Developing Environmental Literacy for CIRS Patients: A Framework and Real-Life Lessons
Introduction: Why Environmental Literacy Matters
For people living with CIRS, the starting point is clear: water-damaged buildings are central obstacles to recovery. But the “health” of a home depends on more than its drywall, HVAC system, or bathroom fans. It is shaped by the ecosystem around it: the air outside the window, the soil beneath the foundation, nearby rivers and waterways, and the history of construction in the neighborhood.
Environmental literacy is the ability to place these signals in context—understanding how they fit together and how they might influence recovery. It is not about chasing perfection—no home is flawless, and no environment is without challenges. Rather, it is about developing the ability to:
Recognize exposures that matter,
Understand how they influence health, and
Respond with proportionate, informed choices.
Recognizing Patterns in Daily Life
For CIRS patients, this skill often develops out of necessity. Once the obvious sources of exposure are addressed, attention shifts to subtler patterns: how symptoms change after rain, how one grocery store feels different from another, or how a summer smog layer alters tolerance indoors. Some patterns are easy to spot—such as visible mold in a bathroom. Others only emerge over time, like the influence of a nearby water treatment plant or an HVAC system that recirculates air between units.
Recognizing these patterns does not mean labeling every discomfort as a hazard. It means treating observations as data—recording what changes, when it happens, and under what conditions. Over time, those notes can reveal whether symptoms are linked to a consistent environmental factor or whether they reflect temporary fluctuations.
This kind of precision often comes from lived experience, which can highlight connections that formal assessments overlook. Its value lies in what follows: patterns that repeat may call for action, such as avoiding a particular store, adjusting cleaning practices, or reconsidering the location of a home. Patterns that do not repeat may be less significant and may not require major decisions. The goal is not to eliminate uncertainty, but to respond in ways that are proportionate and sustainable.
As you continue to heal from CIRS, you will find your body will become better at tolerating many environmental exposures. But we want to be able to rule out the loudest environmental signals in spaces where we spend most of our day-to-day time (home, work) that may pose risk for relapse.
Why Indoor Scores Don’t Tell the Whole Story
If indoor testing tells only part of the story, the rest is shaped by what lies beyond the walls. Four aspects of the external environment—air, water, infrastructure, and biology—consistently influence how tolerable a place becomes. Looking at a home through these lenses can help explain why two spaces with similar scores feel so different in practice.
Air and Urban Context
Air quality sets the baseline for how tolerable an environment can be. Long-term levels of particulate matter (PM2.5), ozone, and volatile organic compounds influence recovery in ways that are sometimes overlooked. In dense cities like Los Angeles, California, inversion layers can trap smog for weeks, and proximity to major highways can raise background exposure.
In multi-unit buildings, the handling of make-up air becomes critical. If an HVAC system draws from the roof or recirculates from neighboring units, even a new apartment can sometimes become difficult to tolerate.
Hydrology and Moisture Risk
Nearby floodplains, wetlands, canals, and irrigation ditches increase baseline microbial activity, while humid continental and coastal climates each bring distinct challenges. Knowing the flood history of a neighborhood—through FEMA maps or local records—can help prevent setbacks. The goal is not to avoid water entirely, but to recognize and avoid the highest-risk areas when possible.
Infrastructure and the Built Environment
The structures and systems within a short radius of a home can alter exposures. This may include water or wastewater treatment plants, septic systems, ongoing construction projects, or visibly deteriorating neighboring buildings.
When questions come up about septic tanks, the guidance is not to assume danger but to ask practical questions—such as how often nearby systems are serviced. Environmental literacy does not mean treating every feature as a threat; it means knowing where to look if concerns arise.
Biological Hotspots
Large lakes, rivers, or bays with recurring cyanobacterial blooms, and agricultural areas with heavy manure use, can raise risks such as endotoxin or cyanotoxin exposure. For patients who stall in treatment, targeted dust testing—actinobacteria, cyanobacteria, or endotoxin panels—may help determine whether the broader environment is contributing.
Indoor strategies such as high-quality filtration, bipolar ionization as implemented by Air Oasis with the iAdaptAir, maintaining positive pressure where possible, and consistent cleaning can reduce impact even when relocation is not feasible
Case Studies: What the Environment Taught Me
These four lenses help explain why test results alone rarely tell the full story. The same principles became clear in my own experience. In both Northern Virginia and Los Angeles, the conditions outside the home proved just as important as the conditions inside.
During my postdoctoral program in the DC area, I was still in a hypersensitive stage of illness. For months I moved between different Airbnb’s, hoping to find stability. Even in a brand-new building with a reassuring HERTSMI score, I never felt well. The moment I stepped outside, symptoms often intensified. The external conditions, not the home itself, appeared to drive several of the ongoing symptoms.
Looking back, several factors help explain why. The DC metro area carries a legacy of toxic sites and industrial activity. Rivers and canals in the region have a long history of sewage problems and runoff. The latter became especially noticeable after heavy rainfall. The routine tasks like grocery shopping became difficult, as certain stores consistently triggered symptoms and limited safe options. The indoor testing alone could not account for the impact of the wider environment.
I later relocated to Los Angeles. Initially, conditions seemed manageable: my studio apartment had a good HERTSMI-2 score, and the drier air was easier to tolerate. This however changed with the arrival of summer. Smog season set in, temperatures rose, and the building’s shared HVAC system drew air from the roof and neighboring old buildings, carrying outdoor pollution directly indoors.
Several characteristics of the city compounded these effects. Los Angeles has long ranked worst in the United States for smog, with particulates and biotoxins held in place by inversion layers. Dense and aging building stock added further stressors, while wildfire smoke and emissions from nearby ports remained constant in the background.
The apartment’s scores still appeared reassuring, but the wider environment consistently undermined recovery.
Applying Environmental Literacy in Practice
Because both environments and individual tolerance shift over time, environmental literacy is less about certainty and more about having a framework to guide decisions as conditions evolve. It does not mean examining every detail or anticipating every possible risk. Instead, it focuses on what matters most—air, water, infrastructure, and biology—so you can screen broadly at first and then refine choices based on how your body responds.
Some practical considerations include:
Long-term air quality trends for the area.
Flood history and obvious moisture risks before choosing a home.
How make-up air is handled in multi-unit buildings.
Ongoing construction or visibly neglected buildings nearby.
Targeted dust testing for actinobacteria, cyanobacteria, or endotoxin outside the home if recovery is not advancing.
Refinement also comes from observing changes over time. Seasonal patterns are one example: some patients like myself notice symptoms intensify in fall. Tracking these cycles can guide decisions and help avoid unnecessary setbacks. Sensitivity itself also shifts throughout recovery. In hypersensitive phases, even small background exposures may feel overwhelming and stricter boundaries are needed. With progress, tolerance can expand, and environments that once felt intolerable may become manageable.
Environmental literacy supports these adjustments—showing when boundaries should remain firm and when greater flexibility is possible—without falling into either perfectionism or avoidance.
No environment is flawless. The world has always had microbes, toxins, and stressors. Healing with CIRS is not about removing all risk, but about recognizing meaningful exposures clearly and responding in ways that support recovery.
