Abby Kinchy and Dan Walls – Department of Science and Technology Studies, Rensselaer Polytechnic Institute
Like many university staff, we have watched the COVID-19 crisis unfold from the relative safety of our homes, trying to continue our research while physically distanced from the people and places that are central to our investigation. Throughout this unsettling experience, we have reflected on how this pandemic, and the United States government’s response to it, creates a new lens through which we see the dangerous exposures that are more familiar to us, such as toxic pollution.
We are in the early stages of studying the politics of urban soil testing and remediation. Readers of this journal will likely be familiar with the dangers of lead exposure, particularly in childhood. Urban soil can be a source of lead exposure, primarily due to the legacy use of leaded gasoline and lead-based paints. It is obvious that exposures to lead and the novel coronavirus are dissimilar in many ways, perhaps making them incomparable. Yet as we have sought understanding of COVID-19, each revelation points us toward questions about lead that seem increasingly relevant.
The emergence of COVID-19 in the US was met with shocking delays and shortages of testing for identifying affected patients and monitoring the progression of the virus. Now, as schools and businesses plan how they will reopen, testing is often discussed as a necessity to prevent further outbreaks. These discussions have prompted us to think carefully about how testing fits into public health strategies, including prevention of lead poisoning.
Today, the most common testing for lead is done at the state level through blood tests of children, with data reported to the federal Centers for Disease Control and Prevention (CDC). Each state has different legislation regarding testing requirements. For example, New York mandates that a child must be tested twice, at ages one and two years, while Pennsylvania has no universal testing law.
Testing blood for lead is considered a secondary prevention strategy, as children with high blood lead stand in as representatives of their polluted environments. This is similar to the COVID-19 testing strategy, where people sick enough to get a COVID-19 test stand in for the broader community spread of the virus. Yet there are significant limitations of relying on blood lead tests to illuminate the dangerous environments in which children live.
A map published by Reuters, Looking for Lead, represents childhood lead exposures exceeding the CDC’s Blood Lead Reference Value, currently 5 micrograms of lead per deciliter of blood (μg/dl). The map reveals not only geographic disparities in the prevalence and magnitude of lead exposure, primarily in urban areas, but also geographic disparities in the number of children tested, primarily across states.
Our knowledge of lead contaminated environments comes through exposed children and is further limited by uneven access to blood tests. Uneven access to COVID-19 tests, highlighted in reports from Syracuse University and University of Alabama at Birmingham, suggest a similar pattern, producing gaps in knowledge about where the disease is circulating.
An additional concern is regulatory fragmentation and the question of who is responsible for testing. The initial testing response to COVID-19 was restricted to private research hospitals using internally developed tests, as the CDC was slow to respond. Even now, it is unclear who is responsible for developing and providing access to tests. Likewise, in our research, we have encountered multiple government agencies across several levels of government, as well as university researchers, that are involved in studying and monitoring lead in the environment. Yet there is no coherent program to identify and prevent soil lead exposures. The answers to the questions of who bears responsibility for testing and for acting on the results remain unsatisfactory for both lead and COVID-19.
It is now evident that COVID-19 is disproportionately taking the lives of people of color in the US. In New York City, for instance, the latest data indicates much higher death rates among Black/African American people (92.3 deaths per 100,000 population) and Hispanic/Latino people (74.3) than the death rates for white (45.2) or Asian (34.5) people. COVID-19 is not unique in this regard, and again the parallels with lead exposure are troubling. Black and Latinx children in the US have far more lead exposure than white children. We have found it clarifying to think about the shared roots and implications of these disgraceful disparities.
In the case of COVID-19, public health researchers have been clear that the disproportionate impact on people of color reflects the broader conditions of oppression. For instance, Melissa Creary, a health policy professor at the University of Michigan, explained:
“Many [black and brown people in the US] can’t afford to not work, or are on the front lines in jobs such as grocery clerks, janitors, or bus and train operators. Many rely on public transportation and are experiencing forced exposure. …Economics influences these decisions. It’s not about the body itself, but the societal situation in which the body is embedded.”
Research on lead exposure brings attention to the historical roots of these societal situations. Conditions of “toxic inequality” “remain closely linked to racial and ethnic segregation.” Historian Leif Fredrickson’s research shows that “government-supported suburban development and racial segregation after World War II contributed to lead poisoning by concentrating minority families in substandard urban housing.” By the 1960s, it was obvious that children were being poisoned by flaking and deteriorating lead paint in aging urban housing stock. Many white families moved to new housing in the suburbs, during a wave of “white flight” from urban centers. However, “discriminatory government policies effectively excluded minority families from buying homes in suburban neighborhoods, leaving them trapped in cities, where a vicious cycle of deterioration and disinvestment exacerbated lead hazards.”
If the case of lead teaches us that racial health disparities in the US are the result of decades of policy decisions, it also shows that the documentation of disparities does not necessarily lead to actions to correct racist policies and practices. In our research, we have been interviewing scientists whose research focuses on lead in urban soils. Many of these scientists tell us that they believe urban soil contamination has not been a national policy priority because it is seen as an inner city problem, affecting racial and ethnic minorities.
In the case of COVID-19, public health experts have already critically analyzed the tendency to misinterpret racial health disparities. Merlin Chowkwanyun and Adolph L. Reed, Jr. co-authored an article in the New England Journal of Medicine, cautioning, “Disparity figures without explanatory context can perpetuate harmful myths and misunderstandings that actually undermine the goal of eliminating health inequities.” These misunderstandings include “myths of racial biology, behavioral explanations predicated on racial stereotypes, and territorial stigmatization.”
