The dream that haunts Christine White is always the same, and though it comes less frequently, it isn’t any less terrifying. 

The black water comes rushing at the witching hour, barrelling toward her front door in Lost Creek, Kentucky. She’s outside, getting her grandson’s toys out of the yard. It hits her in the neck and knocks her off her feet before racing down a street that has become a vengeful river. She and her husband run to a hillside and scramble upward, grabbing hold of tree roots and branches. She finds her neighbors huddled at the top of the hill. As dawn comes, everything is unrecognizable, the land shifted, houses torn from foundations. They begin to walk through the trees, over the strip mine, out of the forest, in their pajamas and underwear with whatever they were able to carry when they fled. 

Then she wakes up.

That night used to replay every time White went to sleep. She started taking antidepressants six months ago, something she felt ashamed of at first but doesn’t anymore. They’ve helped a little, but the dream still haunts her, lightning-seared and vivid. 

It’s been one year since catastrophic floods devastated eastern Kentucky, taking White’s home and 9,000 or so others with it. Her current abode — a camper on a cousin’s land — has become, if not home, no longer strange. But it’s the closest thing to home she’ll get till her new house, in another county, is finished. Lost Creek, though, is all but gone forever. What houses remain are empty husks. Some are nothing more than foundations overgrown with grass. 

White is never going back. “All the land is gone,” she said.

In the early hours of July 28, 2022, creeks and rivers across 13 counties in eastern Kentucky overran their banks, filled by a month’s worth of rain that fell in a matter of days The water crested 14 feet above flood stage in some places, shattering records. All told, 44 people died and some 22,000 people saw their homes damaged —staggering figures in a region where some counties have fewer than 20,000 residents. Officially, the inundation destroyed nearly 600 homes and severely damaged 6,000 more. A lot of folks say that tally is low, based on the number of residents who sought help from the Federal Emergency Management Agency. As of March about 8,000 applications for housing assistance had been approved. That’s half the number the agency received. 

The need for help, specifically housing assistance, was, and remains, acute. Most people here live on less than $30,000 a year, and at the time of the disaster, no more than 5 percent had flood insurance. Multitudes of nonprofits, church and community organizations, businesses, and government agencies have spent months pitching in as best they can. Yet there is a feeling among the survivors that no one’s at the rudder, and it’s everyone for themselves.

President Biden issued a federal disaster declaration the day after the flood, and his administration has disbursed nearly $300 million in aid so far. The state pitched in, too, housing 360 families in trailers parked alongside those from FEMA. Many of those have moved on to more permanent housing, but up to 1,800 are still awaiting a solution.

Some in the floodplains are taking buyouts — selling their homes to the federal government, which will essentially make the land a permanent greenspace. It’s a form of managed retreat, a ceding of the terrain to a changing climate. Some local officials openly worry that the approach doesn’t solve the biggest problem everyone faces: figuring out where on Earth people are going to live now. Eastern Kentucky was grappling with a critical shortage of housing even before the flood, and much of the land available for construction lies in flood-prone river bottoms. That has people looking toward the mountaintops leveled by strip mining.

Kate Clemons, who runs a nonprofit meal service called Roscoe’s Daughter, sees this crisis every day. As the water receded, she started serving hot meals in the town of Hindman a few nights each week, on her own dime. She figured it would be a months’ work. She’s still feeding as many as 700 hungry people every week. Recently, an apartment building in Hazard burned down, displacing nearly 40 people. Some of them were flood survivors. They’ve joined the others she’s taken to helping find homes.

“There’s no housing available for them,” she said.

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Clemons often brings food to Sasha Gibson, who after the flood moved with her boyfriend and nine children into two campers at Mine Made Adventure Park in Knott County. At first, she felt optimistic. “I was hoping that this would open up a new door to something better,” she said, after asking her children to go to the other trailer so she could sit for the interview in her cramped quarters. “Like this is supposed to be a new chapter in our lives.”

But the park, built on what was once a strip mine, became purgatory instead. 

