Long Term Exposure to Combustion Gases including NO2 from Faulty HVAC Units Are Traced with Data from Residents

Tim Jowers, BS EE/CE, MCE/CSLinda Jowers, BSN

timjowers@gmail.com, 919.525.0123Wake Forest, NCAugust 28, 2017

Abstract: The families in this case study endured varying levels of combustion gas exposure over multi-month and multi-year periods. The short term and long term changes to their indoor environments are investigated and related to the characteristics of natural gas combustion. Particularly of interest are the human-detectable characteristics including physiological effects, odors, changes with temperature, Carbon Monoxide alarm behavior, and surface observations. The evidence is further supplemented by limited air analysis after but not during releases. Testing, seasonal variation, discovery of widespread faulty HVAC units, and other observations are evaluated and point squarely to the natural gas heating systems. The empirical evidence is compared to known characteristics of natural gas combustion to arrive at a scenario affecting the residents and residing materials. HCN, NO2, NO, and N2O5 are implicated by observations related to temperature variations. NO2, H2NO3, and H2SO4 are implicated by surface observations. Odor characteristics implicate NO2, C4H10, C2H4, C2HF5, mercaptan, and others. Post release testing documented NO2, C4H10, NH3, N2O, and others. Medical effects are investigated and related to specific chemicals; thus implicating CO, NO, NO/NH3, NO2, N2O, and possibly HCN and others. Why testers and government agencies were not willing nor able to diagnose the problems is reviewed. Wide-spread implications and future medical analysis, chemical analysis, combustion analysis, and other opportunities are listed throughout.

DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 2

Table of Contents

THE HOUSES THAT SMELLED “NEW” – IN THE WINTER......................................................................................3

WHAT ARE FAULTY COMBUSTION GASES.........................................................................................................3

MAPPING OBSERVATION TO CHEMICALS..........................................................................................................5ODORS AND ODOR THRESHOLDS.................................................................................................................................5TEMPERATURE PHASE TRANSITIONS.............................................................................................................................7SOLUBILITY............................................................................................................................................................10LATENT CHEMICALS.................................................................................................................................................11LASTING SPREAD OF CHEMICALS................................................................................................................................12“NO2 SMELL”?......................................................................................................................................................13

SYMPTOMS EXPERIENCED AND CHEMICAL MATCHES.....................................................................................13CLASSES OF MEDICAL EFFECTS..................................................................................................................................16LONG TERM MEDICAL EFFECTS.................................................................................................................................19

DECISION TREE...............................................................................................................................................20

NOX: EXTREMELY MASSIVE YIELDS OF NITRIC OXIDE......................................................................................22

NOX: NITRIC OXIDE YIELDS LAUGHING GAS YIELDS N*O*?..............................................................................24

CONCLUSION..................................................................................................................................................26POOR MAN’S TEST.................................................................................................................................................26

AFTERWARD...................................................................................................................................................27BAD SCIENCE.........................................................................................................................................................28GOVERNMENT ASSISTANCE.......................................................................................................................................29

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The Houses that Smelled “New” – In the Winter

The odor of several of the homes was characterized as a “new home smell” by some people including residents and an air quality engineer. One professional engineer called it “hedonistic”. Others called it a sweet chemical smell. One described it as like incense but more thick and more chemically. It was described as pleasant. After weeks to months of winter it would become so strong it would literally flow out of the homes when the doors were opened and could be smelled to the road. At multiple houses it could be smelled flowing out beneath the front door if one bent down, such when picking up a package. Two contractors separately observed it outside in the middle of the street in the winter, months apart from one another. What was this smell? Why did it reduce or even go away in the summer only to return at high concentrations in the winter? What did these several houses have in common? Eventually all of the houses were found to have faulty HVAC units. Almost two years after initial documentation, a CPSC investigator would be shown a faulty system and when it was opened the attractive chemical smell could be clearly smelled from inside the unit. The units had a faulty design whereby metal strips were inserted into the gas burning chamber inside the heat exchanger clam shells. These metal strips were variously called turbulators, Nox units, baffles, or screens. They were about the size of a one-foot ruler with hole-punch sized holes running up the length of them. These turbulators melted and caused the heat exchanger shells to have splits multiple inches long and splitting off in multiple directions. The splits were large enough to insert a quarter, or even a pencil into some. One source reports the faulty part caused the heat exchangers to crack within one month. A manager with the manufacturer claimed it happens within six months. In units three or four years old, the turbulators were burnt completely off such that only an inch remained. The units were all from the same model line. Some units had two heat exchanger “clam shells” and others had three. Typically, all shells had significant splits in them. The entire HVAC unit was replaced at one home, and the smell dissipated. How was the smell related to the split heat exchangers? How was the smell related to the mangled turbulators?

What are Faulty Combustion Gases

Natural Gas reputes to be Methane. Ophardt (2003) gives this simple formula for combustion of Methane:

CH4[g] + 2 O2[g] -> CO2[g] + 2 H2O[g] + energy

Notice the lack of Carbon Monoxide in the above equation. Also note the absence of Nitric Oxide, Ammonia, and other chemcials which are very important in this study; as CO has no odor and remains in gas form. Engineer Toolbox (2017) provides a more expanded equation:

[C + H (fuel)] + [O2 + N2 (Air)] -> (Combustion Process) -> [CO2 + H2O + N2 (Heat)]

In fact, the natural gas supply in Wake Forest, NC consists of about 87% Methane and about 13% non-methane gases: about 5% Nitrogen and various other gases including Ethane, Propane, and Carbon Dioxide (RDH, 2016). The combustion formula is more complex. It is believed other locales have differing percentages and mixtures based on spoken conversations with staff from Lennox Industries International and other sources (Lamphier 2016).

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Textbooks and other sources document numerous chemicals (“species”) which are produced from combustion of methane. These include C, C(s), C, CH2, CH3, CH4, CN, CO, COS, CO2, C2H, C2H2, C2H4, C2H4O, C2N2, H, HCHO, HCN, HCO, HNO, HNO2, HNO3, HO2, H2, H2O, H2O2, H2S, H2SO4, N, NH, NH2, NH3, NO, NO2, NO3, N2, N2H, N2O, N2O5, O, OH, O2, O3, S, SO2, and SO3 (Flagan, 1988). Many people know realistic combustion produces Carbon Monoxide. Real combustion is imperfect. In fact, CO can build up over hours in a closed space if an exhaust system has a hole in its exhaust pipe such as from a car in a closed garage or a pump in a pool area. For example, a car may release about 10PPM of CO from its tailpipe. Standing near a tailpipe of a car won’t kill you; but, in an enclosed space eventually the CO can concentrate high enough to set off a carbon monoxide alarm (35 PPM) and eventually even kill persons in the enclosed space. Similarly, standing near someone smoking a cigarette doesn’t harm a person per se; but long term smoking clearly does. Just as with smoke, the chemicals in this study permeated surfaces and materials and took months to fade in smell from materials removed from the environment. Just as with smoke or even CO in an enclosed space, it is the enclosed space and the continual release of chemicals that cause the build-up over time in the environment. As shown above, carbon monoxide (CO) is but one of the many chemicals produced. This study found multiple other chemicals implicated. Further investigation needs to be made into all of the other chemicals produced. For instance, the “shoe polish” smell1 attributed to Nitrobenzene was observed sporadically and infrequently. What about Nitromethane, or another similar chemical? The authors of this paper lacked the equipment and expertise to perform extensive, deep further research in order to identify each chemical in the environment but believe this provides significant opportunity for scientific advancement for anyone capable. E.g. nitromethane and nitrobenzene deposit as liquids so would be detectable with some sort of surface sampling. Nonetheless the hypotheses documented in this cases study potentially provide significant advancement over the current knowledge corpus of most parties contacted including HVAC technicians, HVAC specialists, air quality technicians, Professional Engineers, EPA employees, Department of Health employees, University Scientists, Toxicologists, Doctors, and many others. Possibly an expert in this area does exist; but none could be properly engaged yet. Dozens of academic papers related to the crux of study were located in the University of North Carolina library and journal search systems and are referenced herein.

1 Nitrobenzene. PubChem. https://pubchem.ncbi.nlm.nih.gov/compound/nitrobenzene Draft. Subject to change. 4

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Mapping Observation to Chemicals

Empirical observations from multiple parties over several winters allows this study to profile a list of potential chemicals. Certain chemicals are well known; but, some effects of many overlap; so, exact matches require data points from different decision trees.

Odors and Odor Thresholds The first, most obvious observation is odor characteristics and odor thresholds (PubChem 2017). Odor is tricky because each chemical may well have its own distinctive odor; but the English vocabulary is very weak in describing odor. A best approach may be to engage a person who knows what each of several specific chemicals do smell like and them have them enter the homes and identify the chemicals under the interesting conditions such as heat running, various temperatures, et cetera.

Chemical Odor Threshold

Odor Characteristic

Match

CO No smell No smell N/ANO 0.3600mg/

c3, ~290ppb

Sharp, sweet odor.Pungent. Chlorine-Like

Residents, Professional Engineer, Mover

CH4, Methane

No smell No smell N/A

ButaneC4H10

1 ppm Petroleum like, gasoline like

Yes. Air Quality Tester, residents.

Propane5,000 ppm Petroleum like N/A

C2H5SH,Mercaptan

1 ppb overpowering, garlic-like/skunk-like odor“rotten egg”

No. No gas leak was detected while systems were off. No gas usage was metered over months with systems off. Gas leakage at units while running was found on some units.

N2O, laughing gas

Odorless, slightly sweet, threshold unknown

Narcotic effect Residents and visitors to home.

NO2 100 ppb Sweetish, acrid

Residents, Professional Engineer, Gas company technician

NH3, Ammonia

40 ppb detect100ppb irritate

AmmoniaSharp, cloying, repellent

Residents. Irritation of multiple residents in upper nasal passage.

HCN 0.8 ppm,20% unable

Almonds Residents describe “warm, comfortable” smell when home allowed to heat to mid-to-upper 80’s F. Resident agreed with “almonds” smell. Smell was described as more “chalky or like talcum power and not petroleum-like”

Pentafluro-ethane

high Ethereal, faint sweetish

Refrigerant repeatedly added to the system; but no leak was found in five visits (Weather Master 2015)

Difluro- No smell odorless No

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methaneOther 1 ppb Old time shoe

polishSmelled a few times but not dominant odors.

Mercaptan 2.7ppb “rotten egg” One residence reported.See Ruth (1986) for more odor information.

