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Flint Timeline

All, l’ll be updating the attached HHS timeline as we go forward with our activities in the city of Flint. | can glean some items to include from the daily SitReps and I’m also asking that you provide any additional noteworthy items to me at the end of each week. Please forward to anyone that I’ve not included here. Thanks for your cooperation. Linda B. Dyhena, PAD. Environmental Public Health Director Giision of Environrnental Health Michigan Department of Health & Human Services S17,335.8566 dykermal@ michigan gov xxxEND_PAGE:dhhs02_b0492_1910_1910_1

Fwd: Update from GCHD meeting with Flint Schools and Rep Neeley this morning

Good afternoon, Rep Neeley, Mr. Tawwab, Jaime G (United Way), Eileen T, Director of School Nursing, Toni Larocco and Mark Valaceck and | met this morning at Flint City Superintendent’s office. Regardless of half-life of lead and potential for “false reassurance” which has been a concern of most of us, primary the providers, the Superintendent does want an event which will include parental education followed by testing if wanted, at one of his schools sites. GCHD agrees that there are children that need to be tested, regardless of the Flint River episode, and working with the schools is a great way to reach those children and educate and test as needed. All are comfortable with the following plan: o November 12" there will be a “Lead Awareness Event” (title still being worked on) being held by the Schools in partnership with GCHD. This will be held north of the city at Northwester school, where parents of children 0-5 will be targeted and asked to come for a lead awareness education event and testing if needed. There will be WIC, SNAP, Home Depot, cooking demos, etc. They do want Wes Priem’s program to be there to talk about abatement as well if they can make it (| know they will be there at the Burton GCHD one on the 5"). © One thing | may have been wrong on in the past: Adults who present for testing to GCHD, the Nov 5 or Nov 12" events will be asked to get their testing with their primary provider; this is in line with our prioritization for children 0-5. The Superintendent and Rep Neeley agree on this prioritization. o Rep Neeley interested in MDHHS reaching out to two radio stations to spread any messages out about lead (he gave me the contact info, and the Mayor emphasized last week about the usefulness of Channel 12. 1 xxxEND_PAGE:dhhs02_b0342_1286_1287_1 001287 Eeren Eeken V. Wells, MB, MPH, FACPI Chief Mretifeal Breeutine Mititigan Department ef Health anid Hurtin Serviees 201 Tewreehd St, 5" Fleer CVE Lansing, Ml 48918 xxxEND_PAGE:dhhs02_b0342_1286_1287_2

RE: Talking Points

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.

RE: Talking Points

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

RE: Talking Points

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

2012 MMWR re Lead in DW

“Current water sampling protocols were designed to assess the adequacy of water treatment, not the level of human exposure to lead. Important fluctuations in water lead levels might be missed because of limitations inherent in sampling protocols developed for regulatory purposes.” Linda ®. Dyhena, PAD. Environmental Public Health Director Division of Environmental Health Michigari Department of Health & Human Services 517,335,8566 dykernal@ michigan gov xxxEND_PAGE:dhhs02_b0501_1930_1930_1

FW: Director's Office Assignment -- Flint - need update asap

Wes - per the EPA request to you, the attachment contains two graphics on childhood blood lead testing in Flint. Jay - this information likely will be shared with the local health department, if it hasn't been already (there is an MDHHS childhood lead poisoning health educator in the Flint-area), because the MDHHS toxicologists, MDEQ and the county health department spoke last week about the development of standard messaging related to lead in drinking water.

