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OAKLAND – Laura Smith took her infant daughter to the doctor for a routine wellness check. But when the results came back, Smith was shocked.
One-year-old Lucy had been diagnosed with lead poisoning, which in severe cases can cause irreversible neurological and organ damage.
“We never would have suspected it (lead poisoning),” said Smith, who lives in Oakland and is deputy editor of California, a general-interest magazine produced by the Alumni Association of the University of California at Berkeley.
Equally troubling to Smith and her ex-husband was the suspected source of the poisoning: the family’s charming century-old apartment on College Avenue in Berkeley. It turned out their situation was not unusual.
Alameda County, which includes Berkeley and nearby Oakland, has a high rate of lead poisoning, comparable with that of Flint, Mich., which garnered national headlines in 2014 over shocking amounts of lead in the city’s municipal water supply and led to criminal charges being filed against a number of state and local government officials.
In Alameda County, contaminated water isn’t the main source of dangerous lead. Here, it lurks mostly undetected in homes with lead paint. And now with a virus-born pandemic keeping more people at home, the risks for health problems related to lead are expected to dramatically worsen, according to public health officials.
Many families are likely unaware that their home improvement projects, such as sanding down walls and window sills that contain lead paint, can expose them to severe health problems unrelated to the novel coronavirus. Even prior to the pandemic and stay-at-home orders, testing for lead poisoning lagged, drawing scrutiny from state lawmakers and urgent calls for reform to increase testing.
“We often refer to lead poisoning as this kind of invisible disease,” Larry Brooks, director of the Alameda County Healthy Homes Department, said.
Brooks, who has been working on lead prevention for three decades, said many children, especially babies, do not show symptoms of poisoning, such as hyperactivity or slurred speech.
Smith feels fortunate that Lucy’s pediatrician took it upon herself to order the test. Otherwise she would never have known or suspected a problem.
“What’s hyperactivity in a toddler?” Smith said. “You can’t really tell at this age.”
No amount of lead in the body is known to be safe. Children are at particular risk for long-term health problems related to exposure, according to the World Health Organization.
Brooks said babies can develop a habit of finding chipping paint or dust and then putting their fingers in their mouths. Some kids even start to crave lead and become ravenous for lead-soaked dirt or paint chips. Lead can also enter the body in the form of inhaled lead dust or fumes.
“Lead-based paint tends to have a sweet taste to it,” Brooks said.
Lead poisoning can cause hypertension, organ damage and birth defects. In the worst cases, children can suffer seizures and even die. If lead poisoning isn’t treated, lead will be stored in a patient’s bones and eventually cause even more damage like kidney failure. Pregnant women can pass on lead poisoning to a fetus which can cause miscarriage, stillbirth and low birth weight.
Even low levels of lead in the bloodstream are associated with mental and physical disabilities. These include attention deficit disorder and decreased IQ levels, slurred or delayed speech, damaged hearing and anemia.
“Basically, their brain is getting brain damage,” said Assemblyman Bill Quirk (D-Hayward), who has advocated for universal lead testing for children in California.
Right now, only 11 other states mandate testing for lead in children’s blood. Children enrolled in Medicaid nationwide are supposed to be tested. However, in the past decade, many states, including California, fall dramatically short of that goal.
In California for the past decade, fewer than half of children under age two on Medi-Cal were actually being tested, according to a California state auditor report published in January. In total, almost 1.7 million children who were supposed to be tested weren’t.
After a 2012 budget cut, the Centers for Disease Control and Prevention slashed funding to states for lead poisoning prevention programs by 90 percent, Reuters reported in 2016. Though some of the funding was eventually restored, it’s still been hard for state health agencies to restore their programs and increase testing.
The CDC recommends that all children be tested in areas where over 27 percent of housing is built before 1950, a threshold that Alameda County exceeds with 38 percent of housing built before 1950.
In Alameda County, more than 75 percent of housing was built before 1978, the year lead was banned from paint.
Oakland is even more of a hot zone, with 90 percent of the housing there built before 1978, The older the home, the more likely it is to contain multiple layers of lead-based paint.
Even with the CDC’s criteria, doctors may choose to forgo testing if they believe a child is not at-risk.
“We have heard many stories of situations where parents have actually been aware of the fact that their children should be tested and when they asked, they’d been ignored by them (doctors),” said Brooks.
He said some parents are unaware of the risks of poisoning, while others might feel ashamed and fear consequences for speaking up.
“If I’m a poor person living in the house where there’s chipping, peeling paint, I may be reluctant to tell a doctor,” Brooks said.
Brooks supports mandatory testing statewide but lawmakers have been unable to pass the necessary legislation. Quirk co-authored Assembly Bill 1316, which originally proposed universal testing in 2017. But that aspect was deleted from the bill.
“As you can imagine, the medical industry doesn’t like legislators or anyone else telling them their business,” said Quirk.
He said pediatricians and industry organizations claim they offer tests in all cases where it’s warranted. “And of course, that’s not true,” he said, pointing to low testing rates.
“I don’t think we’re going to get universal lead testing as long as the pediatricians are opposed,” said Quirk referring to the fact that doctors have cited low “societal benefit” for universal testing in California.
The American Public Health Association published an article in response to AB-1316 stating that universal testing would raise insurance premiums by .0045 percent and that almost 5,000 lead poisoning cases would be detected within the first year of implementation. Quirk advocates for finger-prick testing as a cheap, reliable way to detect a lead-poisoned child that costs as little as $10 and can be done in a few minutes at the doctor’s office.
Quirk also proposed AB-2278 in February of 2020 that would require all children be screened for risk of lead poisoning. But Quirk said the bill was stalled indefinitely.
Brooks pointed out that the lack of testing has disproportionately impacted lower-income Black and immigrant households for decades and coincides with continued health disparities today.