Likely several other specific chemicals should be profiled; but, the authors have started with this short list. Inquiries are outstanding to the EPA, NIH, and other organizations as to what chemicals should be considered; and their input could add value to this analysis. The odor descriptions are very limited in their descriptiveness. One chemical which is common and seems more easily identified is Ammonia. Certainly many readers are familiar with the nasal irritation of ammonia; yet, some sources attribute nasal irritation to Nitric Oxide, though many others do not. It is not clear if the sources have specifically tested with only a single chemical or have reported on a mix of chemicals. Absolutely, the common exposure is from a mix of chemicals; and this is the general case for these cases studied herein. Certain examples where it is believed one or a small cluster of chemicals are being smelled are those of secondary, or later, exposure from chemicals deposited on or in the residences and their contents. These chemicals are not experienced normally by the average person and so are very difficult to describe. It is easy to describe they are not odor matches for other well-known chemicals. To validate no relationship with flooring products and other potentials, a can of xylene and a can of styrene were purchased and dripped onto cloth. Smelling them later identified distinctive smells; but smells which in no way matched the smells observed in the houses. Similarly, smelling combustion gases from a running lawn mower or a running diesel generator do have some similarities to one or more of the odors; but do not match the predominant odor which filled the house and all items within it. That odor is more sweet, pleasant, and attractive. The smell is reminiscent of when an old time kerosene heater sputters out of fuel. ADM Associates (1999) found in a study of manufactured homes that one home using propane heat did have 277 ppb of NO2 and one home having kerosene heaters had a peak of 90 ppb of NO2. EPA (2010) ranks these levels as very unhealthy and unhealthy respectively. Elsewhere they relate the temperature of the former was 73F and the latter 85F. Other homes in their study ranged from 12 ppb (at 72F) to 90 ppb (at 85F). No statistical median is listed and no correlation with temperature is included. Both of these could well reveal very important understanding of the relationship of temperature to NO2 levels in air and do warrant further research. Apparently the temperature measurements were near the heat source and not near a cold window or wall; and this matches with the observations of this study that NO2 remains in liquid form until heated and with the documentation by EPA (2010) that NOx binds with particles and becomes particulate. ADM Associates (1999) concentrated on CO problems but relationships with NO2 measurements could well be established between CO levels and NO2 levels. A gas-like smell also pervaded the house and clothing. The air quality technician remarked “Its as if you spray gas all over your house every day” (Bali, 2015). At this time the heat was being run most nights but the AC during the day. His air testing was done at a later date during the day with the AC set to 68F and after the house had been aired out for days. No testing for combustion gases was performed. No testing with the heat running was performed. Additional testing included soil samples to try to determine if a gas tank was buried beneath the structure. Results were negative. Over a year later two Professional Engineers would review the house and inform the homeowner that with the vapor barrier in place there would not be vapor intrusion even if there was a tank buried beneath the house. As above, Methane has no smell; but, the smell of refrigerant (R-410A) seemed to match one odor which was an

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odor in clothes. It was not as sweet and incense smelling as the predominant odor, but was certainly noticeable.

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Temperature Phase Transitions In addition to odor characteristics, it was observed the odors rise, dissipate, reside, and change with temperature and medium.

ChemicalOdor Temp Low

Odor Temp High

Medium Match

Sweet chemical

70F 90F Clothing, mattresses, other absorbent items

NO2 comes airborne.

Gas-like 30F 120F Surfaces, clothing. Remains on surfaces when cold even if sprayed with water.Inside air (Bali, 2015)

Unknown but seems to be some form of “oil”. Hydrocarbons? E.g. similar smell to R-410A offgas (pentafloroethane, difloromethane)

Sintered 30F 60F Outside air on overcast winter days

Detected outside of these houses during winter.

Old time shoe polish

- - Air near unit, much more rarely smelled.

Nitrobenzene. Nitromethane?

Machinery-Chemical smell

- - Outside air beside faulty unit

Hydrocarbons? E.g. similar smell to R-410A offgas (pentafloroethane, difloromethane)

Washing detergent

- - Outside air in winter, ranging to 100+ feet from homes

Marijuana 70F or so

Air from vent, off gas from large cloth items

Per Attorney and former Psychiatric Nurse with deep Chemical Dependency experience.

comforting 80F Air. Detected in some areas, rooms.

Less of predominant chemicals and more clean, warm smell. HCN.

Pungent,Bleach

100F+ - Air. Smell from unit and observed to re-appear after items were hot such as in hot garage when a container of items was opened after months.

Professional Engineer, Mover, Residents. Multiple times a bag or container from the house would be opened after months in a hot garage and a poof of pungent chemicals come out.

It is important to note the smell outside the homes occurred outside of various homes but not many other homes. A match was later found to homes having been built by one builder and having the same HVAC models. The smell would seem to pool in low areas outside of the homes on cool but not cold overcast winter days. It would not be present outside in the summer. It would not be smelled on days below 40F, for instance.

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Compare these to known boiling points and appearance as listed in PubChem (2017):Nitric Acid,HNO3

boils: 83°C (181°F) Colorless, yellow or red fuming liquid.“yellow precipitate” PubChem (2017)

miscible

NO2 melts: −11.2 °C (11.8 °F)boils: 21.2 °C (70.2 °F)

characteristic yellow   color Requires hydrolysis

N2O boils: −88.48 °C (−127.26 °F)

colorless gas, slightly sweet -

HF melts: −83.6 °C (−118.5 °F)boils: 19.5 °C (67.1 °F)

colourless gas or colourless liquid miscible

Ammonia boils: −33.34 °C (−28.01 °F) Colourless gas31% w/w (25 °C)

HCN, CHN boils: (78 °F) Colorless. “A deadly human poison by all routes” PubChem (2017)

high

C2H4O boils: 51.3°F Colorless. Sweet, Ether-like odor, Reminiscient of bruised apples (match)

Miscible

HNO2,Nitrous Acid

Acid.Only known in solution.

“NITROUS ACID can form water-soluble nitrites and stable esters” PubChem (2017)

“When heated to decomposition it emits highly toxic fumes of /nitroxides/.” PubChem (2017)

SO3 melts: 16.9 °C (62.4 °F)boils: 45 °C (113 °F)

Fibrous. Colorless to white crystalline solid which will fume in air.

Reacts to give sulfuric acid

H2SO4 melts: 10 °C (50 °F)boils: 639 °F (pure)boils: 212° F (dilute)

colorless to slightly yellow viscous liquid.colorless, oily liquid

soluble

NO3 ester “Nitrite and water are converted in the body to nitric oxide“

soluble

N2O5 melts: 41 °C (106 °F)boils: 47 °C (117 °F)sublimes

colourless crystals.“colourless crystals that sublime slightly above room temperature … decomposition … produces the highly toxic nitrogen dioxide gas“ - Wikipedia

reacts to give HNO3.

MercaptanMethanethiol

melts: -189° Fboils: 42.7° F

irritating or foul. may deaden sense of smell

“rotten egg” smell was not smelled. No gas leak found.

Comparing the temperature noted for smells to appear and dissipate and the table of boiling points of temperatures allows focusing on HF, CHN, and NO2 as the production of gas; with NO2 being the closest fit to the “around 72F” temperature identified. The sweet chemically smell of the houses was noticed in October 2014 when one set of residents viewed one of the houses with a real-estate agent. These residents noted the smell upon moving into the home in December 2014. This smell was obvious in several other homes. Over a year later in a subsequent winter, a technician from the gas company noted this smell in the middle of the road while

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crossing the road to test another house, without being prompted. He then noted the smell again as being far stronger in the initial house after the heat had been running for about 15 minutes. During residency of that home, the smell became pervasive and filled all clothing, furniture, and other items in the home. After airing the house out for an entire summer, the smell went away. This was repeated the following summer as well. After cutting the heat back on in Dec 2015, the smell returned after a few weeks. It became so pervasive that entry into the home for 10-15 minutes would saturate clothing and fill the car from those saturated clothes when the homeowner left the house. To prevent further contamination, the homeowner took to wearing over-clothes which could be removed and left at the house or to riding a bicycle to the house when going to investigate or retrieve items. After replacement of the faulty HVAC unit, the smell gradually dissipated. It is important to note the smell still could be detected over a period of months in various items such as in a cloth curtain or in the back of one of the kid’s closets. Each house has two HVAC units. One is a packaged unit containing the heating furnace and the cooling coil and compressor all in one single metal box. This unit sits outside. It cools the main, bottom floor. The other is a separate heating furnace which resides in the attic and a compressor which resides outside. This second unit cools the upstairs floor. Not sure where the condenser coil is for that one. Some families have a finished attic space and some unfinished. The sweet chemical smell could continue to be detected for about 1-2 months once the fans of the second cooling unit (for the upstairs) was turned on; but eventually could not longer be detected. Many cycles of leaving the windows open with fans running any time it was not raining were repeated. About seven fans including an industrial shop fan were employed. Interestingly, after a year plus of use some of them spun slower and slower. Eventually the smell was removed from the house. The rerelease of the “pungent” and “bleach” smell from clothing and other items in a container in a hot garage or hot storage shed probably heated in excess of 110F may well correspond to a rerelease of Nitric Oxide. The items were in a closed trash bag for months or in closed plastic bins with locking lids for many months. Olsen et al (2010) reference Heywood (1988) and state “the reaction for the conversion of NO2 back to NO is NO2 + O -> NO + O2”. It may well be that latent NO2 and Nitrous Acid yield Nitric Oxide when heated in an enclosed container over an extended period. This is one more area for further research. It may also well refer to N2O5 or SO3, as their boiling points appear to be matches. SO3 is said be be pungent and choking and the experience is one of a pungent chemical which will quickly damage ones brain and lungs. This same experience happened several times on visits into the residences when the heat was running; so seems related to a byproduct of combustion, namely Nitric Oxide. It was not “choking” but does have effects on one’s lungs and brain within 5-10 minutes, depending on the location in the house and level of exposure.

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Solubility The residents observed a chemical residue on surfaces as well as in the bottom of a container containing toys washed with water. This yellowish residue was detected in cleaning surfaces. A very thin but sticky film coated all hard furniture and hardwood flooring. It would not dissipate when hard furniture was left outside in the winter but required washing with soap and water to remove the smell from hard surfaces. It would dissipate if the furnishing was left in a very hot garage for weeks. In fact, it could be smelled for days or longer in the garage in the air as it evaporated from the surfaces. Residents report observations the flooring was very slightly tacky. They report having a slight tackiness on their feet from walking on the wood floors and attributing it to some juice must have been sprayed over the floor, or that somehow the flooring had not dried completely thought it was installed many months earlier. The report being unable to slide much in socks and even not being able to slide much once new, clean socks were put on their feet.

CompoundWater Solubility (g/100 g water)

The solubility table here is reproduced from Olsen, Kohls, and Arny (2010). Notice the addition of various. Probably these chemicals warrant deep investigation as well. As in other studies, they found the exact chemical makeup of NOx is dependent on various conditions. They find “one cannot assume that NOx is mostly NO from industrial natural gas engines” and “formation of NO2 is highly temperature dependent”. Interestingly, Methane is fairly soluble. What was observed is a chemical which coats materials but then settles into the bottom of the container when items are sprayed with water for about a minute and then the container drained. What matches this?Nitrogen Dioxide. Yellowish-brown liquid. NO2 + H2O -> HNO3 -> Nitrates?SO3 + H2O -> Sulfuric Acid: oily liquid which is light yellow or varies by associated molecules (yellow, pink, red, brown, black)N2O5 is another possible match and sublimes to release NO2.Other chemicals might be matches.Extensive further research is needed to identify the exact candidates.

