A new study shows that rates for black lung disease in Appalachia are surging. At the same time, the Trump administration is putting regulations that could reduce miners’ exposure to the dust associated with the disease on hold.
The disease afflicts miners all over the country, but is concentrated in West Virginia, Kentucky, Virginia and Pennsylvania.
Longtime NPR investigations correspondent Howard Berkes retired in 2019 after following this story for many years. But he continues to report on it for NPR, Public Health Watch and Kentucky Public Radio, as well as FRONTLINE, the PBS documentary series. He joined The Allegheny Front’s Reid Frazier to discuss his latest reporting on black lung.
LISTEN to the interview
The transcript has been lightly edited for clarity.
Reid Frazier: What is black lung disease?
Howard Berkes: Black lung disease is a respiratory illness that plagues coal miners who’ve inhaled coal and silica dust while they work. It afflicts both underground and surface coal miners. These dust particles lodge in the lungs, and the lungs fight back with “fibrotic” tissue to try to expel the particles.
The silica dust particles, in particular, cannot be expelled. The lungs continue to build fibrotic tissue over time to fight these invasive dust particles. Ultimately, over time, this fibrotic tissue basically compromises the ability of the lungs to function. In the worst stages of the disease, miners essentially will suffocate.
Reid Frazier: What happens when a coal miner gets black lung disease? What are the treatments and is there a cure?
Howard Berkes: It’s an incurable disease. And in advanced stages, it’s fatal, unless a coal miner is lucky enough to get a lung transplant. There’ve only been a little more than 130 lung transplants since 1995 for coal miners with black lung. There are thousands and thousands of miners with the disease, so the chances of getting [a transplant] aren’t good, and getting one — they’re really expensive.
They cost upwards of a million, two million dollars. And some miners, because their other body organs have been weakened and don’t survive that long, miners don’t last as long with new lungs as other people who get new lungs. The mean survival rate is less than seven years.
One of the trends we’re seeing is that younger and younger miners are getting black lung disease. It used to be it was something you saw in miners in their 60s and 70s. We’re now seeing it in miners in their 30s, 40s, and 50s.
If they’re developing disease when they’re young, it’s going to get worse and worse as they grow older, making it difficult for them to do the basic, fundamental things that everybody does every day, [like] walking up the driveway to pick up mail from the mailbox, picking up your grandkids, playing with them, running around, holding a job, fishing, hunting. Miner after miner told me about how their lives have been severely restricted as they struggle to breathe, as their lungs develop more of this fibrotic tissue.
So something has been going on in the coal fields of Central Appalachia that is causing this extraordinarily high rate of disease.
There’s nothing you can do about it. There’s no cure. There is respiratory therapy, which can help you address some of the symptoms, make it maybe easier to breathe over time. But ultimately, the disease is going to win and the miners are going to lose.
Reid Frazier: New studies are showing higher rates of this disease. What are researchers finding?
Howard Berkes: The National Institute for Occupational Safety and Health tracks the occurrence of black lung disease, and they’ve been doing that for decades. And the way they track it is they actually conduct X-rays of coal miners. Their most recent study found that in central Appalachia, in Kentucky, Virginia and West Virginia, miners who were still working when they got tested by NIOSH in the last five years, 32.5% of the miners tested had black lung disease. That’s from the group of miners who’d been working 25 years or more.
But even miners who’ve been working less periods of time underground had higher rates of black lung disease than had been seen in decades. For that group of miners with the longest tenure working underground, one in three testing positive — that hasn’t been seen since 1978, almost 50 years. And that’s also an enormous increase since the lowest rate of disease, which was in 1999: 9% of miners, then one in 10, now one in three [had black lung disease]. So something has been going on in the coal fields of Central Appalachia that is causing this extraordinarily high rate of disease.
Reid Frazier: Do they know why these rates are going up?
Howard Berkes: The most likely explanation, and an explanation that has a lot of scientific backing to it, is [increasing] exposure to silica dust in coal mines.
