So she was puzzled — and scared — last February when, over the course of just a few days, Miguel began acting oddly: He was clumsy, irritable and high-strung. She took him for a checkup and four days later got a bold-faced letter from the city health department that said Miguel was "probably lead-poisoned."
Pediatricians ring alarm bells when a child's blood tests show lead levels above 10 ug/dL (micrograms per deciliter) of blood. A microgram is a millionth of a gram; a deciliter is one-tenth of a liter.
A blood test put Miguel's blood lead level at 33 ug/dL. A few more points and he would have had to be hospitalized. A city inspector visited the house, wipe-tested surfaces throughout and found what he expected: The lead was coming from paint dust created by years of opening and closing the home's windows.
Massive recalls of lead-laced trinkets and lead-painted toys from China are making news these days. Mattel recalled 675,000 Barbie toys last month, including Barbie's Dream Puppy House and Kitty Condo. But for the thousands of kids sickened by lead each year in the USA, it's not Barbie's Dream House that makes them sick. It's their own house.
The U.S. government banned lead paint in 1978, and U.S. oil companies began phasing out leaded gasoline in 1975. Since then, the percentage of children with high levels of lead in their blood has plummeted from 88% in the 1970s to 1.6% in 2005.
It's "one of the great triumphs in public health in this country over the last 20 to 25 years," says Philip Landrigan of Mount Sinai School of Medicine in New York. Joel Schwartz of the Harvard School of Public Health calculated that average IQ levels nationwide have risen four to five points as a result of lower lead levels in the environment.
But Landrigan and others warn that the effort hasn't wiped out lead poisoning. They consider that goal feasible: There's a broad public health effort to eliminate lead poisoning by 2010, but current estimates indicate it won't happen that soon.
Nearly three decades after the paint ban, hundreds of thousands of children — most of them under age 6 — show signs of lead exposure. The American Academy of Pediatrics estimates that one in four children live in housing with deteriorated lead paint, part of a toxic legacy from generations past when less was known about the dangers of such substances.
Now, an economist and a housing researcher say they have come up with a plan that could virtually wipe out lead poisoning in a few years: Find every home in America built before 1960 and replace the old, original, lead-painted windows. It's an odd but compelling idea that a few housing advocates say is not as crazy as it sounds.
"It's a no-brainer," says Ruth Ann Norton of the Baltimore-based Coalition to End Childhood Lead Poisoning, which since 2000 has been pushing for a sweeping window-replacement program. "It can be the difference between sending (children) to the hospital or sending them to college."
Eliminating lead from gasoline, paint and other products has paid off: Lead concentrations in the air have declined about 96% from 1980 to 2005. Only two U.S. counties now have lead levels that exceed federal air-quality standards (Lewis and Clark County, Mont., and Jefferson County, Mo.).
Yet while local, state and federal figures show that fewer children now suffer from lead poisoning, lead still harms 310,000 children in the USA, the U.S. Centers for Disease Control and Prevention reports. In Milwaukee alone, officials in 2006 found 1,414 cases of high lead levels. About 53,000 houses here need remediation.
And the CDC figures are simply estimates. Although all Medicaid-eligible children must be screened for lead at ages 1 and 2, doctors don't test all children. The CDC doesn't recommend testing unless a child lives in a home built before 1950 or a pre-1978 home that has been renovated.
Testing is often spotty. Even in Wisconsin, a model for lead-poisoning prevention, state officials said earlier this month that only half of 97,000 Medicaid-enrolled children got required blood tests.
A potent neurotoxin, lead affects the brain, kidneys and nervous system — often irreversibly. Even exposure to a few fingerfuls of dust can raise a toddler's blood lead to dangerous levels, scientists say.
Dozens of studies have linked lead to lower IQs, severe learning difficulties, behavioral problems and even death. Researchers also have found that children exposed to lead are more likely to end up with juvenile and adult criminal records.
Poor and minority children in big cities are among those hit hardest, according to the CDC — and many researchers say that statistic has kept the nation's lingering lead problem from generating more public outrage.
"People think this is just a 'city thing,' " says former Rochester, N.Y., school principal Ralph Spezio. In 1999, he began wondering why so many of his students needed expensive special-education services. He looked at their medical records and found high lead levels in 41%. Among special-education students, it was 100%.
"If we had 41% of our children wading into Lake Ontario, and they came out with permanent brain damage, we'd be guarding the shores with state police," he says.
Replacing old windows
In the early 1990s, Milwaukee pioneered a technique for making homes lead-safe. While it includes stabilizing paint on walls, porches and other surfaces, it primarily focuses on replacing windows or repairing them by shaving down the wood and repainting it, then covering the inside of the frame with vinyl or aluminum.