1,3-Butadiene 0.5Acetaldehyde MiscibleAcetylene 0.106Acrolein 21.25Ammonia 54Benzene 0.18Carbon dioxide 0.14CO 0.004Ethane 4.7Ethylene 26CH2O 55Hydrogen cyanide MiscibleIsobutylene 0.03Methane 3.5n-Butane 0.006NO 0.006NO2 MiscibleN2O 0.121Pentane 0.04Cyclopropane 0.308Propane 0.007Propylene 44.6SF6 0.007

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Latent Chemicals It was observed the chemicals lie latent in materials and come out when the materials are warmed in a garage or in hot summer sun. One mattress was left on top of a car for 2.5 days in the summer, after which time the smell was not longer observable by smelling up close on it. Another mattress was brought to an apartment when guests were visiting. Immediately upon laying down an adult male who was from an entirely different country began sneezing. His teenage children had helped remove items from the house in a misguided remediation attempt and both had sneezing fits lasting tens of minutes while working with the furniture and materials. There was no normal dust build-up to attribute to this. This was around September 2015 and the house had been aired out for months. The chemicals had remained latent in the house and in the materials. One homeowner described it as like a chain smoker’s house but with a different smell. Another homeowner described it as “its like a tiny painter lives in our closet and comes out every day”; though the smell was not matching paint but was similar in its intensity to fresh paint. Similarly, it is observed that working with large items such as a large tarp from the house would result in effects on the worker/breather later than evening and night. As well, placing a coat from one of the problem houses but then exhibiting no smell into a closet in another unrelated house and warmed to 80F by Internet equipment resulted in a closet pervasive in the “new house” smell the next morning – though the closet was in an entirely different house and one where the “new house” smell had never before been observed. The smell is not as of paint and drywall but a sweet chemical making one think on incense or fresh, “clean” chemicals. The reality is its hard to describe the smell as it is not like another smell. One family vacated their home in June 2015. They financed all sorts of testing with no positive results. They refinished all of their hardwood floors. By November 2015 they could reenter the house fine. Then in December they turned the HVAC systems back on in the home. In three weeks they entered and were sick within 10 minutes in the home. In one case the person was so sick vomiting was induced. Other families sold their homes and “put the problem behind them”. Entry into the home in the ensuing weeks with an HF gas mask still led to sickness within 10 minutes. Additionally, the clothing worn by the entrant became imbued with the “new home smell” and would even secondarily fill the car used to pick him up. The smell was very strong, as it had been the prior winter and spring. The entrant took to using a set of over-clothes and took other precautions such as gas mask and immediate showers upon returning to the apartment. Multiple times the entrant re-experienced the micro-burns/itching all over and then realized the cause was in fact the house. The sweet chemically smell appeared sometimes to be more concentrated around the floor. ConSpec (2017) states “Nitrogen dioxide is heavier than air, so that exposure in poorly ventilated, enclosed, or low-lying areas can cause asphyxiation”. EPA (2010) confirms and describes pockets of NO2 as well as ground level pollution. Other studies also found the non-uniform distribution of NO2 pollution with the greater levels being near to sources. The summary point is the chemicals do not simply disappear. In the case of Nitric Oxide, it yields several other chemicals. NO2 is a liquid at 70F, so will not simply evaporate away. Tests performed on several of the residences a few weeks after the end of winter revealed each house had levels of NO2 present. These were in the 201 ppb range, the top range listed by the EPA and one identified as “very unhealthy” (EPA 2010). Note, this was in an air sample; which is possibly not the smartest way to sample since NO2 is a liquid at 70F. Experience above suggests the NO2 or other NOx dust or particles re-release Nitric Oxide at higher temperatures; so, measurement requires fastidious expertise. This is certainly an area for further research.Draft. Subject to change. 12

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One other observation was a distinct smell from the crawlspaces. A smell which could simply be described as like a chemical factory after a fire. The houses were designed with enclosed crawlspaces with a special design of an air duct flowing into the crawlspace with no return. No fresh air system was in place. Apparently the houses acted as a giant distillation machine with heavier chemicals accruing in the crawlspace. A similar smell was apparent behind the door to the attic for the first feet of the access stairs. The second gas heater was located in the attic. For some homes, the attic area was enclosed and heated by an additional unit. The crawlspace smell was unusual, extremely strong, and observed in multiple homes. One homeowner stated “It flew out at you when you opened the crawl space door.” The air quality technician decided to take a material sample of the insulation in the crawlspace after observing the chemical smell flowing from it upon opening the crawlspace door. Airing it out with fans blowing outwards for weeks when not raining did eventually established an earthy and wooden smell typical of crawlspaces.

Lasting Spread of Chemicals What has been missing from the scientific puzzle is documentation of what happens once Nitric Oxide and NOx are released into the environment. The Environmental Protection Agency engaged this gap in 2010 with the release of their flyer “Air Quality Guide for Nitrogen Dioxide” (EPA 2010). It pegs the dangerous level of 100 PPM for exposure for one hour and of 53 ppm for continued exposure.

NO2 is linked with a number of adverse effects on the respiratory system. NOx reacts with ammonia, moisture, and other compounds to form small particles. These small

particles can penetrate deeply into sensitive parts of the lungs.

This flyer specifically identifies two key aspects of the chemical behavior.A. The chemicals remain resident in the area of release.B. The chemicals become affixed to small particles which effectively store them for

transport and/or re-release. This finding exactly matches the case study observations. The residents observed continued sickness even when turning off the faulty heating units. In fact, air samples taken when the units were not running still revealed levels the flyer lists as “very unhealthy” in each of four homes sampled. As 19 homes reported faulty units, then it is likely all of these homes had conditions listed by the EPA as “very unhealthy”. Many homeowners choose not to share their homes for testing. Others refused to turn their heaters back on ever again until they were fixed. Cernansky and Sawyer (1974) document stratification of the chemicals in the air: “NO measurements are only about 2/3 of NOx measurements up to one inch and about 3/4 of the NOx measurements at two inches. At ten inches the NO is about 90%”. Please note this is near the burning location; but suggests a spread and stratification in to the air. An observation is the NO2 smell can be smelled in ResidenceP entering the air about 5 minutes after the unit was turned on; but only above about 5 feet in the room. A similar observation is the NO2 smell could be smelled entering Residence1 about 5-10 minutes after unit cut-on and also at about the same level. After 15-30 minutes it could be smelled more pervasively throughout that level of the house. Similarly, the NO2 smell was smelled coming from beneath the front door of Residence1 in winter2015, coming out of house of Residence2 in springv2015 and winter 2015, and coming out from beneath the front door of ResidenceP in spring 2017. In fall 2014, winter 2015, and spring 2015, the smell permeated Residence1. It was also smelled in and around other residences. In summer time, it was not observed around the residences.

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DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 14

“NO2 smell”? This smell is attributed to NO2. It may, however, include other NOx gases and other chemicals. The NO2 smell is unique and peculiar. It is attractive. The residents of Residence1 called it a “sweet chemical” smell, or a “new home smell”, only much stronger. One Professional Engineer identified it as a “new home smell”, independently. One technician from the gas supply company identified the smell as well but did not know the cause. The smell could be removed by cooling the house below 68F. The smell would re-appear (re-odor) when an item was allowed to warm above 72F or so, as discussed above. As documented above, residents reported saturated clothing and other items. Removal of the sweet chemical smell from clothing required washing the clothing three times. Return visits to a vacated home would saturate the visitors clothing within 15 minutes identically to a chain smoker’s home; but with a different smell. Returning to an automobile would fill the interior cabin with the smell. The chemicals clearly were not a benign gas which simply floats away. They clearly became affixed to clothing and other materials. They also clearly would be released/detached by warming the clothing in a warm car, on a warm body, or in a warm house. After a large amount of residential items were moved into a garage then the garage took on the house’s smell for many months. Similarly, a large amount of other items was moved to a standard storage unit and the sweet chemical odor could be smelled for months afterwards when attempting to retrieve items. After many months the odor transitioned into more of a repulsive odor and then, eventually, was no longer detectable after a few summers in the not-conditioned storage unit. What did appear to remain, however, is a chemical dust which affected persons who worked with large, exposed items as much as a year later. One resident nicknamed this “speed dust” as it would cause the victim to become almost vibrating with an energized core. This was described as roughly similar to drinking five cups of a strong caffeine drink. Sometimes after exposure it was so bad the victim would not be able to sit and work the next day without getting up and walking around repeatedly to try to calm it or slow it. Could N2O5 be the “speed dust” which was observed? Or is it some kind of nitric acid or nitrous acid? The effects and identification of this dust or coating certainly warrant further research.

Symptoms Experienced and Chemical Matches

Symptoms progressed over time from fatigue to flu-like symptoms and upper respiratory issues. To continual low grade stomach ache and continual continual sick feeling. Itching all over sporadically, bloody noses, continual sneezing around the clock for weeks, to vomiting and dry heaves from lungs. To dizziness, loss of mental capacity, loss of memory input and loss of memory recall, to displaced words, inability to stay awake, and eventually blacking out. Numerous rare and unusual symptoms were suffered including lump in throat (one or more had resulting throat surgery), hearing damage (one or more children had ear surgery, possibly as a result), miscarriages, dental damage (teeth chipping off, jaw clenching, cracked teeth, bleeding gums), false heart attacks, inability to get oxygen, both pinkies going to sleep on multiple occasions, strange rash over arms and torso, muscle jerks as if shocked (similar to spasm from over-exercise but different and more like shock response), and others. Other symptoms include loss of acuity and coordination, immediate exhaustion if tried to jog 10 steps, out of breath when doing household tasks, and having to take a nap in the middle or the day or even every 1-2 hours throughout the day. How can these be related to chemicals? Do different chemicals affect the human body differently? One family who vacated recounted taking one month to be able to walk around the parking lot, six months to be able to jog some, and continued re-gaining of brain power over a two-year period for multiple family members. They observed much of the damage was complete and does not heal; but, rather they had to relearn words and learn to speak clearly and to monitor what they say to Draft. Subject to change. 14

DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 15

correct spurious errors and misstatements which occurred after poisoning. They also observed a change in personality, reduction in level of sensory perception, and reduction in overall interest as well as contentment with life. Due to the continued nature of exposure, it was difficult for many families to accept the relation of the onset of allergies or other ailments to the potential relationship with faulty combustion. The long term effects are as yet unknown though at least one person has developed cancer already, after three years living in their new home; but, it is not clear if this cancer is related to the faulty HVAC units or will be followed by other, future cases. Two doctors separately assessed the patients were sick from something in their home and told them to stay out of the houses. One resident received a an intensive, on-site bio-detoxification program prescribed by one of the doctors and had good results. It is also possible the elated high caused by some of the chemicals is addictive to the residents. One resident was told multiple times by his attending physician to stop going into the vacated home; but, continued to return for brief stints on the auspices of “testing”. Was something more base and biological at play, such as addiction? Are some residents unable to act appropriately due to an addiction to the laughing gas produced in their homes? This may seem a strange line of reasoning; but, the possibility and match are real. Certainly the residences became habituated to the smell and to being ill. Along these lines is the psychological pressure many residents faced. A few sold their homes and transferred the problems to new home owners. Arguably, nobody had correctly documented the causation; so, they have plausible deniability. Others who had numerous doctor visits and even surgeries also chose not to pursue testing because of the high expense and because they felt a need to have the systems repaired immediately while the manufacturer was still willing to cover the cost. The HVAC company refused to allow homeowners to retain the broken equipment on the argument it would void the warranty. So, there was both corporate pressure as well as psychological pressure. For many homeowners, admitting the home had a problem was not digestible because of the problem with selling it later; so, they took the position that repairing the units would make the problems go away. Removing the faulty equipment would remove the introduction of new gases but did not clean up the house and its contents, nor remove any health damages caused. One homeowner stated she was afraid if they reported the issue to authorities that the HVAC company would then refuse to fix the unit for free.

