Correspondence between

xxxEND_PAGE:dhhs02_b0614_2228_2229_1 002229 if you haven't seen the Bridge article based on Zip codes statewide the link to the article is in the text below. The alder annual reports an the MDHHS web site don’t suppress info, of course.

Can | send Linda the lead report for 12/7? This is the update, not the zip. Thanks, Patricia McKane, DVM MPH - Manager, Maternal & Child Health Epidemioiagy Section |Michigan Department of Health and Human Services| Lifecourse Epidemiology and Genomics Division [PQ Box 30195 / 201 Townsend St 4" Floor - Lansing, MI 48909 | Cell ‘ PPI H {Office ph: 517-335-9456 Fax 517-335-9790 | [email protected] : : Work Hours: M_F 7:30am —4:00 pm Michigan has a public records law. Most written communications to or from state officials regarding state business are public records available to the public and media upon request. Your e-mail communications and any attachments to them may be subject to public disclosure. This message, including any attachments is intended solely for the use of the named recipient(s) and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure, or distribution of any confidential and/or privileged information xxxEND_PAGE:dhhs02_b0611_2223_2224_1 002224 eenttofded in this CATH is expressly protibéted. if you are nett the intetnied recipient, phease eentdct the sender by reply e-rrril/ att! destroy any aid all copies of the orginal message. xxxEND_PAGE:dhhs02_b0611_2223_2224_2

State20151204 rtf; 2014 zips.xlsx Hi all, Some of these are arepeat. Lead by zip code for 2044 is my file and is new. | ran this today to cornpare te Bob’s numbers. Bob’s file is “2044 zins” The ‘Documenting the SAS cade ‘fle walks through the numbers from the raw dataset to the final analytic fle that Yan and {| used. Bob has 143,123 for 2014 andi have 141,355 for children less than 6 years. Any thoughts. [would like to send the ‘Docurnenting the numbers to Boh/Martha/Junaid ASAP, Patti

Hi all, Bob Scott updated me on the upload of child lead data into the warehouse “As of next Monday, we'll be two weeks behind on Lead records in the Warehouse. Jessica’s computer (and everyone’s around here) was upgraded to Office 2013 last Friday. ....but Access 2013 will not handle DBF files. We have used Access for a few years as a pass-through to get the DBF format (dates, | think) exactly right for loading to the Warehouse. When | get back, I’ll work with the folks from Optum to see what we can do about getting files in Warehouse-ready format.” Bob will be back next Monday. ican pull data from the warehouse next Monday, but be aware that it may not be complete. Patricia McKane, DVM MPH - Manager, Maternal & Child Health Epiderniology Section | Michigan Department of Health and Human Services | Lifecourse Epidemiology and Genomics Division | PO Box 30195 / 201 Townsend St 4" Floor - Lansing, MI 48909 | Cell Work Hours: M_F 7:30am — 4:00 pm Michigan has.a public records law. Most written communications to or from state officials regarding state business are public records available to the public and media upon request. Your e-mail communications and any attachments to them may be subject to public disclosure. xxxEND_PAGE:dhhs03_b0401_1522_1524_2 001524 This message, inclsttiag any attainments is intedred solely for the use af the RAHA reciprent(s) anh may eerttitin confistentia! and/or priviteged informtrtion. Any uirrtrehorzed review, use, dactesure, or distribation of any confitential endfor prviteged informenion eomtofded in this emi! is exprasty protibited. if you are net the irtterrfed recipient, please ewrtdct the sender by reply exraill art! destroy any td all copies of fe original messoge. xxxEND_PAGE:dhhs03_b0401_1522_1524_3

Thank you and Patth {and Yan}! Linda is in Flint this rnorning $0 | propose sending it to the larger group, including Linda. But Sarah - give me a call when you get back fram your mecting with Deb Kimball.

FYI Let me know if/when ok to share with Linda or forward. Table is for internal use only as it contains data that should be suppressed. Yan Tian, analyzed this yesterday, including manually reviewing all Flint duplicates by quarter. Patti xxxEND_PAGE:dhhs02_b0592_2185_2185_1

Yes, definitely send it to Lina.

Can | send this to Linda? It’s a simple summary. We should prepare a more detailed ‘how to’ once things settle. xxxEND_PAGE:dhhs02_b0590_2182_2182_1

Thanks Patti.

