A report by physicians from three clinics in Virginia and the National Institute for Occupational Safety and Health has identified the largest cluster of advanced black lung disease ever recorded.

The research, published in the Journal of the American Medical Association, examined radiographs collected during a two-year period from 11,200 current and retired coal miners. Of these, 416 (3.7 percent) showed evidence of progressive massive fibrosis (PMF) – a condition characterized by inflamed fibrotic lesions in the lungs caused by an immune reaction to accumulated coal particles. Eventually, lung tissue begins to die, resulting in chronic breathing difficulties and heart attacks due to high blood pressure in the lung’s arteries. There is no treatment other than a lung transplant.

Improved health and safety oversight combined with more advanced equipment appeared to have decreased the prevalence of PMF in recent years, yet clearly something is still very wrong with mining work conditions.

"We've gone from having nearly eradicated PMF in the mid-1990s to the highest concentration of cases that anyone has ever seen," said investigator and NIOSH epidemiologist Scott Laney to NPR. (Follow the organization’s ongoing investigation here)

Because the authors only looked for PMF, a complication of coalworker’s pneumoconiosis, many less developed yet still severe cases were not accounted for. In the year since study data collection ended, the clinics have made another 154 PMF diagnoses.

"That's an indication that it's not slowing down," clinic director Ron Carson said to NPR. "We are seeing something that we haven't seen before."

Even more troubling, a high proportion of the PMF patients were miners with less than 20 years of experience. In the past, most miners with PMF had worked in the industry for double that time, suggesting that conditions are somehow worsening. One hypothesis is that longer daily shifts are spent in mines where the big seams of coal have already been removed. To access remaining thinner strips, machines must cut through rock, and in the process, aerosolize dusts that are more dangerous than coal.

These upsetting findings reveal the true nature of the health impacts of coal mining – a reality that the Trump administration is actively attempting to conceal in their platform of deregulation and private industry support, feebly disguised as an effort to protect American blue-collar jobs.

In 2017, the Department of the Interior (DOI) canceled a study investigating the health effects of surface coal mining (also known as strip mining) in Appalachia, citing budgetary concerns. The results may have provided more definitive links between the toxic work environment and the poor state of public health in mining communities of Kentucky and Virginia. It was scheduled for publication in 2019.

Just last month, the DOI posted a video to social media proselytizing the social and economic benefits of the newly re-emboldened American coal industry.

It features smiling male miners struggling against the terrible production value to share their support for a type of energy everyone else in the world is trying to phase out.

How many of them have fibrotic black lungs?

The study’s authors conclude that a new federal rule passed in 2014 mandates lower allowable dust concentrations and boosts worksite and employee health monitoring.

“Whether these added protections will decrease severe occupational lung disease in coal miners requires continued surveillance,” they write.