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Pandemic poses threat to lead poisoning programs for kids

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As the COVID-19 pandemic took hold of health departments’ resources for months, it limited efforts to protect young children from exposure to lead at home. And children in Indianapolis’ poorest neighborhoods are likely to pick up the expensive tab.

Pandemic lockdowns meant that more kids stayed at home longer — a dangerous trend in areas where the risk of contamination is high.

Meanwhile, fewer kids were being screened for lead exposure. At one point, the rate of routine blood testing for lead in Indiana fell 65% compared to the pre-pandemic period, according to data from the Centers for Disease Control and Prevention (CDC).

“The concern would be that, especially with lower-level lead exposure, kids won’t necessarily have noticeable symptoms. And so, that’s why blood lead screening is done,” said Dr. Blake Froberg, a pediatrician at Riley Children’s Hospital and director of the Indiana Poison Center.

Parents may not suspect their child is at risk from lead in drinking water, soil and house paints. But the continuous, silent exposure can accumulate, leading to health problems and even lead poisoning, Froberg said.

Froberg said removing the source of lead is usually the most important step in addressing the problem. This happens when blood tests show a child has elevated lead levels — but what if the testing rate is declining?

“That’s tens of thousands of families who might not have any awareness or understanding that their child was exposed to lead. And so therefore, they haven’t done anything to solve the problem,” said Gabriel Filippelli, a biogeochemist and professor of earth sciences at IUPUI.

An average of 820 Indiana children were found to have elevated lead levels each year from 2013 to 2017. But those numbers do not show the real scope of the problem, Filippelli said.

CDC guidelines require children on Medicaid to get tested for lead at ages 1 and 2. Some data show that before the pandemic hit, over 40% of children on Medicaid were not being tested.

Efforts to address the lead problem were slowing well before the pandemic, as screening rates faltered over the past decade due to CDC budget cuts.

With so few tests being performed, Filippelli worries about the big gap in data on lead’s impact. In fact, the most detailed maps he uses to pinpoint lead in Indiana are a decade old.

Still, that’s not the “saddest part,” he said. “The way we are able to locate lead hotspots is by using maps of poisoned kids.

“And so, you can use that sort of human map to go back and find out what is driving those hotspots. And the reason I say it’s a sad aspect is that these kids are already lead poisoned. So, you’re kind of coming in after the fact.”

Adjacent but different worlds

Lead is a serious problem in Indianapolis and many other U.S. cities — and the burden often falls heavily on parts of the Black community.

Discriminatory policies have pushed Black families away from suburbs and into older, urban neighborhoods with high lead levels. The most common exposure for children comes in older housing, where paint chips and dust can float in the air or fall on the ground.

Maps of lead in Indianapolis’ soil provide insight into glaring racial and socioeconomic disparities. While the amount of lead in the soil is almost the same around Meridian Street — even north of 38th Street, where wealthier neighborhoods begin — lead poisoning levels of kids are drastically different. It’s a “whole other world,” Filippelli said.

“Once you pass 38th Street, [and go to] 40th Street it has the same amount of soil lead in it, but almost no lead poisoning in kids,” Filippelli said. “So, this is the one time where you can’t take the blood lead values without having that little sociological and access to health care filter on.”

A number of factors contribute to this disparity, including better access to health care and good foods. Well-maintained interior paint in older houses and landscaped yards that keep lead from being released are also crucial.

Froberg of the Indiana Poison Center said a diet that is deficient in iron can lead to children developing disorders such as Pica that make them more likely to eat non-food items, potentially increasing their exposure to lead.

“There’s also when kids have nutritional deficiencies, and then are exposed to lead, they may have more absorption of that lead,” he said.

Citizen-science: A step toward awareness

Now that the pandemic is slowing, lead mitigation efforts are picking up. Still, community leaders worry about the health care barriers for children.

For starters, many families with children never heard of the risk of lead, said Phyllis Boyd, executive director of Groundwork Indy. The nonprofit works on environmental sustainability and improvement.

“There is a big awareness gap for sure,” Boyd said. As part of youth development programs, her organization offers informational and hands-on sessions on lead and its risks.

High school student Kiwane Reed is one of the participants in Groundwork Indy’s Green Team summer program. He lives in a house with three siblings, including two under the age of 10. Their 46208 zip code is considered a high-risk area for lead contamination.

His family didn’t realize they needed to watch for lead in drinking water, paint or soil.
Reed was introduced to the concept recently through a session provided by Boyd and organized by Filippelli at IUPUI in partnership with Groundwork Indy and other community organizations.

Reed loves to drink tap water and prefers it to bottled water. But now that he has learned lead could be in the water, he said, “I don’t drink it as much.”

He took a do-it-yourself lead testing kit that Filippelli’s team developed at IUPUI. It’s meant to be a simple, free tool to test lead levels in water, soil and dust at home.

He hopes when he sends the samples to be tested, they won’t indicate lead at his home. Results will be available within a few weeks.

Fear and distrust as barriers

Even if families are aware of lead’s dangers, some might not have their homes inspected or their kids screened, said pastor Ivan Douglas Hicks, senior minister of First Baptist North Church.

“They do not want Child Protective Services, they do not want the health department to be intrusive and to levy fines,” Hicks said. “And they think their children would be taken away if they were discovered to have lead.”

Some families also cannot afford to have their house tested for lead — a process that can cost up to $300.

These are some of the reasons Hicks partnered with Filippelli’s lab. Through a coalition of pastors, the Indianapolis Ministerium helps distribute anonymous testing kits so families can check their homes by themselves and get results for free.

For Hicks, the main goal isn’t the testing itself.

“The effort then is to ensure that pastors have information about lead, and that they also are equipping their congregations and their members in their communities with lead kits so that we can get this information back and we can … grow and learn.

“So, we’re really testing the kit out right now. And so, we’re using pastors, we’re using ministries, and we’re using community partners … as we seek to grow to a larger scale this project.”

Filippelli also wants to work with health departments to make these testing kits available at a larger scale. The hope is that by removing barriers to testing, families can be reassured and there will be more data available to map lead risk in the community and take measures where they are needed the most.

This story was reported as part of a partnership between WFYI, Side Effects Public Media and the Indianapolis Recorder. Contact Farah Yousry at fyousry@wfyi.org or 857-285-0449. Follow her on Twitter @Farah_Yoursrym.

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.

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