What’s happened over the years is that the biggest coal seams in Appalachia were mined out. What remains are thinner coal seams. The mining machines aren’t any smaller. So you have these drums that are cutting into coal seams that are maybe six feet high. But the seam of coal may only be a couple inches, or 30 inches, or a big one would be four feet [deep].
That coal is embedded in quartz in Appalachia. When you cut up quartz [to get to the] coal, you’re creating silica dust. Silica dust is 20 times more toxic than coal dust alone.
Well, that coal is embedded in quartz in Appalachia. When you cut up quartz [to get to the] coal, you’re creating silica dust. Silica dust is 20 times more toxic than coal dust alone. It is easily respirable. When the mining machines cut into it, they are cutting the quartz into very, very fine particles of silica. And that’s easily inhaled. Often when it’s inhaled, you can’t expel it, so that becomes the beginning of the creation of disease.
The Black Lung Disease Epidemic that ‘Shouldn’t Have Happened’
Reid Frazier: In 2024, the Biden administration implemented new silica regulations for mining. What do these regulations do and why are they important?
Howard Berkes: The Biden administration was the first in basically 50 years to finally follow recommendations that first came out in 1974 to make the exposure limit to silica dust in coal mines twice as tough and to directly regulate the overexposure of silica dust. Those two things didn’t exist before.
So that was implemented in 2024 by the Biden administration, admittedly on their part in response to our reporting about what has turned out to be an epidemic of severe black lung disease directly tied to exposure to silica dust.
With the Trump administration, those regulations are on hold. The mining industry sued to block the implementation of those regulations; a federal appeals court put them on hold. The Trump administration not only did not oppose that hold on the new silica regulations, but voluntarily said, ‘We’re not going to enforce it indefinitely.’
One of the reasons the Trump Administration is doing that is because it is revisiting that silica regulation. And it is revisiting that in part because of the resistance of the mining industry.
Reid Frazier: What is the mining industry saying about this, and why does it say that these regulations are too tough?
Howard Berkes: There’s two things going on. One is that the Biden administration decided to apply this tough new restriction on silica dust exposure, not only to coal mines, but all other mines in the country.
The new regulation included requirements that have been done in coal mines but have never been done in those other mines before, like medical surveillance of the miners on a regular basis, which happens with coal mining, with sampling of dust in the mine as a requirement of the mining company.
So that part of the mining world was facing regulation that it never really had to do before. They argued that there isn’t the demonstrated effect for those kinds of miners that there is with coal miners.
So that’s one thing. In the coal mining world, the mining industry basically doesn’t argue with making the exposure limit twice as tough; it does argue with the enforcement mechanism.
In underground coal mines in particular, mining companies are required by law to provide a safe and healthy working environment. And that means an environment free of dust that could cause disease. There are many ways that’s done underground, including robust ventilation in the mine that sweeps away dust and water sprays on mining machines that can tamp down dust.
But when those things don’t work well, and sometimes they don’t, there’s overexposure. What the mining industry wanted is for the ability to allow coal miners to work in dangerous conditions with too much silica dust and to deal with that by putting on dust masks or respirators or special helmets, and protect miners that way.
That’s not permitted in part because it doesn’t deal with providing a safe workplace, number one. And number two, there have been all kinds of problems with dust masks and respirators and those helmets.
Reid Frazier: Are there any issues or problems with coal miners wearing dust masks in these dangerous conditions?
Howard Berkes: The law says that [miners] have to be given dust masks, but they can’t be forced to wear them. Anybody who wore an N95 mask during COVID knows that those things get hot; breathing can become difficult. The dust masks that have traditionally been used don’t necessarily screen out the very fine particles of silica dust. There are hundreds of lawsuits over the failure of dust masks to protect miners. And some of those suits have resulted in multimillion dollar verdicts and settlements.
They can interfere with communication. The helmets can get fogged up and can interfere with vision. And you’re working in an environment where you’ve got this super heavy equipment. As one miner recently told me, the miner is the softest thing working in the mine, and that equipment can easily crush miners. So you have to have the ability to communicate with other miners to see what’s going on. So that’s a problem.