Before 1973, lead was used in gasoline to boost fuel efficiency and some of that fuel spilled into the soil, leaving behind “legacy lead.” Oakland has worse cases of lead poisoning partly because it’s an industrial city.
Kids who play in poisonous soil can kick up and inhale the dust. This is especially common near the Port of Oakland and the airport where residents are surrounded by planes, ships, and cars that all used to spew lead particles in the air.
These neighborhoods in Oakland were also victims of red-lining, a discriminatory housing policy against Black residents. These neighborhoods are now largely Black and Latino. Brooks said lead poisoning and racial disparities are inseparable.
He said lead poisoning, especially undiagnosed cases, can have lifelong consequences. Poisoned children later in life can develop kidney problems, hypertension, and lifelong cognitive issues.
“It’s a vicious cycle,” he said.
Over a dozen scientific studies have examined the lead-crime hypothesis, which says that lead poisoning impairs childhood brain development and leads to increased aggression, reduces impulse control and impairs the ability to assess risk.
Lead was eliminated from gas around the time of an exponential rise in crime in America, and in 1991, the CDC recommended that all children be tested for lead. Violent crime rates subsequently declined sharply – a fact some researchers attribute in large part to declining rates of lead poisoning.
More recently, lead prevention efforts have tapered off. And Brooks said legacy lead could explain why areas such as East and West Oakland are disproportionately affected by the novel coronavirus.
Brooks described Fruitvale, a neighborhood with a mix of industry and homes, as “ground zero” for lead poisoning, with the highest rates in the county.
During Flint’s water crisis, President Obama urged parents to get all children tested, and later nearly five percent of children tested positive. In Fruitvale, over seven percent of children tested positive for lead poisoning. But there has been little national attention on the issue.
“Lead-poisoned kids develop the conditions that make them more susceptible to COVID-19,” said Brooks.
As of late-July, African-Americans represented seven percent of COVID cases but make up 21 percent of COVID deaths in Alameda County. Latinos are also disproportionately affected by COVID-19 as they compose 25 percent of Alameda County’s population but 51 percent of COVID-19 cases.
With gentrification and more middle class families living in run-down apartments, Brooks says, he’s seen the racialized stigma of lead negatively impact white families or white-passing Latinx families as well.
“White parents who, when they bring it (lead testing) up, they’re told, don’t worry about it,” said Brooks.
He hears about these cases eventually because the child is eventually diagnosed with lead poisoning.
“[It’s as if] being white means that your child can’t get lead poisoned,” he said.
Smith and her ex-husband never dreamed their apartment, in a fourplex in Berkeley’s Elmwood neighborhood, posed a threat. But after Lucy’s diagnosis, the couple immediately tested their apartment for lead, using an at-home kit that costs $10 at any hardware store.
The test included a marker-like swab that when rubbed over surfaces containing lead, turns red.
“It was just red, red, red,” Smith said.
Lucy was learning to walk, and she pulled herself up near doors and windows, which had some of the highest concentrations of lead in the home.
Shocked and scared, the family moved out of the apartment two days later. Smith tested her new apartment for lead before signing the lease.
Brooks warned about the accuracy of at-home tests and risks for false negatives. He said equipment used by building inspectors is much more reliable. He also recommends painting walls and surfaces often to ensure any old lead paint doesn’t enter the environment. Removing a child from the lead source is a crucial first step toward recovering from poisoning.
But now with the pandemic, testing for lead has all but stopped, according to Julie Kurko, a nurse who oversees lead-poisoning cases in Alameda County.
“Everyone stopped going to doctors. It just came to a screeching halt,” she said.
Fewer children also are being treated for lead poisoning as a result of the pandemic, Kurko said. Normally, medical teams work with families to identify and remove sources of lead, and monitor patients using blood tests and home visits over a period of months or even years.
“We’re like little lead detectives,” Kurko said of her team of nurses. Now, their sleuthing is limited to phone calls and televisits as a result of the pandemic, making it that much harder to identify and treat lead poisoning, she said.
Kurko said another troubling trend that predates the pandemic is an uptick in contaminated spices and cosmetics imported from India and Afghanistan.
Kohl, an eyeliner thought to protect eyes and improve eyesight in Indian and Middle-Eastern cultures, is illegal to import into the U.S. because of its lead toxicity but it still makes its way to the U.S. and onto children.
The FDA issued an alert on ayurvedic spices because some have high amounts of heavy metals like lead. Some shipments are stopped from entering the U.S., but no ayurvedic products are reviewed or approved by the FDA. Smaller online purchases of ayurvedic medicine often slip through regulatory cracks and may end up poisoning the kids or adults that ingest them.
Kurko said a blood screening registry that connects to the immunization registry would help keep track of a patient’s treatment for lead poisoning. Today, if a patient diagnosed with lead poisoning moves, their new doctor may not get any information about their case, causing treatment to be delayed or discontinued.
Both Kurko and Brooks believe more proactive building inspection for rental units would also help ensure homes are safe.
“We’re using kids as little lead detectors as opposed to getting in the homes ahead of time and identifying the hazards before children become lead poisoned,” said Brooks.
In Alameda County, homes are not routinely inspected for lead. Building inspectors will only investigate when homes are suspected of contamination.
Fortunately for Smith, Lucy’s most recent blood tests showed remarkably low levels of lead in her system, a huge relief for her mother.
“I was texting everyone,” Smith said.
But healing from lead poisoning can take years, related to how much lead has been consumed and individual metabolic rates.
Smith described herself as feeling “haunted” over her daughter’s diagnosis. But she pins hopes on Lucy not suffering any long-term health issues.
In the meantime, she’s encouraging everyone she knows to test for lead.
“It’s so common in an area where there’s so many old houses. Why wouldn’t you test?”