Unprecedented six bills introduced within days of each other to address valley fever

Assemblyman Vince Fong, R-Bakersfield, will introduce two bills Wednesday aimed at combating valley fever, the orphan disease which infected Californians at epidemic levels last year.

His proposed legislation promises to provide more accurate case counts while standardizing testing for valley fever, Fong told the Center for Health Journalism Collaborative in an exclusive interview.

The announcement comes one week after Assemblyman Rudy Salas, D-Bakersfield, introduced what advocates were heralding as the most robust legislative package in the state’s history to address the orphan disease. Fong said his bills complement Salas’ legislation.

Together, the combined six bills — four from Salas and two from Fong — have brought unprecedented attention to what has long been known as an orphan disease. Never before has as much legislation been introduced to target the disease, which has historically received little attention politically despite the toll it takes on impacted communities. The effort is also notable for bipartisan collaboration in an era of partisan rancor.

“This effort has been building momentum over the years,” said Fong, adding that he’s been in talks for months with his former boss, House Majority Leader Kevin McCarthy, R-Bakersfield, about how to bring more attention to the respiratory disease as he crafted his bills. “It’s not something that just happened.”

Fong’s legislation takes aim at standardizing testing standards and bridging the gap between how data is reported between the state and local health departments. His office provided The Collaborative with draft bills not yet introduced.

Among the key provisions of the legislation:

• Health providers must take a one-time mandatory training on valley fever by Jan. 1, 2020.
• A new state-mandated local program based on Kern County standards would require physicians to perform two specific blood tests that look for antibodies in a patient’s blood in suspect cases.
• Finally, the bills build in requirements that make it less likely that state and local agencies have inconsistent data, by codifying the need for more communication around data collection and reporting inconsistencies, a common problem in California. Experts say such inconsistencies distort the picture on the scope of the disease.

Valley fever, or Coccidioidomycosis, starts with breathing. It’s caused by the Coccidioides fungus, which grows in the loamy soil of the southwestern United States. When disturbed, often through agricultural tilling, construction and high wind, microscopic fungal spores can become airborne and, once inhaled, cause valley fever. Most people are asymptomatic, but others develop flu-like symptoms, including fever, cough, headaches and chills. In some cases, when left untreated, the fungal spore can spread throughout the body and cause a lifetime of health issues, and in rare cases, death.

In the past two years, cases have spiked statewide to epidemic levels, prompting warnings from the state health officer as the disease spreads outside of its traditional Central Valley boundaries. If there’s a silver lining, it’s that the epidemic has brought greater policy attention to the disease, long overlooked when it comes to allocated resources for treatment, vaccine research or even basic public health campaigns, advocates say.

“Now we have legislators not only in Kern County, but legislators in the Antelope Valley, on the Central Coast and throughout the state of California beginning to understand that valley fever affects their communities,” Fong said. “We’re building a coalition bigger than we ever have before.”

Part of Fong's legislation — a provision requiring better communication on disease reporting between state and local health departments — addresses an issue first uncovered in 2016 by the USC Center for Health Journalism Collaborative. That report found significant discrepancies between valley fever cases reported at the local, state and federal levels. Salas, the Democratic assemblyman from Bakersfield, said reporting by the Collaborative also informed his thinking on next policy steps.

While crafting the legislation, Fong worked closely with the Bakersfield-based Valley Fever Americas Foundation, and the Kern County Public Health Services Department — which he described as a “leader” in all things valley fever.

However, Kern Public Health officials — who were reviewing the draft legislation Tuesday night to provide Fong with feedback ahead of his planned Wednesday introduction — said they’re unsure how to receive the bills. In the past, legislators have crafted bills asking for state funding for valley fever vaccine projects, research and awareness, but none legislated the details of disease reporting or mandated the types of tests a doctor must order.

“I don’t know if there’s a precedent for this,” said Kim Hernandez, Kern County Public Health epidemiology manager. “I’ve never heard of a legislator being able to decide what tests a doctor orders when they suspect a condition.”

There are at least 10 different types of tests for valley fever, but most labs use one of three. Some advocates say that one of the tests preferred by commercial labs turns around results fast, but sacrifices accuracy.

Requiring every laboratory in the state — including those privately operated— to use the same tests is a critical component to getting accurate information about the disease, said Rob Purdie, the vice-president of the Valley Fever Americas Foundation. “It’s about creating a level playing field across California so we can then begin to build and know things are being counted the same way.”

Hernandez said she’s worried, however, that the legislation could discourage doctors from ordering valley fever tests at all.

“I’m worried about us meddling with healthcare providers,” Hernandez said. “I’m afraid if we say they must order tests that they won’t order them, and if there’s a repercussion for them not ordering, that will really impinge on the medical provider’s decision-making.”

And while Hernandez acknowledged that Kern County does have more cocci cases than anywhere else, she’s not sure whether local practices should be mandated statewide.

“We’re trying to talk to other counties about what they see in the legislation and how we can all contribute,” Hernandez said. “We appreciate being looked at as a county to have a lot of input, but we know this is statewide legislation, so we want it to work for everybody. We’re not the only opinion.”

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