When Carmen Aponte-Vincent became a new mom at 15 years old, she received a frightening phone call from the doctor.
The results from a follow up to her baby boy's routine blood test for lead were in. Experts say no amount in the body is safe, but Chase, then 9 months old, had skyrocketing levels, 10 times higher than the federal benchmark.
“The doctor was like, ‘Check everything in your house.’ That’s when I realized he was chewing on the windowsills,” said Aponte-Vincent, 22.
The doctor called the Pennsylvania Department of Human Services to the small two-bedroom rental home she shares with her Puerto Rican grandfather, who helped raise her. Workers cleared the crumbling, toxic lead-based paint and painted over the walls.
But the paint still chipped, and Aponte-Vincent, who herself battled heart problems after Chase's birth, couldn't afford to move. When her second child was born about two years later, he too tested positive for lead.
Though his levels were much lower than his older brother's were, they were still too high. The lead poisoning caused significant, irreversible developmental damages to both Chase and little Jake. Today, both receive intensive speech and behavior therapies.
“They have to suffer,” Aponte-Vincent said. “They have to live with this the rest of their life.”
The health impacts of lead contamination have gained renewed attention from the Biden administration. As part of the American Jobs Plan, it has focused on one aspect of exposure, calling on Congress to invest $45 billion to eliminate and replace the nation’s aging lead pipes and water service lines. The proposal, however, lacks support from Republican lawmakers, and does not address other sources of lead exposure that still plague the nation.
Though Congress banned lead-based paint in 1978 and lead pipes in 1986, they continue to be a hazard in older buildings. The Biden administration estimates 6 million to 10 million homes still use lead pipes. Roughly 37 million have some amount of lead paint, the Department of Housing and Urban Development estimates.
Children are especially vulnerable to damage from lead because of their rapid development. Those of color and kids living in poverty are at greatest danger. Black children are three times more likely to have high lead levels in their blood than white children, according to the National Academy for State Health Policy.
Kids can miss major developmental milestones because of lead exposure and suffer long-term, significant harm to the brain and nervous system. Lead also can slow growth and cause learning, behavior and speech problems, research shows. Studies tie elevated lead levels to lower IQ, decreased focus and even violent crime and delinquency.
The pandemic made children more vulnerable, experts say, as many critical lead screenings occur at school. With buildings shuttered, about 500,000 fewer children were tested for lead in the early months of the pandemic, according to a February CDC report.
“People had thought lead poisoning had gone away – that it was a problem that was over. And I think what we’ve seen post-Flint – is that it isn’t,” said Dr. Maida Galvez, a New York City pediatrician who specializes in environmental health.
“Children shouldn’t have lead in their body. That’s the bottom line.”
‘Not routinely screening’
Though Flint, Michigan, put the issue on the map with its water crisis in 2014, dozens more communities have elevated lead rates, many even higher than Flint’s. The problem disproportionately afflicts communities of color.
In Philadelphia County, where Aponte-Vincent lives in the largely minority Kensington neighborhood, more than 200 Hispanic children and 1,284 Black children tested positive for blood lead levels above the federal standard of 5 micrograms per deciliter, compared with 167 white children, according to 2019 state data released in January. All were under age 6.
But the numbers are likely higher. Only 26% of children that age in the county were tested in the first place. Statewide, fewer than 20% of kids were tested. Despite multiple sources of exposure and lead prevalence in older communities, undertesting fails to capture just how many children have elevated levels – and fails to treat them.
“Lead screening is critically important to identifying children exposed to lead,” Galvez said. “What we know now is the health impacts can be seen at those low levels … cognitive impacts can happen at very low levels of exposure.”
Even before the pandemic, lead screening rates suffered. Low-income children covered by Medicaid are required to be tested only at 12 months, 24 months and up to age 6 if not yet tested.
Testing recommendations vary state to state. As of 2019, 19 states and Washington, D.C., had some kind of mandatory testing requirements for children not enrolled in Medicaid. But only eight required universal testing, according to the Network for Public Health Law. The others targeted just high-risk children.
Biogeochemist Gabriel Filippelli is executive director of Indiana University’s Environmental Resilience Institute, which researches climate change and its impact on public health and infrastructure.
In a 2018 study, Filippelli and a team of researchers found that despite high levels of lead in the blood of children living in South Bend, where Black residents make up more than a quarter of the population, children were inconsistently tested.
Data collection and reporting also were poor: 30% of children in the study had missing race data, and more than half had missing ethnicity.
“To move toward equity you have to over-test (those) populations,” Filippelli said.
Galvez directs a consultation program in New York City that trains health care providers to screen children for environmental health hazards.
