As mystery of Escanaba paper mill's blastomycosis outbreak deepens, its victims try to heal

ESCANABA — As sudden, excruciating pain ripped through Eric Phillips' chest in mid-February, he was sure he was having a heart attack. The paramedics believed he was, too.

But when the 46-year-old reached OSF St. Francis Hospital in Escanaba, "The doctor kept saying, 'It's not his heart; it's not his heart,' " Phillips' wife, Crissy, recalled.

A CT scan revealed a huge mass on Eric Phillips' right lung. "We immediately thought he had cancer," Crissy Phillips said.

He was quickly sent by ambulance two hours south to the more advanced HSHS St. Mary's Hospital in Green Bay, Wisconsin. After a lung biopsy, a doctor approached the couple.

"He said, 'I believe you have a fungal infection, blastomycosis,' " Crissy said. "Then he asked Eric, 'Have you been around any disturbed wood or soil?' And Eric and I just looked at each other."

Nearly 100 cases, more than a dozen hospitalizations

Eric Phillips is an employee at the Billerud paper mill in Escanaba. He would go on to spend 23 days in the hospital, on oxygen, being intravenously administered powerful, potentially liver-damaging antifungal medications.

"Watching him struggle to breathe is something I will never be able to get past," Crissy Phillips said. "It was devastating. I felt helpless as a wife."

As Phillips battled his own illness, other cases emerged at the vast paper mill, the largest manufacturing employer in Michigan north of Midland, with more than 800 employees.

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According to the local health department, Public Health Delta and Menominee Counties, 104 workers, contractors and visitors to the Billerud mill are now affected by blastomycosis. At least 17 cases have been confirmed through biopsies and laboratory tests, with most considered probable cases, people exhibiting the symptoms of blastomycosis and with positive antigen or antibody tests for the fungal infection in their blood, urine or saliva.

Including Phillips, 13 of those infected have required hospitalization. One, a contractor from Gladstone who worked at the mill, died earlier this month. On the day that death was announced publicly, April 14, Billerud officials also announced they would temporarily idle the mill for up to three weeks to allow for a deep cleaning, inspection and filter replacement in ventilation systems, and testing of raw materials entering the mill for blastomyces fungal spores. The company, which declined interview requests, is continuing to pay its employees during the shutdown.

"Our top priority now and always is protecting the health and safety of our employees and contractors who work at our Escanaba mill," Billerud President and CEO Christoph Michalski said in an April 14 statement. "We care deeply about their well-being and are doing everything we can to protect them and identify and address the root cause of the blastomycosis fungal infections."

It's the largest known blastomycosis outbreak in U.S. history, and how it happened is puzzling infectious disease experts who have spent more than a month trying to find the source of the infection.

How does a person get blastomycosis?

According to the U.S. Centers for Disease Control and Prevention, people contract blastomycosis after breathing in microscopic fungal spores from the air, often after participating in activities that disturb the soil. Once inside the lungs, the body's warmth and moisture can transform the spores into yeast that can stay in the lungs or be transferred through the bloodstream to other parts of the body, including the skin, bones, joints, organs, brain and spinal cord.

Though symptoms of blastomycosis often mirror a cold or flu — cough, fever, body aches, night sweats — unlike a cold or flu, it isn't transmitted person to person.

That may indicate that scores of people at the Billerud mill were exposed to the same materials laden with blastomyces spores. But Billerud officials, on an informational webpage about the outbreak that the company has established, escanabamillinfo.com, state, "At this time, no blastomyces spores have been found at the mill," adding, "at present, it has not been confirmed that the source is the mill and no public health authorities or agencies have suggested at any time that we should restrict operations. We are idling the mill as a precautionary measure while we perform systematic deep cleaning."

The blastomycosis cases come from all over the mill, and include visitors and others who would have far less contact with the facilities than an everyday worker. Phillips said he worked almost exclusively outdoors, outside the mill building, while his two brothers-in-law who also contracted blastomycosis — one also requiring hospitalization in Marquette — worked inside. Phillips added that he was the only person working in his area known to have contracted the fungal infection.

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Blastomyces spores exist in nature throughout the eastern U.S. and Canada in moist soil and decomposing matter such as wood and leaves, including in the Upper Peninsula. The Escanaba mill has turned wood products from that environment into paper for more than a century, taking in more than 4,250 tons of pulpwood a day. So why hasn't a blastomycosis outbreak like this happened before? What happened to cause this one?

"When you talk to the experts, that's what they are mystified by," said Jamie Dier, first vice president of United Steel Workers Local 21, the union representing about 700 of the Billerud Escanaba Mill's employees.

"One of them told me, 'We wish this was any other fungus besides blastomyces because we know so little about it. You only get one or two cases for every hundred thousand people.' "

In addition to the local health department, responding agencies include the Michigan Department of Health and Human Services and the CDC's National Institute for Occupational Safety and Health (NIOSH).

NIOSH officials returned to Escanaba last week, urging Billerud employees to voluntarily submit urine samples for a blastomyces antigen test and to answer a work and health questionnaire to see whether patterns emerge.

The workers' union is encouraging its members to participate.

"Information is power, right? The more people you get to do it, the better it's going to be for everybody," Dier said.

"If you get a test now and if you find you have it, maybe you catch it early enough where it doesn't turn into a problem for you. Or maybe you're one of those people where you just fight it off."

Mill has a huge local economic impact

The paper mill's history in Escanaba — actually located just outside the city limits in Delta County's Wells Township — goes back more than a century, to 1911. Operated by Mead Corp. for decades, mergers and sales had the now-sprawling mill that covers more than 2,000 acres changing hands four times in the 2000s. BillerudKorsnäs, a Swedish pulp and paper manufacturer, acquired the Escanaba mill from Verso Corp. for $825 million last year.

