One day in October 2011, as Rob Purdie was working in his yard in Bakersfield, he took what he calls "the wrong breath." Nearly a decade later, he still feels the effects of the disease he contracted by inhaling tiny fungal spores: Valley fever.

Valley fever is just one name for coccidioidomycosis, a disease caused by inhaling so-called "fugitive dust" that contains spores of the fungus Coccidioides. Cocci is highly endemic to Kern County, California, where Bakersfield is located, and case numbers have been on the rise there for years.

As climate change heats up and dries out the West, the endemic area is also expanding, and could eventually reach as far as Canada. Some jobs carry greater risks — solar farms, military bases, prisons and freeway construction sites have all had significant Valley fever outbreaks — but anyone who takes a breath outdoors in an endemic area can contract the disease. In the midst of the much more widespread COVID-19 pandemic, activists are still spreading awareness of Valley fever and demanding better protections for workers.

For many years before the 1990s, the average number of Valley fever cases in Kern County hovered around 250. "Now we’re at 10 times that number," said Royce Johnson, medical director at the Valley Fever Institute at Kern Health, "so clearly something’s changed."

"I’d heard of Valley fever, but I didn’t associate it with me being at risk for it, even after living all my life in Bakersfield," said Purdie.

After the former life insurance salesman first felt the disease’s effects in the form of a pounding headache on New Year’s Day in 2012, he went to urgent care and received his first misdiagnosis: a sinus infection.

Several rounds of antibiotics later, Purdie’s headaches kept getting worse and he decided to see an ear, nose and throat doctor. "I got out of bed, went to that ENT doctor’s appointment, came back home, got back in bed, and didn’t do anything else," he said. "Being outdoors in the light was too much."

"If somebody had handed me heroin I probably would have tried heroin," Purdie said. "It was that bad."

A month later, Purdie was looking at a Powerpoint at work when he started seeing double. At Kern Medical, doctors finally realized that Valley fever was causing a buildup of pressure in his spine and performed a lumbar puncture. "My wife thought I was gonna die that night," he said.

Purdie spent six weeks in the hospital and began a rigorous course of medication, starting with the antifungal fluconazole, which caused side effects, including painfully, persistently chapped lips. "I tried everything on my lips except 30-weight Pennzoil," he said.

Eventually he moved on to amphotericin, nicknamed "amphoterrible," which he still takes every 10 weeks intrathecally, through a port on his head. As tough as the treatments were, Purdie knew how lucky he was to have them. "Everybody that had what I had prior to the 1950s died within two years," he said.

Valley fever is already endemic to areas beyond California’s San Joaquin Valley, its namesake.

Anna Hodes, a former U.S. Army soldier, began to have difficulty breathing soon after being assigned to Fort Huachuca in the Sonoran desert of Arizona. "I thought I was just having difficulty acclimating to the altitude," said Hodes, who uses they/them pronouns.

Hodes had respiratory issues for months before starting fluconazole and developed lung granulomas that still hinder their lung capacity, so they need to use an inhaler often. They now live in their hometown of San Diego and fear the consequences of the climate and COVID crises on their compromised respiratory system.

"I have a really distinct memory of not being able to take a full breath and how panicked that made me feel," Hodes said. "I really have this fear of catching COVID and re-experiencing that."

Not only could the effects of COVID-19 be disastrous for someone like Hodes, low air quality caused by wildfires compounded the issue. They say they have been reaching for their inhaler more often than ever during this record-breaking fire season.

Ample evidence suggests climate change, which is responsible for worsening wildfires, will also spur a broader reckoning with Valley fever, a disease that remains nearly unknown in much of the country.

UC Irvine researcher Morgan Gorris compared temperature and precipitation levels in counties across the United States and found that in the next century, a vast swath of the country will become hospitable to coccidioides. Extending far beyond its current range in the Southwest, the fungus could become endemic to areas as far away as Washington, Montana, the Dakotas, and Nebraska. "That’s really driven by increasing temperatures causing areas to become more suitable for the fungus to live," Gorris explained.

