The Architecture of Illness
Millions of Workers Are "Sick of Work"

By David Steinman, author of Diet For a Poisoned Planet
UPdate Fall 1993

This winter, the topic of indoor air pollution will have an important day in court.  In the  Superior Court in Washington, D.C., 19 people are scheduled to testify that the air quality in the building in which they work or used to work  (the headquarters of the U.S. Environmental Protection Agency (EPA)) made them severely ill.

Only a handful of indoor air pollution suits have ever been filed in U.S. courts by employees against a building’s managers and owners.  And none has received the widespread attention of this case, which involves indoor air pollution at the headquarters of the nation’s top anti-pollution agency.  If the plaintiffs who are asking for some $35 million in damages are victorious, many other sick building-related suits are sure to follow.

How did the air at EPA headquarters get so bad, bad enough that hundreds of employees - a fifth of the building’s work force, according to the most conservative estimates - became ill?  It all began, ironically, when the building was designed with the environment in mind.  As with many office buildings built in the 1970’s, when energy conservation was of great concern, the offices and corridors at Waterside Mall EPA headquarters were virtually closed to outside air sources.

Few windows opened to allow in fresh outside air; some offices had no windows.  A mechanical heating, ventilation and air-conditioning (HVAC) system was supposed to bring in fresh air and remove stale air.  During the next two decades, the number of employees at EPA headquarters quadrupled.  In 1987, after 16 years at Waterside Mall, EPA officials began extensive renovation of their office complex.

Town Center Management Corp., the building’s management group, was responsible for routine painting, waxing and cleaning.  The EPA arranged for new carpeting and furniture to be installed.  Gradually, employees started to get sick.  They complained of difficulty breathing, burning legs, sinus infections, headaches, chills, fevers, muscle and joint aches, colds, coughs, chronic bronchitis, numbness of the hands, dizziness and difficulty concentrating - a textbook list of the symptoms of sick building-related illness.  And yet, the employees of the EPA - an educated, sophisticated work force of experts on pollution and contamination - didn’t see through the fog of their own illnesses to make the connection between their symptoms and the renovation at first.

“I thought I was the only one who was sick”, says a former EPA employee who is now suing the building’s owners and managers and requested anonymity.  “At first, only the most chemically sensitive people became ill.  We all occupied different parts of the building, so I thought it was just me and that there was something wrong with me.  I had no idea other people were having problems.  Then I found out that seven people within the same week came in with doctor’s notes saying they couldn’t work in the building anymore.”

The EPA office workers’ illnesses could have been caused by any number of pollutants.  According to numerous sources, there were the accumulated fumes from 12 poorly ventilated copy centers, particle-board furniture, cleaning materials and pesticides that were never effectively removed by a ventilation system that was already strained by the increased personnel; there was the HVAC system itself which was unable to exchange enough air for the large number of employees and in which bacteria, viruses and other micro organisms were growing; there were stacks of damp, musty old documents; there was the lack of fresh air circulation caused by an intricate labyrinth of corridors and closed-off offices; and with the renovation, there were paint fumes, pervasive dust, odors from newly installed drapes, and chemical fumes emitted by 27,000 yards of newly installed carpet.  By 1989, more than 40 percent of the EPA employees at Waterside Mall were suffering from sick building-related symptoms, according to Indoor Air News, a union publication for EPA workers.

EPA officials placed the number slightly lower at 880 of the 3,700 employees, or 24 percent, based upon their own indoor air quality survey, which they conducted after the unions complained.  Either way, prevalence of symptoms was astonishingly high - “higher by an order of magnitude than I expected”, according to a letter sent to the National Federation of Federal Employees by Mark Bradley, M.D., an occupational health physician hired by the EPA to determine the extent of illnesses among its work force.  Eventually, more than 50 employees became so ill that their physicians said they could no longer work at Waterside Mall.