Inequities in both lead exposure and COVID-19 bring to light the pervasive racism of the US, which creates health-threatening living and working conditions for people of color. In both cases, inaction is rooted in racism and disregard for the communities that are most severely affected.
Amid the COVID-19 crisis, workplaces have been major sites of exposure, particularly for healthcare workers. Additionally, grocery, warehouse, slaughterhouse, delivery, and public health workers have been affected as well. As we became increasingly alarmed about inadequate protections for workers during the pandemic, we felt compelled to look more closely at lead exposures in the workplace. Are there parallels here, as well?
Today, workplaces in the US where lead exposure is common include lead mines and smelters, lead acid battery manufacturing and recycling facilities, and painting and renovation. The CDC’s National Institute for Occupational Safety and Health works to reduce the rate of adults with blood lead levels that exceed this reference value through its Adult Blood Lead Epidemiology and Surveillance (ABLES) program. In 2015, it designated 5 μg/dl as its reference blood lead level for adults. The program relies on participation at the state level to mandate reporting of blood lead levels by testing laboratories, with the CDC reporting that 37 states were participating as of April 2018. Overall, the CDC reports that blood lead levels have progressively declined, while cautioning that their data is a low estimate based on unavailable data for many lead-exposed workers.
Despite the periodic lowering of the NIOSH reference blood lead level, the Occupational Safety and Health Administration (OSHA) standard for lead has not changed since the late 1970s. The blood lead level at which OSHA will remove a worker from contaminated conditions (50 or 60 μg/dl) greatly exceeds both the CDC reference level as well as today’s average adult blood lead level of approximately 1 μg/dl. Further, mandatory blood testing is only required for workers who could be exposed to airborne concentrations of lead exceeding the OSHA action level (30 μg/m3).
Two members of the American College of Occupational and Environmental Medicine Task Force on Blood Lead Levels have called on OSHA to update their standard for lead in three ways. First, lower the blood lead level for mandatory medical removal. Second, include surface lead dust as a source of exposure in addition to airborne lead. And third, redefine a lead-exposed worker requiring mandatory blood testing as “any worker who is handling or disturbing materials with a significant lead content in a manner that could reasonably be expected to cause potentially harmful exposure through lead dust inhalation or ingestion, regardless of airborne lead concentrations or surface contamination levels.”
Clearly, viral contagion at work is a different kind of health threat than exposure to toxic chemicals. Nevertheless, we found a disturbing parallel to the spread of COVID-19 from workplaces to homes. CDC findings have shown that the children of lead-exposed workers have elevated blood lead levels, far above the national average. Thus, as we investigate the politics of lead testing and governance, the current crisis reminds us not to ignore workplaces as pivotal sites of exposure with ramifications beyond the worksite.
We have also gained some insights from our study of lead that shed light on unfolding events related to COVID-19. The case of lead pollution in the US shows that it is crucial to have public funding for infrastructure that prevents exposures. Tragically, US lawmakers decided that coordinated prevention of lead exposures was too expensive. In Lead Wars, Rosner and Markowitz write:
“More than thirty-five studies were done during the 1980s and 1990s about various lead-abatement strategies. Yet, despite the evidence compiled, by the turn of the twenty-first century policy makers were unwilling to commit the needed resources to finally remove lead from children’s homes, and the courts were unwilling to hold accountable the companies responsible for this ecological and human tragedy.”
Today, homes across the country remain polluted with lead paint, pipes, and contaminated soil. Doctors and public health agencies advise parents to take precautions such as avoiding peeling paint and frequently cleaning up dust that might contain lead particles.
Current regulatory strategies for reducing lead exposures resemble what Andrew Szasz calls “inverted quarantine,” or quarantining of healthy/non-exposed people to prevent their exposure to harm. Szasz uses this concept to highlight the problems with consumerist responses to environmental pollution, such as purchasing water filters rather than demanding action to protect clean water. Inverted quarantine emphasizes shielding the individual rather than collectively creating safe living environments. In the case of lead, rather than working to remove legacy lead from polluted homes and neighborhoods, the Environmental Protection Agency (EPA) and Housing and Urban Development (HUD) depend on voluntary participation to meet lead safety standards.
In many ways, the COVID-19 crisis poses a stark contrast to the (lack of) federal investment in lead exposure prevention. The federal government has already allocated $2.4 trillion toward the crisis. Broadly speaking, these expenditures make it possible for people to stay at home, so they can avoid exposure to the virus and prevent its spread.
Yet even in the midst of this massive spending, a highly individualized approach to preventing exposures prevails. We see this, for example, in wide reports that medical staff and other essential workers are buying their own personal protective equipment (PPE) and relying on volunteers to sew masks. It is also evident in the President’s own insistence that wearing a mask is a personal, voluntary choice. As states begin to lift restrictions meant to slow the spread of the virus, we will see an even greater reliance on “voluntary” precautions. And of course, only some will have the resources necessary to remain healthy while the virus is still circulating.
The COVID-19 crisis has laid bare many enduring problems in American society. While we hope that the pandemic will come to a rapid conclusion, we will continue to contend with these problems as they manifest in other health threats, such as lead pollution. We hope that the sobering lessons of COVID-19 will improve our efforts to create safer environments for all.
Header image: https://www.flickr.com/photos/cgull/2378882777