RE: Flint Water FAQ Document

Flint to issue lead in water warning after push from doctors, health officials xxxEND_PAGE:dhhs02_b0325_1248_1256_1 001249 xxxEND_PAGE:dhhs02_b0325_1248_1256_2 001250 Ron Fonger t rfongerl @milive.com Sex 24, 204& or o Reddit FLINT WATER « Flint to issue lead in water warning after push from doctors, health officials e GoFundMe page created by Virginia Tech researcher to buy filters for Flint residents « U.S. congressman calls for more testing of Flint water ® Lead fievels in Flint water soiked after switch to river, state records show » Appeals Court rules that lowered Flint water rates will remain in place AL Stories xxxEND_PAGE:dhhs02_b0325_1248_1256_3 001251 ouainal fie phate FLINT, MI -- The city of Flint is expected to advise its water customers on ways to ° minimize exposure to lead in water -- particularly for children -- after a group that includes doctors and health officials strongly suggested the step. Flint Mayor Dayne Walling confirmed the move on Wednesday, Sept. 23, after The Flint Journal-MLive learned the Greater Flint Health Coalition approved a resolution two days prior urgently asking the city to issue the advisory. Representatives of the coalition met privately with Walling and other city officials to express their concerns about the safety of Flint water, and issued a statement saying "not enough was being done to alert the public to potential risks of consuming Flint city water that could lead to elevated levels of lead.” Walling's statement said the city "will be issuing an advisory” on the matter "in cooperation with health partners promoting wavs to minimize the exposure to lead such as flushing pipes when the water has been sitting.” He did not specify when the advisory would be issued. Walling, who earlier this month asked Gov. Rick Snyder for $30 million for Flint's infrastructure, including $10 million to replace lead service lines to homes, said in an email that he “will continue to pursue funding for a comprehensive healthy homes initiative that addresses lead in paint and pipes.” "We have to get the lead out of our community to eliminate the threat of childhood lead poisoning,” the statement says. "I am extremely concerned to hear from doctors about any elevated blood lead levels in Flint's children.” 4 xxxEND_PAGE:dhhs02_b0325_1248_1256_4 001252 The Journal could not immediately reach Walling for more information on the concerns expressed to him by doctors about lead. Kirk D. Smith, president and chief executive officer of the Greater Flint Health Coalition, and state Senate Minority Leader Jim Ananich, the chairman of the group's board of directors, issued a statement to The Journal about the coalition’s recommendation on issuing precautions. "As a coalition of concerned physicians, health care professionals and county leaders, we are compelled to inform the public when there is a possible threat to their health so they can fake appropriate precautions and actions to protect themselves and their families,” the joint statement says. “At our last meeting and in recent days we have heard from numerous physicians who shared strong concerns that not enough was being done to alert the public to potential risks of consuming Flint city water that could lead to elevated levels of lead.” A resolution approved by the nonprofit coalition's board of directors, which includes representatives of Flint area hospitals, universities, physicians and unions, comes after researchers from Virginia Tech University reported their testing here shows a far-reaching problem with lead in water. Ten percent of Flint homes tested by Virginia Tech had 25 parts per billion of lead or more, far more than the allowable level -- 15 ppb -- set in federal guidelines, according to the university researchers. City and state officials have said their testing shows Flint's water supply meets all health and safety regulations, never rising above 11 ppb in more than 10 percent of homes during the last 16 months, but data from the state Department of Environment Quality shows lead lev souree in April 2014. At the urging of state and federal officials, the city announced three weeks ago that it would speed up the development of plans aimed at making Flint water less corrosive. Professor Marc Edwards of Virginia Tech has said treated river water is currently far more corrosive than water the city had used for decades -- Lake Huron water that was treated and piped here by the city of Detroit. Edwards has criticized the city and the state for not having developed a plan for reducing the corrosiveness of Flint's water because an estimated 15,000 homes in the city have lead 5 xxxEND_PAGE:dhhs02_b0325_1248_1256_5 001253 or lead solder in service lines and plumbing, making the homes much more susceptible to lead leaching into water. City Councilman Scott Kincaid, also a member of the GFHC, said he supported the organization's request for further action -- particularly after physicians raised concerns about how high lead levels could affect infants and young children. "I'm supporting the resolution. I think we need to advise people that there is a potential concern,” Kincaid said. "Lead isn't good for anybody, but the effect on infants" is especially disturbing. Although the city has yet to issue its lead advisory, Walling’s mention of allowing water to flush through pipes is the same advice given by Virginia Tech earlier this month. Researchers at the university have also recommended that infants not be fed formula made with unfiltered Flint tap water and that residents who are not flushing water for five minutes before using it for drinking or cooking should use a filter certified to remove lead. The Journal eould not reach Dr. Lawrence Reynolds, president and CEO of Mott Children's Health Center, for comment Wednesday. Other coalition members said Reynolds led the push for additional, quick action by the city. Lead is a toxic metal that was used for many years in products found in and around homes, according to the U.S. Environmental Protection Agency. Even at low leveis, lead may cause health effects such as behavioral problems and learning disabilities. Current regulations for lead in water began in 1992 and require a limited amount of testing to measure the degree to which lead leaches into tap water after flowing through lead service lines and lead solder in home plumbing. Flint has struggled with its water quality since switching to the Flint River as its primary water souree in April 2014. Previously, the city had purchased water through the city of Detroit, which got its water from Lake Huron. Flint was required to step up its testing of water in homes after it shifted to the Flint River, which is intended to be a temporary move as the city and Genesee County are partners in building a new water pipeline to Lake Huron through a partnership called the Karegnondi Water Authority. xxxEND_PAGE:dhhs02_b0325_1248_1256_6 001254 The city has been using -- and Walling and state emergency managers have supported continuing te use -- the Flint River as a stopgap water source until the KWA pipeline is expected to be completed in 2016. In state testing of city water samples, Flint has stayed below the federal threshold for lead, with less than 10 percent of tap water samples exceeding 15 ppb. Water systems can be required to take steps like making water less corrosive or replacing lead service lines if sampling shows such elevated lead levels. But after the Virginia Tech testing showed lead was much more prevalent than Flint's testing by the city and DEQ. Kildee said in a news release Sept. 21 that "the city, DEQ and (U.S. Environmental Protection Agency) have not adequately answered my questions on their testing methods to ensure the safety of Flint's water.” Redait

