Lead testing plummets during the pandemic, an alarming development for Michigan children

LANSING — Lead testing rates have plummeted since the coronavirus pandemic hit Michigan, potentially leaving hundreds of children across the state unknowingly exposed to the dangerous heavy metal.

The implications are huge. Lead exposure can lead to developmental delays, diminished intelligence, poor attention span and other issues in children. Without testing, those children are less likely to get help before the worst effects set in.

"It can make or break their life, basically," said Sara Durner, a Lansing woman who discovered in 2018 her son had a small amount of lead in his bloodstream. "You want to find it out obviously as soon as possible or they're going to be dealing with this for the rest of their life."

Fewer parents are making that life-changing discovery this year.

Blood lead level testing declined by 61% statewide in March, April and May compared to last year, according to Michigan Department of Health and Human Services data.

Some of the most troubling testing declines were in high-risk cities such as Lansing, Flint and Detroit, said Thomas Largo, Michigan Department of Health and Human Services environmental health surveillance section manager.

"They are areas that we focus on [for lead screening], and the decreases were pretty large," he said.

The decline has continued through the summer, Largo said, and is unlikely to return to normal before the end of the year. 

It's another sobering side effect of the coronavirus pandemic, which has killed more than 6,700 Michigan residents since mid-March and caused skyrocketing unemployment and financial instability for working families. 

Many clinics that typically test children's blood for lead exposure have been closed for months. People afraid of contracting the coronavirus are avoiding medical appointments, so even open health clinics are less busy.

Meanwhile, children who are exposed to lead in their homes are spending lots of time there.

"We know kids were impacted by lead before the pandemic," said Tina Reynolds, leader of the Michigan Alliance for Lead Safe Homes. "Now we've amplified their risk in many cases."

Despite pipe replacement, Lansing a hot spot for lead exposure

Roughly 21% of Michigan children younger than 6 are tested for lead poisoning in a given year. They tend to be low-income children who are at higher risk of exposure.

Usually, about 3% of them have what is considered an elevated amount of lead in their bloodstreams — more than 5 micrograms per deciliter of whole blood — although no amount of lead exposure is considered safe.

About 40,000 tests were administered across Michigan in March, April and May of 2019. Fewer than 16,000 were administered those months in 2020. That's about a 60% decline.

Assuming 3% of the children who didn't get tested during the six months of the pandemic would have had elevated lead levels, there are about 1,300 in the state unknowingly exposed to high amounts of lead who, in a non-pandemic world, would have otherwise been told.

That's 1,300 children who could be missing out on medical interventions as well as free nutrition and home-repair programs available for children with lead poisoning. 

It's worse in Ingham County, according to state data. Testing dropped off by more than 73% in the first three months of the pandemic. About 3% of children in the county typically have elevated lead levels.

Urban areas, including Lansing, are known hot spots for lead exposure, Reynolds said.

Although the Lansing Board of Water and Light started replacing the city's lead water pipes in 2004, a decade before the Flint water crisis, and removed the last of them in 2016, the city's old housing stock puts many children at risk.

Lead is common in the paint, soil and dust in old homes. The largest source of lead poisoning in children comes from dust and paint chips, according to the National Institutes of Health.

More:BWL removes Lansing's last lead water service line

The vast majority of Lansing homes were built before 1978, the year the U.S. Environmental Protection Agency outlawed lead in paint, Lansing Community Development Coordinator Barb Kimmel said.

Children living in those homes could be exposed to it in the soil, dust and paint, particularly if the home is poorly maintained. Children between 1 and 2 years old are especially at risk, Kimmel said, because of their tendency to put things in their mouths.

"They're ingesting that heavy, sticky lead dust," she said. "That is the way that most kids get poisoned. It's not from chewing on windowsills."

Lansing runs a program using federal grant money to remove lead from homes rented or owned by low-income families in the city. It just received notice it will get $4.6 million to fund the program for 3.5 years.