The city pays homeowners $160 a window to repair or replace them — an offer extended to landlords, too, unless a child in their building turns up with elevated blood lead. Then the landlord must pay the costs; if he fixes that property, he's eligible for city aid for other properties.
"That's kind of when they really see the light," says Sara Mishefske of the Milwaukee Health Department. If a landlord refuses to do the work, the city can get a court order to do it and bill him.
By all indications, the program has been a success. In 1995, 39% of city kids had elevated blood lead; by 2006, it was down to 6.6%. Total cost: $53.5 million — about two-thirds of it from federal grants.
Walking through a home undergoing window replacement, city lead inspector A. Thomas Brandt says the focus on windows makes sense. "It's cost-effective, it does the job. It gives us the biggest bang for our buck," he says. "Ninety-nine times out of 100, the child is poisoned by this window."
He's backed up by years of research showing that opening and closing windows generates enough lead-paint dust to poison children decades after the paint was applied. (Lead helped paint adhere better and last longer.)
"It's like a lead-dust machine, even 40, 50, 100 years after the lead was put into those windows," says )Rick Nevin, a Fairfax, Va., economist who has done extensive research on lead's role in rising crime rates. Windows, he says, are "a huge part of the problem."
He and David Jacobs, a former U.S. Housing and Urban Development Department housing research director, are proposing a public-private effort to replace windows in the nation's aging housing stock.
Their proposal was published online last week in the journal Environmental Research. They say the money spent — $22 billion, less than the federal government spends on education in a year — would yield $67 billion in benefits, including lower rates of special-education enrollment, ADHD, juvenile delinquency and crime — and lower heating costs.
Nevin's findings on lead and crime have been applauded by researchers but have barely made an impression with the public.
Since high blood lead levels in children are known to reduce cognitive function and impulse control, Nevin maintains, the push in the 1970s to reduce environmental lead did more to fight crime by juveniles who came of age in the 1990s than an improving economy or public policies such as fixing up neighborhoods or adding cops to city streets. Replacing old windows, he adds, would virtually wipe out lead poisoning, pushing the crime rate even lower.
Milwaukee is among a few cities that have moved aggressively to guard their aging housing stock from lead. The problem remains so pervasive in so many cities that efforts to eliminate the problem could take decades — if not the rest of the 21st century.
Lead paint in walls or windows chips or rubs off as a house ages. In most houses, such as Miguel's, paint dust settles on and around the windows, after years of opening and closing. The simple act of letting in fresh air grinds the old paint in the cracks to a powder. Miguel touched the dust and, as 3-year-olds do, put his fingers in his mouth.
Blanca and her husband bought the house in 2002, but for decades the windows apparently had been painted with lead-based paint. Owners would have switched to safer stuff only after the 1978 ban — more than a quarter-century before Miguel was born.
Less lead, but hazard remains
A soft, heavy metal that has been used since antiquity (the word "plumbing" comes from the Latin word for lead, plumbum), lead had its heyday in the USA from the 1920s to the 1970s. After lengthy fights over its safety, industry began phasing out lead from gasoline and household paints in the late 1960s. But for many kids, researchers say, the hazard remains.
"That storehouse of lead that exists in the older housing in this country is enormous," says Landrigan, a pediatrician. "It's going to be there for decades and decades."
While most middle-class children now live in newer homes built or remodeled since 1978, poor kids are concentrated in older homes. In cities such as Detroit, as many as 90% of homes were built before 1978, according to the U.S. Environmental Protection Agency.
For many kids, a routine blood lead test uncovers dangerous lead levels in their homes.
Jamia Handy, her husband, Thaddeus Chatman, and four children were living in a rental house in Baltimore for four months before a well-baby check last August for her daughter Jaiah Chatman, who is nearly 2, came back with a lead level of 82 — eight times the "action level." The culprit: lead dust in and around the home's windows.
Norton's coalition moved in to renovate the home and replace the windows, after negotiating with the property owner; they finished the work earlier this month. The owner declined requests for comment. The family stayed in a hotel while the work was done but is now back in its home.
Doctors admitted Jaiah immediately to intensive care, where she began oral chelation therapy: one dose every eight hours of a concoction containing a chemical that binds to lead in the blood so she can dispel it through her urine.
Jamia Handy, who attends nursing school, says none of her training has covered how to prevent lead poisoning. Jaiah had the symptoms — loss of appetite, irritability — but Jamia says they were unusual only in hindsight. "She's always irritable — she's the baby, she's got brothers. I didn't notice it."
