The Tech Got Sick Two Weeks After the Attic Job

Why this matters

When a tech gets sick from a job, the illness usually arrives long after the job is forgotten. Infections picked up from droppings, animal urine and floodwater have incubation periods of days to weeks, so by the time the fever starts, the tech has worked twenty other houses and the doctor is looking at what seems to be a bad flu. What lets anyone connect the two is a written record of where the tech was and what he breathed. This is one case reconstructed from that record, including what the record left out.

The call on day 15

A residential HVAC tech, eight years in the trade, calls in sick on a Wednesday morning. Fever since the weekend, a dry cough, an ache behind the breastbone when he breathes deep, and he is wiped out. Two days earlier he went to urgent care, said he had flu symptoms, and was sent home with advice to rest and drink fluids. He feels worse, not better.

The office manager asks the question that changes the case: has he been anywhere unusual in the last few weeks? He says no, just attics, same as always. She pulls his job history for the previous three weeks anyway and finds one ticket with photos attached and the word "droppings" in the notes, fifteen days earlier.

What the record held

JOB 4471  Day 0 (Tue)  Duct repair, 1950s cape
Tech: R.  Arrived 9:05  Departed 13:40
Work: replace 18 ft flex supply run, relocate
      one supply boot near east gable
Notes: "Attic hot. Heavy droppings at east gable
       under vent, mouse? Photos for customer,
       recommend attic cleanup quote."
Photos: 3 - gable floor, pile close-up, boot
Materials: flex duct, boot, mastic, strapping
Customer signed 13:35

That is the whole entry. It held more than it looked like it did, and less than it needed to.

What it gave. A date, which fixes the timeline: symptoms began on day 12 and the call came on day 15. A location in the house, the east gable. A task, which put the tech's face close to the floor at exactly that spot, setting a boot. And three photos, the most valuable thing on the ticket. The close-up of the pile showed droppings heaped in a mound below the vent, many of them crumbled to powder, with a glint of what looked like insect fragments. A handful of hard, rice-grain pellets sat scattered near the attic hatch in the first photo.

What it did not give. Whether anything was disturbed, and how. Whether he wore any respiratory protection, and what kind. How long he spent at the east gable versus the rest of the attic. And who else was up there.

How the doctor read it

The office manager printed the ticket and photos, and the tech took them to his own doctor the next morning, day 16. The doctor's reasoning ran through the infections that fit a dusty attic and a two-week gap, and which ones the record could separate. We describe it here because it shows what the record is for, not as medical guidance; the diagnosis is the clinician's.

Hantavirus first, because it is the one that can turn dangerous fast. The scattered rice-grain pellets near the hatch were mouse droppings, and hantavirus, carried in deer mouse urine and droppings, has an incubation period CDC gives as one to eight weeks, so day 12 fits. Its early phase looks like flu, and it can progress to a severe lung illness. The doctor checked for it with the blood work she used to assess him, and the picture did not point there. See related: Rodent Droppings and Hantavirus for the Trades.

Then the pile. The heaped droppings below a vent, crumbling to dust and glittering with insect shell, looked like bat guano, not mouse droppings. Bat and bird droppings can carry the fungus that causes histoplasmosis, an infection caught by breathing spores released when dried droppings are disturbed. CDC gives its incubation as 3 to 17 days, so day 12 fits that too, and fever, dry cough, chest pain and fatigue are its typical picture. The doctor ordered a test for it. See related: Bird and Bat Droppings and Histoplasmosis.

What the timing ruled out, and what it did not. Ordinary flu has an incubation of a few days, so a flu caught on day 0 would have shown up by about day 4; but flu can be caught anywhere, so the gap does not rule out flu caught later, which is why the test mattered. Psittacosis, from bird droppings, fits a 5 to 14 day window as well, and nothing in the photos suggested birds.

The histoplasmosis test came back positive. The doctor treated it as a mild acute lung infection, the common form, and followed him until it cleared. He was back at work in about two weeks.

What made the difference between day 13 and day 16 was not a better doctor. The urgent care clinician on day 13 heard "flu symptoms" and "I work in attics" and had nothing more. The doctor on day 16 had a date, a photo of the source and a reason to test.

