Time to heed warnings on 'silent killer'

It is called the "silent killer" because it is colourless, odourless, tasteless and non- irritating. Yet, if not caught early carbon monoxide - from heaters and other appliances - can be deadly.

More people die from carbon monoxide exposure than any other kind of poisoning but LJMU research shows that people are often not listened to or believed when they have been exposed to CO.

A conference in Liverpool on 3 July will explore the important work taking place at LJMU researching the lived experience of carbon monoxide exposure survivors.

We spoke to Dr Julie Connolly, an environmental health expert in the School of Public and Allied Health who is co-organising the event with the CO Research Trust, and asked her why up to 4,000 people a year are hospitalised by these poisonings.

Firstly, where does CO come from?

Indoors, CO comes from appliances which burn fuels such as wood, oil, natural gas, propane, kerosene, coal and gasoline.

So people are exposed just by living their lives normally?

Yes. Traffic is a big one too. A car exhaust will produce almost 600 lbs of CO over a year, which is why turning off your engine when stationary or at traffic lights is important for public health. People living in temporary accommodation (caravans, trailers, boats, tents, etc) are more exposed and the numbers here are growing as the financial situation worsens. People who use BBQs, generators, engines, wood fires or wood burners, or coal or any open fire can be added to the list as can those who have adjoining neighbours with a CO leak because it comes through walls. People are also at risk doing DIY - sealant gives off CO as it's drying, for example, and a couple died on holiday when the room next door to them was treated for bedbugs, as the chemicals used gave off CO as a by-product.

A large proportion of the public can be affected then?

Yes. There is consensus that the 4,000 hospitalised each year and 50-60 deaths isn't reflective of the numbers affected. Most people think of CO exposure as being a chance-in-a-million event that probably won't happen, if they think of CO at all. They think that the amount a person is exposed to has to be high to be damaging and that if someone is exposed to CO, they will completely recover. Neither scenario is true. Lower levels can impact health substantially. As CO is toxic to all cells in the body, the damage caused can be lasting. This covers a wide range of symptoms; physical, cognitive, mental and emotional harm can occur and be lasting, even permanent.

And your research suggests that CO poisoning is hard to prove?

Yes, one of the issues is proof. If a CO alarm is triggered, on phoning the National Gas Helpline, or 999, the advice would likely be to open the windows and vacate the property. This means that the levels have gone down in the property. There is only one reliable biomarker, COHb, and this dissipates very quickly when the person is away from the CO source. Another issue is that in a lower-level exposure, the person might just feel generally unwell and ascribe this to any manner of things. People can often underplay these issues too; if you get a headache, you'll probably take a painkiller and then try and just forget about it.

There's a general lack of awareness around this, isn't there?

Yes, even among healthcare providers. Concerns can be readily dismissed as 'something else', particularly when complexities such as poverty, power dynamics, and existing, common conditions and behaviours, etc., etc., are part of the mix.

So what is your public health message?

First, get all of your gas appliances serviced (not just checked) by an engineer with Gas Safe Registration. Have a monitor and audible alarm on each level of your home. Educate yourself on potential CO hazards and risks. CO exposure is preventable.

What more are you doing, apart from the conference?

The CO 'community' is active - there is a CO Research Trust, a new data platform, and various charities, Gas Distribution Network members (e.g. Cadent), the Gas Safe Register, and technological companies involved. We also have an All-Party Parliamentary Group and support from some MPs.

- Making Sense of Carbon Monoxide Exposure: the lived experience of survivors and understanding the experience of underserved communities will be hosted at LJMU on Wednesday 3 July, 10.30am to 4pm. Register online.

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