Symptom experienced

Chemical match

Reference

Profound weakness with near collapse

Carbon Monoxide,HCN, others

Resident reports near collapse many times throughout the day. Reported one blackout episode.

Dizziness Dizziness and Profound weakness were every day experiencesVertigo Loss of balance even while sitting was a regular occurrenceMemory loss Trouble finding words, trouble remembering things.Loss of mental capability

Residents describe “brain fog”, “5% brain power”, and other examples.

Lump in throat, blockage of throat

Nitric OxideAmmonia – inflamed epiglottis, trachea, lungs.

Known long term effect of taking Nitric Oxide supplements. Several residents.

Sneezing constantly for weeks

Two residents sneezed constantly for months until moving bed or installing new AC register so air did not come on them at night in the winter.

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DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 16

Turning blue in the lips

Nitric Oxide Experienced by resident and led to making an appointment with Pulmonologist. No prior pulmonary issues.

“turning blue in fingers”

Nitric Oxide Both and only pinkies going to sleep.

Rapid heart rate

Nitric Oxide “false heart attack”. Visits to emergency room and another person to doctor and for stress test. Both false for heart attack. Former had a heart attack about a decade earlier and latter had no history of heart disease. Effects last for several days and the lingering portion is like “tennis elbow” on the heart, approximately.

Severe shortness of breath, dyspnea

Nitric OxideAmmonia

Described various ways by residents. “Drag in chest”. Etc. Lasts for a few days to a few weeks after exposure.Out of breath just putting stuff in the car or walking up steps.

Micro-acid-burns on skin

Nitric Acid.Nitrous Acid?Ammonia? (corrosive to the skin)

All over on various mornings or upon short-term re-entry the following winter. Multiple persons. Like tiny battery acid burns all over. Would appear with 10-30 one morning and sometimes would have none. Tried prescription medicine, showers, sterilizing all items, etc. Son developed permanent open scratches on legs from constant scratching.Determined due to the home after returning to vacated home the following winter for short entries to test and having the itching that night and following 1-3 days.

Methemo-globinemia

NO3.Others?

Intellectual disability, bluish coloring of the skin, Headache, Fatigue, Shortness of breath, Lack of energy

Sleepiness Unusual sleepiness. Hard to stay awake even while driving. Drank sodas constantly to stay awake. Set alarm to wake up while in line to pick up kids. Naps throughout the day. Etc.

Awaking at night and unable to go back to sleep

Maybe not the same as insomnia. Can go to sleep but awake around 3-4AM. Wide awake and unable to go back to sleep. Unable to think and be productive. Driven to eat something though not physically hungry. Countless nights one resident observed his wife awake at night sitting by the window. Then he began to do the same and they would sit on the porch.

Sleeping propped up

NO2. See ConSpec (2017)

Residents took to sleeping with multiple pillows stacked under them to the point their backs and necks were strained in the mornings. Residents would regularly awake at night and open a window to get air.

Affected eyes Ammonia Resident reported reduced oxygen from breathing, micro-burn itches on skin, and continually watery eyes unlike tears occurring over next 2-3 days after entering home for 15-30 minutes to test.

Dragging lungs NOx Out of breath for next few days doing even simple tasks. Occurred after as short an exposure of 15 minutes.

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DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 17

Fried lungs Nitric Oxide Depending on exposure will be sick in bed for 1-2 days, then will possibly have vertigo on day 2, will have low oxygen for a week or a few which gradually improves, will have burning across chest for about 2-3 days starting in day 3 or so, will pull up small sputum from chest about 2-3 times a day a week or so later, and can having a reflexive lung-vomiting fit from lungs if try to exercise hard a week or a few after exposure and in which small sputum will be produced and after which one largely returns to normal.

Continual low-grade stomach ache

Stomach ache which was ever present for about five months. Sort of life feeling of hunger. Always present in the background. Initially mistaken for food poisoning.

Unusual, extreme food cravings

Sweets. Sugary foods.

Cancers NO2, others? TBD

Wang et al (2016) determine the production of HONO (Nitrous Acid) from NO2 and NH3; both of which are known results form natural gas combustion. Logically, the itching/burns experienced by numerous persons could be attributed to production and release of Nitric Acid and/or Nitrous Acid. This list could easily span a paper much larger than this one to fully cover the symptoms experienced and their longevity, intensity, transitions, and time variations. A short list is included here as a quick input to the decision tree. Several residents have reported allergy-like symptoms and asthma-like symptoms which may also be related. Further research could more fully document the exact physiological and medical effects.

Classes of Medical Effects An attempt is made below to classify the medical effects in order to zero in on certain chemicals. The most clear-cut is the “speed dust”. This also exhibited itself in inhaled air when the home was allowed to heat naturally in 90+ F weather for many days. Its effect is one of over-energizing the body. Heart pain often ensues, depending on the level of exposure (time in the home, for instance). The victim will awaken around 2, 3, or 4 AM. In severe cases the entire core of the body is extremely energized like electric arcs running through it. Due to the appearance above 80F, this may well be CHN, hydrogen cyanide. This match matrix relates published symptoms from PubChem (2017) to symptoms experienced. Testing was done by the victims returning to the house after being unaffected with these symptoms for an extended period. Immediately upon re-exposure of times often as little as 10 minutes then the victims would be affected with the various classes of symptoms; depending on whether heat was running, how hot the house was, et cetera.

Possible match: HCN, Hydrogen CyanideInorganic cyanide salts Observed dust/coating would "come off" items via

affecting handler of the items in locations elsewhere from them when items were later handled

Absorbed through intact skin Certainly seems plausible as affects ensued even when care taken with breathing

Distributed to all organs and tissue Absolute match. Feels as if the entire body is overdosed on

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DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 18

caffeine and vibrating like a bell.toxic amounts are absorbed through bronchial mucosa and alveoli

Absolute match in that walking through home when heated above 80F leads directly to effects within hours and lasting one day or so.

burns to skin and eyes Did experience but home probably below 79F at the time; though heat was on at that time and unit still defective.

Cardiovascular effects Pain on heart. False-heart attack. Others.Respiratory tract irritation Slight soreness or tenderness in lungsprimarily in effects on the central nervous system

Absolute match. Victim sent to Neurologist by attending physician long before source was determined.

The above symptoms appear to match CHN. As listed previously in the discussion of a “speed dust” as a latent chemical, this chemical appears when the temperature is warm (i.e. in the 80’s F) and can come from breathing and from working with coated items. It results in noticeable heart and core “excitement” and has been related to drinking multiple energy drinks or being electrified. Unfortunately, the testing for HCN is complicated and beyond the grasp of this study. Enthalpy Analytic has prepared a test methodology for the EPA for HCN. Notably, special techniques are used: “heated probe, a heated filter, three impingers containing sodium hydroxide (NaOH) solution, and an impinger containing silica gel“ (Enthalpy 2011). They were contacted various times throughout this period but refused to work with individuals. No funding existed for further investigation into HCN presence.

The above symptoms are distinctly different in when they occur and noticeably different in symptoms than another class, the direct exposure class.

Possible match: Nitric OxideTinnitus Continual to extremely severe ringing in earsPulmonary irritation to lung damage Fried lungs, common to exposuresPersistent headache Fried brain, if really bad6-24 hours after exposure, labored breathing and unconsciousness

Lung damage is a delayed effect. Like exhaling all but the last breath and then how one feels is the typical feeling when doing moderate activity. Often sitting there with mouth gaping.

Only slightly irritating to upper respiratory tract and eyes ... dangerous amounts of fumes may ... be inhaled before any discomfort is noticed

Hits you later that evening, that night, or next day.

Some nasal irritation Pungent. Nasal irritation/slight nasal burningSome 6-24 hours after exposure, a sensation of tightness and burning in the chest develops, followed by shortness of breath, sleeplessness, and restlessness

Delayed effects. Check.Burning in chest is more like 2 days later and lasts 2-3 days. Similar to indigestion but across entire chest.Shortness of breath also is noticed the next day and lasts for one to two weeks or so, gradually improving over days.Victims could not sleep through night for a month or so after exposure due to awaking at 3-4AM or so.

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DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 19

Delayed effect After several days to a week victim will start to pull small sputum from lungs. It will only be a few times a day. No associated prevalent cough exists.

Delayed clearing After a few weeks the victim can exercise vigorously and will experience an episode such as vomiting but coming from the lungs. The episode will include uncontrollable coughing for a few minutes to several minutes. After this time the victim will return to nearly normal breathing ability.One resident believes what he thought were “dry heaves” while living in the home may have in fact been lung clearing attempts.

This class only occurs directly when the heat is running or a milder dose from opening a container stored in a hot garage or storage unit for months (estimated 110F). The milder dose is the exact same smell but not as severe effects. One victim was observed as visible short of breath by an attending physician. His lips “felt blue, like when snow skiing and its very cold”. The attending physician also observed this state. He was referred to a pulmonologist but the earliest appointment was five weeks later and the lung scan could not be scheduled until 8 weeks or so had passed. At that time no issues were found other than a small lump. “Nitric oxide is readily oxidized to nitrogen dioxide and peroxidation then occurs (PubChem 2017). NO2 exposure is determine by ongoing exposure even when heat is not actively running but also when the house is warmed above 70F. This class creates a definite “drag” on the lungs but does not fry them like the “Nitric Oxide” class above.

Possible Match: NO2dyspnea (shortness of breath)

Drag in lungs

Sick like with flu within 24 hoursFatigue, lethargy Very tired for day 2-3 or 4mental confusion Brain fog, “loss of IQ”Nerve signal inhibitor Loss of coordination, knocking stuff over, dropping stuffloss of consciousness loss of consciousness

Vertigo occurs next day after exposurenausea Continual low grade stomach ache

This class is characterized by a very sick period lasting one to two days and then a prolonged sickness period lasting up to about 10 days. In the initial day or two the victim feels similar to having a bad flu and may sleep around the clock. After this the level of consciousness remains affected for up to 10 days. The final class is from experiences while living in the home for about five months. Vomiting also occurred due to one occasion re-entering the home for about 10-20 minutes the following winter after the house had been closed up for several weeks with the HVAC systems running.

Probable Match: COvertigo vertigo

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DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 20

vomiting vomitingauditory loss Significant loss of hearingheadache Severe frontal lobe headache in re-entry casedizziness Continual dizzinessweakness Profound weaknessaltered mental state Extreme changes in mental capacity over several

months for all four family members. Observed mental capacity issues for several neighbors.

 fetal death due to accidental nonlethal maternal carbon monoxide intoxication

miscarriages reported while living in affected home

Speech pattern and pronunciation issuesmyocardial ischemia or infarction False heart attacksrash Strange rash on body most closely to reddish goose

bumps. Significant itching.amnesia Unable to remember anythingbewildering myriad of clinical features of carbon monoxide poisoning

Numerous medical visits for many residents with no exact diagnosis from any medical professional.

cognitive and sensory disturbances

Hallucination of music. Regular nightmares (not occurring before nor after vacating). Dreaming while not yet asleep.