Notice which part of the ticket did the work. The tech's own written guess, "mouse?", was wrong about the pile that made him sick, and a reader who trusted the note over the photo would have chased hantavirus alone. The photo let a second reader, with a different question in mind, correct the first reader's guess two weeks later. That is the argument for photographing a hazard even when you think you know what it is: a description records what you concluded, a photo records what was there.

What the record was missing, and what it cost

The disturbance. When the shop asked the tech to reconstruct the job, he remembered dragging the old flex duct across the floor at the east gable and sweeping a path with a hand broom to set the boot flat. Both put dried guano into the air at face height. None of that was written down. It would not have changed this diagnosis, but it changes what the shop learns: the exposure came from the broom, which is a habit, not from being in the attic, which is the job.

The protection. He was wearing a disposable dust mask, the single-strap kind, not a fitted respirator. It filters coarse dust and does not seal. The ticket did not say, so nobody could tell from the record whether he had been protected.

The second person. Dispatch showed a helper had been on the job for the first hour, handing duct up through the hatch and spending about 20 minutes in the attic at the east end. The helper was not on the ticket. When the office called him on day 16, he mentioned a cough he had been ignoring for a week. He saw his own doctor with the same printout, mentioned the attic, and was tested as well. Had the office not cross-checked dispatch, he would have been the case nobody connected.

The customer. The ticket recommended an attic cleanup quote and stopped there. The pile below the gable vent was, in all likelihood, a bat roost. The homeowners had a heavy guano accumulation above their bedrooms and a possible colony at the gable, and the shop had told them it was mouse droppings. The office called back, corrected it, and referred them to a licensed wildlife control operator for the bats and a qualified cleanup crew for the guano. See related: Bats in Attics and the Maternity Season.

The paperwork the illness created

Because the illness arose from work, the shop reported it to its workers' compensation carrier when the diagnosis came in, using the ticket as the documentation of the exposure. It was recordable on the OSHA log for a shop required to keep one under 29 CFR 1904, since it involved medical treatment and days away from work. The helper's case was opened separately. Both claims went through without a dispute, because the ticket dated the exposure and showed the source in a photo taken before anyone was sick. A claim that rests on a tech remembering an attic from three weeks ago is a much harder conversation.

What the crew does now

The shop changed three things, and each traces to a gap above.

A droppings stop before any disturbance. When a tech finds droppings in a work area, the work at that spot stops before anything is swept, dragged or blown. The tech photographs the droppings, judges the type by looking and by pressing with a stick, never a finger, and follows the control routine for that hazard: The Rodent-Contaminated Work Area SOP for mouse and rat droppings, and the guano controls in the histoplasmosis card for bat and bird accumulations. A broom never comes out. Heavy accumulations are left for a qualified cleanup crew and the job is rescheduled around them.

Five more fields on the ticket. When droppings are noted, the ticket now asks: type (rodent, bat, bird, unknown), disturbed or not and how, respiratory protection worn (none, dust mask, fitted N95, other), minutes spent in the affected area, and everyone who entered the space. It takes a minute. In this case each of those five was a question someone had to reconstruct from memory two weeks later.

A sentence to say to the doctor. Every tech is told: if you get sick in the weeks after any job with droppings, dead animals, sewage or floodwater, say so at the first visit, by date and address, and bring the ticket. The office will print it. The tech in this case lost three days because he said "I work in attics," which was true and told the clinician nothing.

The shop also stopped stocking the single-strap dust masks on the trucks, replaced them with fitted N95 respirators, and put the techs who wear them into its respiratory protection program for fit testing and medical evaluation under 29 CFR 1910.134, because a respirator the shop requires has to come with both.

References

• CDC, Histoplasmosis: sources, incubation and symptoms
• CDC, Hantavirus: incubation, symptoms and cleanup guidance
• OSHA recordkeeping, 29 CFR 1904; Respiratory Protection, 29 CFR 1910.134
• See related: Bird and Bat Droppings and Histoplasmosis
• See related: The Rodent-Contaminated Work Area SOP