Yan provided preliminary data for most of the tables, but the INT between testing date and Report date was not very clean for Flint. The mean was way too high and there were quite a few ‘outliers’---results from 2012 and 2013 reported October 30, 2015. We haven’t looked further into this, because we need to get the report done. We will use the specimen date and will be a dynamic report. As soon as | have preliminary data from Yan | will forward to you. Patricia McKane, OVA MPH - Manager, Maternal & Child + Epiderniclogy Section | Michigan Department of Health and Hurnan Services! L#ecourse Epidemiciogy and Genomics Division [PO Box 30195 / 204 Townsend St 4°" Floor - Lansing, M/ 48909 | Cell SU7- 292-2718 Office ph: $17-335-9456 Fax 517-235-9790 | [email protected] Work Hours: M_F 7:3Gam - 4:00 pm Michigan has a public records law. Most written communications to or from state officials regarding state business are public records available to the public and media upon request. Your e-mail communications and any attachments to them may be subject to public disclosure. This message, including any attachments is intended solely for the use of the named recipient(s) and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure, or distribution of any confidential and/or privileged information contained in this e-mail is expressly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy any and all copies of the original message. xxxEND_PAGE:dhhs02_b0588_2180_2180_1

{think the immediate needs of the department in relation to this incident have changed since we last spoke. When we meat we can discuss products and how they should be provided to department leadership. The trend data will be very important over time.

{don’t see why it can’t be shared with Nancy, Bob and if they want to provide it to CDC while down there they could.

Importance: High Car | share this with Nancy and Bob? ff se can they show it io CDC partners, since this was for public knowledge is it ok if ishare, or do thay need to make the recnest to Eden? Sorry to ping you both, but honing that one of you can answer quickly. Thanks, Patti

Dear Corinne If my memory serves correctly, | think that Kristi Tanner from Detroit FREEP requested these items: 1) The numerators and denominators behind the percent positive tests each quarter for Genesee County areas, to match the graphic she has already received. The attached file (Flint Lead by zip suppressed submit 100715.xls) has had cells with fewer than five events suppressed to protect confidentiality. 2) The output from the Poisson regression model that was discussed at the Flint press conference last Friday. The attached has the raw SAS output for events occurring among children less than six years of age. The counts of positive tests each month (EBLL5) are modeled, with the predictor of interest being “PlaceTime5” which is defined on page 1 of the output. Season and age were included in the model as well (Child’s age at testing date and QY or quarter-year). The log of the monthly counts of tests was used as the offset. Child ID was used to subject effect, with an exchangeable correlation structure. As always, we are available to answer questions about this work or further explain our methods and assumptions. Sarah Lyon-Callo, MA, MS Director, Lifecourse Epidemiology and Genomics Division Bureau of Disease Control, Prevention and Epidemiology Population Health and Commmunity Services Administration Michigan Department of Health and Human Services 201 Townsend St., 4"" Floor Capitol View Building PO Box 30195 Lansing, MI 48909 PH: 517-335-9315 This message, including any attachments, is intended solely for the use of the named recipient(s) and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure, or distribution of any confidential and/or privileged information contained in this e-mail is expressly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy any and all copies of the original message. Please note: Michigan has a public records law. Most written communications to or from state officials regarding state business are public records available to the public and media upon request. Your e-mail communications and any attachments to them may be subject to public disclosure. xxxEND_PAGE:dhhs02_b1024_3643_3644_1 003644 xxxEND_PAGE:dhhs02_b1024_3643_3644_2

Thank you! shall forward to Nick with some highlights, and caveats about adjusting. What he cans see is that these are not greatly huge numbers... Eden

Dear Eden — lam sorry the answer to a simple question is taking so long. The “number of excess cases” is derived from the Poisson regression formula, which controls for age and season as well. If we use the available data as our comparison period, the model picks up the excess in cases for the high risk zip codes in Flint, but not for the remaining city. If limit the comparison period to immediately prior to water switch (Jan 2013- March 2014), which is similar but not identical to the Hurley time period, the model identifies excess cases in both geographies. Comparing to January 2010 thru March 2014: ears oe ar aerate Hehae ae no (here were 20 mare positive tests Ue period afte) ie ewitch ta Fin River Wi He i ees) ees oe ot fom the onuen shen Ieee . rr (Apt 70le Avs - is ee Ce ee petites ye beats) During the post period, 7.65% of tests were positive each quarter (controlling for age and season). In the period before the switch (January 2010-March 2014), 6.43% of tests were positive each quarter. FOL the remaining Ent 2ip cudes, no Geese were detected By (Be mide! The positive test rate prior to and after the switch to the Flint water system are similar (4.85% and 4. ‘A7%), although significantly higher than the remainder of Genesee county. Comparing to January 2013 thru March 2014: 4 phe bleh ee ee Sea ae OF a Hine Ress were 36 sassreusooresasnoestiis Ei Bh ie ee tor ee ci 25) on eo ine Co ” Lee posibve tere, SEES EM Se eer During the post period, 8.46% of tests were positive each quarter (controlling for age and season). In the period immediately before the switch January 2013-March 2014), 6.17% of tests were positive each quarter. xxxEND_PAGE:dhhs02_b0339_1280_1281_1 001281 o ie ey eB EH pees as eee : au a thanexpected, During the post period, 4.78% of tests were positive each quarter. In the period before the switch to Flint River water, 4.39% of tests were positive each quarter. Sarah Lyon-Callo, MA, MS Director, Lifecourse Epidemiology and Genomics Division Bureau of Disease Control, Prevention and Epidemiology Population Health and Commmunity Services Administration Michigan Department of Health and Human Services 201 Townsend St., 4" Floor Capitol View Building PO Box 30195 Lansing, MI 48909 PH: 517-335-9315 This message, including any attachments, is intended solely for the use of the named recipient(s) and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure, or distribution of any confidential and/or privileged information contained in this e-mail is expressly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy any and all copies of the original message. Please note: Michigan has a public records law. Most written communications to or from state officials regarding state business are public records available to the public and media upon request. Your e-mail communications and any attachments to them may be subject to public disclosure. xxxEND_PAGE:dhhs02_b0339_1280_1281_2