Long Term Medical Effects Some residents are medically affected with what appear to be effects from long term exposure. Many of these appear permanent. Throat surgery. Ear surgery. Permanent hearing reduction. Loss of mental capacity. Tinnitus. Intolerance or low tolerance of various chemical exposures. Personality changes. Chipped teeth. Cracked teeth. Developmental and psychological issues. Potentially cancer. Some studies have investigated chemical onset of asthma. This study did not go in depth but many families reported asthma-like conditions arising in young children. Certainly a public health surveyor or other person could perform further research. Several studies have related NO2 to cancers. Goldberg et al (2016) determined a relationship between long term NO2 exposure and breast cancer. Their study determined interquartile levels below 4ppb for one set and around 11ppb for another set; air samples taken at the homes in this study were in the 200ppb range – seriously and dangerously higher. Pederson et al (2017) also suggest a relationship between liver cancer and air pollution. They did find “Confidence intervals for associations with NO2 and NOx were narrower than with other exposures.”; yet, why the interval was narrower needs further research; and, most of all, they were dealing with NO2 levels around 5ppb increase which is two orders of magnitude below the levels measured in some of the homes in this study. Al-Ahmadi and Al-Zahrani (2013) provide not only a survey of other studies relating cancers to pollution; but, provide an in-depth study showing increasing cancer rates in their target area and concluding a relationship between NO2 and cancers: “High coefficients of determination were observed between NO2 concentration and lung and breast cancer incidences, followed by prostate, bladder, cervical and ovarian cancers, confirming results from other studies”. At least one teenager in the target area did develop cancer after

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DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 21

about two years in their new home. No effort has been made to investigate any possible relationship between his form of cancer and the chemicals released into the homes. Again, this is an area of further research. It is the opinion of at least one expert in Carbon Monoxide exposure that the loss of memory recall and thinking ability is permanent. One resident observed words have to be relearned and some memories are damaged and no longer retrievable. Short term and medium term recall does improve over months and years. Zest for life, interest in family and other matters, and former interests are also greatly reduced and changed. Effectively, the victims redevelop memories, personality, and interests. Tolerance is greatly reduced from tolerance of social intricacies to tolerance of complex situations to tolerance of background noise. Perhaps the ability to “juggle” mental inputs and mental models is greatly reduced. Psychological damage such as inability to contain anger and becoming immediately reactive like a cornered animal from even the simplest frustrations cannot be properly quantified but are real effects. These also attenuated over time and were re-experienced during re-exposure – but in much lower levels than while residing in the faulty home. One resident described the mental condition in the home as “as close to being a zombie as humanly possible”. The family would be constantly tired, have slow reflexes, be unable to run, be awake during the night, have trouble hearing others, as well as have a loss of coordination, loss of communication skills, and changed eating patterns. While all of this attenuates over time, the general outlook and approach to life never returns to its prior state. This permanent change is not purely psychological as the way one physically perceives and mentally processes changes permanently. It takes months to years to be able to communicate effectively again in a work environment, for instance. One’s sense of smell, broad vision, and other senses become less deadened after many months out of the faulty environment. One family observed continual improvement over a two and a half year period after leaving the home. After leaving the home then hearing improved for some victims. After a few days the family-wide itching subsided. After a month the greasy sweat, greasy residue in showering, and unnatural smell of sweat and hairline largely subsided. In about the same timeframe the parents were again able to wear their wedding rings. These had been removed a few months after moving to the home as they became far too tight. The mother remarked her feet appeared swollen like “pregnancy feet”, and this too subsided after some time after leaving the home. After a month the most-affected victim was able to walk around the parking lot. After about two months the residents were able to sleep less than 14 hours per day. After several months the worse-affected victim was able to jog for limited distances, which they used to do religiously in the past. After about six months the sensation of smell and touch improved. After months, mental function improved. After about 18 months one child was able to jog again. After about two years the worse-affected victim regained better memory and mental capacity and after a handful more months was able to actively engage in normal activities. Eventually, the tinnitus and ringing in the brain attenuated as well.

Decision Tree

Determining the chemicals released can be facilitated by a decision tree. Medical professionals diagnosed the victims as having suffered chemical exposure in their homes; but were not able to determine the exact chemicals from medical tests; yet, the carboxyl hemoglobin test for Carbon Monoxide was not even performed on any of the victims as the poisoning was long term and the medical staff not trained in diagnosing Carbon Monoxide and other chemicals. A Toxic Effects Core panel found nothing wrong except for elevated hydrocarbons. The occupational health doctor had already diagnosed the patient with petrol exposure through other onsite tests. The ‘solvents” test of the panel indicated high

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DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 22

levels of Ethylbenzene, Styrene, and Xylene; but it is possible these are indicative of hydrocarbons in general. Further research would be needed to determine how this test indicates chemicals and what it could match. The below matrix narrows the source of the chemicals. Various known chemical problems are listed for reference. An “X” is used to eliminate the source from consideration.

Decision Matrix for Potential Sources of ChemicalsSource Engineer/

EvaluationSurface

Smellinside

Smelloutside

PhaseTrans.

Quantity Winter related

Years Tests

Gas leak X X X X XGas heatersR-410A X X *Xylene X X X X XStyrene X X X X X X X XFormald. X X X X X X X X XMold X X X X X X XGas Tank X X X X XSewage sys. X X XBlownInsul.

X X X X X X

Drywall X X X X X X XX - demarcates “Does not match” and omits the possible source.* - one lab was able to test to 20ppm. Two labs can test to ppt. Other labs could not test.

As may be seen above, the natural gas supply is the only source capable of producing the Quantity of gas observed and also the only source which appears in the winter but dissipates and eventually disappears each summer (Winter related, Season). The Years column suggests building materials would attenuate off-gassing over the multi-year period; but, the gas presence did not attenuate over a two-year period until the HVAC unit was replaced. The Quantity of gas was so extreme it could be smelled pouring out of various houses in the winter-time when their doors were opened. It was immediately observable inside the homes. Various persons also smelled the gases outside the homes on overcast, not-too-cold winter days. In fact, these persons observed the smell was only around certain homes – the neighborhood having four different builders which each used different home designs. Natural Gas Heat is the only source not eliminated by this decision matrix. The gas stove, gas logs, and gas water heater were off in one residence during the second winter and third winter; so are not candidates for being a source. Reviewing some known chemicals from natural gas combustions directs towards specific chemicals to investigate. A checkmark indicates a match.

Decision Matrix for Potential Chemicals Affecting ResidentsChem. Water

Remain

Sur-faces

Smellinside

Smellout

PhaseTrans.

Qty Seas-onal

CO Beep

Tests /Inv.

Symptom*

CO NO

Draft. Subject to change. 22

DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 23

N2O NO2 NH3 HNO3 HF(R-410A)

Styrene X X XMold X X X X X X Gas Tank

X

BlownInsul.

X

Radon X X X X X X X XDrywall X X X* headache and other general symptoms were not considered as they are listed for too many chemicals to be useful in identifying any specific chemical.

Hydrofluoric acid was considered due to the apparent refrigerant leak. The refrigerant contains R-410A, which consists of pentafluoroethane and difluoromethane. An MSDS reports the creation of Hydrofluoric Acid and Carbonyl Halides from combustion at 250F (Honeywell, 1997). It also lists the odor of R-410A as “faint ethereal odor”. Some residents believed the refrigerant smell to match one of the odors found within the home. More than one home was found to have ongoing refrigerant leaks lasting multiple years and not fixed by repeated attempts by the HVAC warranty company. Potentially, refrigerant was also being leaked into the homes. The MSDS also lists hazardous decomposition products as “halogens, halogen acids, and possibly carbonyl halides”. These have not been considered in this study further; so, further research could be made. Styrene had been reported in other news reports as a result of cured in-place piping. The water department did assist with a sewage system backflow test and no faulty traps were found. Equally, they did report zero upstream business operations which might be releasing chemicals and stated the residence was “near the top of the system” for the sewage system. They also stated the piping being installed in the area was new and would not use CIPP. The piping was observed to be solid and believed to be made of styrene. A can of styrene was purchased and its odor in no way matched the odors of the home. It smells like a fiberglass repair shop like in a boat repair facility.

NOx: Extremely Massive Yields of Nitric Oxide

The Environmental Protection Agency has documented conditions causing Nitric Oxide spikes and production in prodigious quantities: “NOx formation rates are exponentially dependent…” (Gagnon, 1993). In fact, this has been well known for a long time: “38 ppm of NO2 and 62 ppm of NO” and “a peak NO level of 1000 ppm” (Engelman and Bartok, 1976). 1000 ppm is extremely dangerous if continued in quantity. Poozesh et al (2015) found NO spikes extremely rapidly as CH4 concentration is increased from 40% to 65%. The NO production slowly reduces after 80% CH4. They also found NO spiking as more air enters the burn area: “up to 0.4 for O2 mass fraction, NO formation substantially increases”. Loffler et al (2004) provide an elegant, simplified model for calculating NO production. They also find NO increasing rapidly as more air is in the burning mix: “Fig. 8 shows the NO emissions with increasing air-Draft. Subject to change. 23

DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 24

to-fuel ratio from 0.75 to 1.5 at 1600 8C. As expected the NO concentration increases from 19 to 157 ppm”. Furthermore, they reiterate “NO emissions from natural gas combustion increase significantly with increasing temperature” and chart a high approaching 1000 PPM. Jerzak et al (2014) chart NOx increasing directly as CO increases. This suggests any system which releases high levels of CO is also releasing high levels of NOx. In their study, as reference points, 250PPM of CO corresponded to 60PPM of NOx and 500PPM CO to 90PPM NOx. While these may be high numbers, the near linear increase in NOx with increase in CO may forebear a very dangerous truth. One of the residences did have the CO alarm go off on multiple occasions. The residents did not know during occupancy the alarm was for CO because the alarm makes the same sound as the battery alarm (but a different pattern), is in the same unit as the fire alarm, the residents were not aware the fire alarm included a CO alarm, and upon investigation the alarm would stop (e.g. when a door was opened to the garage to look for any smoke or fire). As these alarms go off at 35PPM, then perhaps a corresponding level of NOx could be calculated by someone significantly learned in this area. This is a second area for further research. How much NOx is present at 35PPM CO? It is not linear because it varies by the burn characteristics as well. As listed above, Poozesh et al (2015) and others report on varying percentages based on various supply characteristics and various supply characteristics. Also, very importantly, CO remains a gas and gas float out of the environment whereas NOx converts to liquids, nitrates, and particulate matter so will remain and build up in the area. How can CO from a cracked heat exchanger build up to 35PPM? The answer is recirculation of air. The persons asked to test for CO were not properly trained and simply cut the heat on for about 5 minutes and declared there was no problem. This includes the fire department and an HVAC company. Eventually a CO expert was brought in after the faulty equipment was replaced and determined the second unit was OK for not sending CO above 1 PPM into the home. It is believed some homeowners did detect gas and/or CO as a few had their units fixed independently and one reported a finding of gas leaking in their home. This is another area requiring further research; but, it is well known that operating anything which emits pollution in a closed building will cause an ever-increasing level of pollution. Five minutes is not long enough to test. Modern homes are designed to be extremely air tight and exacerbate the problem of a lack of air exchange with fresh air. Given these conditions, NOx will build up more. Whereas CO and other gases will be diluted with air movement, as much as exists; in contrast, liquids and solids released from combustion will aggregate more and more over time. In the cases of liquids which become gases at room temperature and warmer environmental temperatures, then the toxic substances can be released en masse if the house and saturated items are allowed to warm. In one residence, the family experienced severe nervous system effects including loss of mental capacity, loss of recall and short term memory, and other effects when the cooling unit on the HVAC system did not work and the lower floor warmed to 84F and higher. At this time, the family was running the heat at night due to cold nights but needed the cooling during the day. This study shows the probability the heating unit released toxic gases which resided in the home longer term.

