Lead in drinking water, which has ignited a public health crisis in Flint, Michigan, is largely ignored as a potential contributor to elevated blood lead levels in thousands of Wisconsin children, records and interviews show.

Nearly 4,000 children in Wisconsin were diagnosed with elevated levels of lead in their blood in 2014, though the number has fallen over the years thanks in part to bans on lead in paint and gasoline. Unlike in Flint, however, it is not known to what extent lead in the drinking water contributes to elevated blood lead levels in Wisconsin.

The percentage of lead-poisoned children among those tested in Wisconsin — 4.5 percent — is similar to the 4.9 percent of children diagnosed in 2015 in the Flint region, where state and federal officials have declared a state of emergency over the spike in lead in drinking water and children’s blood.

In Milwaukee, the percentage is even higher: 8.6 percent of children tested in 2014 had blood lead levels above 5 micrograms per deciliter, the level at which children are known to suffer health problems, according to the Wisconsin Department of Health Services.

Even those percentages likely understate the magnitude of the problem, said Marc Edwards, the Virginia Tech professor and MacArthur “genius grant” recipient whose team helped identify the lead problem in Flint’s water. Standard testing for lead in blood begins around age 1, a time when children become mobile and may be exposed to lead paint or dust — ignoring infants on formula who may be ingesting large amounts of lead-tainted tap water.

“Neither in Flint nor in Wisconsin is the greatest at-risk group being tested,” Edwards said.

Matt Campbell / Wisconsin Center for Investigative Journalism

Lead’s effects are severe and permanent. Reduced intelligence, learning disabilities and developmental delays have all been attributed to lead exposure in young children, particularly those under age 6 whose developing brains are most vulnerable.

Some studies have linked childhood lead poisoning to disruptive behavior at school and a greater likelihood of violent crime in adulthood. Lead exposure in pregnant women has been associated with an increased risk of fetal death.

The U.S. Environmental Protection Agency acknowledged the contribution of water to the nation’s lead exposure in 1991 when it estimated that drinking water accounts for about 20 percent of average lead exposure, but as much as 85 percent of exposure for infants consuming formula made with tap water.

Because of the dangers of lead, the United States started phasing out leaded gasoline in 1973 until it was virtually eliminated in 1988. The use of lead-based paints steadily decreased after 1950 until the additive was banned from the market in 1978. The use of lead for plumbing was outlawed in 1986, although until January 2014, “lead-free” indoor plumbing components could legally contain up to 8 percent lead.

Matt Campbell / Wisconsin Center for Investigative Journalism

Officials at the nation’s Centers for Disease Control and Prevention and Wisconsin’s Childhood Lead Poisoning Prevention Program attribute childhood lead exposure almost exclusively to deteriorating lead-based paint and lead dust in older homes.

But lead paint is not the only hazard of old housing stock. For decades beginning in the late 1800s, lead was a commonly used material in the pipes that carry drinking water from the water main to individual homes, also known as lead service lines. There are an estimated 176,000 such lead pipes in Wisconsin, where greatly elevated levels of lead of at least 100 parts per billion — or more than six times the federal safety level — have been detected in public water systems in 24 of the 72 counties.

Recognizing the danger posed by lead in water, some scientists have argued for years that the focus of health officials on lead-contaminated paint and dust as the cause of childhood lead poisoning is too narrow and that water should be investigated as another significant exposure source.

Virginia Tech

Yanna Lambrinidou, a researcher and instructor at Virginia Tech, said the CDC and public health community are “doing tremendous damage” by failing to require testing for lead in drinking water when a child is lead poisoned.

“It’s putting generations of kids in harm’s way for absolutely no good reason,” she said.

A study led by Dr. Mona Hanna-Attisha, the Flint pediatrician who sounded the alarm about elevated blood lead levels among children in her community, described the crisis as a warning to other communities with aging water infrastructure and limited budgets.

“The situation in Flint, Michigan,” Hanna-Attisha and her research colleagues concluded, “may be a harbinger for future safe drinking-water challenges.”

Thousands of children affected in Wisconsin

In 2014, 3,922 Wisconsin children under age 6 had blood lead levels of 5 micrograms per deciliter or higher. About 20 percent of Wisconsin children are tested in a typical year.

The Wisconsin Childhood Lead Poisoning Prevention Program provides technical assistance, funding and consulting to health providers to prevent, detect and treat childhood lead poisoning. It projects lead-poisoned children “will likely cost Wisconsin billions of dollars in reduced intelligence quotient (IQ), lifetime earning losses and the associated societal costs for health care, education and correctional services.”