“The most affected employees have had their careers, social life, health and for some, the ability to support themselves, destroyed by this incident”, wrote Environmental and Health News Editor Joanne Bahura, one of the 19 plaintiffs.  The irony, or course, was too good to keep secret.  The Washing Times reported that a “leading indoor air consultant” called EPA headquarters one of the sickest buildings in the nation.  Since 1987, the EPA has spent more than $4 million on health care costs, studies and renovations in an attempt to alleviate indoor air pollution at Waterside Mall.

The agency has enlarged fresh air intake vents, vented fumes from copy centers directly outside, cleaned the HVAC system, eliminated loose stacks of paper and other dust traps, tested new carpeting for toxic fumes and installed it only at night or on weekends so that even non-toxic fumes would have time to dissipate, and relieved overcrowding by acquiring additional office space.

Indoor air quality has improved.  But some employees, who were sensitized to certain families of chemicals, contend that they still cannot work in the EPA headquarters.

The minimal amount of lingering contamination - well within the range present in most office buildings - is now too much for them.  As a result, some employees now work across the street in a rented apartment, and others work from home.

Town Center Management, Corp. building owner Bresler-Reiner Corp., and the other defendants in the suit deny they were negligent or that they are responsible for the employees’ illnesses.  “The defendants’ position is that the building has been tested and retested by the Occupational Safety and Health Administration (OSHA) and by the EPA and consultants and contractors working for EPA”, says Gregory A. Krauss, the defendants’ legal counsel with the firm of Carr, Goodson and Lee, in Washington, D.C.  “The conclusion of those studies and reports is that this building is no different than what one would expect from a similar office building.”

The Sick Facts

You’re working in a “sick” office building, room or space when 20 percent or more of the people who work there complain of illnesses or symptoms that are linked to time spent in that space.  How many people are affected nationwide by such sick buildings?  “We don’t really know exactly.  There are only estimates”, admits Barbara Sparc, an EPA indoor air pollution specialist in San Francisco.  Those estimates vary pretty widely, but most suggest that a minimum of 20 percent to 30 percent of office buildings in the United States are sick.

The most recent EPA fact sheet on indoor air quality cites a 1984 World Health Organization report that estimates as many as 30 percent of all new and remodelled buildings worldwide are sick.  In a survey of U.S. office workers, 24 percent said that indoor air quality was a problem and 20 percent believed that it affected their work performance.  Two kinds of culprits may be responsible for causing the symptoms of sick building syndrome:  biological contaminants such as dust, mold, fungi, protozoa, algae, mites and airborne bacterial micro organisms; and synthetic chemicals, range from the merely unpleasant to the carcinogenic.

Offices are especially vulnerable to biological contaminants because fungi and bacteria breed in stagnant water that accumulates in ducts, humidifiers and drain pans; on water-damaged ceiling tiles, carpeting or insulation; and even in dirty washrooms, reports the American Lung Association.

Symptoms of exposure to biological pollutants include coughing, chest tightness, fever, chills, muscle aches, mucous membrane irritation and upper-respiratory congestion.  In extreme cases, microbial contamination can even result in death.  Harriet Burge, Ph.D., director of the University of Michigan allergy laboratories in Ann Arbor, says that an estimated 30,000 deaths annually can be attributed to pneumonia caused by legionella bacteria that thrive in poorly maintained hospital HVAC systems.  These bacteria also thrive in office ventilation systems, and although office workers are a less vulnerable population than hospital patients, legionella and other bacteria, mold and dust mites are responsible for an untold number of illnesses.

Burge estimates that about one-third of the 200,000 annual emergency room admissions for allergies are caused by airborne biological contaminants found indoors.  Synthetic chemicals also cause serious indoor air pollution.  In addition, they accumulate in the body’s tissues, where their eventual effects are not fully understood but are suspected of causing everything from allergies to cancers.  A 1990 study published by Archives of Environmental Health found that blood concentrations of several neurotoxic chemicals were higher during the winter than during the summer.