Gagnon (1993) provides a succinct summation:

The qualitative global kinetics of thermal NOx formation show that NOx formation rates are exponentially dependent on temperature, and proportional to N2 concentration in the flame, the square root of oxygen (O2) concentration in the flame, and the residence time. Thus, the formation of thermal NOx is affected by four factors: (1) peak temperature, (2) N2 concentration, (3) O2 concentration (or flame stoichiometry), and (4) time of exposure at peak temperature. The emission trends due

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to changes in these factors are fairly consistent for all types of boilers -- an increase in flame temperature, N2 availability, O2 availability, and/or residence time at high temperatures leads to an increase in thermal NOx production regardless of the boiler type.

Given that the turbulators were seen by an HVAC senior staff and a Professional Engineer as glowing orange within one of the units and were bent, mangled, and even burned completely in half for some of them, then the temperatures must have been hot enough to melt metal. Methane may burn at 1950 C, which is high enough to melt metal. As the metal of the heat exchangers was also heated high enough to melt/form tears in the surrounding metal heat exchanger shells, then the flame stoichiometry ranged over the expanse of the “glowing” hot metal parts within the system. Ostensibly the burning area was the size of a large sub/hero sandwich. This wider area would afford a higher mixture of air/oxygen. The supply already has high amounts of N2 (e.g. 5%). As the turbulators warped and mangled they would block airflow and increase the residence time. All of the ingredients appear present in these systems for extreme, exponential increases in NOx.

NOx: Nitric Oxide yields Laughing Gas yields N*O*?

Textbooks list Nitric Oxide as a primary yield of natural gas combustion. They say the Nitric Oxide is not stable and converts into various NOx chemicals. Loffler et al (2004) measured production of Thermal NO, N2O/NO, and NNH as in varying percentages as temperature changes. In their study, N2O/NO is about 44% and NNH about 56% at 800C. By 1400C Thermal NO has risen to about 22% and N2O/NO and NNH have dropped to about 23% and 55% respectively. By 1700C, Thermal NO constitutes about 95% of the measurement. A senior HVAC trainer commented that NOx is just N2O and won’t do anything but make you feel good. Perhaps, for a while, N2O will relax the victim; but, the next days are followed with a sickness reminiscent of a hangover. One visitor who stayed two nights in one of the residences commented she “felt like I was floating in an ocean all night”; and mentioned she had developed a flu when she returned home. This experience was repeated multiple times by one of the homeowners. Oddly, one specific room seemed to be the most prone to the “high” intake. Just 20 feet away in the main area the resident normally experienced fried lungs, if not headaches. It is not clear how the chemicals spread; but, eventually, the house would be entirely filled with the smell after several weeks to a month of running the system. An employee badge sample in one residence determined N2O present at 670 ppb. Note the badge samples have a reporting limit very close to this; so, other badges could well have recorded N2O at high levels but below the sampling limit. An air sample taken at the same time yet analyzed later measured Nitric Oxide as high as 520 ppb, Ammonia as high as 330 ppb, Methane as high as 2.99 ppm, Butane as high as 6.33 ppm, and total hydrocarbons as high as 32.81 ppm. This was after the faulty HVAC unit had been replaced around 9 months earlier. Were the gases latent in the items in the home? Or was the second, attic unit also faulty? Note the N2O and other NOx chemicals may have traded percentages as the air sample sat in a hot garage for a few weeks. Subsequently, the attic unit was analyzed with a NOx study and found to have very little NOx. This study did use a 25-foot intake tube and the measuring equipment sat in a sub-65F area; so, the sampling procedure may have had an effect; but, some changes were made since the prior measurements, and the homeowner felt the house was no longer producing the levels of chemicals to make him sick at that time. Three changes had been made. One, the furniture had been removed. This is an expected reservoir

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of the gases; but, the house had been aired out for months with many fans running 24x7. The furniture had been in the homeowner’s prior residences with no ill effects. Secondly, the upstairs unit had been run a handful of times at 80+F. Thirdly, technicians had examined the heat exchanger of the second system. They had some trouble re-installing it and had to use pliers to adjust something in order to have it inserted properly. Was it never installed properly until that point? #1 seems plausible but the levels measured seem way too high. Molloy et al (2012) found lower levels of these gases in homes they sampled such as NO2 at 8.4ppb and Benzene at 0.4ppb. Geddes et al (2016) determined long-term NO2 levels at 4.9 ppb for Asia Pacific (highest), 4.1 ppb for Western Europe, 0.2 ppb for Caribbean, and 1.6 ppb world-wide. Meier et al (2015) determined similar results of 4.9ppb in homes in Switzerland. Mullen et al (2016) surveyed 352 homes over a long period and conclude ”associations still exist between the presence and the use of some gas appliances and elevated concentrations of CO, NOX, and NO2”. They found the highest interquartile range spanning from about 20ppb to about 40ppb. Comparably with these studies, the levels found in the homes in this study are strongly higher and not due to background levels nor normal use of gas appliances. Since no gas appliances had been used in the home for over a year and the gas water heater was also turned off, then the gases could only have come from a natural gas heating unit. Butane boils at about 31F; so, does not seem probable to have remained in the home over months; but, is it produced from combustion of natural gas? No other sources or equipment were run in the home for about a year where this Butane measurement is quoted; and the samples were taken at the top of the stairs to the second floor; so, one must question where the PPM levels of butane and methane derived. One may also question the analysis as no source of Butane can be determined. Does it derive from faulty combustion of Methane? The MSDS for the supply natural gas does list Propane and Ethane as constituents; but not Butane. Or, perhaps, does the analysis technique list Butane when actually Propane or Ethane match? Methane would also have been a gas so also does not seem probable to have remained in the home. This line of logic suggests than not only was the outdoor unit faulty; but also the second, upstairs unit. This line of logic is supported by reports from 3+ other families who had medical problems which appear related to running their HVAC systems. One of these reported the same odors, “lump in the throat”, extreme fatigue, kids stopping breathing at night and emergency room visits, bloody noses, and other similar symptoms to families having the known-broken outdoor HVAC systems. These three families did not have that same outdoor model but may have the same indoor model, and no investigation has been made as to whether their model line was also broken. Again, someone significantly educated in this subject and having the proper equipment would be able to assert or deny a problem with this model line. Further research is needed. The typical combustion analyzer starts measuring NO at 1,000 ppb, which is about 5 times the highest danger level listed by the EPA for NO2. Obviously, this tool is not useful for a “slow” leak but is generally useful for a smokestack analysis. Even given its inappropriateness, this is the only equipment for NOx owned by HVAC companies, and less than 10% of the companies contacted even had a combustion analyzer! Simply put, HVAC companies lack the equipment and training to even get in the ballpark of identifying these classes of chemical problems. In fact, several broken systems were under annual contracts and were inspected without the cracks/tears being found. Were they really inspected? One HVAC technician was asked to determine if a NOx unit was present and reported it was not. A re-inspection found it was and could be seen from casual inspection by removing one panel – the HVAC technician lacked knowledge of what a NOx unit was! Another senior HVAC technician reported two units as not cracked from simple visual inspection. Later inspection with mechanic’s mirrors and a flashlight revealed multiple tears – one in each heat exchanger clamshell. As another technician put it “I

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have never seen anything like this in 10 years”. The problem of these faulty units is not an everyday occurrence and not one the average HVAC technician is prepared to observe or handle.

Conclusion

Residents with faulty HVAC systems were poisoned by chemicals over a multi-year period. Numerous persons may be able to attribute current and future medical injury to the faulty products. The damage from chemicals was recognized by health professionals but the exact chemicals involved proved elusive. A quiver of observations and test results allows narrowing down the candidate chemicals. Prior studies lead to a serious consideration of NOx, and specifically Nitric Oxide and Nitrogen Dioxide. Further analysis for this study also identified HCN, hydrogen cyanide. Ironically, the air quality technician may have been on the right path when he tested an insulation material for isocyanate; but, unfortunately, his air testing did not include HCN, was performed at 68F, and was not performed with the heat running (Bali, 2015). He did identify various “unknown hydrocarbons” at 13ppb in one resident and 21 ppb in another. His analysis does include “isophorone diisocyanate” but this also would not be gathered using the testing procedure engaged as the samples were taken at 68F but the boiling point is 316F and no samples were taken with the heat running anyway. Other chemicals may well be involved; but the levels of NO2 were dangerous and the observations and other data match NO2 exactly. Initial test results record the indoor environments remain dangerous for some time after the faulty units are discontinued. The injuries to the residents needs to be properly compiled. The long term effects to the residents are frightening based on studies cited. An important finding is that in cases of Carbon Monoxide poisoning, the forensics experts may be able to use measurement of NO2 in air and possibly NO2, HCN, N2O5, Nitric acid or a related measurement for surfaces to establish the past presence of faulty equipment. In multiple instances of this study the HVAC company and manufacturer actively removed evidence and withheld information to prevent implicating themselves in these poisonings. It is a sad editorial of our society that they are willing and allowed to do this with no recompense. The wider implication is the EPA and other government agencies need in depth training internally and need to establish thorough training programs for the public and practitioners about this potentially wide-spread risk. Various studies found outlier cases where NO2 was in the unhealthy range. In this study, the levels were in the “very unhealthy” range. The incapability of standard combustion analyzers to detect these levels and the lack of knowledge of air quality testers, HVAC technicians, and others imply this latent health hazard will continue to slowly destroy lives and health until the proper scientific work is done to quantify it and expand the knowledge base.