Gibson, who lived on family land before the rains came, wants to leave. It’s just that the way out isn’t apparent yet. Many rentals won’t take so big a family. It doesn’t help that many of their identity documents were lost to the flood, making the search that much harder. She got some help from FEMA, but said the money went too quickly. 

A caseworker helps navigate a labyrinth of agencies designed to help Kentucky flood victims, and they’ve put in applications at a grab bag of charities building housing. One has told Gibson her case looks promising, but she’s still waiting to hear a final word. Other applications are so long and such a crapshoot — one ran 40 pages, for a loan she’d struggle to pay back — that she’s too tired to put them together.

“It’s a big what-if game,” she said. “They’re not reaching out to you. You’re expected to call them.”

Meanwhile, ATV riders sometimes ride through to the park, kicking up dust and leaving a mess in the restrooms. Gibson tries not to resent them. It’s not their fault she’s stuck.

“While it’s great and, like, they’re having a good time, it’s not a great time for us because we feel like we’re stuck here and we’re, like, an inconvenience and we’re in the way,” she said. “We don’t want to bother anybody.”

As extreme weather intensifies due to climate change, stories like Gibson’s will play out in more and more communities. Though eastern Kentucky hadn’t flooded like this since 1957, parts of the state could face 100-year floods every 25 years or so. About half of all homes in the region hit hardest by last year’s floods — Knott, Letcher, Perry, and Breathitt counties — are at risk for extreme flooding. 

Some residents worry that the legacies of surface mining – lost topsoil and tree cover, a ruined water table, and waste retention dams like the one that may have failed near Lost Creek, drowning it – will make communities more vulnerable to floods, compounding the effects of generational poverty and aging rural infrastructure. Housing needs to be built, and some say it needs to go up on the only high, flat land available — that is, the very same strip mines that contributed mightily to this whole problem in the first place.

High ground, especially former strip mines, in the region tends to be off limits. A study completed in the 1970s showed that most of what is available belongs to land companies, coal companies, and other private interests. About 1.5 million acres is believed to have been mined. Many of those sites are too remote to be of much use for housing, though, and those that are closer to town typically have seen commercial development. As the flood recovery has dragged on, though, some of these entities have decided to donate some of what they hold so that there might be more residential construction. Other parcels have been donated by landowning families with cozy relationships to the coal industry, though that hasn’t always gone smoothly.

Chris Doll is vice president of the Housing Development Alliance, a nonprofit dedicated to building single-family homes for low-income families. It was beating the drum of eastern Kentucky’s crisis long before the flood. The situation is even more dire now. Without an influx of new construction, he argues, the local economy will spiral even further.  

On an overcast and gentle day in June, Doll walked around a former strip mine turned planned development in Knott County called Chestnut Ridge. It sits near a four-lane highway and close to other communities, with ready access to water lines. The Alliance is working with other nonprofits to build around 50 houses here, along with, it hopes, 50 to 150 more on each of two similar sites in neighboring counties. A $13 million state flood relief fund has committed $1 million to the projects.  

The road leading to what could, in just a few years, be a bustling neighborhood opened up into a bafflingly flat landscape, almost like a wooded savanna. It was wide open to the sunshine, unlike the deep hollers and coves that characterize this part of eastern Kentucky. To an untrained eye, it appeared to be a healthy ecosystem. Look closer, though, and one sees the mix of vegetation coal companies use to restore the land: invasive autumn olive, scrubby pine trees, and tall grasses, planted mostly for erosion control.  

Still, it’s ideal land for housing, and most folks around here won’t mind the landscaping. Doll said the number of people who need help is overwhelming, and his team can’t help everybody. But they hope to build as many houses as they can.

“There are so many people that have so many needs that I am of the mindset that I will help the person in front of me,” Doll said. “And now we can turn them into homeowners. If that’s what they want.”

