How wetter storms drive mold-related health issues as Hurricane Ian’s anniversary approaches

"He would be out of town for a week and be fine where he was staying for work, and come home and literally spend the weekend in the hospital," said Kendra Elliott about her fiancé who suffered from mold poisoning.

Rain pounded outside as water pushed in through the baseboards. Hurricane Ian had reached Southwest Florida. Christian Childers and Kendra Elliott hunkered with their two boys, staying away from windows in the hallway of their Englewood home."It sounded like jets constantly flying over our house," Elliott said. "It was horrible. I was scared the whole time."

The danger posed to Elliott, Childers and their kids by last fall’s storm had hardly begun. The family would be shattered, but not by the original brunt of Ian.

Floodwaters filled the family’s two-bedroom unit to ankle depth.

"We had a good amount of water in our house, and Christian sat there all night scooping it out," she said.

Without power for the two weeks following, the family couldn't run air conditioning, despite extreme heat and humidity. That, combined with the pervasive dampness, produced ideal conditions for a nightmarish mold outbreak.

"The walls started to turn to muck," Elliott said. "Mold just started growing."

The family sought emergency housing support but was turned down because the roof wasn’t damaged. Elliott said they couldn't afford to move because their landlord continued to demand monthly rent for the moldy Englewood unit.

Elliott, a medical assistant, was even more strapped for cash as she had to skip work to stay home with one of her kids, whose school was closed for about a month after the storm. Plus, Childers, who did lawn care, was also out of work for two weeks due to flooding.

Childers suffered from asthma and fell ill after the mold appeared, and he ended up in the emergency rooms a few times in three months after the storm.

"He was working in Punta Gorda, so he would be out of town for a week and be fine where he was staying for work, and come home and literally spend the weekend in the hospital," Elliott said.

On Christmas Eve, the 26-year-old Childers went into cardiac arrest and died after about a week of unconsciousness.

"I have two boys and they're really close with their dad, and I just can't give them what he can give them, you know? It's just hard doing everything on my own now," Elliott said. "On holidays, it's even worse."

Elliott said she and Childers met in 2015, while both were working at a car wash in Venice. She accepted his marriage proposal last summer.

“He was very shy. Big heart. Really down-to-earth guy. Very easy to get along with. Very caring,” Elliott said. “He was perfect for me. Couldn’t have found anyone better.”

The moldiest state

There was an increase in hospital visits from neighborhoods affected by Ian, including patients sickened with symptoms associated with indoor mold, according to Dr. Iahn Gonsenhauser, chief medical officer at Lee Health, which operates hospitals and other medical services in Southwest Florida.

He said patients living with mold, like Childers, were often healed and discharged only to be readmitted after returning to their homes, where they were exposed anew.

"While it's difficult for us to say specifically that these were mold-related issues, there was a correlation between individuals who were living in areas that were heavily mold affected and their need to access immediate care with our health system," Gonsenhauser said.

There are many varieties of indoor mold — strains of fungi sometimes called mildew — and their invisible spores abound in the air. Some are more dangerous than others. No U.S. state is more vulnerable than Florida, where the climate is hot, muggy, rainy and fraught with tropical storms — a veritable fungal cornucopia.

"Florida is one of the epicenters for mold-associated issues, period," said Gonsenhauser. "That's in general — including after major hurricanes and floods."

As fossil fuel pollution traps heat, it's pushing up temperatures and humidity levels, intensifying storms and rainfall rates, hoisting sea levels and thrusting storm surges higher and farther inland, according to scientists. The changes have turbocharged flooding in recent years in Florida, New York City, Vermont, St. Louis, Houston, Eastern Kentucky and Puerto Rico, destroying homes and lives and fueling outbreaks of indoor mold.

When mold spores land on suitably damp material, they sprout to form mold colonies. When chemicals released by these colonies settle on food, they can be poisonous. Inhaling the chemicals can trigger symptoms reminiscent of seasonal allergies. Those most at risk are the elderly, children or people with lung diseases or immune problems.

Researchers who study the health effects of indoor mold say more funding for research into the chemicals produced is desperately needed.

"Mold is one of the most serious results of water damage — it grows as quickly as 24 to 48 hours after water sets in," Gonsenhauser said. "Given the preponderance of mold occurrence here in Florida, and the fact that we know it can carry with it health impacts and concerns, it is something that we're always looking for."

Climate change means more flooding

A tropical storm that formed in the eastern Caribbean on Sept. 23 hit western Cuba as a major hurricane four days later, where it knocked out power and killed two people. Hurricane Ian's eye passed near Punta Gorda the following day, producing a storm surge that peaked at 15 feet at Fort Myers Beach — taller than most ranch houses.

"Water was the factor making Ian uniquely destructive," said Daniel Noah, a federal meteorologist with the National Weather Service. "Saltwater storm surge destroyed areas near the beach while flooding rain produced historic overland and river flooding that spread from southwest to northeast Florida."

Englewood was spared the brunt of the storm surge, but it was inundated nonetheless because of the effects of Ian's copious rainfall.

Scientists have long projected that climate change would boost rainfall, because warmer atmospheres can hold more moisture. And they said warming oceans would boost hurricane winds because tropical storms draw their energy from the sea beneath them. In recent years, a field of climate science known as extreme event attribution has detected effects on rainfall during hurricanes that exceeded expectations.