"Whoever has owned it over the years, to us it's just 'The Mill,' " said Terry Packer, general manager at the Halbinsel Volkswagen-Mazda dealership in town.

The mill's estimated annual economic impact is nearly $360 million, including wages, salaries, taxes paid and raw materials and services purchased.

"As far as the economy, no employer has the impact that the paper mill in Escanaba does," said Ed Legault, executive director of the Delta County Economic Development Alliance.

It's a view shared by John Caswell, owner of Caswell's Barber Shop in downtown Gladstone, just up U.S. 2 from the Billerud mill.

"We have the train companies, and logging is big here. But the mill is the biggest one," he said. "It's important; it trickles down to all of our businesses."

The mill is one of the best-paying manufacturers in the region, with an average hourly wage of more than $36. Virtually everyone locally has a family member, friend or acquaintance who works there. So, as the blastomycosis outbreak emerged, the community activated. A fundraiser held by USW Local 21 at its union hall raised more than $30,000 in a single day. Diners and bars around town have coffee cans urging donations for particular employees off work because of the disease.

"Fundraising, donations, meals, whatever it looks like, it's almost a given that when something happens, everyone is going to get involved in whatever way they can," Legault said.

The news that the mill would temporarily cease operations jolted some in the community, Packer said.

"It caused some controversy in the town," he said. "Some people say, 'You close that mill, that's our economy.' I say this is about people's lives."

Those concerns have relaxed since it was announced Billerud would continue to pay its idled workers, Dier said.

The Escanaba mill has primarily produced papers for magazines, catalogs and books over the years — a declining demand as publications transition to online. But Billerud is proposing a more than $1 billion retooling of the mill to convert it to primarily constructing paperboard, used in cereal and other consumer product boxes. A paperboard machine is expected to begin operations in Escanaba by 2025, with a second in place by 2029, according to Billerud's website.

"It really puts the mill where it's going to be around for at least another 50 years," Legault said. "It stabilizes the mill, keeps all of the jobs that are there, and while they are doing this enhancement, all of the engineers and contractors will bring another 1,000 people to the area for about five years."

In January, the Legislature and Gov. Gretchen Whitmer approved a $200 million state grant to help with the project. Late last year, both Wells and Escanaba townships designated the mill as a Forest Products Processing Renaissance Zone, allowing the mill to abate taxes of nearly $2 million annually over 15 years, a resulting savings of more than $29.4 million. Local school districts, Bay College, the Delta-Schoolcraft Intermediate School District, and local libraries will not be affected by the abatements, with the state reimbursing those taxing units, the Escanaba Daily Press reported.

The blastomycosis outbreak is not giving Billerud second thoughts about the Escanaba mill transition, Dier said.

"We have been assured that this project is going full steam ahead; that we are going to beat this and get this behind us," he said.

A $275,000 hospital bill

Eric Phillips returned to Gladstone, where he grew up, after 20 years in the U.S. Army that saw him do tours in Iraq, Afghanistan, Korea and Europe.

"I said, 'I'm tired of seeing the world; I want to go home where I can hunt and fish again,' " he said.

Phillips said he eventually "got bored" and took the job at the mill about a year ago.

Now at home, Phillips takes oral antifungal medication. One blastomycosis mass in his lungs is shrinking; another has not. It's still possible that Phillips may lose a portion of his lung.

As Phillips talks, longer sentences leave him reaching for air at the end, straining to get the words out. This is progress; two months ago, he couldn't finish a short sentence without running out of breath.

"Stairs still suck," he said. "For me it's shortness of breath and fatigue. Just doing regular things … I was raking gravel out of the grass pushed up by the plow over the winter and raking it back to the driveway. And I can only do so much before I run out of breath. It’s horrible.

"But I'm being optimistic about it, and it's getting better to breathe."

Phillips shared his hospital bill from his 23 days in Green Bay. The total cost was nearly $275,000, but it was entirely covered through his Veterans Administration health insurance.

Phillips knows other affected mill employees may not be as fortunate. He noted his antifungal medication costs about $900 for a 30-day prescription.

Billerud has recently approved the workers' compensation claims of some sickened employees, Dier said — a welcomed development, as workers out sick with blastomycosis from the mill have been trying to get by on short-term disability, which is "not even close" to their typical pay, he said.

Dier credited Phillips and a couple of other Billerud employees who were among the first fallen ill with helping expose the blastomycosis outbreak. As they heard others were out sick and being potentially misdiagnosed as having bacterial pneumonia, Phillips and some other workers shared their symptoms and their doctor's findings of the fungal disease on social media and the union's internal message board. People began comparing experiences and urging those with symptoms to visit their doctor and ask for blastomyces testing.

"I know Eric is going through it and it's awful what is happening to him," Dier said. "But if wasn't for him and other people that came out right away and said, 'These are my symptoms, they tried this and it didn't work, and then they tested me and now they know it's this.' ... People like Eric were huge to save their brothers and sisters a lot of pain and suffering."

For his part, Phillips says he wants to recover and go back to work at the mill.

"I absolutely love my job," he said. "I'm going stir-crazy because I like to work."

Understanding what happened at the Escanaba mill may become clearer after the NIOSH testing and questionnaires, and after the detailed cleaning and testing inside the mill. Or it may not. The cause of the outbreak may have passed through the mill months ago and is now gone, Dier said.

"I don't know that they are going to find the source," he said. "But we want to get to a point where people aren't getting sick anymore. And we want the people that have been sick to get taken care of like they should be."

This story has been updated to include new information that Billerud is now approving workers' compensation claims of some blastomycosis-infected employees.

Contact Keith Matheny: kmatheny@freepress.com.

This article originally appeared on Detroit Free Press: Blastomycosis outbreak inquiry goes on at Billerud's Escanaba mill