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Testing and Follow-up Urged for Newark, Doctors Caution Against Panic

Medical experts based in Newark advise against panic over elevated levels of lead in some of the city’s water; they note most lead poisoning cases there are caused by peeling paint

Lead pipe replacement, Newark
Credit: NJTV News
Replacing lead pipes in Newark

Healthcare leaders based in Newark sought yesterday to tamp down possible panic over lead in the city’s water. While conceding the dangers of lead exposure, especially to children, they said the priority is not to alarm but to arm people with accurate information and appropriate services to protect their families and counter the impact of the toxin on children’s developing brains.

They want parents to know that kids who test positive for lead exposure are not doomed. Some may show no symptoms at all; others could struggle with learning difficulties and behavioral issues. But support services — many free or low-cost — exist to help families address these concerns.

“You don’t want people to panic, but you don’t want people to think it isn’t a problem. Because it is a problem,” said Dr. Diane Calello, executive and medical director of the New Jersey Poison Control Center, who has studied lead exposure for years. “We have the science that tells us there’s not really a safe level of lead for the developing brain.”

Questions about lead exposure re-emerged last week when the federal government ordered officials in Newark, New Jersey’s largest city, to provide bottled water to some 14,000 dwellings after tests at three homes prompted concerns about the effectiveness of tap filters installed in two of them. In response, federal, state and city leaders scrambled to set up multiple distribution sites and stocked more than 70,000 cases of bottled water that they are giving to residents served by the Pequannock water system.

Concerns in the community about lead in Newark, including in school water fountains, date back several years. But doctors interviewed Thursday noted the vast majority of the lead poisoning cases in the city, and in other communities statewide, are not the result of drinking water at all. The greater risk is that children, especially toddlers, ingest lead by getting peeling paint — which contained the heavy metal until the 1970s — or tainted dust into their mouths, they said.

Denise Rodgers
Credit: Rutges University
Dr. Denise Rodgers, vice chancellor at Rutgers Biomedical and Health Sciences, and chair at the Robert Wood Johnson Medical School

“We need to not lose sight of the fact that lead in water is a problem, but lead in the paint is an even bigger problem,” said Dr. Denise Rodgers, a vice chancellor at Rutgers Biomedical and health Sciences and chair at the Robert Wood Johnson Medical School; Rodgers also leads the Believe in a Healthy Newark Initiative, a coalition focused on community wellness.

“Let’s also talk about the root cause, which is all these children living in poverty,” Rodgers added. Not only are poor children more likely to live in older houses that could be contaminated by lead paint, she said, but their families also don’t have the resources to remediate the problem in the way that more affluent residents do.

One city can’t solve these infrastructure problems

“Repairing city water infrastructure is important, but so is repairing the housing stock,” added Calello, who is also an associate professor in emergency medicine at Rutgers New Jersey Medical School, in Newark. “And remediation is expensive,” she said. “These aren’t problems that one city can solve with the stroke of their pen.”

More than 203,000 Garden State youth (under age 18) were tested for lead exposure in 2017, the last year for which state data is available, and 1,028 — or 0.5 percent — were found to have blood-lead levels above the threshold for concern. While elevated blood levels were more common in many of the state’s urban areas, largely rural Salem and Cumberland counties — with a history of heavy industry in some sections — also saw high numbers.

The majority of the 1,028 youngsters who tested positive had relatively low levels of the metal in their blood, in quantities that are highly unlikely to require medical interventions or hospitalizations, Calello and Rodgers said. In 2017, 20 children — or 0.02 percent of those tested — showed levels that would suggest the need for inpatient care.

By the numbers

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The greatest number of children with any elevated blood-lead level hailed from Newark, according to the data, which are compiled and tracked by the state Department of Health. Testing in 2017 showed that while 3.8 percent of New Jersey kids under six call the city home, Newark accounted for 13 percent of those flagged for a follow-up in that age group.

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Children’s blood-lead levels have declined statewide since 2008, when more than 2,000 youth tested above the threshold of 10 micrograms per deciliter of blood, to roughly 800 cases in 2014; since then, the numbers have ticked back up to over 1,000. The data for 2018, which the DOH is now reviewing, will paint a different picture; that will be the first annual report to use a new blood-lead safety level that New Jersey adopted in 2017 to align with the federal standard of 5 m/d, half the previous level.

