Lead Poisoning (Tony Bacewicz)
When Angely Nunez’s parents had to relocate the family quickly after a fire last year, they found an apartment a stone’s throw from the state Capitol.
Though she cleaned constantly, Angely’s mother said dust was everywhere, and the walls and ceiling were covered with peeling paint.
At their 3-year-old’s physical several months later, Angely’s parents received startling news: The level of lead in the girl’s blood was nearly three times what the state and federal governments define as poisonous in a child.
Her parents realized, her mother said at a recent clinic visit, that Angely had been acting "antsy, really anxious, and would just start screaming." The clinic doctor said Angely has a speech delay as a result of the lead in her system.
But even with the frightening diagnosis, the Hartford girl could be considered fortunate. Many children in Connecticut with high levels of lead in their blood are not diagnosed so early because of significant gaps in state-mandated testing, medical experts say.
The failure to test properly is significant, especially considering the number of cases that are caught. Nearly 60,000 Connecticut children under age 6 were reported with lead exposure in 2013, and an additional 2,275 children had high enough levels of the toxin in their blood — 5 micrograms or more per deciliter — to be considered poisoned.
Even though Connecticut has some of the strictest lead-screening laws in the country — requiring every child to be tested twice, once when they’re age 1 and a second time before they turn 3 — state Department of Public Health figures show that only half were screened twice.
Unlike in Flint, Mich., whose residents were poisoned when a corrosive water source was directed through aging, lead-lined pipes, the main culprit in Connecticut is lead paint. Though its use was banned in 1978, lead-based paint is still present in countless older homes and apartment buildings, especially in urban centers, such as Hartford, New Haven and Bridgeport.
State law says labs have 48 hours to inform the state and local health departments when they have a report of someone whose lead count is above a certain level.
Most pediatricians are doing the screenings, said Dr. Lisa Menillo, who created and directed the regional lead treatment center at St. Francis Hospital and Medical Center in Hartford before it was closed in 2014.
But, she said, "They’re not doing it correctly. They’re not doing it at the right ages, and they’re not doing it as often as they should."
Screening ‘A Hard Sell’
DPH records show that about 30 percent of children between 9 months and 2 years old did not have a blood lead test in 2013, a total of just more than 22,000. And about half of all 3-year-olds that year who had been tested once when younger never had a second test.
Screening "is a hard sell, sometimes," said Lisa Honigfeld, vice president at the Farmington-based Child Health and Development Institute, which is under the nonprofit Children’s Fund of Connecticut.
She says that because Connecticut’s screening laws are stricter than the federal government’s, some pediatricians may not take the laws seriously. This spurred the institute to launch a training program recently to educate doctors on the medical imperative of following state lead laws.
A spokeswoman for DPH says the agency, which oversees physicians, "is currently working on increasing our outreach efforts in order to bolster second test numbers."
Menillo said some of the problem also may be a perception among pediatricians that lead exposure "is just an inner-city problem."
That’s not the case, she said. DPH’s 2013 numbers show that children age 6 and under were exposed to lead in West Hartford, East Hartford, New Britain, Bloomfield, South Windsor, Enfield, Manchester, Vernon and other towns across the state.
Still, in the two decades since Connecticut started screening, the larger cities generally report the highest numbers of lead-exposed children.
DPH’s 2013 records show:
>>Bridgeport had 5,754 children with a blood-lead level of 4 micrograms or lower, and 402 at 5 mcg or higher.
>>New Haven had 4,114 children with a level of 4 mcg or lower, and 405 at 5 mcg or higher.
>>Waterbury had 4,152 children with a level of 4 mcg or lower, and 229 at 5 mcg or higher.
>>Hartford had 4,426 children with a level of 4 mcg or lower, and 161 at 5 mcg or higher.
Although Hartford still has high numbers, Arlene Robertson, who has headed the city’s lead program since 1998, is proud that the capital city is now No. 4 in lead poisoning rates and that levels of poisoning are lower than they once were.
"We have accomplished a lot," she said, through education, in the form of literature and speaking to community groups, and by better screening.
High Risks For Kids
Young children are lead’s likeliest, and most vulnerable, victims. Their risk of exposure coincides with their peak period of brain development.
Healthy babies and toddlers are driven to move and explore. Through frequent hand-to-mouth activity, they may ingest the toxin through peeling lead paint chips, which taste sweet, and lead dust, created as doors and windows in older housing open and close over the years, grinding down the paint.
"Kids who are younger absorb lead at [many] times the rate adults will absorb it," said Dr. Hilda Slivka, director of the Regional Lead Treatment Center at Connecticut Children’s Medical Center in Hartford.
Lead exposure can cause cognitive deficits — a loss in IQ points — and speech and developmental delays, as well as hearing and behavioral issues, and hyperactivity.
But its immediate impact can be subtle or even imperceptible, since its symptoms are not uncommon: loss of appetite, fatigue, abdominal pain, constipation or diarrhea, irritability.
