Lead tests for children plummet in Cleveland; advocates worry about long-term fallout
This story is provided by Ideastream as part of special community coverage of COVID-19 and funded by Third Federal Foundation and University Settlement.
by Rachel Dissell
(Plain Press, August 2020) CLEVELAND, Ohio — State shutdown orders meant to prevent the spread of the novel coronavirus have created a double-whammy of lead poisoning risk for young children in Cleveland.
Many of these children are spending more time in homes with potential lead hazards, and fewer are getting tested to see if they’ve been exposed to the toxin.
Tests for lead have plummeted by almost half compared with previous years in Cleveland and across Ohio, driven mostly by a dip in March, when most pediatricians’ offices and labs were closed to non-emergency visits because of the pandemic.
State health data shows a slight uptick in the percentage of Cleveland children tested who have elevated levels of lead in their blood.
The setback couldn’t have come at a worse time, local lead-safety advocates say. For the past year, they have been working to prevent children from being poisoned in their homes, rolling out a new strategy that includes city-mandated lead inspections in rentals and new grants and loans for hazard cleanup.
Testing children for lead is the main way to identify lead hazards that can continue to do damage. The tests also allow parents to get help recognizing developmental delays or behavioral issues linked to exposure to the toxin, which can cause irreversible damage to a child’s brain.
The pandemic-related drop in testing means that fewer lead-exposed children will receive help from state-supported early intervention programs, which are now offered automatically when a child’s blood test shows exposure.
It also means that public health authorities won’t receive as many referrals to investigate potential lead hazards in homes, which are triggered by a high lead test. That could result in prolonged exposure for children to lead dust or paint chips.
“I worry about children who are at home, playing on porches full of lead paint or in the dirt nearby,” said Patricia Barnes, executive director of the Ohio Healthy Homes Network and co-chair of the Ohio Lead Free Kids Coalition, which advocates statewide for policies to eliminate childhood lead poisoning.
An Ohio Department of Health spokeswoman said that while test rates have dipped across Ohio during the pandemic, other “lead belt” states fared even worse.
Tests in Ohio have picked up in recent weeks as more parents schedule routine well-child visits, said state lead poisoning prevention advocates.
“There is nothing we are doing to make up on the missed testing,” ODH spokeswoman Rachel Feeley wrote in an email.
“This is something the (Centers for Disease Control and Prevention) is tracking, as it is a national occurrence,” she wrote. “We will continue to monitor the situation and follow CDC guidance on the matter.”
“I feel like we’re almost starting over again,” Kathy Schoch, nurse case manager for Cuyahoga County’s lead-poisoning prevention program, said about the interruption in testing.
Schoch and others have wrestled with improving lead testing for years.
Only one in five Medicaid-eligible children entering kindergarten in Cleveland public schools from 2011 to 2016 had federally recommended tests for lead poisoning at both ages 1 and 2, according to research released last year by Case Western Reserve University and Invest in Children, a county early childhood initiative.
The study also showed that even a “high dose” of 18 months or more of high-quality preschool education failed to help most lead-poisoned children catch up with their peers.
As lead testing stalled in the spring, so did new referrals to Ohio’s Early Intervention program, said Karen Mintzer, director of Bright Beginnings, formerly known as Help Me Grow.
The Early Intervention program, run through the Ohio Department of Developmental Disabilities, can assess children for developmental delays linked to lead exposure.
Referrals to the program from Cuyahoga County also dropped to zero at one point, but have since rebounded, Mintzer said.
Any child younger than 3 with lead in their blood at levels of five micrograms per deciliter or higher is automatically referred.
Safer than the grocery store
When the MetroHealth System resumed well-child visits in late April, many parents were reluctant to bring their children to the doctor’s office or a lab because of fears about the virus, said Dr. Abdulla Ghori, vice chair of Pediatrics at MetroHealth Medical Center.
There has been a slight uptick in visits in the past few weeks, he said.
In terms of risk, “coming to the hospital is better than going to the grocery store,” Ghori said. “And certainly, much safer than [attending] a birthday party.”
Ghori, also a professor of pediatrics at Case Western Reserve University said it is difficult to increase the rate of lead testing in part because testing practices vary by location and even by facility within a single health system.
Sometimes blood can be drawn in the doctor’s office. Other times, parents have to wait at a lab at a different location, which can be impractical for families with limited time and resources.
At MetroHealth, Ghori said, about a quarter of lab orders for lead tests aren’t ever completed.
While long-term solutions continue to be debated, Ghori said MetroHealth took the step of “bulk ordering” lead tests for any children who need them, rather than having doctors order the test individually during visits.
The orders will automatically show up in the mail or on electronic medical records for parents, he said.
Ghori said that’s good, but even better would be free, accessible blood-drawing locations in the city.
Ghori said he understands the focus on catching up on immunizations for children under 2, especially immunizations against highly contagious and dangerous diseases such as measles. Immunizations are often needed to enroll in day care or school.
That doesn’t mean lead testing should be an afterthought, though.
Both are important, Ghori said, but he worries people will de-emphasize lead testing. That, he said, would have dangerous long-term consequences.