On a hillside overlooking another mine site, Doll and I walked up to the ridge to see if we could get a better view of the terrain. It is covered in a thicket of brush, too dense to see beyond. The path wound toward a small clearing, where worn headstones and stone angels sit undisturbed. Family cemeteries are protected from strip mining, and this one was clearly still cared for; the bouquets at the angels’ feet were fresh. The lifecycle of coal had come and made its mark and gone. 

“You can see where they cut out,” Doll said. “They just entirely destroyed that mountain. It’s such a wild thing to think that strip mine land is going to be part of the solution.” 

Doll thinks of it as a post-apocalyptic landscape, or maybe mid-apocalyptic, ripe for renewal, but still carrying the weight of its past. The land was gifted by people whose money was made from coal, after all.

“And, you know, it’s great that they’re giving land back,” he said. “I would prefer if it was still mountains, but if it was mountains, we couldn’t build houses on it. So yeah, it’s ridiculously complex.” He shrugged.  “Bigger heads than mine.”

He squelched across the mud and back to the car. In the summer heat, two turkeys retreated into the shade of a scrubby pine grove, their tracks etched in the mud alongside hoofprints, probably from deer and elk. The place was alive, if not exactly the way it was before.  

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The former strip mine developments are financed in part by the Team Kentucky flood relief fund created by the governor’s office. Beyond the four projects already in motion, eastern Kentucky housing nonprofits like the Housing Development Alliance are working with landowners, local officials and the governor to secure more land in hopes of building hundreds more homes. 

“Working together – and living for one another – we’ve weathered this devastating storm,” Governor Andy Beshear said last week during a press conference outlining progress made since the flood. “Now, a year later, we see the promise of a brighter future, one with safer homes and communities as well as new investments and opportunities.”

That said, nothing is fully promised just yet, and the process could take years. The homes will be owner-occupied and residents will carry a mortgage, but housing advocates hope to lower as many barriers to ownership as possible and help families with grants and loans. Applications for the developments are expected to open within a couple of months. The plans, thus far, call for an “Appalachian look and feel” that combines an old-style coal camp town and a suburban subdivision to create single-family homes clustered in wooded hollers. Though some might argue that density should be the priority, local housing nonprofits want developments that feel like home to people used to having a bit of land for themselves. 

The Housing Development Alliance has built houses on mined land before, and some of them are among those given to 12 flood survivors thus far. Alongside other entities, it has also spent the year mucking, gutting, and repairing salvageable homes, often upgrading them with flood-safe building protocols.  Even that comparatively small number was made possible through support from a hodgepodge of local and regional nonprofits, and the labor of the Alliance’s carpenters has been supplanted with volunteer help. 

Though the Knott County Sportsplex, a recreation center built on the mineland next to Chestnut Ridge, appears to be sinking and cracking a bit, Doll said houses are too light to cause that kind of trouble.  Nonetheless, geotechnical engineers from the University of Kentucky, he said, are studying the land to make sure there won’t be any unpleasant surprises. The plan is for the neighborhoods to be mapped out onto the landscape with roads and sewer lines and streetlights, all of which require the involvement of myriad county departments and private companies; then the Alliance and its partners will come in and do what they do best, ideally as further disaster funding comes down the line. 

Still, all involved say that there’s no way they can build enough houses to fill the need.

More federal funding will arrive soon through the U.S. Housing and Urban Development disaster relief block grant program. It allocated $300 million to the region, and organizations like the Kentucky River Area Development District are gathering the information needed to prove to the feds the scale of the region’s need. Some housing advocates are critical of this process, though. 

Noah Patton, a senior policy analyst with the Low-Income Housing Coalition, said HUD grants are too unpredictable to forge long-term plans. “One reason it’s exceptionally complicated is because it is not permanently authorized,” he said. A president can declare a disaster and direct the agency to release funds, but Congress must approve the disbursement. Although it all went smoothly in Kentucky’s case, the unpredictability means there are no standing rules on how to allocate and spend funding.

“Oftentimes, you’re kind of starting from scratch every time there’s a disaster,” Patton said.  

