Correspondence between

Updates in bold. Genesee hasn’t been reporting total numbers of filters distributed this week so | took that out of the plan for now. Highlights this week: Genesee CHD Nurse training Suggested language for health threshold Testing event held at Brownell School held Follow-up with Molina regarding testing Congressional Call re: Ready to Feed Formula Please let me know if you have any changes or additions before | send to Nick and all. xxxEND_PAGE:dhhs03_b0292_1098_1098_1

We cannot wait that long to get a message out- we can definitely provide some descriptive epi ---the data does not need a full in depth analysis to present useful information.

We cannot wait that long to get a message out- we can definitely provide some descriptive epi ---the data does not need a full in depth analysis to present useful information. xxxEND_PAGE:dhhs03_b0166_0704_0705_1 000705 ig this an accurate timeframe?

Mikelle And | just discussed and she is going to find out what exactly has robe done to get the results completed and what the real timeframe is. We discussed how unfortunate it was that this information was not shared internally first so we could have the appropriate information BEFORE it was shared externally so we could have these questions answered. Sent from my iPhone

Yes ~ We can have a new version with better silhouettes by tomorrow morning. Thanks, Kory

Importance: High Kory — our concern before was that the document would not print off well in black and white. On the revised copy, the white outlined people are really faint now. We can barely see them. All we can really see is the unborn baby. Any improvements you could make to that so it will print off better?

Please find attached the updated final infographic. Thank you,

| just talked to the health officer, Mark Valacak; our colleagues in DEQ should directly call or email Jim Henry, 810 257- 3618 or [email protected]. Jim was involved in the original school testing two weeks ago and will be point. Thanks Mark

HI folks, This is for water testing, right? Have good planning for blood testing already underway-- My understanding is that this should be Jim Henry, EHS supervisor. Eden

| have just heard from DEQ that they are frustrated that they have not been able to get anyone from the Genesee County Health Department to call them back regarding meeting with the schools for further conversations on testing. | believe it is George Krisztian who is trying to reach them so Sue and Eden could you please reach out to Mark and find out who their point person should be on this. Brad--if you need them to connect with anyone other than George, please let us know. 1 xxxEND_PAGE:deq15_b384_1613_1614_1 Sent from my iPad xxxEND_PAGE:deq15_b384_1613_1614_2

Department All, Attached is the revised fact sheet and the Infographic | mentioned at yesterday's briefing. Please note that the Genesee County loge was pulled from the internet: GCHD may have a different ane they would like to use. We'll send these materials to them for final review once we're good to go internally. Linda

Department Just a few edits that we have in the attached, Amy has put aur edits an “sticky nates” in the attached pdf sa please refer to those for aur comments and eclits. Please make sure we get the final version so we can alsa provide to partners, etc. Thank you. xxxEND_PAGE:dhhs02_b0767_2685_2694_09 002694

Importance: High And Genesee County and the Genssee County Health Department, have just issumd the attached public health advisary and on the final paragraph it says: Michigan Department of Health aia i Ore CORN: sive and Funt addresses which would : je addresses in water from the Weter Author ty is prepared to take her 4 outs erefore, walt lunderstand that we are still reviewing the data—-but the county has basically issued a ransom date that they want this information by tomorrow. Ecden-—please coordinate an answer so Nick can walk inte the 1:00 p.m. meeting prepared on this.

Attachinerits: Pages from CLPPP 2013 Data Report pdf: 2014 Lead Testing and EBLL.O-5 072015.pdf FYE ~ on the call with EPA that Wes participated in. today.

(DCH); Scott, Robert L. (DCH)

DC. lead in Drinking Water FY]-on the call with EPA that Wes participated in today. xxxEND_PAGE:dhhs02_b1265_4745_4748_1 004746

Importance: High Hello —I’m going to send a series of emails with materials you have asked for, as a way to organize them. The first document attached to this email is our CLPPP updated analysis of the blood lead testing data we have for children aged 0-16 in Flint. This is an update from what we sent to the Director’s office earlier in the year, in that we added an additional year (2010-2011), and added data for May-August 2015 (per Geralyn’s request in an email late last week). Regarding this data: e Weare using the timeframe of May —April for this chart, because the water source change in Flint happened in April 2014. So, we started by looking at the 12 month time period from May 2014 — April 2015. Then we went back and compared that same time frame to the 4 previous years, to see if the pattern was similar, significantly different, etc. e = We included all children with a Flint address, which may not exactly conform to the city boundaries. e We only included first time blood lead levels of > 5 mcg/dL, not all subsequent tests a child may have received. e We included all types of blood samples — venous blood draws, capillary samples, or unknown (e.g. not labeled as venous or capillary). Typically we would point to venous samples as the best, most reliable, but we had many non-venous samples, so to be inclusive added those in. Looking at the charts, you can definitely see the seasonal impact associated with lead poisoning. We do NOT see a different pattern of results for the 2014-2015 year, right after the change in water source. That year looks more like the data from 10-11, and 11-12. For the full 5 years worth of data, testing rates were pretty consistent, so we don’t think that is driving the data. However, note that testing levels for May-August 2015 appear to be lower than in the previous 5 years. The second document | have attached is a presentation sent to us this morning by Dr. Mona Hanna-Attisha, from Hurley Medical Center. She shared this related to her data request that she sent to our program. In scanning it, we noted that 1 xxxEND_PAGE:dhhs03_b0791_2864_2865_1 002865 shre is using different datta than We did by age, by zip code, tirme frames, with years she inclutted, EtG, so conmparing our data ehatt to her results is like conpparing apples atid oranges. We have net rum amy analyses using her parameters. \Wfe dit] nee sense slides in her decuneatt that We might disagree with, fer example her statenvent that waiter is the primary source ef leat (im Méthigan, it renrinss lead paint that is eur primary source of leat] exposure). Please let us krtiw if you have questions you Page abot the data ebarts We produnced. Next email will Be some ef our progam materials, that may be of use in the upconiiag outtreath effort. Also, Rastmhi imiewted Wh | should inchade en this email, anid | trust you will share with otters as appropriate. Naney xxxEND_PAGE:dhhs03_b0791_2864_2865_2