The other thing is that a lot of miners like to have facial hair, right? Well, you can’t get a good seal on a mask or a respirator with facial hair. But because they’re so difficult to work in, almost every miner I’ve interviewed, I’ve interview dozens and dozens of coal miners in the last 15 years, and almost every one of them says that wearing a mask is a problem. Generally, they just can’t do it for very long while they’re working.
Reid Frazier: What is the Trump administration saying about delaying the implementation and revisiting the rule? Why are they doing this?
Howard Berkes: They aren’t saying very much. The new head of the Mine Safety and Health Administration in the Trump Administration, Wayne Palmer, in the only hearing that has been held in Congress on this issue on safety and coal mines, he neglected to answer any questions about that, saying ‘We’re being sued, there are lawsuits, so we’re not going to comment while we’re being sued.’ Number two, ‘We are reconsidering the regulation, and we cannot comment while we’re reconsidering a regulation.’ And of course, the agency declined to do interviews with us on our reporting so far.
Living With Black Lung: Coal Miners Caught in the Epidemic
Reid Frazier: Trump campaigned as a proponent of coal, and he supported the coal industry with lots of policies, and he was supported by many coal miners and people in coal country. How do they feel about what his administration is doing right now with respect to black lung and silica regulations?
Howard Berkes: This is a difficult conversation in coal country. While I think many coal miners have supported Trump in the past, this probably causes some to think twice about that. But a lot of that [support] has to do with who is running against Trump and whether, for them, it’s better to go with somebody who actually supports the coal industry.
Because, you know, they don’t want the coal industry to die. These miners, many of them are still working before their symptoms develop so bad that they have to stop working. These are the best-paying jobs in these parts of Appalachia.
I talked to a miner who made $120,000 last year coal mining. He got laid off in October this year, and now he’ll be lucky if he makes $30,000 or $40,000. Coal miners often have the best houses, the best pickup trucks, the best ATVs, the best shotguns, the best boats. They don’t want the coal industry to die, but they also want some controls on black lung disease, and both things can happen.
And President Trump has offered the coal industry close to $700 million to keep coal plants open and to help support the export of coal.
But, you know, one thing I have to point out is…as I’ve traveled across Appalachia over the last 15 years, I’ve seen lawn signs that say ‘Friends of coal’. And there’s a formal organization that supports the industry called Friends of Coal. I think the reality is that people who claim to be “friends of coal” are not necessarily friends of coal miners.
There’s been no push from, certainly, the Republican members of Congress from coal country to support legislation that would help control the exposure…and to help [coal. miners] get reasonable benefits once they suffer black lung disease.
Because there’s been no push from, certainly, the Republican members of Congress from coal country to support legislation that would help control the exposure that miners suffer and that causes black lung disease and to help them get reasonable benefits once they suffer black lung disease.
Democrats have supported that legislation and proposed it; Republicans [haven’t]. Republicans aren’t saying much about this occurrence of black lung. We didn’t get much of a response from Republican lawmakers when we were reporting this new increase in disease.
Reid Frazier: You retired in 2019. Why do you continue to follow this story?
Howard Berkes: My sources don’t leave me alone. They drop documents in my lap. They text me and email me about developments. I keep in touch with some of the miners that I’ve interviewed over the years and see what they’re going through.
When you’ve talked to as many miners as I have who can barely get through a sentence without losing breath, who are sitting there looking at their grandkids but not able to pick them up, or follow them out into the yard and run around with them, who can’t go anywhere without oxygen.
One miner who was only 49 years old took me into his family burial plot on his property, and he pointed out where he was going to be buried. You know, not quite 50 yet, already planning his burial. I mean, this is tragedy beyond comprehension that the world needs to know about. Telling these miners’ stories, that’s an important thing.
So it keeps drawing me back because I have a privilege that these miners don’t have: I can go back to retirement; I can play with my granddaughter; and I can breathe. But I do feel that I owe them the ability to tell their stories while they can still tell them.
Howard Berkes, a former NPR investigations correspondent who retired in 2019, continues to report on black lung for various news outlets.