If the 2017 report is a guide, the change will result in nearly four times as many youngsters being flagged for required follow-up, including tests to find the source of the toxin, additional blood lead screenings, and behavioral therapy or educational assistance, if needed. Of the more than 203,000 kids tested that year, 4,269 had a blood-lead level between 5 m/d and 10 m/d, or more than 2 percent of those screened. More than 1,000 of this group lived in Essex County, including some 590 in Newark under age 6.

Higher numbers mean more children are eligible for assistance, Rodgers noted, which will require more federal, state and city resources. Calello questioned the capacity of local officials — who oversee inspection and remediation of lead problems in buildings, water systems and more — and healthcare providers to respond to this greater need.

“Those systems are in place and they do happen across the state,” Calello said. “But when you take the number of children who are eligible and double or triple the numbers, that creates a problem.”

Testing children

The healthcare experts said any parent with concerns about exposure should have their children tested; the same goes for pregnant women, or those seeking to become pregnant. “That gives you an objective perspective to start with. A lot of this is fear of the unknown,” Calello said. “But information is power.”

New Jersey law requires children be tested at 12 and 24 months, or between 3 and 6 years if they haven’t been fully screened earlier. Testing is also required if the youngster is known to have been exposed to lead. The procedure, which is covered by insurance, is available at doctors’ offices, federal clinics, and health departments and many sites also offer it for free. (The DOH maintains a web page with additional information on these resources.)

DR. DIANE CALELLO OF NJ POISON CONTROL CENTER DISCUSSES THE ISSUE

In addition, Newark’s University Hospital — which has a unique public mission — will host a free lead-screening clinic on Saturday, Aug. 17, from 9 a.m. to 5 p.m. Residents who receive Pequannock water can call (973) 972-9000 to make an appointment, which is required. The hospital is also providing bottled water and prevention information to discharged patients returning to homes served by the same water system.

“We feel we can be supportive to the community by providing lead screening for as many children as possible this weekend,” said Dr. Shereef Elnahal, the hospital’s president and CEO, and former state health commissioner. Detecting the problem early is critical, he said, but so is the proper response, which involves removing the source of the lead, conducting repeat testing, and carefully tracking children who do show elevated levels.

Shereef Elnahal
Credit: Edwin J. Torres/Governor's Office
Dr. Shereef Elnahal, president and CEO of University Hospital Newark

“The critical piece of this is to establish regular follow-up care if the kids don’t have it —as well as all the downstream steps, including case management,” Elnahal said, noting that University Hospital will continue to work with state and city officials to assist the community.

Even if tests come back showing toxicity, programs exist to boost children’s learning skills and help them manage behavioral issues, experts said. “That number alone doesn’t predict your future,” Rodgers stressed, referring to the blood-lead level diagnosed.

In addition, the doctors noted that lead has long existed naturally in the air and soil in amounts that healthy bodies can shed, but high levels of the metal — which was once added to gasoline and is common in many industrial processes — are hard for most people to process. “We’ve had lead in our environment for millennia and not everybody has terrible things happen to them because of lead,” Rodgers said.

That said, newborns and babies in utero are particularly susceptible to damaging effects of lead exposure, they said. For young brains, the toxin can impact neurological development and lead to learning and behavioral problems, which, without treatment, can be lifelong. (However, these problems can also result from childhood exposure to violence, poverty, parental incarceration and other adverse situations, Rodgers noted, making it nearly impossible to determine the cause of damage in some children.)

‘This is not like Flint’

Residents are urged to contact the New Jersey poison center (1-800-222-1222) for more information on prevention — including tips on how to protect against carrying contamination into the home from a parent’s workplace — and for help interpreting the results of a blood-lead level test, Calello said. They are also urged to watch for peeling paint, wipe up dust in areas where children play, especially along the windowsills of older houses, and wash their hands and their children’s hands frequently.

But the experts counseled against alarm, noting that Newark’s situation is not the same as the water crisis that has gripped Flint, Michigan and resulted in national news. Rodgers — who grew up in Flint — and Calello said that Flint’s problems involved water riddled with multiple pollutants, including bacterial contamination and carcinogens. “This is not like Flint,” Rodgers said.

“The water in Newark is not that way,” Calello agreed. “But Flint was not the first city to have lead in the water and Newark will not be the last,” she said. “Aging urban water infrastructure is going to be a problem everywhere.”

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