CENTRAL FALLS, R.I. — During the pandemic, home has been a haven, a place to keep family members safe from a highly contagious, potentially deadly virus.
But for many children in Rhode Island, home poses a hazard — a place where poisonous lead lines the walls or flows from the faucet.
Last year, as families huddled inside during school closures and stay-at-home advisories, the number of children poisoned by lead for the first time rose from 388 to 472, according to state Department of Health data.
That 22 percent increase was even more remarkable because it occurred as 17 percent fewer children were being tested. Health experts say the extent of the lead poisoning is likely far greater.
Lead poisoning exacted its highest toll on children in Rhode Island’s four “core cities” — Central Falls, Pawtucket, Providence, and Woonsocket — places with older housing stock where 69 percent of the elevated lead levels were recorded and where 74 percent of the youth are children of color. Meanwhile, in rural and suburban towns such as East Greenwich, Foster, Scituate, and Tiverton, no cases of lead poisoning were detected last year.
“Lead poisoning is a matter of environmental injustice, with a disproportionate effect on low-income families and people of color,” said Laura Brion, executive director of the Childhood Lead Action Project.
No city has been hit harder — both by the pandemic and by lead poisoning — than Central Falls, an impoverished, 1.29-square-mile, majority-Latino city of triple deckers built long before 1978, when lead was banned from house paint.
Last year, 32 of the 599 children tested in Central Falls had blood lead levels above 5 micrograms per deciliter — the “blood lead reference level” set by the US Centers for Disease Control and Prevention.
No blood lead level is considered safe in children, and even low levels of lead in blood can affect IQ, ability to pay attention, and academic achievement. Symptoms include abdominal pain, constipation, memory loss, and loss of appetite. Very high lead exposure can cause death, according to the CDC.
The Central Falls incidence rate of 5.3 percent was higher than any other city in Rhode Island last year. (The Block Island town of New Shoreham had a higher rate, but health officials disregard it because it was based on just nine tests.)
Dr. Beata F. Nelken, who runs a pediatric medical practice across from Central Falls City Hall, said the state statistics vastly understate the extent of lead poisoning in that community. She pointed out that far fewer children went for physical exams during the pandemic, and in Central Falls, undocumented, uninsured families are often reluctant to go for testing or to complain to landlords about lead paint.
Children are supposed to be checked for lead levels at 9 months old and 2 years old, and sometimes they’re also checked if lead exposure is suspected, Nelken said.
In any case, she said, officials shouldn’t be waiting for lead poisoning results to launch urgent efforts to inspect homes and make them safe.
“Why are we using these kids as the canaries in the coal mine?” Nelken said. “It’s the wrong approach. We know we have lead in the paint, the pipes, the food, the toys, and our dust.”
Children can get lead poisoning by ingesting or breathing dust from lead paint, ingesting lead chips from chipped window sills, drinking tap water that has lead from old pipes, or even eating fruits or vegetables that have lead on them from the soil outside of an old home. Nelken noted that lead has even been found in baby food.
The hazards posed by lead poisoning are all too real for the family of Guadalupe Martinez, who immigrated from Mexico to Central Falls 14 years ago and now brings all four of her children to Nelken for medical care.
With Nelken serving as a translator, Martinez told the Globe that three of her four children have been poisoned by lead: Edwin, 12, Dylan, 5, and Scarlett, 3, were born in Central Falls and have elevated blood lead levels, she said.
Edwin has struggled in school after being diagnosed with a learning disability and attention-deficit/hyperactivity disorder (ADHD), she said. Dylan is hyperactive and compulsive, and while Scarlett can sit still and play normally, she said, “We’ll find out in time.”
Martinez said her family had been renting a home on Sumner Avenue when they learned that Edwin was lead poisoned. Inspectors traced the lead to paint on the framing of doors and windows, which were replaced, she said.
Since then, her family has purchased the two-family home, and earlier this year they learned that Dylan and Scarlett were lead poisoned, too, Martinez said. Inspectors found lead paint around the entrance way and on the exterior of the home, so the family fixed those problems, replacing a grassy area with concrete, and the house is now considered lead safe.
But the damage done by lead poisoning is permanent, and Martinez said she is very worried about her children. She wonders, for example, whether Edwin will need assistance as an adult.
Nelken said treatment for blood poisoning includes giving people iron, which is thought to decrease the intestinal absorption of lead.