Because its effects are generally irreversible, lead exposure has long-term societal impacts, such as the millions of dollars spent on special-education programs annually, experts say.
In two recent studies, researchers at the Children’s Environmental Health Initiative, out of Duke University and the University of Michigan, examined lead-screening results and Connecticut Mastery Test scores, focusing on 18,000 fourth-graders.
In both studies, CEHI said that the "stark difference between blood lead levels by race" — especially between white and black fourth-graders — was mirrored in the wide disparity in CMT scores in both reading and math.
Both studies concluded that "exposure to lead may account for part of the achievement gap among Connecticut schoolchildren."
Since 2012, the Centers for Disease Control and Prevention and Connecticut health officials have defined lead poisoning as a blood lead level of greater than or equal to 5 micrograms per deciliter — although experts agree there is no such thing as a safe level.
Once it enters the bloodstream, lead can affect the nervous system and nearly every other system in the body. Scientists say high levels can cause anemia, kidney damage, muscle weakness, brain damage and death.
And study after study shows that "levels as low as 5 [micrograms per deciliter] … affect IQ, ability to pay attention, and academic achievement."
Without a blood test, pinpointing the cause of a child’s illness or condition can be difficult, in part because the toxin can affect children differently.
"There isn’t necessarily one area of the brain that’s always affected," said Slivka, of Connecticut Children’s Medical Center.
Lead exposure "can cause hyperactivity, it can cause some decreased ability in speech, it can cause decreased hearing as well as just [decreased] cognitive functioning," Slivka said.
Slivka runs a Tuesday morning lead clinic at CCMC’s Primary Care Center. The clinic gets one or two new patients every week, she said, and "a lot more" in the summer.
Her current caseload is about 65 children, from Hartford, Manchester, Meriden, New Britain, Waterbury and elsewhere — including Angely Nunez of Hartford.
At the little girl’s physical last June, her parents learned that Angely’s blood lead level was 14 micrograms per deciliter, nearly three times the 5-microgram level that the DPH defines as poisoning in a child. Her parents realized how differently their little girl had been acting.
When staff at the federally funded Healthy Homes Program, based at CCMC, inspected their Buckingham Street apartment in the fall, they advised the family to move.
Angely and her parents now live on Park Street, but, in late winter, the little girl was still being seen at the clinic. Slivka said Angely has a speech delay as a result of the lead in her system.
Waterbury resident Latasha Mewson had a more alarming experience with her son. When she tried to enroll 3-year-old KJ into a new day care center last year, she was told they could not accept him because a blood test had shown his lead level at 47 mcg/dl.
Mewson said she had noticed a change in KJ’s behavior in the eight months since they’d moved into their Section 8 apartment, which had holes in the walls, peeling paint and decrepit windows, all of which the landlord had refused to fix. The boy had become "very hyperactive," she said, which was "very new."
When, as required, the boy’s lead level was reported to the DPH and the city, Waterbury workers inspected and put the family up in a hotel for three weeks, before placing them at their current address several blocks away. KJ is still being treated at CCMC.
Slivka said it can take several years of chelation therapy — in which a substance to remove heavy metals is injected into the child’s body — to lower lead levels.
Nearly 75 percent of Connecticut’s housing was built before 1980, compared with 57 percent nationally, according to the National Center for Healthy Housing. This, and the fact that such housing is often in poor cities, makes the state one of the top 10 nationally in terms of lead poisoning risk, according to a 2012 DPH report.
Removing lead paint, or lessening the risk of exposure, takes special training or its dangers can be increased.
Since 1999, the U.S. Department of Housing and Urban Development has funneled more than $116 million to the state government and to cities and nonprofits for lead abatement and related activities.
The nonprofit Healthy Homes Program has received $31 million from HUD since 2003 to help property owners in 15 cities, where 62,000 children enrolled in Medicaid live, remove or minimize lead paint.
Many communities have programs that can help eligible property owners cover the costs of remediating lead problems. Once a landlord or homeowner applies — by contacting their local government — and is approved for financial help, Healthy Homes will assess it for lead, and other hazards, as well.
Under state law, the failure to make corrections can lead to fines or even imprisonment.
Ronald Kraatz, Healthy Homes’ senior manager, said, "We make progress, but 2,000 kids a year are still poisoned."
The biggest challenge, Kraatz said, is "the sheer numbers we’re dealing with" and the fact that "we can reach, perhaps, 200 houses a year."
Of Bridgeport’s 58,500 housing units, more than 75 percent were built before 1978, when lead paint was outlawed. In 10 years, after four consecutive HUD grants, the city has remediated "almost 1,000 units," said Sabine Kuczo, until recently the manager of Bridgeport Lead Free Families. Bridgeport’s most recent allocation, for $2.3 million, is aimed at making an additional 110 housing units lead free.
Of New Haven’s 57,500 housing units, 83 percent are pre-1978, according to environmental health director Paul Kowalski. New Haven has remediated about 1,250 housing units.
Between the state’s two largest cities, more than 100,000 housing units still need to be remediated.
This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).