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This story has been updated.

Tell me if you’ve heard this one before: A U.S. city is facing a public health crisis, after years of denying that it had a problem with lead in its drinking water supply. In 2016, that would have been a reference to Flint, Michigan. This week, it’s Newark, New Jersey, where city officials on Sunday resorted to handing out bottled water to affected residents.

Lead has long been recognized as a potent neurotoxin. The health effects of lead exposure in children include lowered IQ and increased risk of behavioral disorders. Exposed adults are more likely to develop a slew of health problems including nerve, kidney, and cardiovascular issues. Pregnant women and babies are especially vulnerable, as even low levels are associated with serious, irreversible damage to developing brains and nervous systems.

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No amount of lead is considered “safe,” but the federal government has set a limit of 15 parts per billion in drinking water. At one point, tests in Flint revealed lead levels at over 100 ppb. In July, a test showed Newark water lead levels at 55 ppb. In both cases residents say the city’s denials and delays came at a cost to their wellbeing.

“The mayor keeps saying that this isn’t like Flint,” Newark resident Shakima Thomas told Grist way back in November. “It is the same as Flint in the way that they tried to cover it up. We were victimized by this administration. They gamble with our health. They put politics first before justice.”

And that pattern appears to be continuing. Some experts say they already have a good idea of where the “next, next Flint” might be.

How Newark became “the next Flint”

The warning signs have been in Newark since 2016 — the same year Flint’s crisis hit the front pages. City officials have long denied it has a major lead problem with its drinking water, insisting the issue was limited to buildings with aging infrastructure — though they did shut water fountains down in more than 30 schools, providing bottled water instead. A city-wide water testing plan was set up in 2017 – and over the following 18 months, multiple tests showed more than 10 percent of homes in the city had lead levels exceeding the 15-parts-per-billion federal limit.

Last fall, the city began giving out water filters to some 40,000 residents. But residents complained that they were not told how necessary the filters were, or were unclear on how to properly install them. Then last week, the Environmental Protection Agency sent the city a letter citing serious concerns about drinking water safety, saying the filters Newark residents were given may never have worked properly. The EPA tested water filtered through the city-provided filters and lead levels still came out above the federal limit.

“We are unable at this time to assure Newark residents that their health is fully protected when drinking tap water filtered through these devices,” the EPA’s letter read.

When the city began handing out bottled water this weekend, some residents waited in line for water for hours, only to find out it was only being passed out to people who live in certain areas. (The Natural Resources Defense Council brought a federal lawsuit against the city to force Newark to deliver bottled water to expand its bottled water giveaway to residents who are pregnant or have children age 6 or younger in the eastern part of the city.) Efforts hit another snag when officials realized the bottled water had expired and had to temporarily stop the handouts.

New Jersey Governor Phil Murphy and Newark Mayor Ras Baraka issued a joint statement Monday, calling on federal officials to help. “We take this very seriously,” they said. “We want to be out ahead of this.”

The next “next Flint”

While Newark currently holds the dubious moniker of “the next Flint,” advocates say another city is in the running for the title: Pittsburgh. Lead concerns in the Steel City have been bubbling up for years now, culminating in a partial settlement between the city and Pittsburgh United, represented by NRDC attorneys, earlier this year. Legal proceedings are still ongoing.

In 2014, the Pittsburgh Water and Sewer Authority changed which chemicals they use in the public water pipes. (Chemicals can interact with the lead pipes in different ways, and in some cases, cause corrosion of lead pipes.) By 2016, the number of resident requests for water testing had risen significantly, according to local media. The problem wasn’t publicly acknowledged until 2017, when the city made a plan to distribute water filters to some residents. (That part took through 2018.)

In February 2019, the NRDC and Pittsburgh United settled their lawsuit against the city. The terms? The city agreed to replace thousands of lead pipes, provide all low-income residents with free water filters, and to prioritize action for homes where children live. Lead levels still exceed the federal standard but have been falling over this past year.

“The time lag is extremely serious — and it has a real impact on not only the health of families, but also a huge psychological impact once they find out,” said Dimple Chaudhary, an NRDC attorney and lead counsel in cases against both Flint and Pittsburgh. “I’ve spoken to mothers who are absolutely devastated when they find out they may have fed their baby lead-tainted formula.”

A familiar pattern

So why do these lead problems take so long for cities to acknowledge?

Chaudhary, who is advising on the NRDC and Newark Education Workers Caucus’ lawsuit against Newark (filed in early 2019), says she sees a pattern with lead contamination crises. First, community members suspect there is a problem, but may not have access to all the related information due to a lack of transparency by public officials. As residents advocate their case to city officials, weak regulations, poorly presented data, and low political will can lead to belated city acknowledgment of the problem. And even when both residents and city officials agree that something must be done, finding and implementing a solution can be chaotic.

“You have confusion about the state of the water, you have mixed messages about what people should do, and then, if things go well, you may have a court or part of the government step in and try to fix it,” she said. “But you’ll see in a lot of cases that the damage has already been done, both to people’s health and the public trust.”

Experts agree that issues with collecting and accessing data are a big part of the problem. It starts with weak regulations: The EPA’s Lead and Copper Rule, part of the Safe Drinking Water Act, only requires cities to test for the two metals every three years. And officials are only required to sample about 10 percent of residences. And even that limited data can be hard to access.

“There are technical limitations in place that seem designed to frustrate access to the data,” said Laura Pangallozzi, a visiting professor of geography at Binghamton University. She explained that the publically available data sets on the EPA website are hard to use without programming skills. This can prevent people (even scientists) from being able to look at lead levels in drinking water nationally to identify outliers. And, according to Pangallozzi, some states don’t report their data at all.

Even assuming a city becomes aware of a lead contamination issue, officials do not always let the public know in a timely or efficient manner. Cities are not required to report lead levels to the public until lead levels hit 15 parts per billion — the threshold at which cities must begin corrosion control measures, like adding chlorine to the water to prevent lead seeping in through the pipes, or, if the state requires it, replace lead pipes in the city water infrastructure.

“How officials roll out the public education requirement will have a big impact on how many people know about it,” Pangallozzi said. “Officials have choices in these matters, and it is such a negative for the reputation of a place, there is going to be natural reluctance to publicize.”

Given the proper incentive though, she said, change can happen fast — like when Washington, D.C. discovered it had a lead problem back in 2004. “They got that taken care of very quickly, by comparison,” she said, “because there were members of Congress drinking the water.”

As for a future “next Flint,” Newark and Pittsburgh may only be the tip of the lead pipe. According to an investigative report commissioned by Congress, about 2 percent of public water systems across the country exceeded the federal limit on lead between 2014 and 2016 — and that was with less than half of states reporting back.

“Even Flint’s highest levels were not atypical for water systems that have problems,” Pangallozzi said.