As director of the New River Health Association's Black Lung Clinic, Emery's seen guys as young as 45 getting double lung transplants as disease rates soar among miners forced to dig through more rock filled with deadly silica to reach the remaining coal — far worse than the dust their grandfathers inhaled.

Data collected from her clinic, along with more than two dozen others nationwide, spell out what she sees in real time every day: Of the 11,500 coal miners from central Appalachia from mid-2020 through mid-2025, 55 percent had some form of black lung with the highest annual rate — 62 percent — recorded among miners seen in the past year, according to researcher Kirsten Almberg at the University of Illinois Chicago.