Local development districts, such as the Kentucky River Area Development District, are holding meetings around the affected counties, urging people to fill out surveys so it can collect the data needed to apply for funding from the federal program. And HUD is overhauling its efforts to address criticism of unequal distribution of funds. Still, the people who might benefit from these block grants may not see the homes they’ll underwrite go up for a few more years, Patton said. 

On the state level, housing advocates have been pushing the legislature for more money to flow toward permanent housing. Many also say the combined state, FEMA and HUD assistance isn’t nearly enough. One analysis by Eric Dixon of the Ohio River Valley Institute, a nonprofit think tank, pegged the cost of a complete recovery at around $453 million for a “rebuild where we were” approach and more than $957 million to incorporate climate-resilient building techniques and, where necessary, move people to higher ground.

Sasha Gibson has heard rumors of the new developments. She’s somewhat interested insofar as they can get her out of limbo. Until she sees these houses going up, though, they’ll be just another vague promise in a year of vague promises that have gotten her nowhere but a dusty ATV park. It’s been, to put it bluntly, a terrible year, and the moments where the family’s had hope have only made the letdowns feel worse. 

 “I have no hope to rely on other people,”  she said. “I don’t want to give somebody else that much power over me. Because then you’ll just wind up disappointed and sad. And it’s even sadder when you have all of these little eyes looking at you.”

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As Gibson waits, others long ago decided to remain where they were and rebuild either because they could or because there wasn’t another choice. 

Tony Potter, who’s lived on family land in the city of Fleming-Neon since birth, has spent the past year in what amounts to a tool shed. It’s cramped and doesn’t even have a sink, but the land under it belongs to him, not a landlord or bank. It’s a piece of the world that he owns, and because a monthly disability check is his only income, he doesn’t have much else and probably couldn’t afford a mortgage or rent. Asked if he’d consider moving, he scoffed.

“You put yourself in my shoes,” he said. 

He can’t believe FEMA would offer to buy someone’s land, or that anyone would take the government up on the offer. “I mean, my God, why in the hell you wanna buy the property and then tell them they can’t live on it?” he said. “What kind of fool would sell their property? Why would you want to sell something and then go rent something?”

James Hall, who also lives in Neon, lost everything but is staying put, in part because he doesn’t think it’ll happen again. The words “thousand-year flood” must mean something, he said. But that didn’t keep him from putting his new trailer a foot and a half higher just in case. He might bump that up to 3 feet when he has a minute. Through it all, he’s kept his dry sense of humor. “If the flood comes again,” he said, “I’m gonna get me a houseboat.”

That kind of outlook buoys Ricky Burke, the town’s mayor. He said the community’s used to flooding – the city sits in a floodplain at the intersection of the Wrights Fork and Yonta Fork creeks – but last year’s was by far the worst. Water and mud plowed through town with enough force to shatter windows. People went without water and electricity for months in some places. A few buildings, like the burger drive-in on the corner at the edge of town, have been repaired, but others remain gaunt and empty. 

Still, Burke, a diesel mechanic who was elected in November, is confident the town will pick itself up. He’s heard talk that Neon might need to move some of its buildings, that a return to form simply isn’t viable. He’s dismissive of such a notion. What Neon needs, he believes, is a big party, and he’s planning to celebrate the community’s resilience with flowers, music, and a gathering on the anniversary of the flood.

“These people in Neon ain’t going nowhere,” he said.

Some folks, through persistence, hard work, and a bit of luck, have moved into new homes.

Linda and Danny Smith got theirs from Christian Aid Ministries, a Mennonite disaster relief group, though construction started a couple months later than planned because it ended up taking awhile to figure out exactly where the floodplain was. It was built on their land at the end of a Knott County road called, whimsically, Star Wars Way. According to the Smiths, the group, which was from out of state, nearly ran out of time before having to return home and only just finished the job before leaving. They left so quickly that Danny Smith said he still needed to paint the doors. He isn’t complaining, though. Other homes were left half-done, their new owners left searching high and low for someone to finish the job. 