“The busy clinician often doesn’t get to environmental exposures in a 15-minute well-child visit, unless the family specifically raises that concern,” Galvez said. “They could be connected to the interventions they need. But we’re not routinely screening.”
Finding the source of contamination can be challenging. If Biden's proposal to tackle lead contamination in water systems were to receive funding, experts say simply finding the lead pipes would be a tedious task. Many municipalities don't chart where they're located.
"We only have a rough idea of where old lead pipes are," Filippelli said. "This whole process is going to be a ton of detective work."
Radhika Fox, the Environmental Protection Agency’s Office of Water principal deputy assistant administrator, said the agency would use current grant and financing mechanisms to dole out funds to states and let them spearhead the process.
"Because states are closer to the ground, as far as where those lead challenges are, they will really be able to target resources to the community," Fox said.
But she acknowledged, "It's very mixed and uneven across the country. Some communities really have accurate maps of where their lead service lines are." For those that don't, the proposal calls for inventories to be developed over time.
Environmental justice advocacy groups analyzed violations of the Safe Drinking Water Act between 2016 to 2019 and found higher rates of drinking water violations in communities of color, low-income communities, areas with more non-native English speakers and those with lack of access to transportation or living in crowded housing conditions.
“High poverty communities and communities of color often suffer disproportionate burden of childhood lead poisoning because those are the very same communities that are afflicted with substandard housing,” said Galvez, who helped develop the New York State Children's Environmental Health Centers, which refers families to resources, interventions and provides multilingual toolkits on addressing lead and other environmental toxins.
Researchers and advocates alike have long awaited more stringent lead surveillance from the EPA. At the start of this year, the Natural Resources Defense Council filed a lawsuit against the agency, claiming a revision to its lead limit rule proposed by the Trump administration didn't go far enough to keep families safe.
Under the proposed revision, the EPA would keep its “action” level for lead in water at 15 parts per billion, but add a new “trigger” level of 10 parts per billion that would initiate remediation efforts.
But those levels, said Filippelli and others, are "just too high." Under the Biden administration, the agency has solicited public input and extended the effective date of the revision until later this month.
‘No one told us’
Exposure from contaminated soil is another issue. Lead deposits don’t biodegrade and can remain in soil for thousands of years.
When Akeeshea Daniels and her three sons moved into the West Calumet Housing Complex in 2004, she didn't know it was built over the site of the Anaconda White Lead Company, a former lead refinery.
Her youngest, Xavier, was about a month old when they moved to the complex, located in the majority-Black and Hispanic town of East Chicago, Indiana. Soon her boys started developing repeated serious infections, including scarlet fever.
The EPA began taking soil samples in 2014. Two years later, a letter from the mayor's office was posted on her front door, telling residents they had to relocate because of extreme levels of lead contamination in the complex.
West Calumet had alarming rates of lead contamination in the soil – as high as 91,000 parts per million, according to reports. That's more than 200 times the legal limit of 400 ppm. Inside Daniels' apartment, lead levels tested at 32,000 ppm. The water also was contaminated.
Unbeknownst to Daniels and many others, the complex had been declared a Superfund site by the EPA five years earlier.
"No one told us anything," she said. "I just feel like it was a slap in the face, like they didn't care ... It makes me feel like we don't count. We don't matter."
Her son Xavier, now 17, has suffered from ADHD, allergies and asthma, and he was held back in school.
"They played outside in the dirt. He was a child. That's what children do," she said. "These children have been damaged for the rest of their lives."
Daniels has since become an activist on the issue – writing columns, speaking at commission meetings and calling for compensation for the children.
"I feel if our children had been of any other color," Daniels said, "then it would have been handled differently."
‘Not rocket science'
Back in Philadelphia, Aponte-Vincent is worried her water might be contaminated, but she doesn't know where to start to find out.
“We'd make iced tea from sink water. We would drink and use the sink water,” she said.
Colleen McCauley, a registered nurse and health policy director at Public Citizens for Children and Youth, an advocacy group that serves the Philadelphia area, has heard the same concerns and confusion from many a worried parent.
“The first thing they test is for dust in a home, looking for deteriorated (lead) paint. If they don't find it there, they usually find it in the soil and water,” said McCauley, who has lobbied around the issue for 20 years. “But they usually find it in the paint, and they stop.”
McCauley used to be a nurse at a public housing community clinic. But frustration drove her to make the switch to advocacy.
“Working in direct care, I just didn’t see change happening quick enough,” she said. “What strikes me is this is entirely preventable. This is not rocket science. We know how to protect our babies.”
This article originally appeared on USA TODAY: Biden plan to eliminate lead pipes highlights lingering toxic problem