The past year has been an ordeal for her family. Central Falls emerged as Rhode Island’s hot spot for COVID-19, and Martinez said she, her husband, and Edwin tested positive for the virus. “We were all in lockdown,” she said. “It was very hard. When the vaccines came, we all got them.”
Lead paint is a bigger problem for Rhode Island than most places. Only Massachusetts and New York have a higher percentage of houses built before 1940, state health officials said.
In 2002, Rhode Island’s lead poisoning rate stood as high as 25 percent, with at least 6,300 children found to have elevated lead levels that year. Since then, the state’s lead poisoning rate has plunged, reaching 1.7 percent in 2019.
But then the pandemic hit, and the lead poisoning rate rose to 2.5 percent last year.
Michelle Almeida, the CDC lead program manager and evaluator for the state Health Department, explained that children spent longer periods of time in their homes last year, increasing their exposure to lead hazards. She said that reality highlights the number of properties in the state that still contain lead hazards.
Another potential factor was the difficulty that homeowners and landlords faced in finding contractors to address lead hazards during the pandemic, Almeida said. Also, with job losses, families had less money to pay for those projects, she said.
The problem was most pronounced in the four core cities, where 61 percent of the homes were built before 1940 — about twice the statewide rate.
Almeida said Rhode Island designates cities with a child poverty rate greater than 25 percent as core cities, and two-thirds of all minority children live in one of the four core cities. “Therefore, they are at increased risk for lead exposure and its associated adverse health consequences,” she said.
Brion said the pandemic posed a dilemma for many families in those core cities.
“People had this impossible choice between two different dangers — families facing the risk of permanent damage due to lead poisoning versus the risk of possible death or unknown symptoms from COVID,” she said.
Health officials aren’t to blame, she said, because they needed to protect public health by keeping people home amid the outbreak. “We blame the conditions that are there in the first place — conditions that were preventable and are preventable going forward with more investment in repairing homes and ensuring access to safe, affordable housing,” she said.
Brion credited Central Falls with being an active partner in trying to make homes lead safe.
Central Falls Mayor Maria Rivera said safe, affordable housing is her top priority. The city held a three-day housing summit in March, it hosted a housing fair in July, and last week it issued a report titled “Building Central Falls: Creating a Stronger, Safer City Through Housing Opportunities.”
The report says 60 percent of Central Falls housing units were built between 1900 and 1919, and more than 95 percent were built before lead was banned in house paint. It quotes Dr. Nelken as saying that in the past year, she and other colleagues “have seen the lead issue double, if not triple, from what the state’s Department of Health is reporting since most kids are not getting tested for lead during the pandemic.”
“It’s scary,” Rivera said. “Lead is a problem we have had here many years. We can’t expect to bring that lead level down if we don’t focus on updating these properties or building new homes in the city.”
Central Falls officials will soon go door-to-door, distributing information in English, Spanish, and Portuguese about how to make homes lead-safe, she said. The city has hired a full-time bilingual housing inspector to make sure tenants and landlords have the information and resources they need to address lead paint and other housing problems, she said.
Also, Central Falls has sent notices to the owners of some 200 properties that lacked a lead-safe certificate, City Solicitor Matthew Jerzyk said. Using a carrot-and-stick approach, the city brought those property owners into city Housing Court, connecting them with Rhode Island Housing’s lead-safe program, he said.
James Comer, deputy executive director at Rhode Island Housing, said the organization’s LeadSafe Homes program provides loans and grants to help homeowners address lead paint hazards, and it offers answers to tenants’ frequently asked questions. Also, the state maintains a list of lead violations and certifications.
There’s no doubt the pandemic exacerbated problems with lead exposure, Comer said. “It’s like the perfect storm for lead poisoning because it keeps kids at home, prevents work to remove lead hazards, and people are exposed to the potential hazards for longer periods,” he said.
Comer said he hopes the downward trend in lead poisoning resumes as more people get COVID-19 vaccines and schools and businesses reopen.
But Dr. Nelken said that even when schools reopen, the same lead hazards will exist in the community. Lead poisoning does not receive as much attention as COVID-19, she noted. “It doesn’t make news. It’s not dramatic.”
Yet it’s no less a public health crisis, Nelken said. “Kids endure the wrath quietly.”
Edward Fitzpatrick can be reached at firstname.lastname@example.org. Follow him on Twitter @FitzProv.