Placards posted above water fountains in 2016 warn against drinking the water at Flint Northwestern High School in Flint, Mich. (Jim Watson/AFP/Getty Images)
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In May 2015, residents of Flint, Mich., began to complain about the water coming from their faucets. It smelled and tasted bad and appeared to be making kids sick. It turned out that the city in 2014 had changed its water source to the Flint River to save money but had not taken steps to ensure that the old underground pipes would not leach lead.

It was discovered that lead had entered into the water and thousands of adults and children were exposed, including nearly 9,000 children younger than 6. Lead at any level in the human body can be dangerous and has been linked to a number of diseases, learning disabilities and behavior issues, experts say.

The crisis occurred when Rick Snyder was governor, and a 2018 report by University of Michigan researchers found that he bore some responsibility for the water crisis. Snyder, a Republican who left office early this year, just withdrew from a fellowship at Harvard University’s Kennedy School of Government after his appointment sparked severe criticism. The dean of the Kennedy School, Doug Elmendorf, sent a letter to the school community Wednesday saying he had decided that having Snyder serve as a fellow “would not enhance education here in the ways we intended,” WBUR reported.

Officials in Michigan said 90 people were sickened and 12 died from exposure to bacteria during the 18 months that water was taken from the Flint River. However, an investigation by PBS’s “Frontline” found that the death toll was probably much higher. It found 119 deaths during that time from pneumonia, which could have been caused by the legionella bacteria — which causes Legionnaires’ disease — found in the water.

Today, officials say the Flint water meets the same standards of other similar cities. Still, Mona Hanna-Attisha, founder and director of the Pediatric Public Health Initiative and author of “What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City,” wrote recently in The Washington Post:

In the medical community, we still recommend that Flint residents drink only filtered tap water or bottled water, as the city is in the last phase of a massive public works project to replace the old lead pipes. This infrastructure work has the potential to disrupt more lead in the water system, and we don’t want to risk exposing more people to lead. In less than a year, when those lead service lines are completely replaced, Flint residents shouldn’t have to worry about getting a glass of clean tap water.

The post below looks at why the Flint water crisis may never go away for some of the children who were affected. It was written by Marilynne Wood, a professor at the University of Toledo in Ohio who is a pediatric educator, clinician, researcher and community activist. For the past decade, she and her University of Toledo College of Nursing graduate students have educated hundreds of families regarding lead poisoning prevention and screened their children for elevated lead levels.

Wood has collaborated with city government to pass a lead ordinance to assure “lead safe” housing for young families in the Toledo area. And she was the principal investigator of the 2013 “Elevated Lead Levels in Children: Academic Achievement and Health Policy Implications” study, which assessed the long-term effect of early-childhood lead exposure on academic achievement in math, science and reading among elementary and junior high school children. It found that high blood lead levels in a child younger than 6 years old were strongly associated with poor academic achievement in Grades 3, 5 and 8.

This was first published on the Conversation website, and I was given permission to publish it.

By Marilynne Wood

When the Flint water crisis took place in 2014 and 2015, one of my graduate nursing students decided to get involved.

Having already worked with me in the Greater Toledo area to screen children at risk for lead poisoning, my student helped conduct blood lead level screenings of the children exposed to the water. Test results later showed that the number of lead poisoned children in Flint had doubled after the crisis.

Since that time, some have worried that children in Flint are suffering academic setbacks as a result of being exposed to high levels of lead in Flint’s water supply.

State officials advised that as many as 9,000 children under the age of 6 in Flint be treated as having been exposed to high levels of lead after the city’s drinking water supply was switched in 2014 from water from Lake Huron to water from the Flint River.

Others, however, have pushed back, arguing that Flint’s water crisis is not the culprit behind any academic losses. Certainly lead was a problem for children in Flint long before the water problems.

But as a nursing professor and parent educator who specializes in treating children with elevated lead levels, I believe that just like in Detroit — where lead poisoned children have suffered academic setbacks after being exposed to lead, mostly from lead paint in their homes — similar academic setbacks are likely taking place in Flint.