RE: Flint Water FAQ Document

Fyi any And frorn Gongwer this arn... Officials have found lead in Flint's water system, but it is corning frorm final service connections, Department of Environmertal Quality officials said in response to a push from US. Rep. Ban Kildee for additional water testing in the city. xxxEND_PAGE:dhhs02_b0325_1248_1256_7 001255 Mr. Kiidee (5-Flint} called Tuesday for the DEQ and the ULS. Environmental Protection Agency to have independent tasting conducted on the city's water systern after the fead findings and complaints of murky water in the systern (See Gongwer Michigan Report, Septernber 22, 2015}. Brad Wurfal, spokesperson for the DEQ, said there is a federal rule calling for converting lead pines to copper, but that the rule is designed to reduce the problem, not eliminate it "We felt we were clear that the lead detected in Flint's water Is strictly the product of lead in home plumbing,” Mr. Wurfel said of the meeting with Mr. Kildee and staff fram other elected leaders. "It doesn't come from the river, or the dant, or the cast iron pipes employed for most of the delivery system. it comes from water passing through lead service connections - more than 15,000 of thern in First, and it comes from home glumbing in older homes.” But he noted that Mr. Kildee is in the best place to push for change because much of what he would like te see happen wind require federal funds.

FW: Flint Water FAQ Document

Fyi oridy And from Gongwer this arm... Officials have found lead in Filnt’s water system, but it is coming from final service connections, Departrnent of Environmental Quality officials said in response to a push frarn U5. Rep. Dan Kildee for additional water testing in the cHy. Vir. Kiidee (D-FHint) called Tuesday for the DEG and the U.S. Environmental Protection Agency to have indenendent esting conducted on the city's water system after the lead findings and complaints of murky water in the system (See Gongwer Michigan Report, Santember 22, 2015}. Brad Wurfel, spokesperson for the DEQ, said there is a federal rule calling for converting lead pipes to copper, but that he rule is designed to reduce the problem, not eliminate it. “We felt we were clear that the lead detected in Flint’s water is strictly the product of lead in hore plumbing,” Mr. Wurfel said of the meating with Mr. Kidee and staff from other elected leaders. "It doesn't come from the river, or the plant, or the cast iron pines employed for mast of the delivery systern. it comes frarn water passing through lead service connections - more than 15,000 of them in Flint, and it cornes fram home plumbing in older homes.” xxxEND_PAGE:dhhs02_b0324_1246_1247_1 001247 But he noted that Mr. Kildee js in the best place to push for change hecause much of what he would like to see happen would require federal funds.

Env. Health Perspectives on Washington DC. lead in Drinking Water

iittos//www nchi.nim Excerpt below with the plan they implemented. Following the LCR (1.8. EPA 1991), guidance from the U.S. EPA, consultation with the DC Department of Health, and its own contingency plans, in 2003 the DCWASA implemented plans for families living in homes with lead lines or testing above the LAL: Advisories were disseminated recommending that water lines should be flushed for 10 min before consuming drinking water. Specific advice for limiting exposure to children < 6 years of age and pregnant and nursing women was sent to all households with suspected lead service lines, in the form of flyers prepared in English, Spanish, Korean, Chinese, Vietnamese, and Amharic. Filters were distributed to homes with suspected lead service lines and later to all homes with a test result > 15 ppb (the LAL). Replacement filter cartridges were then sent to the same homes at 6-month intervals for the duration of the period of the exceedance, ending in June 2006. The board of directors of the DCWASA decided to adopt a voluntarily accelerated program to replace the public segment of all lead service lines in the District of Columbia, exceeding requirements of the LCR (U,8. EPA. 1991). Homeowners were offered replacement of the private segment of lead service lines on their property, at cost, at the same time that the public segments of the lead service lines were replaced. When the public line is replaced but the private line is not, lead levels are reduced proportionally to the length of pipe replaced but not eliminated. Low-cost financing was arranged with a local bank for qualifying property owners who wished to replace the private part of the lead service line on their property. The DC government later made grants available to low-income eligible residents for this purpose. The DCWASA offered free water testing to any customer in the distribution area who requested it. 1 xxxEND_PAGE:dhhs02_b1201_4589_4590_1 004590 xxxEND_PAGE:dhhs02_b1201_4589_4590_2