CLEVELAND - Families skipping or delaying pediatric appointments for their young children because of the pandemic are missing out on more than vaccines. Critical testing for lead poisoning has plummeted in many parts of the country.
In the Upper Midwest, Northeast and parts of the West Coast - areas with historically high rates of lead poisoning - the slide has been the most dramatic, according to the Centers for Disease Control and Prevention. In states such as Michigan, Ohio and Minnesota, testing for the brain-damaging heavy metal fell by 50% or more this spring compared with 2019, health officials report.
"The drop-off in April was massive," said Thomas Largo, section manager of environmental health surveillance at the Michigan Department of Health and Human Services, noting a 76% decrease in testing compared with the year before. "We weren't quite prepared for that."
Blood tests for lead, the only way to tell if a child has been exposed, are typically performed by pricking a finger or heel or tapping a vein at 1- and 2-year-old well-child visits. A blood test with elevated lead levels triggers the next critical steps in accessing early intervention for the behavioral, learning and health effects of lead poisoning and also identifying the source of the lead to prevent further harm.
Because of the pandemic, though, the drop in blood tests means referrals for critical home inspections plus medical and educational services are falling, too. And that means help isn't reaching poisoned kids, a one-two punch, particularly in communities of color, said Yvonka Hall, a lead poisoning prevention advocate and co-founder of the Cleveland Lead Safe Network. And this all comes amid COVID-related school and child care closures, meaning kids who are at risk are spending more time than ever in the place where most exposure happens: the home.
"Inside is dangerous," Hall said.
The CDC estimates about 500,000 U.S. children between ages 1 and 5 have been poisoned by lead, probably an underestimate due to the lack of widespread testing in many communities and states. In 2017, more than 40,000 children had elevated blood lead levels, defined as higher than 5 micrograms per deciliter of blood, in the 23 states that reported data.
While preliminary June and July data in some states indicates lead testing is picking up, it's nowhere near as high as it would need to be to catch up on the kids who missed appointments in the spring at the height of lockdown orders, experts say. And that may mean some kids will never be tested.
"What I'm most worried about is that the kids who are not getting tested now are the most vulnerable - those are the kids I'm worried might not have a makeup visit," said Stephanie Yendell, senior epidemiology supervisor in the health risk intervention unit at the Minnesota Department of Health.
There's a critical window for conducting lead poisoning blood tests, timed to when children are crawling or toddling and tend to put their hands on floors, windowsills and door frames and possibly transfer tiny particles of lead-laden dust to their mouths.