Doctors at the county’s only pediatric unit have treated two children in Lancaster County within the past six weeks for severe lead poisoning.
Given so few children are tested each year and many parents skipped routine checkups during the COVID-19 pandemic, experts fear far more could be at risk.
“You can’t do a lead screening by telemedicine,” said Dr. Frances Gross, chair of Penn Medicine Lancaster General Hospital pediatric unit.
Both of the children were younger than 3 years of age. One had a blood lead level of 52 micrograms of lead per deciliter of blood (μg/dL). And the other child’s blood lead level was 112 μg/dL.
While no level of lead is considered safe, the Centers for Disease Control and Prevention (CDC) has identified 5 μg/dL as a “level of concern.”
The urgency, Gross said, is because one of the children with severe lead poisoning had normal levels just seven months ago.
Lead poisoning can be detected with a simple blood test, but only about 20% of Pennsylvania children are tested each year.
In children, lead exposure has been shown to result in a lowered IQ, an inability to pay attention and poorer academic achievement.
Gross, who has practiced in Lancaster County for more than 30 years, does not recall the last time a child in Lancaster County was diagnosed with such elevated lead levels.
The number the pediatric unit at LGH has treated in the past three years: Zero.
"It's a very broken system," said Gross, who last week participated in a virtual press conference to raise awareness on lead paint poisoning.
‘Canaries in the coal mine’
Lead is fairly ubiquitous.
It’s found naturally in soil. It’s also in older water pipes. Pennsylvania law requires lead-free materials be used in constructions and repairs after 1991. And it’s found in imported candies from other countries as well as in certain products such as toys and jewelry.
But the most common source for lead is in homes built before 1978, when lead-based paints were banned.
Nearly 70% of the housing in Pennsylvania was built before 1978.
The kicker for advocates is that lead poisoning is completely preventable.
“Good housing is good health,” said Jordan Casey, an attorney for the Health, Education and Legal Assistance Project with the Foundation for Delaware County.
The problem — as state Rep. Michael Sturla, D-Lancaster, sees it — is identifying which homes have lead paint.
Sturla, who is a landlord, introduced a bill earlier this year that would require a housing inspector to conduct lead testing on housing units built before 1978. The proposed bill would also require the results to be publicly available.
Housing advocates say the bill, which does not yet have bipartisan support, doesn’t go far enough.
“Right now we don’t even know where the places are,” Sturla told LNP | LancasterOnline Tuesday. “We’re using children as canaries in the coal mine to identify where there are high levels of lead. That to me is barbaric.”
Sturla added, noting his proposed bill is a first step, "The costs are enormous and they are lifetime costs."
Prevention, the only treatment
There is no cure for lead poisoning. And the damage is irreversible.
Joyce Ravinskas, program manager for the UPMC Pinnacle Lead Poisoning Prevention and Education Program, said she has seen a 35% increase for investigation referrals.
This is roughly the decrease the CDC found had skipped testing between January and May last year, compared to the same period in 2019. Released in February, the CDC study examined test results from 34 U.S. jurisdictions, and did not include Pennsylvania.
“This is definitely attributed to COVID,” said Ravinskas, noting she typically received 300 referrals a year.
Ravinskas added, “Right now we’re seeing a lot more cases coming in because children are starting to come back for their wellness checks and they’re being tested for lead.”
The CDC report did not collect socioeconomic data, but researchers anticipate a disproportionate impact for children from racial and ethnic minority groups or in economically marginalized families living in older housing. “These groups have also been disproportionately affected by the COVID-19 pandemic,” the report’s authors noted.
Nearly 9,000 Pennsylvania children are poisoned every year.
“The only treatment for lead poisoning is prevention,” Gross said during a Thursday press conference with the Lead Free Promise Project, a coalition pushing for one-time state funds from the American Rescue Plan to be used to remediate lead-laden homes.
Lead poisoning has been a longstanding issue in Lancaster County, with a number of schools identifying the heavy metal in their water.
The real issue, though, is housing.
According to the state Health Department, roughly half of Lancaster County homes were built before 1978.
Colleen McCauley, health policy director for the Philadelphia-based advocacy organization Citizens for Children and Youth, notes Pennsylvania children are poisoned at a rate 2.3 times higher than those in Flint, Mich., at the height of the city’s water crisis.
The difficulty for counties like Lancaster that do not have a local health department is getting data in real time. The most recent information available is from 2019 and state health officials do not anticipate having 2020 data until the end of the year.
“From a general perspective, I believe that a County Public Health Department would be a useful tool in helping to combat lead poisoning throughout Lancaster County,” Democratic County Commissioner Craig Lehman said in a text to LNP | LancasterOnline.
County Commissioner Chairman Josh Parsons and County Commissioner Ray D’Agostino, both Republicans, did not respond to requests for comment on the issue.