Texas enabled the worst carbon monoxide poisoning catastrophe in recent U.S. history

A family used their car to stay warm when a storm brought down the Texas power grid. In a state that doesn’t require CO alarms

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When Shalemu Bekele awoke on the morning of Feb. 15, the townhouse he shared with his wife and two children was so cold, his fingers felt numb.

After bundling up in extra layers, Bekele looked out a frosted window: A winter storm had swept across Texas, knocking out power to millions of homes, including his own, and blanketing Houston in a thin layer of icy snow.

“It was beautiful,” Bekele, 51, recalled thinking as he headed outside to snap photos of his two children, ages 7 and 8, playing in their first snow. After a few minutes, he sent them back inside to warm up under blankets as he cleared ice off his car, unsure if he would be expected to drive into work.

Shalemu Bekele's children, Beimnet, left, and Rakeb enjoy the snow on the morning of Feb. 15.

Shalemu Bekele's children, Beimnet, left, and Rakeb enjoy the snow on the morning of Feb. 15.Shalemu Bekele

Bekele’s wife, Etenesh Mersha, 46, meanwhile, made a fateful decision, one repeated by scores of Texas residents who lost electricity that week. Desperate to warm up, she went into their attached garage and turned the key to start her car. As the engine hummed, it provided power to run the car’s heater and charge her phone while she talked to a friend in Colorado — at the same time, filling her garage and home with a poisonous gas.

There was no carbon monoxide alarm in place to warn the family of the invisible danger. None was required under local or state law.

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When Bekele went back inside 30 minutes later, he found Mersha slumped over in the driver’s seat, poisoned by the fumes flowing from the car’s tailpipe. Confused, he shook her and called her name. Still on the line, the friend in Colorado pleaded over the car’s speakers for someone to explain what was happening.

Not knowing what else to do, Bekele, a devout Christian, ran and grabbed holy water from inside and splashed it on his wife’s face, as his children cried and shouted: “What’s wrong with Mama? What’s happening?”

That’s when Mersha vomited. Suddenly starting to feel ill himself, Bekele wondered if they’d all been sickened by the eggs he’d made for breakfast. Panicked, he sent the kids inside to grab towels to clean up their mother. Before they could return, both children collapsed onto the floor inside.

Bekele fainted next, landing with a thud on the garage’s concrete floor as the car continued to run.

Shalemu Bekele during an interview at his church in Houston.

Shalemu Bekele during an interview at his church in Houston.Annie Mulligan / for NBC News / ProPublica / The Texas Tribune

After the power flicked off in millions of homes across Texas during the state’s historic freeze in mid-February, families like Bekele’s faced an impossible choice: risk hypothermia or improvise to keep warm. Many brought charcoal grills inside or ran cars in enclosed spaces, either unaware of the dangers or too cold to think rationally.

In their desperation, thousands of Texans unwittingly unleashed deadly gases into homes and apartments that, in many cases, were not equipped with potentially lifesaving carbon monoxide alarms, resulting in the country’s “biggest epidemic of CO poisoning in recent history,” according to Dr. Neil Hampson, a retired doctor who has spent more than 30 years researching carbon monoxide poisoning and prevention. Two other experts agreed.

In the aftermath of the unprecedented wave of poisonings two months ago, Texas lawmakers have taken few steps to protect residents from future carbon monoxide catastrophes. That choice caps more than a decade of ignored warnings and inaction that resulted in Texas being one of just six states with no statewide requirement for carbon monoxide alarms in homes, ProPublica, The Texas Tribune and NBC News found.

Instead, Texas has a confusing patchwork of local codes, with uneven protections for residents and limited enforcement, all of which most likely contributes to unnecessary deaths, health policy experts said.

At least 11 deaths have been confirmed and more than 1,400 people sought care at emergency rooms and urgent care clinics for carbon monoxide poisoning during the weeklong Texas outage, just 400 shy of the total for 2020. Children made up 42 percent of the cases. The totals don’t include residents who were poisoned but did not seek care or those who were treated at hospitals and urgent care clinics that do not voluntarily report data to the state.

