Lead Paint with Dr. Robin Felker
Robin: Hi! Okay. Good it works] So, I’m Robin Felker. I’m a resident physician in adult internal medicine and pediatrics at UMass, and I was asked to come and talk about lead poisoning, kind of the risks and sort of why prevention is important.
Lead poisoning ‑ why do we care? Really lead is one of those substances that there is no physiologic use for in the body. We don’t need it and any lead that’s in the body is a foreign substance. Lead interferes with a number of different body processes and organ systems, and it kind of blocks normal processing. It blocks iron. It blocks calcium. It blocks zinc.
Effects in the body – things that we predominantly see include problems with producing red blood cells, problems with signaling from the brain, problems with bone growth, and kidney damage as well from this.
Kids are much more affected from this than adults, and it’s primarily due to their susceptibility to lead. Adults actually can get rid of 99 percent of the lead we’re exposed to. But kids only get rid of 32 percent and that has to do with the fact that they’re storing it in their bones, which are growing, and the lead that’s stored in bones actually can stay there for years to decades. You can find it in x-rays that you do when kids are kind of in their 20s and 30s.
There’s a couple of different things we mean when we say lead poisoning. The first is this kind of acute lead poisoning. I’m going to show some of the numbers only just so you kind of see that it’s a big spectrum for us. So acute lead poisoning is values that are greater than 45 mcg/dL and they can be very, very high.
In kids, the typical things we see are anemia, kidney damage, terrible stomach aches. They can even have brain damage, muscle weakness, and kind of numbness, and tingling from lead. This can progress to coma and ultimately to death, depending on how high the lead levels are.
In adults, this is actually associated with high blood pressure, with more incidence of kidney damage, issues with fertility and in pregnant women with miscarriages and low birth weight infants, and really for this acute lead poisoning, chelation, which is the medical treatment for it, can help, although chelation itself is a very dangerous thing. You have to be in the hospital for it. It’s not a very fun process to undergo.
What we’ve really have come more to mean is this chronic lead exposure, and these are levels that are much smaller than what we were talking about even a decade ago, so talking about levels of 5 mcg/dL to 44 mcg/dL. Really the levels that are even in the 5 mcg/dL, 6 mcg/dL, 7 mcg/dL, we’re finding out to be more important. That’s associated primarily with decreased IQ, and this is huge because these kids have been exposed at 1 –year old, 2 years old, 3 years old. We don’t figure out that they’ve got decreased IQ until they’re 5 years old or 6 years old and in school, and by then it is already too late.
The other things that chronic lead exposure has been linked to are actually failure to graduate from high school, delinquency, decreased literacy rates, school absenteeism, behavioral issues in the school system, so a lot of things that as a society, we should be carrying about. The big thing with this is reducing the lead levels via chelation doesn’t change the IQ difference. It doesn’t change any of these other things. That’s permanent, so once you’ve been exposed, like it’s done.
Really that brings us to prevention, and it’s really the key. Avoiding the lead in the first place is the only way to prevent these neurodevelopmental changes that happen.
Lead comes from a number of places, but really today lead primarily comes from paint. We’ve done such a good job at eliminating lead in the environment from gasoline like lead soda that used to be in cans and all those things, so lead paint is really what remains.
Lead can be inhaled. It can be swallowed. It actually can cross the placenta to the developing fetus. Really what happens is peeling paint and even things like opening old windows that have lead paint create a lead dust, which is very difficult to get rid of. Older homes are more likely to contain lead. We talked a lot about homes before 1978, and really the older the home, the more likely those to contain lead. There are other sources still. Some lead water pipes remain. Lead is in the soil from a number of things, and then some toys and jewelry come to mind.
But why is it important for Worcester? Really, I put this up. This is from the state data on lead elevated levels in children from 0 to 5. I highlighted kind of the surrounding communities, put Worcester in blue. My chart didn’t come out very well. But the blue actually represents the highest levels of lead exposure, and Worcester has a high level of lead exposure compared to the state and compared to a number of the surrounding communities and that really has a lot to do with the risk factors for lead exposure.
The main risk factors are living in a city, living in housing especially before 1950, and then low family incomes. Worcester certainly has a lot of those things going on.
This is all from 2014 data. In the City of Worcester, lead greater than 5 mcg/dL – falling in that chronic exposure – was in 4 out of 1,000 children screened in the year 2014 whereas statewide, the rest of Massachusetts, it’s 2.9.
The other data that they kind of collect are how many houses are pre-1978. In Worcester, it’s the vast majority of residential housing. In 2014, what this breaks down to is there were about 8,000 kids, who were screened, which they had 76 percent, which were screened. It’s really good, better than the national numbers, 4 percent, so 220 kids had this elevated lead levels and 28 actually had an even higher threshold of lead exposure.