There are 60 homes on the waiting list, Kimmel said. The program removes lead from an average of about 50 homes a year.

And they rely on blood lead testing to both find houses that need remediation and follow funding rules.

Kimmel estimated about a third of the homes fixed by the city's lead abatement program are referred by the Ingham County Health Department, which operates a pediatric clinic and staffs the local Women, Infants, and Children program clinics.

Regardless of how families end up in the city's lead-abatement program, grant rules require the city to report blood lead levels of children living in homes that get fixed. That way, children with lead exposure can get medical intervention.

The plunging testing rates might impact the city's lead removal work, Kimmel said.

"We're going to have to figure this out," she said.

WIC clinics close during pandemic, with no timeline for reopening

Durner's son was 18 months old when he was found to have a small amount of lead in his system. She was alarmed by the news until she learned the exposure was very limited.

She hadn't realized the west side home she had recently purchased with her husband was a lead hazard.

"I definitely didn't know," she said. "Just by the looks of it, it looked very good."

Lead isn't a problem in the Durner home anymore. Crews working for the city's lead abatement program replaced a window, re-sided her garage and painted the porch and basement this summer.

Durner would not have known about her son's exposure had it not been for a finger poke at a WIC program clinic in Lansing. 

The federal program provides food and health care referrals to low-income pregnant women, new mothers and young children. Clinical staff screen children's blood to tailor services based on what nutrients a child is missing.

They screen for evidence of lead exposure at the same time, Largo said.

But WIC clinics have been closed during the pandemic. Michigan, like other states, secured a waiver that allows the program to be administered by phone. Clients are still getting benefits, but lead screenings have stopped.

"The WIC clinic is closed and cannot see clients in person," an automated message at a local WIC office says. "During this partial shutdown, voicemail messages and phone calls are our only way of communicating between clients and staff."

WIC offices could remain closed for a month after the national public health emergency declaration ends, according to a Sept. 21 notice of waiver extensions. 

"The WIC program is probably one of the larger programs that does lead screenings in the county," Ingham County Health Department spokesperson Amanda Darche said. 

The health department has continued to screen children for lead exposure at its pediatric clinic during the pandemic, she said. It also provides screening through its mobile health clinic. 

Still, lead screenings have declined sharply. In March through May of 2019, 1,244 tests were administered in Ingham County. That declined to 330 for those months in 2020.

Darche cited a decline in other health care services, such as immunizations, and guessed that lead testing rates have dropped because people are still afraid of contracting coronavirus at appointments. 

More:Child vaccinations plummet during COVID-19 pandemic, worrying Michigan health officials

Lead testing fell short before pandemic hit 

The state's blood lead testing program lagged behind federal mandates even before the coronavirus pandemic hit Michigan.

Children enrolled in Medicaid are supposed to be tested for lead when they are 1 and 2 years old, or, if for some reason they weren't tested early, before they are 6. In 2018, only about 78% of Michigan children on managed Medicaid plans were screened for lead before age 2, according to a state report released last year. 

"We were not doing great but had been making some incremental improvements in our testing," Reynolds said. "With COVID, all of that has been erased."

Reynolds, who is health policy director for Michigan Environmental Council as well as the leader of a statewide lead abatement advocacy group, is pushing state officials to enact more stringent lead testing requirements. 

Every child should be tested for lead just like all are supposed to be vaccinated, she said.

"It just would be a lot easier for families to understand, for physicians to understand," she said. "It would be more traceable and accountable than the environmental health screening that we have now. It would just really solve a lot of problems with testing and improve our testing rates."

Pediatricians are supposed to ask families about the age of their homes to determine whether children should be screened for lead exposure, Reynolds said, but information about those screening questions are not consistently recorded.

"We don't know whether these environmental screens are given because there's no recording," she said. "There's no accountability."

Contact Carol Thompson at ckthompson@lsj.com. Follow her on Twitter @thompsoncarolk.