Although grateful for the help that put a roof over his head, Smith got a little tired of dealing with all the people who came to heal his body, his spirit, and his mind even as he completed mounds of paperwork and made calls to anyone he thought might help. “One guy, he kept insisting that I needed to go talk to someone,” he recalled. “And I said ‘who?’”

The man suggested that Danny talk to a therapist. He laughed at the recollection. It was a laugh heard often around here, the sound of a tired survivor who’s already assessed their own hierarchy of needs many times over. “I said, ‘You know, I don’t need nothing done with my mind. I need a home.”

Despite the frustration, the Smiths are piecing their lives back together, a little bit higher up off the ground than they were before. Christine White is praying for a similar outcome, and thinks she can finally see it on the horizon. The occasional nightmare aside, she’s felt pretty good these days.

FEMA gave her $1,900 awhile back to demolish her house and closed her case, leaving her high and dry. She called housing organization after housing organization until CORE, a national nonprofit that assists underserved communities, agreed to build a small home on a piece of land she owns in Floyd County. Construction began earlier this month. White, who spends her time volunteering at a local food bank, calls it a miracle. “You just gotta go where the Lord leads you,” she says. But it’s not built yet, so she’s trying not to count her chickens.

Parker Hobson contributed to this story.

This story was originally published by Grist with the headline Old nightmares and new dreams mark the year since Kentucky’s devastating flood on Jul 27, 2023.

Climate Connections is a collaboration between Grist and the Associated Press that explores how a changing climate is accelerating the spread of infectious diseases around the world, and how mitigation efforts demand a collective, global response. Read more here.

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In 2016, hospitals in New York identified a rare and dangerous fungal infection never before found in the United States. Research laboratories quickly mobilized to review historical specimens and found the fungus, called Candida auris, had been present in the country since at least 2013. 

In the years since the discovery, New York has become an epicenter for C. auris infections. Now, as the illness spreads across the U.S., a prominent theory for its sudden explosion has emerged: climate change. 

As temperatures rise, fungi can develop tolerance for warmer environments — including the bodies of humans and other mammals, whose naturally high temperatures typically keep most fungal pathogens at bay. Over time, humans may lose resistance to these climate-adapting fungi and become more vulnerable to infections. Some researchers think this is what is happening with C. auris.  

[Read next: A brain-swelling illness spread by ticks is on the rise in Europe]

When contracted, the fungus can cause bloodstream, wound, and respiratory infections, and other severe illnesses. Though not usually dangerous for healthy people, it can be an acute risk for older patients and others with preexisting medical conditions. The mortality rate has been estimated at 30 to 60 percent, according to the Centers for Disease Control and Prevention, or CDC, and it’s a particular risk in health care settings where infections can easily spread, such as hospitals and nursing homes.

The pathogen was first identified 14 years ago in Japan and then found to have emerged spontaneously in three countries on three continents: Venezuela, India, and South Africa. In the  U.S., the most cases last year were found in Nevada and California, but the fungus was identified clinically in patients in 29 states. New York remains a major hotspot.

Fungal disease expert Arturo Casadevall, a microbiologist, immunologist, and professor at Johns Hopkins University, said that humans normally have tremendous protection against fungal infections because of our temperature. “However, if the world is getting warmer and the fungi begin to adapt to higher temperatures as well, some … are going to reach what I call the ‘temperature barrier,’” he said, referring to the threshold at which mammals’ warm body temperatures usually protect them from infection.

When C. auris was first spreading in the U.S., cases were linked to people who had traveled here from other places, said Meghan Marie Lyman, a medical epidemiologist for mycotic diseases at the CDC. Now, she said, most cases are acquired locally, generally spreading among patients in health care settings.

In the U.S., there were 2,377 confirmed clinical cases diagnosed last year — an increase of more than 1,200 percent since 2017. C. auris is also becoming a global problem. In Europe, a survey last year found case numbers nearly doubled from 2020 to 2021.

