Carbon Monoxide Poisoning: Prevention, Politics, and Policy
Andy Rapoport is a student in the Masters of Public Health (MPH) program at Northwestern University, pursuing a concentration in Community Health Research.
Growing up in the suburbs of Chicago, there were several times that our house fire alarm by the kitchen began to beep; thankfully, it was a mere nuisance, due to smoke from cooking, and not from an actual fire. With my grandfather and uncle as former firefighters, we did our best to have fire prevention on the mind. I also remember times where there was small, inadvertent gas leak from a burner being left on, which we would immediately turn off after noticing the smell. That being said, I have no recollections of a carbon monoxide detector ever beeping or being activated, for any reason, which is definitely a good thing, being that:
“Carbon monoxide poisoning is the second most common cause of non-medicinal poisonings [which lead to] death. According to the CDC, over 10,000 are poisoned by carbon monoxide needing medical treatment each year and more than 438 people in the U.S. die annually from carbon monoxide poisoning.”[i]
Carbon monoxide poisoning has unfortunately made its way into the news recently, specifically with regard to the frigid temperatures and snow in Texas that happened last month. There were hundreds of phone calls made to the Texas Poison Center Network, with two deaths reported. When Texans got very cold as power and heat failed, some attempted to create warmth for themselves and their families by running a car engine in a garage or running a barbeque indoors, for example – and accidentally resulted in carbon monoxide levels rising.[ii] The White House posted on Twitter about this very issue:
“Texas — Carbon monoxide poisoning is a major risk. If you’re struggling to stay warm, please do not:
- Run generators indoors
- Use gas appliances like stoves for heat
- Sit in your car in the garage to stay warm Visit http://tdem.texas.gov/warm to find a warming shelter near you.”[iii]
It is important to know that carbon monoxide monitoring requirements do differ by state. In Illinois, there is a specific state requirement regarding carbon monoxide detectors in proximity to each room being used for sleep in any residence, whereas Texas does not have a state requirement that is nearly that specific, only requiring it in certain types of buildings (specifically: “qualifying day-care centers, group day-care homes”), as well as “family homes”.1 Carbon monoxide was actually a problem in 2008 in Texas, with Hurricane Ike, as well. [iv]
From a broader political standpoint, it is important to note that in 2019, now-Vice President Kamala Harris “unveiled a bill… requiring carbon monoxide detectors in federally subsidized public housing, after an NBC News investigation showed how a widespread lack of the devices posed a threat to millions of low-income families”, noting that 11 people since 2003, at minimum, in public housing had died of carbon monoxide poisoning, with U.S. Department of Housing and Urban Development not mandating carbon monoxide detectors.”[v]
Additionally, carbon monoxide has negative societal, financial repercussions, which can be diminished with prevention efforts such as carbon monoxide detector placement inside of residences.[vi] One study showed, amongst parents who were at a pediatric ER, that optimal practice as far as carbon monoxide alarms was associated with certain factors, for example being married or co-habiting with a partner, possessing one’s own home, being where they live for ≥ 2 years, as well as factors pertaining to income, insurance, and receipt of social support from the government.[vii]
A study from a few years ago (published in 2017) lamented research showing the shortage of detectors, with its own attempted randomized intervention at a pediatric emergency room showing results like terms of increased information known by participants, but that was not significant statistically.[viii] Another study published in 2019 – the intervention being called CO Blitz – did not look at statistical significance measurements, but did show benefits in terms of having a functional carbon monoxide detector, via teaching efforts involving community members and organizations.[ix]
This is clearly both an equity and a safety issue, one which differs depending on where a person lives and what sort of housing in which they reside. There are also concerns around batteries, placement, and desired behaviors around carbon monoxide detectors.[x]
That being said, I encourage you to please make sure you are up-to-date on your carbon monoxide detection in your home; for example, the Chicago Tribune reviewed detectors, including one for <$15 pre-tax/shipping on Amazon.[xi] There appear to also be obligations the landlord has, if you live in an apartment,[xii] and the City of Chicago & Fire Department did a few years ago provide detectors to folks; hopefully, that will exist again in some form, at some point, if it does not currently.[xiii] People’s Gas, for example, does have a page regarding guidelines and guidance, but no indication that it will offer help in procuring a detector.[xiv] Clearly, more work remains to be done in research, policy, and politics to ensure equitable safety with respect to preventing carbon monoxide poisoning.