ATTOOOO1. htm, They didn’t take the gascline out per your suggestion Linda but altered the sentence on lead paint exposure from earlier versions at least.

Forwarding- Sent from my iPhone Begin forwarded message:

Sent from my iPhone Begin forwarded message:

Jim Sygo, DEQ, called to ask what the heck Genesee County actually issued and under what authority. i told him we didn’t know either per Brenda Lawson’s view at 5 pm last night.

GENESEE COUNTY, MI — Don't drink the water. That's one message Genesee County officials are pushing to residents who get their water supply from the city of Flint. Genesee County Commissioners Brenda Clack, Jamie Curtis and Bryant Nolden, along with Genesee County Health Officer Mark Valacak, held a news conference Thursday, Oct. 1, urging residents to not drink the city's water until it is checked for lead or they have installed an approved water filter. Don't Drink Flint's Water, County Leaders Warn Genesee County commissioners urge residents to not drink Flint's water until it is checked for lead or until they have installed an approved water filter. The commissioners declared a public health emergency and said they are hoping their declaration will move Gov. Rick Snyder to declare a state of emergency to handle Flint's water crisis. "This falls directly on the doorstep of the governor," said Nolden. "If we look at what happened with going to the Flint River, this falls smack-dab on the emergency manager and the governor. Now, | think it's imperative that the state step up and help us fix this problem. We're just imploring that the state actively engage and look at ways we can connect to the Detroit River. ... This is a major health situation for this entire community." xxxEND_PAGE:dhhs02_b0329_1263_1263_1

Eden, More analysis and review has been done by Sarah’ staff. Here are the talking points: The high risk Zip codes (48503 and 48504} Blood lead level rates among children under six years of age in the high risk Zip codes (48503, 48504} were 2.7 times higher than the rest of Genesee County before the switch to Flint River Water (o<0.0001}, After the switch to Flint River Water, rates in the high risk Zip codes were 3.2 times that of the rest of Genesee County {p<f.0001). Thus, compared to rates during 2040-2013, the rates after the switch to Flint River water in the high risk Zip codes increased 18 percent, although this difference did not reach statistical significance. xxxEND_PAGE:dhhs02_b0025_0147_0149_1 000148 Other Zip codes in Hint Rates of elevated blood lead levels among children under six years of age In other narts of the city of Hint were 2 times that of the rest of Genesee County before the switch to Flint River Water (p<0.0001). The magnitude of the elevated rate remained roughly the same during the period after the water source switch.

Date: Thursday, October 01, 2015 2:18:30 PM More analysis and review has been done by Sarah’s staff. Here are the talking points: The high risk Zip codes (48503 and 48504) Blood lead level rates among children under six years of age in the high risk Zip codes (48503, 48504} were 2.7 times higher than the rest of Genesee County before the switch to Flint River Water (p<0.0001}. After the switch to Flint River Water, rates in the high risk Zip codes were 3.2 times that of the rest of Genesee County (p<0.0004}. Thus, compared to rates during 2010-2013, the r: risk Zip codes increased 18 percent, although this difference did not reach statistical sig Other Zip codes in Flint Rates of elevated blood lead levels among children under six years of age in other parts of the city of Flint were 2 times that of the rest of Genesee County before the switch to Flint River Water (p<0.0001}. The magnitude of the elevated rate remained roughly the same during the period after switch. s after the switch to Flint River water in the high icance, the water source

Importance: High 2 things: 8 Leaded gasoline has been banned for use in road vehicies since 1996, so it’s not likely that Flint kids would be exposed that way 8 The sentence “Mast of the iead In household water usually comes from the slumbing in your house, not frarn the local water supply” is not completely accurate and could be challenged. On the call v EPA today | heard that maybe 50% of the city’s lead supaly lines are lead..these are outside the house and would include i portion of the run ow d by the resident and the portion owned by the city water s