Poor Man’s Test A homeowner could assess their situation based on the presence of symptoms and smell. Various persons in this study made statements such as “that explains why my one year old is always sick and throwing up”, “I always take a nap in the middle of the day”, [I’m always so tired after moving here, my gums have been bleeding, I have headaches and my doctor prescribed vitamin D], “we’ve made multiple emergency room visits for my kids stopping breathing at night”, “I’m having trouble recalling things”, “I keep dropping things”, “so tired I can’t get my head off the pillow”, “what is this strange rash” on a young girl’s arms and torso, “kids appeared to have pink eye but nobody else in their classes did and the clinic did not confirm it with a test”, “we wake up in the night and cannot go back to sleep”, et cetera. Sick after exercise either immediately if very toxic or that night if less toxic. Better if out of the home Draft. Subject to change. 27

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for several days (but note will become sick if exercise). If a homeowner has strange, non-abating symptoms that a doctor cannot resolve or possibly cannot even identify then the homeowner may consider investigating their home. If the home has a smell on a continual basis then they can investigate the smell and its relationship to symptoms. Step one is to cool the house to 68F for a day and note the smell. Then warm the house to 74F for a day and note the smell. Finally, allow the house to warm to 85F or higher on a hot summer day and note the smell. To properly assess the related symptoms, then these will need to be staggered by at least a week and preferably as much as a month. The cool house should not possess the smell of NO2, obviously. The second test may possess the smell of NO2. As documented in this study, the smell at this temperature is unique and attractive. The third test could possess the smell of HCN. As documented in this study is different than the others, not petroleum-like, and also unique. After each test the person should document their symptoms over a 94 hours period. Specifically they should document felt oxygen levels and ability to exercise, healthy/sick feeling, any vertigo, sleep pattern, eating pattern, stool odor changes, chest pains, and any other symptoms which are not average to them. Doing so and comparing to notes in this study will help ascertain the level of chemical exposure they have experienced. Obviously, a person living in this environment long term would have experienced many of the symptoms herein; but, some symptoms such as tinnitus were more severe in some victims, vomiting was prevalent among young children but not adults, yet fatigue and mental challenges were common among most long term victims, if not consciously identified as such.

Afterward

A civil society expects expertise from hired contractors. Residents in this study found the opposite. Simple examples include persons who had their HVAC systems on annual inspection but the cracked heat exchangers were missed. One contractor was hired to check for a turbulator (NOx unit) and opened the unit and look and said there was none. Once the homeowner knew what it was he had the unit rechecked and one was there, as plain as day. Another contractor checked many units and found many cracked heat exchangers but said three were not. Upon further inspection, all were cracked – the cracks were down on the side and not obvious from viewing from the top. It was found some HVAC techs would use their cell phones as a camera and declare units fine. The location of many of the cracks was below a bulge and in a one-inch space where it would be impossible to video or photograph them with a cell phone. Telescoping mechanics mirrors and a strong flashlight were necessary to find these. These are just the tip of the iceberg. A large, recommended air quality company was hired early on to find the problem. They did extensive, costly testing. They did no testing with the heat running and no testing for combustion chemicals; even though the tester said “its as if you spray gas all over your house every day” (Bali, 2015). They did do soil sample testing and material testing as well. They tested air samples using a list provided by the EPA which is called the TO-15 list. Its about 20 years out of date; but remains the standard used by air quality companies. Several chemicals on the TO-15 have been illegal for new installations for one, two, or more decades. The EPA has stated they do not recommend its use (Milhollen, 2017); but it is the standard they have published and is the absolute standard used by air quality companies. Several of the chemicals are out of date and others simply would never be detected with the methodology used. Other serious flaws in the sampling process existed as well. These are simple examples. After being paid a large sum to find out what was wrong with one residence, then the air quality company went to work for the builder and a report was produced concluding nothing was wrong. The report was based on the TO-15 sampling in 343 places (LeBlanc 2015). The report

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concluded no problems were found. Logically, if 343 families have asked for help and the test being used is never determining a problem then another test is needed. The testing approach is garbage logically and scientifically; but perhaps the company is more focused on profits and a “passing” test than actually determining causes. Many, many, many more examples of ignorance and non-expertise can be quoted from the residents. For example, the builder’s insurance company investigator initially determined nothing was wrong without even visiting the house. Months later an investigator visited the house but did not even investigate the HVAC unit although the panel behind which the faulty part could be seen could be removed with two screws. He also concluded nothing was wrong but the insurance company refused to share his report. The summary point is America is not overflowing with experts in chemical exposure or chemical detection and the persons engaged in HVAC repair and maintenance, in air quality sampling, and even insurance company investigators do not have training in chemistry and other fundamental fields.

Bad Science Several factoids permeate society and the minds of persons engaged. These factoids are related to past science but became general assumptions which are not based on science or facts. One recurrent factoid is “it just floats away”. A revision on this is the maxim “dilution is the solution to pollution”. For example, “ventilation can also remove or dilute VOC’s to acceptable levels” (Lipton, 2015). Numerous HVAC techs, government employees, and others sang this worn out auld lang syne. In fact, a product trademarked as Freon used to be used in AC systems but began phase-out in 1987. Contemporary advertisements from HVAC companies still refer to Freon, though the proper term is “refrigerant”. The original “Freon” formula may be a chemical which may have in fact “just floated away”. The modern refrigerant used in AC systems, R-410A, actually is studied for ground aggregation in contrast. The mix of chemicals from burning the mix of chemicals from natural gas supply includes some chemicals which float away and many which do not. Similarly, “dilution” is a nonsensical concept when pollution is ongoing and the pollutants are aggregating. The statement “dilution is the solution to pollution” is equivalent to saying “no pollution is no pollution”. Put another way, the NC State Department of Epidemiology advised one family to just open their windows. This doesn’t work when the outside temperature is freezing; but, shows the utter lack of scientific investigation present in government. Another common factoid is Carbon Monoxide is the only dangerous chemical from natural gas combustion. This has no bearing in science but also has a historical genesis. Various incantations of this factoid exist such as a combustion analysis expert from UCLA who “only focuses on carbon monoxide” and a renowned doctor who also covers only carbon monoxide (but, to be honest, was the person who opened up the lead to NOx). Societally, everyone is familiar with people dying from carbon monoxide. Consequently, in a court of law, the carbon monoxide argument is convincing. The general public has zero idea of other chemicals from combustion. For instance, one detective stated to one resident “so you have problems with carbon dioxide” and the law firm for an involved builder retorted to a request for help “no elevated level of carbon dioxide in the … home”. The utter lack of knowledge of chemistry is astounding and speaks volumes for the level of education present in the USA. The sheer acceptance of ridiculous statements by the State Attorney General and others speaks volumes about the level of accuracy expected, even in accused attempted murder charges. The defending company can simply reply with nonsensical statements and then the charge be dismissed. More importantly, from the scientific viewpoint, studies quoted herein reveal Carbon Monoxide is not a reference chemical for all combustion byproducts. The percentages of chemicals produced vary due to several variables. The long-held concept the CO will kill you before anything else is based on one specific scenario of a broken exhaust system

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and a burn which produces high levels of CO. In contrast, long term release of chemicals logically will result in gases such as CO floating away but solids and liquids aggregating, as evidenced in this study. A third common factoid persists despite many decades of elementary education. This factoid is the idea a family can “keep passing the flu around” and kids can keep catching a flu. This factoid seems ridiculous given the fourth grade education on viruses. Numerous families thought their toddlers just had a flu which never went away. This mentality is reinforced by a medical community heavily focused on promoting flu shots and on health clinics who are quick to diagnose conditions as flus and give zero consideration other possibilities such as chemical poisoning. A fourth example of “bad science” is the tools used by HVAC companies. While these companies are the first line of defense against poisoning, the majority of HVAC companies lacked combustion testing equipment and those with equipment would only realistically be able to measure carbon monoxide (in addition to oxygen et al). The detection limits started at 1,000ppb for NOx and had a wide variance. The gas companies and HVAC companies claim to offer services to detect problems but apparently only possess tools to detect streaming leaks. They do NOT have tools to detect ambient presence of gases, for instance. One example is the AC leak detector possessed by most HVAC techs. It is auto-zeroing every second; so, can only detect a case where gas is streaming from a hole. This is apparently the same sort of equipment possessed by gas company technicians. In fact, it was observed in air samples analyzed in a lab that methane and butane were both above the detection threshold of the gas company’s equipment; but, the gas company technician never notified the homeowner of the background levels of gas in their home. Simply put, the HVAC technicians and the gas company technicians purport to offer a level of safety but actually are vastly undertrained. A similar conclusion can be made about the Fire Department but they openly inform the homeowner they are not a testing organization and are just there to rescue anyone in obvious peril. Still, it would appear a civil society would have some organization responsible for rescuing people from ongoing poisoning. A final challenge is the appropriate conditions for measurement. Heimbinder (2017) said measurement of particles is affected by various conditions and HabitatMap normalizes data on the server. He said temperature can affect NO2 measurements. Milhollen (2017) recounted an expert and said “Tedlar bags are widely known to be inaccurate. The detection limit, which only some of the samples reached, is the limit at which the compound in the air can be plus or minus 100%, meaning all of these samples could be false positives. This method of air sampling is not encouraged by the EPA because these bags have a variety of other problems.” The implications are obvious. 100% lower is still in the “unhealthy” range and about twice the permitted background level whereas 100% higher is off the chart unhealthy based on the EPA guidance. The reality is probably neither of these two claims against measurement of NO2.

Government Assistance One doctor recommended to one homeowner to contact the EPA. An employee of the EPA recommended to the same homeowner to contact a doctor. A viscous circle of non-help. The EPA website directs the citizen to their state division of air quality. The NC Division of Air Quality explained it does not measure pollution on public roadways and stated the only way they would come take an air sample is if a company had a license to pollute. When further pressed to come due to the obvious ambient pollution, they refused. When further asked what if a company is polluting without a license, they still stated they would not come take an air sample on public road or property (Mather, 2017). This resounds with statements from Heimbinder (2017) during a Q&A period. He was asked what government entity HabitatMap has used to report pollution problems found from crowd-sourcing and Draft. Subject to change. 30

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responded there is none. His response was the crowd was able to document the pollution and then use news and other efforts to engage companies into fixing the problems. A long, frustrating list of government employees refused to help. They exhibited many, many ways to effectively say “its not my job”. Other than the pass-the-buck routine as above and in many other cases, a common response is “we are not legislated to do that”. What does this mean? What law prevents you from helping if families are being poisoned on an ongoing basis and you have the tools to help determine the problem? A few employees would show sparks of hope to help the families but then be thoroughly squelched by their supervisors. One example is a local police detective who said he could engage university students to study the chemicals; but later retreated to saying “there is not enough evidence” after speaking to his Chief of Police. This of course is an oxymoronic statement: a detective saying he cannot investigate because there is not enough evidence?! Just one more example of “its not my job”. Similarly, a congressional inquiry was filed with the EPA for help; but, they would not do any testing or even interview the victims. Ironically, the area of this study is a mere 20-30 minutes from one of the largest EPA installations in the country. Without doing any decent inquiry, the EPA responded with platitudes and clear statements of no effort to investigate (Kolb 2017): “encourage you to continue to consult a health care professional with experience in environmental medicine and environmental exposures“ as if the families had not already done so and even seen countless doctors. A simple question to the persons filing the inquiry would have told the EPA this; but, they responded without even asking basic questions. “Whether a person reacts to a pollutant depends on individual sensitivity as well as several other factors, including age and pre-existing medical conditions.” Frustrating, to say the least.. Numerous families were very sick and all of them had the faulty systems with cracked heat exchangers. In fact, at the time of the inquiry an EPA employee could have been guided from house to house to both see the faulty equipment, speak with the families, and even smell the chemicals for themselves. In stark contrast, chemical poisoning is probably not dependent on individual sensitivity other than on levels of past exposure. “The experts I consulted had not encountered the experience you describe of indoor air and surface contamination from a faulty heat exchanger” Another idiotic statement given the EPA has published at least one health safety flyer on NO2 and NO2 is a liquid below 70F. How stupid does the EPA think the public is? Or is it just the persons assigned to respond to a Congressional Inquiry. Unfortunately, a Congressional Inquiry is a one-shot deal. Once the EPA responds then the citizen has no recourse. Certainly the EPA has people educated in faulty combustion since the EPA has published many papers as referenced herein. Another EPA employee stated the EPA has no responsibility for indoor air quality (Milhollin 2017). Why then does the EPA have a “Radiation and Indoor Air Environments Division” and numerous publications including an entire web microsite entitled “Indoor Air Quality (IAQ)”? She further stated “the EPA has no regulations regarding heat exchangers in a residence“ which is a subtle but nefarious misdirection. The laws empowering the EPA are related to chemicals. Whether the chemicals are released from a residential HVAC unit or from a factory smokestack, the EPA is still responsible to govern. The point of exposing these two staff of the EPA is to point out government employees will make unfounded claims to avoid work, even when lives and safety are at risk. The EPA is certainly the largest government department outside of the military; but in no way unique. Other agencies also responded with platitudes (“things affect our families they are important issues”) but no investigation and echoing claims they are not responsible. Passing the buck to the state level was commonplace as well and no less than four federal agencies took that approach and at least one local agency. That agency, the Department of Health refused to come observe and take a report, though the site was about 20 minutes