The researchers attribute this increase to people staying indoors more during the winter and suggest that the greater toxic chemical intake is “probably a consequence of the limited air exchange from indoor to outdoor and vice versa”.

Yet few doctors consider testing their patients’ blood for toxic chemicals, largely because early symptoms of sick building syndrome are the same as the symptoms of the flu, allergies and asthma.  And unlike the employees at EPA headquarters, most office workers are not aware of sick building syndrome and therefore aren’t able to provide their doctors with enough clues to help them determine the cause of their symptoms.  Furthermore, the “chemical sensitivity” label that sometimes is attached to building-related illnesses remains controversial.

Ill workers may be considered chemophobic or hysterical by some physicians, because the medical community, on the whole, is unaware of the health effects stemming from low-level exposure to chemicals.  A 1988 report form the National Academy of Sciences Institute of Medicine concluded, “Many primary-care physicians lack the training and support needed to diagnose and treat illnesses caused by toxic chemicals in the workplace or the general environment”.

The committee noted that environmental medicine is “in its infancy” and that there are only about 1,000 American board-certified physicians in occupational medicine, most of whom are employed in industry or academia, not clinical practice.  Further complicating the issue is the fact that sick building-related illness may result almost immediately or may be a consequence of long-term exposure.  Indoor air pollution experts point out that illnesses caused by synthetic contaminants are most often the result of exposure to many chemicals at low levels, not to a single chemical at a very high concentration.  Indoor air pollutants are emitted from a number of common office furnishings and supplies.  “If you have continued and increasing exposure, say over the course of a few years, allergic diseases including asthma may persist even if you are removed from the environment causing the problem”, asserts occupational health expert Robert McLellan, M.D.

But if it’s there, won’t you smell it?  Don’t count on it.  Sometimes synthetic indoor air pollutants do have odors, but sometimes they don’t.  Many people who suffer from sick building illnesses “report that they respond to substances without distinctive odors”, say occupational health experts Grace Ziem, M.D., and Linda L. Davidoff, Ph.D., of the Johns Hopkins University School of Hygiene and Public Health.

A case in point:  Last March, workers at the now DuPage County Courthouse in Wheaton, Ill., started complaining of everything from headaches, sore throats, nausea and fatigue to paralysis and brain damage.  According to the Chicago Sun-Times, a preliminary diagnosis by National Institute of Occupational Safety and Health (NIOSH) investigators determined that the trouble stemmed from a combination of bad air and an inadequate HVAC system, and that fixing it would cost about $1.7 million.  At present, more than 600 employees who work in the building are being moved out (at a cost of $60,000).  We’re all exposed to many of these indoor pollutants at home, at work, in stores, wherever we go.  Yet most of us are not ill.

At worst, indoor air pollution might mildly irritate us if we notice it at all.  So why do some people become sick?  Nicholas Ashford, Ph.D., professor of technology and policy at the Massachusetts Institute of Technology in Cambridge and co-author of Chemical Exposures:  Low Levels and High Stakes (Van Nostrand Reinhold, 1990), explains that office workers who are made ill by the air in a sick building may have been sensitized by previous acute exposure to certain chemicals.

After sensitization, even low-level or short-term exposures to the same or related substances can trigger allergic and neurotoxic reactions.  For this reason, some workers can be sickened by biological or chemical exposures that affect no one else.  In fact, those who are made ill may be the canaries in the coal mine, signalling the serious contamination.

Turning Pollution Control Inside Out

Federal and state legislators have spent billions of dollars waging a slow, costly battle against outdoor air pollution.  Now legislators are realizing that indoor air pollution is also a serious health threat.  Only in the last few years has Congress focused its attention on indoor air quality legislation that would protect office workers despite the fact that some cancer-causing pollutants are found at concentrations up to 100 times greater indoors than outdoors, and public health regulators believe that the effects of certain indoor pollutants are as serious or more serious than those outdoors.

