HEALTH: Aero­toxic syn­drome.

While the fo­cus of air safety is largely on crash preven­tion, pas­sen­gers and crew may face a po­ten­tially greater risk from aero­toxic syn­drome, a con­di­tion ex­perts have dubbed ‘the as­bestos of the skies’. Linda Moon re­ports.

The Saturday Paper - - Contents - Linda Moon

Nearly three years ago flight at­ten­dant Jes­sica Man­ning was ex­posed to 21 hours of en­gine fumes aboard a flight. In the years that fol­lowed, the pre­vi­ously healthy Queens­lan­der suf­fered per­sis­tent skin le­sions, 75 per cent hair loss, vi­sion de­te­ri­o­ra­tion, mul­ti­ple chem­i­cal sen­si­tiv­ity, im­paired short-term mem­ory and cog­ni­tive func­tion, liver and brain tu­mours, crip­pling fa­tigue and more. “I was told to not risk hav­ing ba­bies as they could have Agent Orange-like is­sues,” she says. “I felt like I had chronic fa­tigue and Alzheimer’s.” Man­ning lost con­fi­dence, friends and suf­fered re­la­tion­ship prob­lems due to her symp­toms.

Man­ning, whose real name has been with­held for le­gal rea­sons, be­lieves her on­go­ing health prob­lems stem from ex­po­sure to known neu­ro­tox­ins while fly­ing. And with the num­ber of crew and pas­sen­gers travers­ing the skies grow­ing each year, so does the risk of con­tract­ing sim­i­lar mal­adies.

In 1999, Chris Win­der, a pro­fes­sor in tox­i­col­ogy and oc­cu­pa­tional health and safety at the Univer­sity of New South Wales, Jean-Christophe Balouet and Dr Harry Hoffman were the first to link tox­ins in cabin air to acute and long-term health in­jury. They dubbed it aero­toxic syn­drome.

The root of the prob­lem lies in a long-known de­sign flaw. In all com­mer­cial air­craft (ex­cept the Boe­ing 787 Dream­liner), out­side air is drawn through the en­gine to sup­ply the cabin and cockpit. In the in­dus­try it’s known as “bleed air”. Win­der’s 2002 jet oil pa­per de­scribes a chill­ing cock­tail of toxic chem­i­cals that might find their way from en­gine oils into bleed air. The most sig­nif­i­cant are car­bon monox­ide and organophos­phates, which were orig­i­nally de­vel­oped to kill as chem­i­cal war­fare agents and pes­ti­cides.

The 2016 court doc­u­ments of Es­cobedo v Boe­ing re­veal Boe­ing – the world’s big­gest man­u­fac­turer of com­mer­cial jet­lin­ers – have known of the health risks since 1953 but failed to act on warn­ings from avi­a­tion ex­perts, the Fed­eral Avi­a­tion Ad­min­is­tra­tion reg­u­lat­ing body and their own air qual­ity depart­ment.

The fight for recog­ni­tion of aero­toxic syn­drome has been driven largely by air­crew, and spawned more than 40 sci­en­tific pa­pers, avi­a­tion in­ves­ti­ga­tions, par­lia­men­tary in­quiries, doc­u­men­taries, and a grow­ing num­ber of law­suits. Sev­eral re­cent air­crew deaths: Matt Bass, 34, Richard West­gate, 43, Karen Lysakowska, 43, and James An­der­berg, 53, have been linked to aero­toxic syn­drome. Based on the ac­counts of pi­lots in­ca­pac­i­tated by fumes, it has also been sug­gested that some avi­a­tion ac­ci­dents might be due to it.

Pub­licly, the air­line in­dus­try de­nies the prob­lem. What it does ac­knowl­edge is that en­gine fumes some­times leak into the cabin.

Ac­cord­ing to Dr Su­san Michaelis, an avi­a­tion health and safety con­sul­tant and the world author­ity on aero­toxic syn­drome, such fume events – of­ten as­so­ci­ated with a “dirty socks” odour – are un­der-re­ported and can ex­pose those on board to haz­ardous lev­els of tox­ins. Ad­di­tion­ally, a 2018 pa­per based on her mas­ter of sci­ence re­search, for which she re­ceived an award, re­ported ex­treme tem­per­a­tures in the en­gine pro­duce aerosolised nanopar­ti­cles that rou­tinely pass through gaps in en­gine seals. “En­gine seals are de­signed to leak in nor­mal op­er­a­tion,” she says. “Whereas the avi­a­tion in­dus­try has done all they can to con­tinue the myth that oil leak­age into the air sup­ply is a rare fail­ure con­di­tion only.”

A for­mer Qan­tasLink pilot, Michaelis be­gan ex­pe­ri­enc­ing aero­toxic syn­drome symp­toms while fly­ing BAe 146s be­tween 1994 and ’97, and was med­i­cally dis­charged from her po­si­tion in 1999. Doc­tors have di­ag­nosed her with chem­i­cal sen­si­tiv­ity, vo­cal cord polyps, chronic fa­tigue, res­pi­ra­tory, neu­ro­log­i­cal and other ab­nor­mal­i­ties, and, in 2013, with breast can­cer.

“My doc­tors and I think there’s a strong like­li­hood my chem­i­cal ex­po­sures were the cause,” she says. In

2007 she was of­fered a pay­out of $250,000 in re­turn for si­lence. In­stead, she con­tin­ues to de­vote her­self to ad­vanc­ing re­search on the topic.