References [i] National Conference of State Legislatures (NCSL). Carbon Monoxide Detector Requirements, Laws and Regulations. March 27, 2018. Accessed March 4, 2021. https://www.ncsl.org/research/environment-and-natural-resources/carbon-monoxide-detectors-state-statutes.aspx#:~:text=Requires%20that%20every%20building%20for,each%20room%20used%20for%20sleeping [ii] Treisman, Rachel. ‘A Disaster Within A Disaster’: Carbon Monoxide Poisoning Cases Are Surging In Texas. NPR WBEZ Chicago. Accessed March 4, 2021. https://www.npr.org/sections/live-updates-winter-storms-2021/2021/02/18/969050038/a-disaster-within-a-disaster-carbon-monoxide-poisoning-cases-are-surging-in-texa [iii] The White House. Twitter. February 18, 2021. Accessed March 4, 2021. https://twitter.com/WhiteHouse/status/1362519940176175108 [iv] Centers for Disease Control and Prevention (CDC). Carbon monoxide exposures after hurricane Ike - Texas, September 2008. MMWR Morb Mortal Wkly Rep. 2009;58(31):845-849. [v] Khimm, Suzy. HUD’s Hazards, Sen. Kamala Harris unveils bill to require carbon monoxide detectors in public housing. NBC News. March 12, 2019. Accessed March 4, 2021. https://www.nbcnews.com/politics/congress/sen-kamala-harris-unveils-bill-require-carbon-monoxide-detectors-public-n982071 [vi] Ran T, Nurmagambetov T, Sircar K. Economic implications of unintentional carbon monoxide poisoning in the United States and the cost and benefit of CO detectors. Am J Emerg Med. 2018;36(3):414-419. doi:10.1016/j.ajem.2017.08.048 [vii] Roberts KJ, Fowler E, Comstock RD, et al. Carbon Monoxide Alarm and Smoke Alarm Use Among Parents Recruited From a Pediatric Emergency Department. J Prim Prev. 2018;39(1):1-15. doi:10.1007/s10935-017-0493-4 [viii] McKenzie LB, Roberts KJ, Kaercher RM, et al. Paediatric emergency department-based carbon monoxide detector intervention: a randomised trial. Inj Prev. 2017;23(5):314-320. doi:10.1136/injuryprev-2016-042039 [ix] Dawson RM, Williams AP, Richardson J. Development and Evaluation of a Theory-Based Approach to Reducing Carbon Monoxide (CO) Morbidity and Mortality: The CO Blitz Model. J Community Health Nurs. 2019;36(3):115-123. doi:10.1080/07370016.2019.1630967 [x] McKenzie LB, Roberts KJ, Shields WC, et al. Distribution and Evaluation of a Carbon Monoxide Detector Intervention in Two Settings: Emergency Department and Urban Community. J Environ Health. 2017;79(9):24-30. [xi] Pollick, Michael (BestReviews). What to Buy, The best carbon monoxide detector of 2020. Chicago Tribune. August 6, 2020. Accessed March 12, 2021. https://www.chicagotribune.com/consumer-reviews/sns-bestreviews-home-the-best-carbon-monoxide-detector-2020-20200806-eqsc5lxjunfhdezaju4nsmegky-story.html [xii] Chicagoland Apartment Association (CAA). General Landlord Responsibilities. Accessed March 12, 2021. https://www.caapts.org/general-landlord-responsibilities## [xiii] CBS. How To Get A Free Smote Detector. August 27, 2018. Accessed March 12, 2021. https://chicago.cbslocal.com/2018/08/27/how-to-get-a-free-smoke-detector/ [xiv] People’s Gas. Carbon monoxide. Accessed March 12, 2021. https://www.peoplesgasdelivery.com/safety/co