“I think that in general, indoor air pollution is a much more serious public health threat than outdoor air pollution”, Ashford says.  “That’s because the concentrations are often much higher indoors and the time of exposure is much longer.  Many workers today spend as much as 90 percent of their day indoors, either in an office or at home.”  Lance Wallace, an EPA air quality specialist in Washington, D.C., agrees; “If we measured outdoors what we are measuring indoors, there would be a tremendous hue and cry to clean up outdoor air.”  Public health advocates would like to see federal legislators establish standards for indoor air quality as well as provide funding for studies to learn more about the potential low-level toxicological effects of air contamination.

“If you’re talking about traditional toxicology, there’s a lot that we know”, says Ashford.  “In the area of chemical sensitivity and the health effects of low-level exposures, much less is known.  The research that’s needed hasn’t been done.”  This year, the U.S. senate approved an indoor air quality bill.  The House version of the bill, introduced by Rep. Joseph Kennedy II (D Mass.), is in committee, where it faces strong opposition.  Kennedy told the House that he took the grates off the ventilation system in his own office “and found mildew, mold and spores nearly two inches thick” in the heating duct.

“If even one of the colleagues did the same”, he said, “I don’t think we would have any problem in passing this bill tomorrow.”  If passed as presently written, the House bill would have provided $53 million in funds for research, given the U.S. Department of Labor authority to set standards for office air quality, and provided state grants to set up citizen response programs for indoor air pollution complaints.  But the House bill never made it out of committee in 1992.

Several similar bills on indoor air quality had been opposed by President Bush and industry lobbyists who contend that forcing office buildings to meet new federal standards for indoor air quality would be prohibitively expensive.  But there is some promising activity on the state and local levels.  New Jersey has a law mandating standards for air quality in buildings that house public employees.

New York City is preparing a model law that could be the basis for future state and local indoor air legislation.  Maine has set ventilation standards for school buildings, and Connecticut is currently studying the need to set health and safety standards for workplace ventilation.  Massachusetts is considering setting standards for ventilation in some office buildings and making it easier for sick building occupants to collect workers compensation benefits.  Right now, however, the United States lacks specific federal legislation and a sufficient scientific basis for promulgating indoor air quality standards.

Sixteen U.S. agencies, including the EPA, OSHA, and NIOSH, have partial responsibility for indoor air quality.  But most federal air quality standards deal with outdoor air or workplace exposures to manufacturing chemicals.  They don’t address the variety of special health conditions and sensitivities found in an office work force, nor do they provide protection for workers exposed to low-level contaminants for extended periods.  And at the local level, very few building codes take the indoor air quality into consideration.  Ultimately, building maintenance is probably more important than legislation.

Experts say that if building managers were more responsible keeping HVAC systems clean and providing adequate ventilation and air filtration, 90 percent of indoor air pollution could be eliminated.  As things stand, HVAC systems are largely ignored; some managers turn them off on weekends, even if tenants are working in the building.  Others reduce fresh airflow during hot days to reduce air-conditioning costs.  Sick office buildings are more than a public health threat.

A sick office affects the health of a business because it lowers productivity and staff morale, and increases medical costs and employee sick days.  The Consumer Federation of America estimates that businesses lose about $100 billion annually in medical bills and potential earnings due to sick building-related illnesses and reduced productivity.

Building managers and owners also are affected; they may lose tenants and run the risk of multi-million dollar lawsuits.  The fact that sick offices harm business and building owners as well as employees may be the best hope for making them well.  Curing a sick building may cost millions of dollars, but if owners are convinced that it’s in their financial interest, they may take on the task.

Meanwhile, if you suspect your office may be sick, take steps to protect yourself.  You may end up knowing more about HVAC systems than you ever wished.  Yet a safe office air supply means healthy, productive workers and long-term tenants.  That’s in everyone’s best interests.