In 2010, Aus­tralian flight at­ten­dant Joanne

Turner was the first per­son in the world to win a civil case against an air­line – East-West Air­lines – for health im­pacts re­lated to bleed air. Ground crew and pas­sen­gers have also be­gun to fill the files of lawyers rep­re­sent­ing aero­toxic syn­drome vic­tims. Twenty pas­sen­gers won com­pen­sa­tion in 2010 for ill­nesses in­curred from toxic fumes on a Boe­ing 767 flight from Lon­don to Florida in 2007. Cap­tain Tris­tan Lo­raine in­ter­viewed some of the af­fected fam­i­lies in his 2007 doc­u­men­tary Wel­come Aboard Toxic Air­lines. “By co­in­ci­dence the re­turn plane was de­layed by three or four hours,” he says. “The kids played with each other and the mums started talk­ing and they soon re­alised that pretty much every­one who was on the plane that flew out had spent the last week sick.” Without those con­ver­sa­tions they wouldn’t have made the link to the flight.

Dr Jonathan Bur­don, a con­sul­tant res­pi­ra­tory physi­cian in Mel­bourne, and co-author of sci­en­tific pa­pers on aero­toxic syn­drome, says the clas­sic symp­toms of organophos­phate poi­son­ing can mimic jet lag. They in­clude foggy think­ing, dizzi­ness, mem­ory prob­lems, fa­tigue, headache, tremor, si­nusi­tis, nau­sea and bal­ance and breath­ing dif­fi­cul­ties. Organophos­phates, typ­i­cally ab­sorbed by in­hala­tion or through the skin, have their great­est im­pact on the neu­ro­log­i­cal and res­pi­ra­tory sys­tem, but can also pro­duce gas­troin­testi­nal symp­toms, he says. “There’s a huge vari­a­tion of symp­to­mol­ogy. Not every­one gets ev­ery­thing.” Many of his pa­tients con­tinue to suf­fer from se­ri­ous health prob­lems years after ex­po­sures.

At present there is no recog­nised di­ag­nos­tic test for aero­toxic syn­drome. “It’s a clin­i­cal di­ag­no­sis based on symp­toms,” Bur­don says. How­ever, it is pos­si­ble to mea­sure organophos­phate ex­po­sure in a per­son’s blood­stream or urine. “There’s now a strong back­ground of solid, re­spected prac­ti­tion­ers who think this is real.

It’s a huge oc­cu­pa­tional health and safety is­sue no dif­fer­ent to the as­bestos or lead prob­lem.”

Tris­tan Lo­raine, the spokesman for the Global Cabin Air Qual­ity Ex­ec­u­tive, says pas­sen­gers are never told or fol­lowed up when they’re ex­posed. “Eleven mil­lion peo­ple fly ev­ery day. What about the preg­nant mother? Let’s say her child is born with some kind of prob­lem – she’s never in a mil­lion years go­ing to make the link to the aero­plane.

“Pick up a tin of oil or a tin of hy­draulic fluid. It ac­tu­ally says on the tin: ‘sus­pected of caus­ing can­cer’,

‘risk of in­fer­til­ity’ and ‘do not breath heated prod­uct’.

This is the stuff pas­sen­gers are breath­ing in on their flights. How is it pos­si­ble that air­lines have no le­gal or moral obli­ga­tion to tell their pas­sen­gers you’re go­ing to be ex­posed to some de­gree to this chem­i­cal when you fly?”

Even with ev­i­dence, it’s hard get­ting the is­sue ad­dressed. “You’re deal­ing with the two most pow­er­ful in­dus­tries in the world – aero­space and oil,” he says.

So­lu­tions al­ready ex­ist. The Boe­ing 787 Dream­liner, which de­buted in 2009, pumps air into the cabin from an in­let sep­a­rate from the en­gine. Cur­rently, 640 Dream­lin­ers fly around the world (Qan­tas cur­rently have four in op­er­a­tion). How­ever, Boe­ing con­tinue to dodge air-qual­ity is­sues on their other models.

In a move viewed as the in­dus­try’s first ac­knowl­edge­ment of aero­toxic syn­drome, Bri­tain’s EasyJet, and the United States’ Spirit Air­lines will be the first to in­stall fil­ters de­vel­oped by Pall Cor­po­ra­tion. Todd Bar­rett, the pres­i­dent of Pall’s aero­space di­vi­sion, ex­plained that a car­bon stage fil­ters out “par­ti­cles, mists and or­ganic vapours”. The com­pany is also de­vel­op­ing a sen­sor that mon­i­tors cabin air con­tam­i­na­tion.

Qan­tas, Jet­star, Vir­gin Aus­tralia and Tig­erair Aus­tralia say they have no plans to in­stall the fil­ters or sen­sors. How­ever, Lo­raine rec­om­mends that fil­tra­tion sys­tems be in­stalled on all air­craft to re­duce aero­tox­i­c­ity, “Would you pay an­other dol­lar to have clean air? You have to pay to choose your seat, but the most im­por­tant thing to hu­man sur­vival, the air you breathe, no­body thinks about it.”

Cur­rently, there is no le­gal im­per­a­tive upon the air­lines to in­stall air fil­ters, ac­cord­ing to Michaelis. “There’s a gap be­tween air­craft reg­u­la­tions and stan­dards, and means of com­pli­ance for pro­vi­sion of clean air in crew and pas­sen­ger com­part­ments. Many peo­ple are at spe­cific risk – the young, el­derly, in­firm and the un­born foe­tus [as well as] crew and fre­quent fly­ers due to re­peated low-level ex­po­sure.”

She’d like to reignite the is­sue in Aus­tralia. “It’s

• been a long bat­tle,” she says.

LINDA MOON is a free­lance health and life­style writer.

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