The Occupational Safety and Health Administration, the Tribune and other news outlets have just reported the case of a man, José Gómez, who required a lung transplant after severe lung damage caused by inhaling silica dust at work. He works as a countertop installer, cutting natural and engineered stone to fit kitchen counters and other surfaces. His father, Antonio Campos, who works at the same company, is also on the transplant list, and a co-worker, tragically, is also at risk. With the dozens of countertop companies and the vibrant home renovation going on, there are likely to be lots of affected workers in Illinois.
Silica is a naturally occurring element found in the earth’s crust. Granite slabs extracted from the ground contain 10% to 45% silica content. Marble has less than 5%. Engineered stone, or “quartz,” contains upward of 90% silica content. For consumers, engineered stone is cheaper than natural stone. For workers, it is way more toxic.
Silicosis is lung scarring caused by inhalation of silica particles. Scarring is ongoing, even after the exposure has stopped. Silicosis is not a new disease — it was first described in 400 B.C. and re-described by physicians across the centuries. Despite this long-standing knowledge, clinicians fail to recognize silicosis, and it is often misdiagnosed until the very late stages of disease. In the last two decades, outbreaks of severe lung disease from engineered stone have been seen in Italy, Spain, Israel, Australia, China and across the U.S.
Prevention of silicosis is easy. It is legislated through the U.S. Department of Labor. Employers are required to monitor air levels and establish dust control measures, such as applying water during cutting and grinding or setting up ventilation so that the dust is sucked away or separated from the worker. Companies are required by law to provide appropriate respirators that protect workers’ airways, provide medical exams to make sure workers are fit to use a respirator and then send exposed workers for regular medical screening for lung disease. If the air level is high, workers must be medically screened at least once every three years, and more frequently if a health care provider recommends it. Training and recordkeeping are key.
The employer of these two workers was denied coverage by a workers’ compensation insurer because of high silica levels in their workplaces and not following the law — for two years in a row. It took the devastation of two Illinois workers, a father and son, to bring the problem to light.
What should we do now? Every countertop fabrication company in Illinois should be assisted by the Illinois Department of Labor’s consultation program to conduct air sampling and get professional guidance on how to protect their workforce. Or they should be investigated by OSHA area compliance officers, just like the company that employed the affected father and son. The Illinois Workers’ Compensation Commission fraud unit should check on the insurance status of countertop companies to confirm they are maintaining insurance coverage for their employees. High insurance premiums assigned to negligent employers, paradoxically, may incentivize them to drop their policy.
Outreach and educational programming should bring forward workers who may be on the path to severe lung disease. And we should educate the public about what they are buying when they choose engineered stone for their countertops.
A task force should be developed to plan expansion of data sharing across state agencies — the Illinois Departments of Public Health, Labor and Employment Security; Workers’ Compensation Commission; OSHA area offices; and the medical examiner. Currently public health surveillance for occupational illnesses and injuries happens through the federally funded Illinois Occupational Surveillance Program at the University of Illinois Chicago’s School of Public Health. Sharing and linkage of cases across datasets could provide a tremendous amount of information about exposed workforces, workplaces and scenarios of exposure related to silicosis and other occupational diseases. It should be analyzed and acted upon in real time.
Finally, the task force should consider following the lead of Australia, which banned engineered stone because of the silicosis risk. Since current OSHA standards are difficult to enforce, we should put forward similar legislation to ban engineered stone.
The tragic case of Campos and Gómez is a call to action and, sadly, the continuation of a story seen across the globe. We must protect our precious, essential Illinois workforce.
Linda Forst is a professor of environmental and occupational health sciences (EOHS) at the University of Illinois Chicago School of Public Health and an occupational medicine physician. Lee Friedman is a professor of EOHS at UIC.
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