Jaiah greets visitors with a smile one recent afternoon, her fifth in the hospital. But her good humor vanishes as a friend of Jamia's tries to coax her into drinking her chelation medicine — a bitter mixture of succimer and red fruit punch — from a sippy cup. A nurse looks on as Jaiah tastes it but doesn't swallow a drop.
The nurse disappears, comes back with a fat plastic syringe and dips it into the cup, drawing out a few inches of liquid. Soon Jamia has Jaiah in her lap, holding her mouth open as the nurse squirts a stream in. The baby swallows reflexively but begins crying. After a few doses, she is screaming, the medicine gurgling in her throat.
The nurse keeps squirting medicine in, and Jaiah stiffens in her mother's arms, lying flat on her back in protest. Most of the pink medicine somehow goes down, but with each squirt, a bit of it ends up in a napkin that Jamia uses to dab Jaiah's cheeks. "Drink, drink, drink," Jamia coos. "Drink it."
Three weeks of chelation got her lead level down to 44, but if it goes up she'll have to be readmitted to the hospital. It's unclear whether Jaiah will have developmental problems — if she does, they won't show up for another two to four years, doctors say. Her 4-year-old brother, Chavez, whose level hovers around 34 micrograms per deciliter (ug/dL), started a series of monitoring tests on Oct. 2. If they go higher, he'll also have to begin chelation.
Lead also lingers in older homes in the suburbs and in rural areas.
Sarah Taylor had no reason to think there was anything amiss in her leafy neighborhood in Charleston, Ill., until a desk clerk at a clinic last year asked if her daughter Amanda, then 2, had been tested for lead. The results were eye-popping: Her blood level was 136 micrograms per deciliter (ug/dL) — more than 13 times the maximum safe level.
Amanda began immediate chelation — in her case, a series of painful injections — to remove the lead. Inspectors found the toddler had eaten a few chips of peeling paint on the front porch, where she had been playing, out of the way of her siblings' noisy games in the yard.
Her lead level was so high that her pediatrician, Charles Morton, says it'll take "many, many years" for it to come down. Her mother says Amanda, now 3, suffers from insomnia and tantrums "unlike any tantrum I've ever seen" because of the lead exposure.
It has been nearly eight months since Miguel's alarming blood test. In that time, workers installed new windows in his house. That and a low-fat diet high in calcium and iron have cut his blood lead level nearly in half, from 33 to 17. But he's still in danger.
"I don't want anybody to face the experience I had," Blanca says. "I prefer that people know more about their house so they can pay attention more, because what happened to me? If my son didn't get sick, I would never have known that my windows have lead."
In the big picture, Miguel is extremely lucky. Before last February, his lead tests were normal, so doctors likely caught the problem quickly.
Paying for lead removal
Federal funding for lead remediation is limited and probably will drop next year — the 2008 HUD lead-control budget is $116 million, 23% less than in 2005.
Many cities and states, overwhelmed by a backlog of cleanups and medical care and competing for federal dollars, are exploring a new way to fund it: They're suing lead-paint manufacturers, saying the paint applied decades ago creates a "public nuisance" that the makers ought to fix, a tactic similar to that used in tobacco litigation.
Since 1987, attorneys in 17 states have filed cases, but the first success came last year, when the state of Rhode Island won a judgment against three paint makers for the cleanup of 300,000 lead-tainted homes. The state said last month that it would cost $2.4 billion.
Milwaukee and a handful of other cities, including New York, Chicago, St. Louis and San Francisco, have filed cases of their own, looking to recover taxpayer dollars spent on everything from lead abatement to medical care and special-education costs. The lawsuits are risky: A jury last June rejected Milwaukee's bid to recover $53 million from NL Industries.
Children's advocates are closely watching a trial that began here Oct. 1: A 16-year-old Milwaukee boy named Steven Thomas, who was poisoned by lead as a child in two homes, is seeking damages from five paint companies. A decision in Steven's favor could increase the number of lead lawsuits.
The state Supreme Court in 2005 ruled that his lawyers don't even need to prove that the defendants made the paint in his boyhood homes. They need to prove only that the five manufacturers produced lead paint when the houses were built, around 1900 — and that they had reason to believe it was dangerous.
Former Baltimore City health director Peter Beilenson says Baltimore has more than 400,000 homes built before the 1978 lead paint ban, with an estimated 80% containing lead paint.
Beilenson says litigation like Rhode Island's may be one of the few ways to pay for large-scale programs. At the city's current pace, he says, "it'll probably take 100 years to get all the properties remediated."
