NPR’s Howard Berkes reports today on the largest cluster of severe black lung disease ever reported in the U.S. It’s a story he’s been investigating for 14 months, and each installment is more powerful than the last.

From January 2013 to February 2017, three clinics in southwestern Virginia diagnosed 416 miners with progressive massive fibrosis (PMF)—the most debilitating and deadly form of coal workers’ pneumoconiosis. The cases have been confirmed by CDC’s National Institute for Occupational Safety and Health, and the findings are reported today in JAMA.

Berkes’ story describes the role of the Stone Mountain clinic in diagnosing the cases and treating coal miners with the lung disease. The clinic director, Ron Carson, told Berkes, “When I first implemented this clinic back in 1990, you would see five to seven PMF cases.” Now he sees that many cases every two weeks. Back then, Carson told Berkes, PMF diagnoses typically involved older miners. Today the diagnosis involve 40 and 50 year old coal miners.

NIOSH’s David Blackley, Ron Carson, and colleagues write in JAMA:

“To our knowledge, this is the largest cluster of PMF reported in the scientific literature. A high proportion of these cases….[involved miners with] coal mining tenure of less than 20 years, which are indications of exceptionally severe and rapidly progressive disease.”

“This report underestimates the total burden of PMF and other severe respiratory disease at these clinics because miners with PMF classifications outside the study period, those with non–B Reader classifications, and those with clinical notes indicating PMF but no accompanying B Reader classification form were excluded.”

“An additional limitation is that only 3 clinics located in 1 state were included.”

The story is not ending with the 416 cases. NIOSH completed its field confirmation of cases from the Stone Mountain clinic in February 2017. Carson told Berkes that his staff has diagnosed another 154 cases since then.

Berkes illustrates yet again the power of journalism. He takes impersonal statistics and connects us with the voices and faces of people behind the numbers. His story published today takes us to St. Charles, Virginia and into Ron Carson’s clinic office. Berkes sees a quote posted on the bulletin board. It’s a paraphrase from the Charleston Gazette’s Ken Ward Jr.:

“Coal-mining disasters get historic markers. Black lung deaths just get headstones.”

Ward wrote that in his 2014 article for Yale Environment 360 “A Scourge for Coal Miners Stages a Brutal Comeback.”

The largest cluster. An epidemic. A scourge.

It’s the U.S. in 2018. Coal miners are dying at record numbers from a dust disease that is 100 percent preventable. This is a national disgrace.