At the moment, it's hard to prove that the sporadic cases of Valley fever that crop up in other parts of the country are due to anything other than travel to endemic areas. But as inland states get hotter and drier, Gorris said, "it could catch people off guard."

"If you’re living in an area where you just have never learned about Valley fever, and your doctors and health care providers aren’t expecting the disease," she pointed out, "it could lead to complications with diagnosis and getting the appropriate treatment."

Droughts and wildfires, two of the most stark indicators of climate change in California, could spread and worsen Valley fever.

"There’s a number of reasons why drought and wildfires can make Valley fever worse," said Dharshani Pearson, a research scientist at California’s Office of Environmental Health Hazard Assessment. "When soil is very dry as caused by drought, the spores can be picked up along dust storms and spread around and people can breathe those spores in."

As for wildfires, Pearson says a vital component of forest management can also threaten to spread cocci. "We have firefighters coming in removing brush," Pearson said. "They’re digging the firebreaks, and so that disturbs the soil and that can release the pathogen into the soil."

The same Santa Ana winds that notoriously fan the flames of wildfires can also whip clouds of dust around and disperse coccidioides spores into communities.

"This has only been getting really bad in the last decade or so," Pearson said, "so there’s something going on."

Besides climate change, population shifts also contribute to higher rates of Valley fever. As California’s major coastal cities get more expensive, many people who have never been exposed to the fungus, and thus are at greater risk of severe illness, are moving into dusty, less developed parts of the state.

"People are moving out of Los Angeles proper and into the Antelope Valley," Pearson explained. "This population that’s moving in is immunologically naive to Valley fever. I don’t even know if they know about it."

Awareness of Valley fever is exactly the point for activists like Julie Solis, a candidate for the State Assembly in California’s 34th District, which includes Bakersfield. She began crusading for more funding and attention to Valley fever after a firsthand experience with the disease.

Her husband Juan Solis had a good construction job, and the family owned a home on the south side of Bakersfield. When Juan developed a fever that persisted for days, and then weeks on end, no doctors seemed to know what was going on. Solis would find a different urgent care on Google Maps every few days and bring Juan there, hoping for a new answer. Finally, a lumbar puncture in the ER revealed the same thing it did for Rob Purdie: Juan had contracted coccidioidomycosis.

Juan’s illness and treatment completely upended the family’s financial stability. "We’re renters again," Solis said.

After several years as an activist, Solis wants to break into Kern County politics, which have long been dominated by Republicans whom she says fail to accept the financial responsibility of fighting climate change and protecting workers from Valley fever.

Solis’s opponent in the state assembly race, Republican incumbent Vince Fong, worked with Rep. Kevin McCarthy in 2018 to introduce legislation aimed at finding a cure for Valley fever. But Solis says lawmakers must focus on prevention.

Solis said she hopes other states "learn from our mistakes" and start paying attention to Valley fever before it becomes endemic to their region.

Eight years after first breathing in cocci spores, Rob Purdie also began getting involved with Valley fever activism. Last year, he attended a Valley fever walk in downtown Bakersfield, which he said was under-attended, and got motivated to do something about it. He started contacting legislators working on a bill that would guarantee stronger protections against and education about Valley fever for California workers, and eventually drove to Sacramento to speak to lawmakers on behalf of the bill, a version of which was eventually signed by the governor.

"It’s not something I ever wanted to do," Purdie told me. "I do it because it needs to be done."

Purdie met Royce Johnson at an NIH event, and Johnson offered him a job at the Valley Fever Institute, where he’s now the patient and program development coordinator. The disease transformed his career, but not before wreaking havoc on his health and personal hobbies.

Outdoor activities like the yard work Purdie was doing the day he contracted Valley fever are a thing of the past. "I enjoyed being outdoors, I liked to be able to go hunting, or fishing, or camping," he said. "Most of that stuff is off limits."