“The number of cases has increased, but also the geographic distribution has increased,” Lyman said. She noted the skyrocketing numbers represent a true increase in cases, not just a reflection of better screening and surveillance processes.

In March, a CDC news release noted the seriousness of the problem, citing the pathogen’s resistance to traditional antifungal treatments and the alarming rate of its spread. Public health agencies are focused primarily on strategies to mitigate transmission in hospitals and other health care settings.

“It’s kind of an active fire they’re trying to put out,” Lyman said.

Dr. Luis Ostrosky, a professor of infectious diseases at McGovern Medical School at UTHealth Houston, thinks C. auris is “kind of our nightmare scenario.”

“It’s a potentially multidrug-resistant pathogen with the ability to spread very efficiently in health care settings,” he said. “We’ve never had a pathogen like this in the fungal-infection area.”

As temperatures rise, fungi can develop tolerance for warmer environments — including the bodies of humans and other mammals.

C. auris is nearly always resistant to the most common class of antifungal medication. Occasionally, it can be resistant to the broadest spectrum antifungal.

“I’ve encountered cases where I’m sitting down with the family and telling them we have nothing that works for this infection your loved one has,” said Ostrosky, who has personally treated about 10 patients with the fungal infection but has consulted on many more. He says he has seen it spread through an entire ICU in two weeks.

As researchers, academics, and public health groups investigate theories that explain the emergence of C. auris, Ostrosky said that climate change is the most widely accepted one. Global temperatures rose about 2 degrees Fahrenheit between 1901 and 2020, according to the National Oceanic and Atmospheric Administration, and the global average temperature is expected to continue trending up in coming decades. Climate change has been found to make heat waves more likely, and a recent study found that temperatures crossing the103-degree mark — classified as “dangerous” heat by the National Weather Service — will be three to 10 times as common by 2100. 

The CDC’s Lyman said it’s possible the fungus was always among the microorganisms that live in the human body, but because it wasn’t causing infection, no one investigated until it recently started causing health problems. She also said there are reports of the fungus in the natural environment — including soil and wetlands — but environmental sampling has been limited, and it’s unclear whether those discoveries are downstream effects from humans. 

“There are also a lot of questions about there being increased contact with humans and intrusion of humans into nature, and there have been a lot of changes in the environment, and the use of fungi in agriculture,” she said. “These things may have allowed Candida auris to escape into a new environment or broaden its niche.” 

Wherever and however it originated, the fungus poses a significant threat to human health, researchers say. Immunocompromised patients in hospitals are most at risk, but so are people in long-term care centers and nursing homes, which generally have less access to diagnostics and infection-control experts.

[Read next: How climate change is making us sick]

The disease is still quite rare, and many doctors aren’t even aware it exists. It’s also difficult to diagnose, with the most widely used blood test missing about half of all cases, according to Ostrosky (he notes that a newer, better test is now available, though it is expensive and not widely available). In addition, the most common symptoms of infection include sepsis, fever, and low blood pressure — all of which can have any number of causes.

Infections like C. auris have also entered the public discourse thanks to the HBO series The Last of Us, the hit drama about the survivors of a fungal outbreak. An infection that can transform humans into zombies is a work of fiction, but addressing climate change that’s altering the kinds of diseases seriously threatening human health is a real-world challenge.

“I think the way to think about how global warming is putting selection pressure on microbes is to think about how many more really hot days we are experiencing,” said Casadevall of Johns Hopkins. “Each day at [100 degrees F] provides a selection event for all microbes affected — and the more days when high temperatures are experienced, the greater probability that some will adapt and survive.”

Adds Ostrosky of UTHealth Houston: “We’ve been flying under the radar for decades in mycology because fungal infections didn’t used to be frequently seen.”

* * *

Explore more from the Climate Connections series:

• How climate change is making us sick

• Mosquitos are moving to higher elevations — and so is malaria

• A brain-swelling illness spread by ticks is on the rise in Europe

This story was originally published by Grist with the headline In the US, a fungal disease is spreading fast. A hotter climate could be to blame. on Jul 27, 2023.