Lead exposure can harm children even before they are born. The Centers for Disease Control estimate that approximately half-a-million children in the United States between the ages of 1 and 5 have an elevated blood lead level.

Although lead poisoning is preventable, the neurological and behavioral effects of lead are believed to be irreversible. No level of lead is safe for children.

However, my experience shows that lead levels in children can be lessened by educating parents on simple things they can do to decrease exposure to lead in their homes.

Ill effects

Lead affects children’s brain development and results in reduced “intelligence quotient,” or IQ. It also leads to behavioral changes, such as shortening of attention span, restlessness, conduct disorders, aggression and reduced educational attainment, as shown in “What the Eyes Don’t See,” a book by Mona Hanna-Attisha, a physician who helped expose the Flint water crisis.

Lead exposure can harm children even before they are born. The Centers for Disease Control estimate that approximately half-a-million children in the United States between the ages of 1 and 5 have an elevated blood lead level.

Screening children

Most of my work with lead poisoned children has taken place in the Greater Toledo area. My graduate nursing students and I have collectively screened more than a thousand students at Toledo Public Schools. Of those children tested, 577 — 38.9 percent — had blood lead levels above 4 micrograms per deciliter. The CDC says intervention is warranted at 5 micrograms per deciliter, but I prefer to intervene at 4 micrograms to focus in on problems before it reaches a higher level.

In individual schools in Toledo, the share of students at or above 4 micrograms per deciliter ranged from 21 percent to 73 percent. Many of the children we screened were already in special education classrooms because of their lead exposure.

What actions are needed

Whenever my graduate students and I detect lead in children, we educate their parents or caregivers about where lead comes from. We discuss what lead does to children’s brains and bodies once it enters their bloodstream. We also offer practical tips about how they can decrease lead exposure in their homes.

For instance, we recommend that caregivers wet mop and clean. Why? Because over 80 percent of the children that I’ve screened for lead in the Toledo area live in rental properties. That’s significant because many of these homes and apartments were built before 1978, the year the United States banned lead-based paint in housing, and are the most likely to have lead paint. As different families move in and out of these properties, many different children get exposed to lead in the same rental home over the years.

It is critical that these rental properties and family-owned homes be certified by local health departments and other governmental agencies as “lead safe.” But just as there are lead threats inside the home, there are also threats outside the home. Those outside threats come from children playing in lead-tainted soil around the home and tracking it inside.

Fighting back

When 18 of my graduate nursing students and I followed up with Toledo families with lead poisoned children between 2016 and 2018, we found 11 of the 577 children had significant decreases in their blood lead levels and improved academic performance.

One 8-year-old girl, for instance, had her blood lead levels drop from 22.6 micrograms per deciliter two years ago to 6.1 micrograms per deciliter.

The girl’s mother was diligent in following the recommendations we made to decrease lead absorption in her daughter, such as increased nutritional intake of vitamin C, iron and calcium.

In addition, the girl began to take daily multivitamins and ate snacks during the day to avoid an empty stomach, since food decreases the gastric absorption of lead. Shoes were left at the door of their home to avoid tracking in lead-contaminated soil from outside. The mother also damp mopped and dusted to decrease exposure to lead from the air. The girl was also encouraged to wash her hands frequently. Referrals were made to the local health department for further assessment of the living environment and possible financial support to secure a “lead safe” home for the family.

Future of Flint

Five years after the Flint water crisis, people are still distrustful of the local water. Efforts to hold officials accountable seem to go back and forth. Residents are trying to sue city officials and the federal government for lead contamination in the water. Criminal charges were dropped on June 13 against several officials who had been charged in the crisis, but may be reissued.

The circumstances by which children were exposed to high levels of lead in Flint and Toledo may be different. But as one who has worked directly with lead-poisoned children, I know it is likely that the impacts will be similar.

Lead-poisoned children in Toledo schools have struggled to stay on task, stay out of trouble, learn reading and math skills, and keep up with their peers academically and socially.

There’s no reason to think that lead-poisoned children in Flint aren’t going through the same thing.