State lowers elevated blood lead levels with new guidelines

Aug. 27—The State of Indiana lowered its threshold on what it considers elevated lead levels in children earlier this year in a move that has been cheered by health activists and health departments across the state. But those same groups say more needs to be done in terms of remediation.

Under the new guidelines, children with blood lead levels between 3.5 and 4.9 mcg/dL (micrograms per deciliter) will be classified as having elevated lead levels. The new guideline aligns with the Center for Disease Control and Prevention's recommended level for children under the age of 6 years old. Previously, the state considered lead levels in the blood 10 mcg/dL as elevated.

In addition, children with blood lead levels above 5mcg/dL will be enrolled in case management with their local health department and be encouraged to allow health department staff to do a home risk assessment, including a home visit to find out where the lead is coming from.

"Reducing the blood lead threshold in Indiana has been a years-long process that has required partnerships with healthcare providers, local health departments and lawmakers to identify the resources and funding needed to ensure that more Indiana children not only were tested for lead, but that those with elevated levels could receive appropriate services," said State Health Commissioner Kris Box said in a statement announcing the change. "The CDC states clearly that no level of lead is safe in a child, and we are grateful to state lawmakers for providing funding through House Enrolled Act 1007 to support our efforts to increase testing and case management to protect our most vulnerable Hoosiers."

A long time coming

For activists and organizations wanting to see the state lower its lead threshold, the change is a long time coming.

Groups such as the Hoosier Environmental Council and many others have been pushing for the state to lower the threshold. Indra Frank, the director for Hoosier Environmental Council, and more than 40 others, including United States Secretary of Transportation Pete Buttigieg and Marion County Public Health Department Director Dr. Virginia Caine, signed a petition asking the ISDH to align with the CDC.

In 2019, Box received the petition favorably and set up an advisory group to talk about lead poisoning. But then the COVID-19 pandemic happened and it was pushed aside as the ISDH focused all its energy on the pandemic response.

This spring, though, the ISDH was able to return to the issue and eventually passed the rule lowering what it considers to be elevated lead levels in children.

The number of children being tested for elevated blood levels is also expected to increase.

A bill passed by the Indiana General Assembly this year requires health care providers to offer universal lead screenings for children under age 6. Previously, only children covered by Medicaid were required to be tested at 12 and 24 months. The new testing requirement takes effect Jan. 1

Frank called the change a positive step for the state.

"Lead poisoning reduces children's ability to reach their full potential, and because of that, it reduces our state's ability to reach its full potential," Frank said.

The dangers of lead in the blood and body of humans has been known as early as 2000 B.C. It is more toxic to the unborn and younger children, though it can negatively impact adults as well. Side effects can include:

* Damage to the brain and nervous system

* Slowed growth and development

* Learning and behavior problems

* Hearing and speech problems

Most lead poisoning in Indiana stems from chipping or peeling lead paint that mixes with dust in the air. Other common sources of lead are from contaminated soil, drinking water and, occasionally, children's toys and jewelry.

While the harms of lead poisoning in children is no secret, it entered into the minds of people all across the country beginning in 2014 during the Flint, Michigan, water crisis. There, between 6,000 to 10,000 children were exposed to drinking water with high levels of lead after the city switched its water source from treated water from Lake Huron and the Detroit River to the Flint River and failing to apply corrosion inhibitors to the water.

Though less publicized, Indiana had its own lead crisis recently.

In East Chicago, hundreds of people living at the West Calumet Housing Complex in East Chicago, Indiana, were exposed to elevated levels of lead in the soil. The reason? The public housing facility was built on the same land where a former facility that produced white lead, a highly toxic ingredient used in lead paint was operating.

An investigation revealed that U.S. The Department of Housing and Urban Development did not properly conduct environmental reviews for decades, despite signs of lead exposure existing at the complex since 1985. The complex was eventually demolished in 2018.

The impact

Under the state's old elevated blood lead level standard, the caseloads were around 600 a year statewide. Under the new standard and a likely increase in testing, the state expects that to increase to roughly 2,000 a year, an increase that will undoubtedly burden local health departments.

To help with the extra work and offset the cost of doing said work, the state of Indiana made available grants through its newly-created "Indiana Health and Challenges Grant." More than 40 health departments received grant money to "support lead case management and associated environmental investigation services" regarding elevated blood lead levels, including Howard and Madison counties.

The Howard County Health Department received $71,772 in the grant. James Vest, administrator for the Howard County Health Department, said the state predicts the county will have 34 additional children deemed as having elevated blood lead levels over the next two years. With the grant in hand, Vest said the health department is now exploring whether or not to use that money to hire an additional staff member or if current staff can pick up the extra work.

Still work to be done

While those in the healthcare field have lauded the state's action over lowering what it considers elevated lead levels in children, they also say there is still much work to be done, primarily in helping subsidize remediation costs.

If a house is found to have elevated lead levels, whether in the dirt or air, it is deemed inhabitable for children until the issue is fixed. In the majority of cases, the source of the lead is obvious, but what's less obvious is who is going to pay for the fix.

Older houses built before 1978 — when the use of lead based paint was banned in the U.S. — are more likely to have elevated levels of lead found in them. Lower income households tend to live in older houses, and thus, are more likely to be exposed to elevated lead levels, but they may not have the means to pay for the remediation, which can be expensive if the contamination is extensive, putting that at risk of

A family renting a house that is deemed to have elevated blood levels faces eviction if the landlord decides they'd rather have the house sit empty rather than remediate the lead issue.

"We asked (the state) specifically, with this grant, is there a way to help for remediation, and they said 'No, it's not geared toward that,'" Dr. Emily Backer, health officer for the Howard County Health Department said. "But the hard part is if you have a homeowner or landlord who can't afford to remediate ... you're forced to move. So we'd like to see that addressed at either the state or federal level."

In fact, the state has started a program for just that.

The ISDH, in conjunction with the Indiana Housing and Community Development Authority, created the Indiana Lead Protection Program that ran from 2018-2021. The money was allocated to "high need" cities — Indianapolis, Muncie, Fort Wayne, South Bend, East Chicago, Gary, Evansville — to pay for lead remediation for qualified renters or homeowners for hundreds of units. The grant was thanks to federal money.

"I think it's right that this comes from federal or from state money because it's a societal wide problem," Frank said. "The people that live in those houses now aren't the ones who put the lead paint there."

Tyler Juranovich can be reached at 765-454-8577, by email at tyler.juranovich@kokomotribune.com or on Twitter at @tylerjuranovich.