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from their office (Lipton, 2015). This list can go on for pages and can also include many healthcare professionals such as one who did a brain scan on a victim but who’s office later refused to schedule a repeat visit once the victim had identified the cause as chemical. The EPA was chosen as it was a common refrain from many people as an organization people thought would help. The EPA was asked how to test, what chemicals could come from combustion, and even filed with a Congressional Inquiry but refused to provide any useful information; so, they sum up the general civil support for persons exposed to chemicals. The belief anyone in government will help diagnose a dangerous chemical pollutant is naïve. What the government will do is add things to a database once several people have died and things have gone through court. The case of the Best Western in Boone, NC where multiple families had to die before any investigation was done provide a clear example (Robinson 2014). In that case, the emergency professionals, police, and others had also failed to diagnose the cause of two deaths in the prior incident and are guilty of the death of a child due to their ignorance and lack of investigation. The same can be said of the many, many, many government employees, insurance company adjusters, and others who failed to perform valid scientific inquiry in the cases in this study. Tragically, the case study here is not pertaining to one hotel but to numerous homes where people are actively being poisoned – possibly thousands or more. The builder, insurance company adjusters, and HVAC companies have a financial motivation to conclude wrongly; but, the lack of support from government entities is perplexing and stupefying. As of this writing, the CPSC is the only agency at the local, country, state, or federal level who might possibly be investigating; but, given they have not even come to perform any chemical samples or testing of the faulty equipment, then it does not appear even they are investigating. It is the intent of this paper to expand the knowledge in this area so future victims may be rescued sooner and further injury avoided. That the builder, insurance company, HVAC contractors, HVAC manufacturer, and so many employees of government refuse to perform proper investigation makes them responsible for the future injuries which are certain to happen and are ongoing. This case study is neither complete nor sufficient. Numerous men, women, and children have been and are being affected. To date, no researcher is engaged in tracking this travesty and nobody is investigating how widespread the problem is outside of the 20 homes identified for this study. Inquiries are welcomed.

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References

ADM Associates (2010). Manufactured Housing Fuel Switching : Field Test Study. Manufactured Housing Research Alliance. 220 West 93rd Street; New York, NY 10025. info@research-alliance.com.

Al-Ahmad, Khalid and Ali Al-Zahrani (2013). NO2 and Cancer Incidence in Saudi Arabia. International Journal of Environmental Research and Public Health. ISSN 1660-4601.

Bali, R. (June 2015). Air Quality Study using the TO-15 list with AC Running after house was aired out for two weeks. EI Group.

ConSpec (2017). Nitrogen Dioxide. Retrieved online at: http://www.conspec-controls.com/products/nitrogen-dioxide-gas-detector.asp.

Engleman V.S., and W. Bartok (1976). Mechanism and Kinetics of the Formation of NOx and Other Combustion Pollutants. Phase I : Unmodified Combustion. Exxon Research and Engineering, EPA Project Officer: W. Steven Lanier. EPA-600/7-76-009a.

Engineering Toolbox (2017). Stoichiometric Combustion. Retrieved online at: http://www.engineeringtoolbox.com/stoichiometric-combustion-d_399.html

Enthalpy Analytical, Inc, EPA (2011). Other Test Method 29 – Sampling and Analysis for Hydrogen Cyanide Emissions from Stationary Sources . EPA-OTM29. Retrieved online at: https://www3.epa.gov/ttnemc01/prelim/otm29.pdf

EPA (2010). Air Quality Guide for Nitrogen Dioxide. EPA-456/F-11-003. Retrieved online at: https://www3.epa.gov/airnow/no2.pdf

Flagan, RC. (1988). Combustion Fundamentals. Textbook. Retrieved online at: http://authors.library.caltech.edu/25069/4/AirPollution88-Ch2.pdf.

Gagnon, Alice, Acurex Environmental Corporation, Edward Aui & Associates, E.H. Pechan and Associates (1993). Emission Factor Documentation for AP-42 Section 1.5 Liquefied Petroleum Gas Combustion. Office of Air Quality Planning and Standards, Environmental Protection Agency. Retrieved online at: https://www3.epa.gov/ttnchie1/ap42/ch01/bgdocs/b01s05.pdf

Geddes, Jeffrey A., Randall V. Martin, Brian L. Boys, and Aaron van Donkelaar (2016). Long-Term Trends Worldwide in Ambient NO2 Concentrations Inferred from Satellite Observations. Environmental Health Perspectives. Volume 124. Number 3. March 2016.

Goldberg, Mark S., France Labrèche, Scott Weichenthal, Eric Lavigne, Marie-France Valois, Marianne Hatzopoulou, Keith Van Ryswyk, Maryam Shekarrizfard, Paul J. Villeneuve, Daniel Crouse, Marie-Élise Parent (2017). The association between the incidence of postmenopausal breast cancer and concentrations at street-level of nitrogen dioxide and ultrafine particles. Environmental Research. 158 (2017) 7-15.

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DEATH BY NOX. A CASE STUDY OF RESIDENTS WITH FAULTY HVAC UNITS 34

Heimbinder, Michael (2017). How Citizen Science is Being Used to Characterize Exposures and Improve Public Health. Habitatmap.org. NIEHS Exposome Webinar Series. Information online at: https://tools.niehs.nih.gov/conference/exposome_webinar/

Heywood, J. (1988). Internal Combustion Engine Fundamentals. McGraw-Hill: New York, 1988.

Honeywell (1997). Material Safety Data Sheet : R-410A (Honeywell AZ-20). Honeywell. No.U-1690E-07; Honeywell Japan, Inc.

Jerzak, Wojciech, Monika Kuznia , Monika Zajemsk (2014). The effect of adding CO2 to the axis of natural gas combustion flames on CO and NOx concentrations in the combustion chamber. Journal of Power Technologies 94 (3) (2014) 202–210

Kolb, Laura. (2017). re: response to indoor air quality inquiry (send by Laura Kolb on behalf of Lareen Burton).. Science Direct. Fuel 85 (2006) 513–523

Lamphier, Jeremy. (2016). Phone discussion of chemical smell returning and family becoming sick upon entry. Regional technician or support person. Lennox Industries International.

Lipton, David. (2015). Email : volatile organic compounds in your home. Industrial Hygiene Consultant. N.C. Occupational and Environmental Epidemiology. Department of Health

and Human Services.

LeBlanc, Gerald A., Preliminary Evaluation of the EI Industrial Hygiene Environmental Quality Study.Prepared for Roger Bernholz, Coldwell Banker Howard Perry & Watson.

Loffler, G., R.Sieber, M.Harasek , H.Hofbauer , R.Hauss , J. Landauf. (2005). NOx formation in natural gas combustion—a new simplified reaction scheme for CFD calculations. Science Direct. Fuel 85 (2006) 513–523

Mather, Tom (2017). Phone calls and Email : Assistance with Nitrous Oxide Pollutant. Public Information Officer, Office of Public Affairs – Division of Air Quality, North Carolina Department of Environmental Quality.

Molloy, S.B., M. Cheng, I.E. Galbally, M.D. Keywood, S.J. Lawson, J.C. Powell, R. Gillett, E. Dunne, P.W. Selleck (2012). Indoor air quality in typical temperate zone Australian dwellings. Atmospheric Environment. Volume 54, July 2012, Pages 400-407.

Draft. Subject to change. 34

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Mullen NA, Li J, Russell ML, Spears M, Less BD, Singer BC. (2016). Results of the California Healthy Homes Indoor Air Quality Study of 2011–2013: impact of natural gas appliances on air pollutant concentrations. Indoor Air, ISSN: 1600-0668, 2016 Apr; Vol. 26 (2), pp. 231-45; Publisher: Blackwell; PMID: 25647016, Database: MEDLINE Complete.

Olsen, Daniel B., Morgan Kohls, Gregg Arney (2010). Impact of Oxidation Catalysts on Exhaust NO2/NOx Ratio from Lean-Burn Natural Gas Engines. Journal of the Air & Waste Management Association (Air & Waste Management Association). Jul2010, Vol. 60 Issue 7, p867-87.

daniel.olsen@colostate.edu

Ophardt, Charles E. (2003). Combustion of Fossil Fuels. Virtual ChemBook. Elmhurst College. Retrieved online at: http://chemistry.elmhurst.edu/vchembook/511natgascombust.html

Pederson, Marie et al (2017). Ambient air pollution and primary liver cancer incidence in four European cohorts within the ESCAPE project. Environmental Research. Volume 154. April 2017. Pages 226-233.

Poozesh, S., N. Akafuah, and K. Saito (2015). NO Formation Analysis of Turbulent Non-Premixed Coasial Methane/Air Diffusion Flame. Int. J. Environ. Sci. Technol. (2016) 13:513–518

Robinson, Kelley (2014). Poison Hotel : Mother Speaks for First Time Since Son’s Death. ABC News. Available online at: http://abcnews.go.com/US/north-carolina-best-western-room-225-open-deaths/story?id=21564280.

PubChem (2017). Compound Search. National Institutes of Health. Available online at: https://pubchem.ncbi.nlm.nih.gov/.

RDH Environmental Consulting (2016). Email from Robert Hill containing MSDS for gas supply.

Reto Meier et al (2015). Differences in indoor versus outdoor concentrations of ultrafine particles, PM2.5, PM absorbance and NO2 in Swiss homes. Journal of Exposure Science and Environmental Epidemiology. 25. 499-505.

Ruth, Jon H. (1986). Odor Thresholds and Irritation Levels of Several Chemical Substances : A Review. Wasau Insurance Companies. San Francisco, CA.

Wang, Xu, Feng-Yang Bai, Yan-Qiu Sun, Rong-Shun Wang, Xiu-Mei Pan, and Fu-Ming Tao (2016). Theoretical Study of the Gaseous Hydrolysis of NO2 in the Presense of NH3 as a Source of Atmospheric HONO. Environ. Chem. 2016, 13, 611–622. Csiro Publishing.

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