had not made a decision about the orchards planted on fallow land.
On a recent weekday, Lauer traveled to Bakersfield, in the east of the country, where new pistachio and almond trees were spreading for miles, their tiny trunks emerging from dry, otherwise bare soil. . She took an initial sample of soil to look for cocci; if she finds it, she will come back for other samples.
"You can see how the pesticides have eliminated all the underlying vegetation. So it is a bare ground and you can see that it is a dust hazard. These are new orchards that, in my opinion, should not have been allowed to be planted there. "
The stakes are changing, in part because precipitation in the southwest has become less common and less predictable. Very wet winters, such as the one just passed, followed by dry summers, have always been particularly painful with regard to the growth of cocci spores, said Lauer.
"The fungus of valley fever could actually expand its territory with climate change," Lauer said, noting that cocci spores were discovered in the state of Washington in 2014.
Although farm workers and other people working outside are in a particularly risky position, the scientist added that there is only one exposure to make someone sick. Those living outside of the southwest are less likely to have developed mushroom immunity. "You [may] visit the San Diego Zoo or Disneyland and get feverish from the valley. When you go home to Maryland, Iowa, Florida or elsewhere, your doctor may not have heard much about [valley fever] and might not diagnose you correctly and then the diagnosis could be delayed, "said Lauer
Is prevention possible?
Dust masks can be effective in limiting certain exposures, but this is not a real solution for those working in the fields.
Manuela Ortega, a farm worker who contracted the valley fever in 2006 and whose brother died at 39, said that the stifling heat of summer makes the wearing of the mask unrealistic. "Even though there is a lot of wind and land, people are still working. In some cases, it is good to wear masks, but in others it is enough to send people home, "she told Civil Eats.
None of the farm workers we talked to had received any mask or information pamphlets at work.
According to spokesman Dave Kranz, the California Farm Bureau Federation monitors health and safety issues for farm workers. "We support research that helps farmers and their employees avoid disease and injury, and we work with health experts and agricultural advisors to ensure that farmers and employees have the information they need to stay on the job. safety and security, "he added. "This applies to valley fever and any other illness that could affect farmers and farm workers."
Two cocci vaccines are under study – at the University of Texas and at the University of Arizona – but it is unclear how close they are to being tested on humans. Last month, three members of the Southwest Congress introduced a federal bill – the FORWARD law – to raise public awareness of the disease while "promoting the development of new treatments and a vaccine."
In the meantime, agricultural workers and their allies continue to face immense challenges.
Mario Celaya, a Mexican-trained medical assistant, has seen patients at the Vida Sana Clinic in Lindsay, California, for 23 years. He has seen valley fever rates increase in recent years and now treats 3-4 people with the disease each week. The majority of his patients are farm laborers and their families.
Celaya said that a timely diagnosis can make a difference in the fact that a patient is seriously affected by the disease. Since the blood test requires a window of two weeks before the results are accurate, he said that false negatives were common. "Patients should be aware that if they do not improve in two or three weeks, they will come back and be re-checked because it could be very bad," he added.
"If you have to tell them," You can not work for two or three months, "it impacts their families because sometimes they are the main source of income. If these patients have to stop working, then the whole family will go through difficulties. "
After a decade of illness, for example, Isabel Arrollo-Toland has gone from being a spontaneous and extroverted young woman to a person who has to live cautiously and follow a dialysis schedule every night. She is still working hard, fighting for clean water and other public services in the farming community, but now she has to take charge. "I would go out all night if I wanted to, visit [people in other cities]working as long as I wanted, and now I can not do it anymore, "she said. "Now I have to plan"
Top illustration by Anuj Shrestha for NBC News.