Black, Hispanic and Asian Texans suffered a disproportionate share of the carbon monoxide poisonings, ProPublica, The Texas Tribune and NBC News found based on a review of statewide hospital data. Those groups accounted for 72 percent of the poisonings, far more than their 57 percent share of the state’s population.

Over the past two decades, the vast majority of states have implemented laws or regulations requiring carbon monoxide alarms in private residences, often on the heels of high-profile deaths or mass poisonings during storms.

But in Texas, where top lawmakers often promote personal responsibility over state mandates, efforts to pass similar carbon monoxide requirements have repeatedly failed.

Lawmakers introduced a slew of bills aimed at overhauling the state’s electric grid after the storm, which had its most devastating effects from Feb. 14-17. Temperatures plunged into the single digits, nearly 4.5 million Texas homes and businesses lost power at the peak of the storm, and more than 150 people died, many of them frozen in their homes.

People wait in line to fill propane tanks in Houston on Feb. 17.David J. Phillip / AP file

Demands for change triggered a series of resignations but, with virtually all of the media and legislative focus on the regulatory failures that caused the power outage, little attention was paid to carbon monoxide alarms. The result was a significant missed opportunity to pass reforms after “an entirely preventable public health crisis,” said Emily Benfer, a visiting professor at Wake Forest University School of Law in North Carolina who specializes in housing health hazards.

Lawmakers this year are considering a broader modernization of state building codes that is unrelated to February’s storm. If the measure passes, it would require carbon monoxide alarms in some new homes and apartments, but not those built or renovated before 2022. And it would allow local governments to opt out.

“It’s completely shocking,” Benfer said. “In a single week we have concrete evidence of a state government’s willful disregard for the health and safety of the most vulnerable residents of the state.”

'Public health disaster'

Bekele and Mersha came to Houston from Ethiopia a decade ago with dreams of a better life for their family. For years, they lived in a small apartment and set aside their earnings as gas station clerks until they could afford to buy a home. In 2017, they purchased the three-bedroom townhouse in southwest Houston where they planned to watch their son, Beimnet, and daughter, Rakeb, grow up.

Shalemu Bekele with his wife, Mersha, daughter, Rakeb, and son, Beimnet.

Shalemu Bekele with his wife, Etenesh Mersha, daughter, Rakeb, and son, Beimnet.Courtesy Bekele family

Looking back, Bekele doesn’t remember if anyone notified them that the home lacked carbon monoxide alarms. State law requires that information to be disclosed when single-family homes are sold, but there is no policy in Houston or across Texas that would have required the previous owners to install one.

“I’ve never been told about carbon monoxide before,” Bekele said, speaking through an interpreter in his native Amharic.

The first thing he remembers after passing out on the morning of Feb. 15 was waking up in the back of an ambulance. He thought he’d only been knocked out for a few minutes, oblivious that it was now after midnight. He and his family had spent more than 12 hours unconscious inside while the friend in Colorado, unaware of their address, frantically searched on social media for family members who could direct emergency responders to their home.

Bekele started to ask the paramedics what happened to his wife and children but blacked out before he could get the words out.

The ambulance driver navigated ice-covered roads to deliver Bekele to Memorial Hermann Hospital in the Texas Medical Center. The hospital was overrun with patients like Bekele. Medical staff were treating so many people for carbon monoxide poisoning that the department was running out of beds and oxygen tanks, said Dr. Samuel Prater, the medical director of the hospital’s emergency department.

“We’ve never seen anything like this,” Prater said later.

Each year, the Memorial Hermann Health System treats about 50 patients for carbon monoxide poisoning at its 20 emergency rooms in Houston and surrounding counties. But that Monday, staff at Prater’s ER alone treated more than 60. Across the Memorial Hermann system, one of the largest hospital chains in the Houston region, 224 patients sought care for carbon monoxide poisoning during the freeze and power outages — more than four times its annual volume of such patients, according to data provided by the hospital.

Prater worked quickly to get more oxygen tanks to the ER and to set up emergency triage protocols to prioritize the hospital’s limited hyperbaric chambers. The chambers, which deliver oxygen at high pressure to more quickly flush carbon monoxide from patients’ bloodstream, are a standard treatment for halting the damage done by serious cases of CO poisoning.