Really what I want to kind of get across is that even though low-level exposure can cause neurodevelopmental damage, and something you can’t get back. You can’t treat it. Preventing exposure is really important to avoid the toxicity. Worcester being a high-risk community, it’s got all the risk factors. We’re urban. We’ve got old houses. The city is not the most wealthy city. We’ve got a lot of the things that make it a high-risk place, and certainly a place where if we can make changes, it will make a big difference.
Okay, thanks [applause].
Rich: Excellent. Does anybody have a quick question for the doctor?
Female Audience 1: It’s a real thing.
Rich: I think that was pretty self-explanatory, but‑
Sandra: Just a comment [unintelligible 0:07:21].
Male Audience 1: To determine the lead, is that a simple blood test?
Robin: Sure. It’s actually another part of Massachusetts law is that we screen for lead levels in children at about age 9 to 12 months, and then again at 2 and 3 years, and actually in high-risk communities, also at 4. We’re watching it and then those kids that we pick it up, we follow them more closely.
Sandra: I was just going to comment. I’m not surprised that we have the highest percentage of the surrounding community where Worcester is the land of the deckers, and a lot of those deckers are pre-’76. I’m certainly hoping that we will find out when the state is actually going to increase the amount of money that it takes to delead an apartment because that certainly would be very helpful. But I think that many landlords would like to try to delead their units but that’s one of the issues is that we do have three-deckers and that’s where a lot of the problems are basically coming from.
Sandra: That’s somewhat skewed because the other communities don’t have the same kind of housing stock that we do.
Robin: No, that makes sense. I actually live in a triple-decker, and so it actually brought new light to the agreement that I remember signing when I started renting my apartment because I now realize like what it’s all about, so.
Rich: Right, and we’ll have somebody tell us the fine later on if you don’t do that with your people moving in. Yeah, Worcester has a lot of triple-deckers. There were 4,000 of them originally. I think there are 3,000 left and most of them were built between 1890 and 1910, so it’s not fair. That’s why our town doesn’t look good on the map.
Male Audience 2: Hi, Doctor. You mentioned these risk sources of lead paint in old houses, windows, friction from the dust, peeling paint. Were there others? Did I miss any?
Robin: That’s mostly what I read about, so.
Male Audience 2: All right, thanks.
Rich: And we’re actually going to have an inspector tell us exactly where they find these things. We’re going to have an abater tell us how to get rid of them, and hopefully we’re going to learn some things about what Sandra is saying. I think that’s one of the big questions in everyone’s mind is, “Well, great. I want to do this. How do I get this thing paid for because it’s pretty pricey, right?” So that’s something we’re going to try to learn about tonight as well. So time for one more?
Female Audience 2: Since Massachusetts requires children to be screened starting at 9 months of age and we seem to be getting the larger number of the 220 coming through around 3 and 4, has the additional questions been asked as to whether these children are moving in already with lead paint that aren’t being screened that aren’t showing up in the ages before, that should be showing up in the 9 months and 2 months whether in those prior screenings? Is there any follow-ups for those or are we‑
Robin: All of the kids who have the elevated lead levels do have further testing and kind of different dietary interventions, things we do to try to minimize how much lead they’re absorbing. But one of the primary things is looking at what the major sources of lead are for that particular child that’s kind of what we would do is see is there something in the house that we can do to intervene? Is there something in the bedroom we can do to intervene?
Female Audience 2: I [unintelligible 0:10:52] like that, but how are we making sure that they’re not coming in from another source outside, that they’re coming in and skewing the Worcester?
Robin: I’m not sure about that.
Female Audience 2: Is that a huge immigration problem?
Female Audience 2: Population in Worcester?
Robin: Sure. Certainly the numbers are sort of how many kids in 2014 had elevated levels? They look at each year individually. Well certainly there are some that are moving in, kind of it’s not accumulative over time of everyone. It’s kind of each year we’re looking at the numbers. I mean it seems to be pretty consistent. I mean the numbers have come down, but it seems to be pretty consistent over the data I looked at.
Female Audience 2: Just so you know there is one other huge source of lead paint.
Female Audience 2: Apparently, it’s marine-based paint that you put on boats. I mean that is lead-based paint and a lot of people don’t know that.
Robin: Right, that’s true.
Female Audience 2: So everywhere.
Sandra: That’s a really good question [unintelligible 0:11:50].
Doug: Doctor, last question. Is it true that the lead laws requiring deleading or incentivizing deleading has made a difference in the number of children poisoned?
Robin: Absolutely. I mean the numbers – so Massachusetts started screening kids for lead levels in 1990, was what I kind of found. The numbers are pretty dramatic. I actually wish I had put in that slide, but I mean we’re seeing a huge decrease, and even nationwide is seeing a huge decrease to the point where now we can avoid thinking as much about the acute like the high-level toxicity and really get on what’s the low level exposure and the rest. And so, it’s a problem that it’s kind of nice to have that we’re so worried about these lower levels because things have just been getting better, but we can still make it better, so.
Dough: Thank you very much.
Rich: Excellent. Thank you very much, Doctor. Let’s give her a hand [applause].