"Every single hurricane we've looked at is wetter because of climate change," said Michael Wehner, a scientist at Lawrence Berkeley National Laboratory who has investigated how warming affected rainfall in dozens of tropical storms.

He's a co-author of an unpublished paper that estimates climate change increased Ian's rainfall by about a fifth.

Although research is preliminary, Wehner believes strengthening winds caused by warming oceans are helping to shake a greater percentage of the moisture out of the sky during storms.

"What's driving that increase in precipitation efficiency is the extra energy in the system," he said. "As we continue to burn fossil fuels, we're just making it worse and worse. So expect more of this."

Research after Hurricane Harvey suggested the additional rainfall associated with climate change increased the number of properties flooded by that 2017 storm by a little more than a third. Wehner said such findings are not available for Ian.

Florida's problematic building design

Building and home furnishing materials common in Florida magnify threats of indoor mold, said Naresh Kumar, a University of Miami professor whose research includes the effects of tropical storms and other disasters on indoor environmental quality and public health.

Carpet and wallpaper can trap moisture and foster indoor mold growth. Mold colonies often grow in air ducts, regardless of whether there has been flooding. Drywall is cheap but can quickly turn moldy after becoming wet, unlike pricier cement board.

Indoor mold infestations can lead to runny noses, sneezing, headaches, nose and throat irritation, breathing difficulties and congestion. Kumar said these allergic reactions affect each of us differently, depending on how our immune systems react to the foreign substances.

"The most important measure is controlling excess indoor humidity," Kumar said. "Installing a dehumidifier can fix this issue."

Kumar’s teams of graduate students test for mold in flooded homes following tropical storms. During tests in homes flooded by Ian, he said, they detected mold in two-thirds of them.

"Unless we improve our understanding of how building material interacts with our climate or the local environment, there is no solution," Kumar said. "Our building design, our air-conditioning systems that we are using here are not suited for this climate — these were suited for a colder climate."

Mold exposure disease lacks a name

In 2005, Joan Bennett was living in New Orleans when her home was flooded by Hurricane Katrina. As a fungal biologist, dealing with the mold that came after the flood sparked an academic interest in its health effects.

Eighteen years later, Bennett is in the "twilight" of her career, as a distinguished professor of plant biology and pathology at Rutgers University in New Jersey. She said a lack of research funding hamstrung her efforts to better understand and communicate mold’s health risks, part of a broader problem she sees in research into indoor environmental quality.

Unlike many other diseases, there's no medical test that can determine if a patient's symptoms are caused by indoor mold. There isn't even a common name for such a disease.

The shortage of mold research and inability to test patients directly for mold exposure makes it harder for victims to sue landlords and file insurance claims. Medical staff in cooler and less humid states often overlook indoor mold as a source of their patients' woes, forcing patients to search for doctors who can help them and sometimes driving them to alternative medicines.

Bennett said it's "well understood" that people with immune deficiencies can succumb to a variety of fungal diseases, that those with allergies and asthma can be affected by indoor mold, and that indoor molds produce toxins that can cause severe illnesses when they settle on food and are consumed.

"What gets more controversial is people who are not immune suppressed, or who don't have known allergies or asthma, who are exposed to indoor mold and believe that they're ill — it's not fully accepted that mold is the problem," Bennett said.

Bennett said the compounds released by mold have been studied less extensively than those produced by sources of outdoor pollution like vehicle exhausts and power plants.

"People need to know that if they feel that they've been made sick by indoor microbial exposure, that it's not just in their heads," Bennett said.

Family forever changed

An autopsy of Christian Childers states that he died because of “home environmental mold exposure.”

Alan Bell, the attorney representing Kendra Elliot, her sons and Childers’ mother, shared snippets of the autopsy report. Bell specializes in representing clients poisoned by mold and other sources of indoor pollution. The family’s lawsuit against the owners of the Englewood unit alleges, among other things, negligence in failing to fix the mold that sickened the family, leading to Childers' death.

In preliminary court filings, lawyers for the landlords denied any wrongdoing by their clients. They did not respond to requests for comment.

Bell has represented victims of indoor mold exposure across the U.S., including residents of rundown Section 8 public housing and well-to-do celebrities. He rattled off the challenges of suing over mold exposure.

"No. 1, you need the proper doctors to diagnose the illnesses as related to mold exposure," Bell said. "No. 2, you need proper testing in the home that would be admissible in court to show the existence of pathogenic mold inside. And No. 3, these injuries are invisible injuries in many instances."

Elliott grew up in Florida, but after her fiancé’s death moved to Tennessee, where she said living costs are more manageable for a single mother.

"I didn't have any more options, I can only do so much," said Elliott, adding that she continues to receive medical care for the effects of the mold exposure. "We weren't waking up feeling well. We were all cranky and angry. My little ones, their noses are constantly running. It just wasn't good.”

More than six months after the death of her fiancé, indoor mold has forever changed her life.

"I literally had everything I ever worked for, our love, just ripped away from me," she said. "I had to leave the state I was raised in. It was just horrible."

Now that Florida is in peak hurricane season and as Hurricane Ian’s first anniversary approaches, Elliott said she hopes others learn from their story about the severe dangers posed by indoor mold.

"It's not something you want to mess with," she said. "But I don't know, because some people could be in my situation, where they don't have anywhere to go … it's just very hard."