With the power still out in millions of Texas homes and temperatures dropping, Prater asked the heads of media affairs at Memorial Hermann and UTHealth’s McGovern Medical School, where he’s a professor, to reach out to news outlets to help warn residents about the dangers of carbon monoxide.

“In no uncertain terms, this is a public health disaster,” Prater said at a televised news conference a day later, urging people who’d lost power not to bring charcoal grills or portable generators inside. “Additionally, never run your vehicle inside your garage and then get inside that vehicle as an attempt to get warm.”

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In an interview later, Prater explained what was at stake: Carbon monoxide is a colorless, odorless gas that, at high concentrations, can kill within minutes. In serious cases, those who survive may suffer from permanent brain damage and other long-term health problems, including memory loss, blindness and hearing damage.

Almost 80 percent of patients treated at Memorial Hermann facilities for carbon monoxide poisoning that week were Hispanic or Black, even though those groups account for 55 percent of the population in the greater Houston region. The majority of patients came from neighborhoods that the hospital identified as home to “vulnerable populations.”

Part of this disparity is a result of where the power outages occurred. Across the state, areas with a high share of residents of color were four times more likely to lose power compared with predominantly white areas, according to an analysis of satellite and U.S. census data released by the Electricity Growth and Use in Developing Economies Initiative, a nonprofit collaboration among five universities.

Image: Eric Traugott warms up his young son, Eric Traugott Jr., beside a fire, made from a discarded wooden armoire outside of their apartment in Austin, Texas, that remains without power on Feb. 17, 2021. (Tamir Kalifa/The New York Times)

Eric Traugott warms up his young son, Eric Traugott Jr., beside a fire made from a discarded wooden armoire outside their apartment that had been without power for two days in Austin on Feb. 17, 2021.Tamir Kalifa / The New York Times via Redux

Once their power went out, families in lower-income communities generally faced greater challenges. Few had relatives they could stay with. Some didn’t have vehicles that could handle icy roads and others lacked awareness of local warming shelters. This left many trapped in freezing homes and at higher risk of carbon monoxide poisoning, said Melissa DuPont-Reyes, an assistant professor at Texas A&M who studies health disparities.

“They have no other option to stay warm,” she said. “They’re going to use whatever means possible, and unfortunately it’s toxic.”

Benfer, the Wake Forest professor, agreed: “The most marginalized communities are also marginalized from information, resources and a safety net they can fall back on in a time of crisis.”

More than 24 hours after passing out, Bekele finally regained consciousness inside one of Memorial Hermann’s hyperbaric chambers. He immediately asked about his wife and kids, he said. A nurse told him he was very sick and needed to rest.

But Bekele kept asking, he said, until finally a doctor sat down at his bedside. He cried when she delivered the news.

His son, Beimnet, was connected to a ventilator in the intensive care unit, the doctor told him.

His wife and daughter, the doctor said, had died before paramedics arrived, poisoned by a gas that until that moment Bekele had never heard of.

Pleading for help

As Bekele was recovering in the hospital, 911 calls continued flooding emergency operators across the state.

In Austin, the state’s capital, Franklin Peña felt increasingly powerless as he watched his 3-year-old son shiver from the brutal cold that engulfed his family’s apartment. On the evening of Feb. 16, after two days without electricity, Peña brought in a charcoal grill to burn wood for warmth.

“My desperation was such that I lost all fear or my head,” Peña said in Spanish during an interview. “The only thing I could think of doing was to bring the grill in.”

Just after 6 p.m., Peña’s wife and two children started to throw up. His own legs shaking, Peña dialed 911.

“Please help me,” he pleaded with the operator in Spanish, according to a recording obtained via a public information request. His wife wailed in the background as he told the 911 operator that his older son, 12, who has a developmental disability, had fainted. Because of their high metabolic rates, experts say, children can be more vulnerable to the effects of carbon monoxide.

“Is everyone out of danger?” the operator asked as Peña explained that they had fled their apartment and were outside in the cold. “They are breathing but they are not doing well,” he responded.

For 30 excruciating minutes, the 37-year-old Mexico native struggled to answer the operator’s questions as his wife and 12-year-old son drifted in and out of consciousness. “Please, sé fuerte mami,”