At New River Health in Oak Hill, West Virginia, Lisa Emery sees disturbing signs of what she calls a slow motion repeat of the Hawks Nest Tunnel disaster. Emery directs New River’s Breathing Center and chairs the National Coalition of Black Lung and Respiratory Disease Clinics.

Construction of the 3 mile tunnel through Gauley Mountain began in 1930. Over 18 months, about 3,000 miners, most of them Black, drilled through sandstone amid silica dust, and more than 750 men died from the exposure.

That danger persists for coal miners, even as federal officials delay enforcement of a rule intended to reduce exposure. The Trump administration paused enforcement in April of last year, and the Labor Department’s Mine Safety and Health Administration announced an indefinite delay this April.

New research shows the urgency. In August, the National Institute for Occupational Safety and Health reported that almost 1 in 3 miners tested in central Appalachia with at least 25 years underground had black lung disease, the highest rate in nearly 50 years.

The rate was 1 in 5 when the agency last reported results in 2018, while the lowest reported rate was less than 1 in 10 in 1999. “We knew this would happen,” said attorney Sam Petsonk. “It’s surprising to me that they only found one in three.”

Silica exposure has increased as more accessible coal seams are depleted and mining operations probe deeper, often through sandstone. The resulting particles are 100 times smaller than a grain of sand and, according to institute research, about 20 times more toxic than coal dust.

Those particles can become trapped in lung tissue and cause a debilitating, sometimes fatal condition. Other occupations at high risk of silica exposure include construction, countertop fabrication, and oil and gas work.

Retired West Virginia miner Kenny Thompson worked underground for 22 years and sometimes cut through four feet of sandstone to reach coal. “You ate a lot of dust,” he recalled, describing nausea and the physical toll of the exposure.

Thompson had his left lung removed in October 2025. He said he spent three months in a coma, flatlined three times, and had to relearn how to walk and talk, while even a trip to the mailbox still leaves him winded and lightheaded.

The silica rule would cut the allowable exposure level in half, matching the standard applied in other industries. It also would require mine operators to use engineering controls such as improved ventilation systems and water sprays.

Industry trade groups, including the National Mining Association, argue compliance also would require respirators and rotating miners away from especially dusty areas. Miners and advocates say respirators can impede breathing, restrict vision, and malfunction, while smaller mines may lack enough workers for rotating schedules.

In April 2025, the 8th U.S. Circuit Court of Appeals granted an emergency stay to give operators more time to comply. The Labor Department later requested permission to gather information on the rule, and its July regulatory agenda indicated an intent to amend it.

Petsonk accused the Mine Safety and Health Administration of going through “bureaucratic motions” while perpetuating “an illegal and lethal status quo.” The Labor Department declined to comment on ongoing rulemaking or litigation.

Chris Williamson, who led the Mine Safety and Health Administration during the Biden administration, said the rule remains in effect but is not being enforced. “It’s on the books,” Williamson said, noting that the Mine Safety and Health Act prohibits weakening existing protections for miners.

Meanwhile, New River Health is diagnosing younger miners with advanced black lung after a decade or less underground. Emery said the youngest person her clinic diagnosed with complicated black lung was 30 and had worked underground for 10 years.

This is no longer simply an older miner’s illness. “It’s your husband’s disease. It’s your son’s disease,” Emery said, raising the grim question of what workers with families can do when they become disabled in their 30s.

More than 90% of coal miners are men. Emery recalled one miner telling his wife that he had not fixed their deck because he could not breathe and was constantly exhausted, a revelation that brought the man to tears.

Trump praised coal in an April 2025 executive order, and six months later the Energy Department announced a $625 million investment to expand and reinvigorate the industry. Petsonk warned that replacing the silica standard with a weaker rule would be “an unconscionable crime against American coal miners.”

For miners such as Gary Hairston, a retired miner and president of the national Black Lung Association, the delays reinforce a painful message. “It seems like coal miners, we’re just a number,” he said. “Just a number.”