Almost 60 percent, or 2,244, of the state’s lead-poisoned children in 2014 were from the city of Milwaukee.

Ramona Jensen, lead liaison for Milwaukee’s Social Development Commission, wonders when officials will finally begin investigating tap water as a potential contributor to lead poisoning in Wisconsin’s children.

Matt Campbell / Wisconsin Center for Investigative Journalism

Jensen’s organization, which plans, coordinates and provides human service programs to the poor in Milwaukee County, is wrapping up work on a multi-year, $3 million U.S. Department of Housing and Urban Development-funded project to identify and remove lead hazards from 231 low-income housing units. Yet drinking water is not part of the program, she said.

“We just quite honestly don’t consider the water,” she said. “We were just painting and replacing siding and things like that — everything except the water, frankly. If you’re not testing the water when you’re doing a (lead) investigation, how do we know if it is or is not an exposure route?”

Lead in drinking water “doesn’t get the attention and it doesn’t get the media (coverage) it should,” Jensen added. “I know some of the experts … actually feel like we’re ignoring the water problem completely, and to some extent, I think that’s true.”

Blood lead level lowered, water standard same

In recognition of lead’s high toxicity, in 2012 the CDC cut in half the amount at which a child’s blood lead level requires reporting and possible intervention from 10 micrograms per deciliter to 5.

But the nation’s standard for lead in public drinking water has not been updated since 1991 when the EPA’s Lead and Copper Rule took effect. The federal law aims to keep lead levels in water below 15 ppb, while standards for lead in Canada and the European Union match the World Health Organization’s guideline of 10 ppb.

Madison Water Utility

The Wisconsin Department of Natural Resources has oversight over public water utilities, which must provide drinking water that meets state and federal health standards.

But public water utilities are required to take remedial action under the Lead and Copper Rule only if more than 10 percent of household tap water samples exceed 15 ppb. No remediation is required for even exceedingly high readings if the 10 percent threshold is not met.

In Wisconsin, 725 tap water samples, or 3.5 percent of almost 21,000 household samples tested between January 2010 and April 2015, exceeded 15 ppb, according to a DNR database analyzed by the Wisconsin Center for Investigative Journalism.

Applying the 3.5 percent estimate to the 176,000 known lead service lines in the state suggests that some 6,200 Wisconsin households may drink public water that exceeds the federal standard. That does not account for the unknown number of homes with lead fixtures.

In addition, an estimated 940,000 Wisconsin homes get their water from private wells. Private wells are largely unregulated, meaning those property owners are responsible for the safety of their own water.

In 2013, the Department of Health Services analyzed almost 4,000 private well samples and found that 1.8 percent of them exceeded 15 ppb of lead. Applying this estimate to all homes on private wells adds nearly 17,000 households to the at-risk total.

When public and private well calculations are combined, they suggest that residents in roughly 23,000 homes in Wisconsin may be consuming unsafe levels of lead in their water.

The percentage of public water samples that tested above 15 ppb was much higher than 3.5 percent in some Wisconsin communities, such as Lake Mills (20 percent), Columbus (18 percent) and Mount Horeb (16 percent).

Milwaukee, which treats its Lake Michigan-sourced water with chemical corrosion control to reduce lead leaching, had just two results above 15 ppb since 2010. However, only a small fraction of its 70,000 buildings on lead service lines have to be tested regularly to remain compliant with the Lead and Copper Rule.

Of the state’s nearly 21,000 recent test results, 202 exceeded 50 ppb, more than three times the federal standard. The state’s highest value was recorded in 2012 in Mount Horeb: 9,370 ppb.

Lead in water, blood linked

Some of the strongest evidence linking lead-contaminated water with children’s blood lead levels has come from studies directed by Edwards in two cities: Washington, D.C., in the early 2000s, and Flint, Michigan, beginning last summer.

Virginia Tech

Edwards and colleagues demonstrated in 2004 that lead increases in the water of thousands of D.C. households were triggered by a change in the water utility’s disinfectant protocol. In a 2009 study, he then showed the change caused a more than four-fold increase in the number of children under 16 months with blood lead levels exceeding 10 micrograms per deciliter.

Edwards and many other scientists have continued to evaluate, and confirm, a strong relationship between lead in water and blood since then.

