Why is it important to remove lead from water pipes? A doctor explains

(CNN) — Last week, the US Environmental Protection Agency proposed a rule that would require water systems across the country to replace millions of lead service pipes within the next 10 years. The new proposed rule is in line with the Biden administration’s goal of removing all lead pipes, regardless of the lead levels in tap or other drinking water samples, though officials have said that certain “limited circumstances” may be allowed to extend the time to complete system-wide line replacements.

This proposal has prompted many questions about the impact of lead on people’s health. Why are high lead levels so dangerous, especially to children? What are the symptoms of lead poisoning, and what treatments exist for it? And how much of a public health impact will removing all lead pipes really make?

To help us navigate these questions, I spoke with CNN wellness medical expert Dr. Leana Wen. Dr. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner, where her responsibilities included overseeing childhood lead poisoning prevention programs.

CNN: Why are high lead levels so dangerous, and why is it that children are most at risk for lead poisoning?

Dr. Leana Wen: A mantra among pediatricians and public health experts is that no amount of lead is safe for children.

Exposure to lead has long been known to have many documented adverse effects — both short-term and long-term — on children’s health. These effects can include damage to the brain and nervous system that could manifest as lower IQ, learning and behavior difficulties, hearing loss, speech problems, and impaired growth and development.

The adverse effects are most pronounced in young children under 6 years of age. That’s for two reasons: First, toddlers and young kids are developing and growing rapidly — these toxins have an outsize impact on developing organs. Second, little kids often put things into their mouths. If there is lead dust in their environment, they may put their hands on the dust and ingest lead without their caregivers knowing it.

The scope of the problem is large: According to the US Centers for Disease Control and Prevention, children in approximately 4 million households are exposed to high levels of lead.

CNN: What are the symptoms of lead poisoning?

Wen: One of the difficulties of detecting lead exposure is that most children have no symptoms. Parents and caregivers may not know that their kids have a dangerous level of lead.

Symptoms don’t tend to manifest until there is a large amount of lead in someone’s body. At that point, they could experience symptoms like abdominal pain, headaches, vomiting, constipation, irritability and seizures. Longer-term symptoms include developmental delays, learning difficulties, weight loss and mood disorders.

CNN: Can adults get lead poisoning too?

Wen: Yes. Lead poisoning in adults is less common and often associated with workplace exposure. There are a variety of potential effects, including anemia, kidney problems, high blood pressure and reproductive health issues, including low sperm count and miscarriage. As with children, adults may not manifest any overt symptoms but still suffer adverse health consequences.

CNN: How are elevated lead levels diagnosed?

Wen: Elevated lead levels can be diagnosed using blood testing. The initial screening test can be done by a standard blood draw, where a needle is inserted into a patient’s vein, and blood is collected and then tested for lead. Sometimes, a finger-prick or heel-prick can be used for the initial screen, too. This needs to be done in a laboratory or doctor’s office; home testing is not an option at this time.

In the United States, children are required to have blood lead levels measured at ages 12 and 24 months. This screening is essential, given the adverse outcomes of lead poisoning and because high lead levels are often asymptomatic. Additional testing may be needed if there is specific concern for lead exposure or if symptoms develop.

CNN: What happens if an elevated amount is found?

Wen: The CDC has recommended procedures based on how elevated the blood lead levels are.

Some of these steps include taking a careful history and physical exam to assess whether there are any other symptoms related to lead exposure. The family may be referred for an environmental assessment of the home and a lead hazard reduction program.

If the blood levels are particularly high, additional investigation may be needed, such as an abdominal X-ray to check for whether a substance containing lead may have been ingested. If there are concerning signs and symptoms of lead poisoning, the child could be admitted to the hospital.

There are some therapies that exist for acute lead poisoning if a child has ingested a large quantity of lead-containing substances. They include giving laxatives to try to flush out the lead and an intravenous infusion to try to reduce lead in the bloodstream.
The problem is that much of the harm of lead poisoning occurs over a longer period, and some of that harm — such as brain and nerve damage — may be irreversible. This is why prevention is so crucial.

CNN: Recently, the US Food and Drug Administration recalled several applesauce products that are thought to be contaminated with lead. Is it safe to for parents to keep feeding their kids applesauce?

Wen: Yes, but I would urge parents to follow FDA advice and stay away from the specific recalled products.

There are occasionally advisories like these that consumers should absolutely heed. But they need to keep in mind that most lead exposure is not through these one-off events that attract a lot of media attention.

A major source of lead exposure is through lead paint. Lead paint was not banned until 1978, and homes built before “probably contain lead-based paint,” according to the CDC. Children can accidentally ingest paint chips. Also, when paint peels or cracks, it releases dust that contains lead. Kids can swallow or even breathe in lead dust and have elevated levels as a result.

There are other sources of lead exposure, too, including lead in soil that comes from years of deposits from leaded gasoline, exterior lead-based paints and industrial sources. When possible, parents should try to prevent kids from playing on bare soil and cover bare soil near their homes with mulch, grass seeds or wood chips. Parents should also be wary of exposure from antique toys and imported toys that may contain lead.

CNN: How much of a public health impact will removing all lead pipes make?

Wen: Lead in drinking water is definitely a problem, with some communities more affected than others because of factors such as the type of service line, the amount of wear in the pipes, the amount of the water that comes into contact with the pipes and the acidity or alkalinity of the water.

Replacing lead service pipes will reduce the number of children exposed. This, though, is not the only preventive measure needed. Parents and caregivers still must be attentive to potential lead exposure through paint, soil and other sources. Lead poisoning is a preventable tragedy, and we can all take steps to reduce its harm.

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