A 2012 federally funded study by Edwards found that while lead poisoning among children had decreased thanks to reduced lead exposure from gasoline, paint and other sources, the relative importance of water had increased. A 2014 Canadian government-funded study that examined paint, dust and tap water as exposure sources concluded that drinking water was “a persistent significant contributor to children’s blood lead levels.”

Another Canadian study from 2015 estimated that an increase of 1 ppb of lead in water “would result in an increase of 35 percent of blood lead (in young children) after 150 days of exposure,” and concluded that “water lead concentrations well under the current drinking water guidelines in Canada (10 ppb) and the United States (15 ppb) could have an impact on blood lead levels of young children after long-term exposure.”

Source investigations ignore water

In July 2013, Crystal Wozniak of Green Bay learned that her 9-month-old baby Casheous had 18 micrograms per deciliter of lead in his blood — more than three times the federal threshold. The finger prick test that Casheous received is mandatory for children, generally beginning at age 1, who are covered under BadgerCare, Wisconsin’s health care program for low-income families.

Photo courtesy of Crystal Wozniak

“When (the nurse) broke the news to me,” Wozniak said, “I was devastated. My heart broke, I cried. I was very worried for him and had no knowledge of what to do next.”

Since then, Wozniak has been consumed with eliminating lead from her son’s environment.

“It’s just everywhere, it gets really tedious. It sort of takes over your life,” she said.

Wozniak thinks her son may have chewed on her bedroom windowsill when he woke up before she did about two weeks before the test.

In an investigation following Casheous’ diagnosis of lead poisoning, the Brown County Health Department identified multiple sources of deteriorating lead-based paint in Wozniak’s home, built in 1900. Eventually, the house was gutted, and Wozniak moved elsewhere.

But she wondered why nobody talked about lead pipes or urged her to get her tap water tested.

A source investigation triggered in Wisconsin by a case of childhood lead poisoning does not require testing the tap water in the child’s home or daycare, despite the documented link between water lead and blood lead levels. The CDC guidelines also do not specifically recommend examining drinking water.

Later testing of Wozniak’s tap water found no lead, but even EPA officials acknowledge that “the existing regulatory sampling protocol … systematically misses high lead levels and potential human exposure.” The city of Green Bay, where Wozniak lived, had a maximum lead level of 490 ppb in one of its tested households in 2012.

Lambrinidou, the Virginia Tech scientist, said regulatory agencies fail to examine lead in water or alert homeowners of ways to protect themselves, including installing filters costing as little as $40.

“Lead in drinking water has been pushed under the rug by almost every single agency,” she said. “Lead particles (in water) can contain far more lead than lead paint chips and can spike a child’s blood lead level literally overnight, and cause irreversible brain damage from one glass of water or one bowl of pasta.

“The outrage,” Lambrinidou added, “is that for many households, the prevention of miscarriages and of irreversible brain damage is $40 away.”

Bridgit Bowden / Wisconsin Public Radio

Casheous, now 3 years old, has had a steady decrease in his blood lead levels since his original test. Wozniak’s experience with a lead-poisoned child has prompted her to reach out to other families whose homes could be lead-contaminated. In collaboration with the Lead Safe America Foundation, she has distributed free testing kits for lead paint at Green Bay events.

For her part, Jensen, of Milwaukee’s Social Development Commission, gives regular public presentations about the dangers of lead and trains landlords on how to reduce lead exposure. She says there is a “knowledge gap” when it comes to lead in water, as many people do not know if they have lead plumbing or solder and remain unaware of the danger they pose.

“You never see (public service announcements) about lead,” Jensen said. “That should be a constant, in my mind. It’s very frustrating. You feel like the voice in the wilderness.”

Steve Carmody / Michigan Radio

In Michigan, Gov. Rick Snyder apologized for the Flint lead crisis during his State of the State address Jan. 19 and asked the Legislature for $28 million to replace faucets and fixtures at schools and other public buildings, provide home water filters, conduct additional blood lead testing and continue to have National Guard troops distribute bottled water to Flint residents.

But parents like Wozniak, professionals like Jensen and scientists like Lambrinidou and Edwards want more than apologies. They believe drinking water must be added to the list of exposure sources that public health officials routinely investigate for any lead-poisoned child.

“I don’t understand why they don’t address the water,” Wozniak said. “If the pipes are lead contaminated, they should use the same process as they do for replacing all the trims, windows, doors and kitchen cabinets in your house.”

Added Wozniak, “It’s essential for life to have water. It should fall in the same category and be tested along with everything else.”