Water. from Horley. df Importance: High Hello — I'm going to send a series. of emails with materials you have asked for; as a way to organize them, The first document attached to this.email is-our CLPPP updated analysis of the blood lead testing data we have for children aged 0-46 . This isan update from what we sent to the Diréctar’s-office earlier in the year, in that we added an additional year (2010-2011), and added data for May-August 2015 (per Géralyn’s request in-an emailtlate-last week). Regarding this data: » We dre using the titneframé of May ~April for this chart, because the water source change in Flint happened in April 2014. So, we started, by looking at the 12 manth time period from. May 2014 ~April 2015. Then we went back ahd compared that same time frame to the 4 previous years, to see if the pattern was similar, @. We intel all children with a Flint address, which may not-exactly conform to the, city boundaries. « We only included first time blood lead fevels of» Smeg/dL, not all subsequent tests a child may have received. ® We included all types of bladad samples — venous bleed draws, capillary samples, or uhknown {e.g. not labeled as venous of capiflary}. Typically we would point to. vénqus samples as the best, most reliable, but we had many nof-vehous samples, so to be inclusive added those in. Looking at the charts, you can definitely see the seasonal impact associated with lead poisoning. We do. NOT see a different pattern of results for the 2014-2015 year, right after the change in water saurce. That year looks more like the data from 10-41, and 11-22. For the fi! 5 years: worth of data, testing rates: were pretty consistent, so we don’t think that is driving the data. However, note that testing levels: for May-August 2015 appear to be fower than in the. previous 5 years. The sécond document | have attached is a presentation sent to.us this morning by Dr. Mona Hanna-Attisha, frara Hurley Médical Center. She sharéd this related to-her data request that she sent to. our program. In scanning it, We noted that. she is using different data than we did (by age, by zip code, time frames, which years she included, etc.}, so. comparing 6tiF data chart to her results is fike comparing apples and oranges. We have not run any analyses using her patameters. We did néte some slides in her dacument that we might disagree with, for example her statement that’ ‘ater Is the primary source of fead {in Michigan, it remains lead paint that is ourjprimary source of lead exposure), xxxEND_PAGE:dhhs02_b0860_2950_2953_1 002951 PIGASe iat us WOW iF you Have questionsyyou have ebeut the dita charts we produced, Next enrail will re sionte Gf our 3 £ i i : 2 z j 2 5 = é Naney: LOR AAR ATOR SELESEOPESPEEEIPLOL LLL OLL ELEC CELE ee ee nnn eee eee ee eee ene nn nnn nn einen ess ness eee EE xxxEND_PAGE:dhhs02_b0860_2950_2953_2 on ite) foo) N fo} 3 Lee See L6E OLE Sez aay EBE, £9E BLE: SCE 86E 68E BO BEE Oke is Toe. HOE SLE OLE. ber BE. £LZ. LEE. She. 902 23g, TRE SOE Tee. ele GEE: AON vag ESE ety ote eny STE BO: AON vBz zy tor ssp eS CIS 808 vOS = Zee ydeg “Sn GbE. GLE: BLE: vee SLE Ane £62 OYE TLE. BE Ose. Rata Kei STOZ storyide PLOZ-ELOZ ELOL-ELOE CIOS T TOT TWOZ ESE ae josueak QT pen Bea] UMP “Gutpy {oO AUD BiGel Ualuiseds pkayasnausiw A Bed SHH tpodnos: S10, St Jaquiagdag UMCUIIUA Jo Auej/ides ‘snouas so addy Biduies-saprlouy WW/EN G =< Sfann] Peay poolg ewh-lsuy AMO-sapaoUy 9593 ou Je BBE: yo sxeOA QE Ue SSB SiLayy AHO Ra[g 03 ApDexa uGQUOD Jou Aguu-~,Juity,, SE BOIS! Si SSBIPPR Sseym uaup}ya, 6 5 5 i v £ £ $ Ee E £ + z 6 g Ei v £ v g €f. £ Z. s or & ss a ¢ 6 a4 OG t th OTE soy eA Gey ouar ag «AON «RO #S|OAZT PRS] POO} TE S&S 6 Lib oY we 68¢ 6e Le wag ny ae: at at OE bE Any Te Oat St OSE Ot €% aunp Agar austy YARIS BUN LISILa UNA 988 jo suw8A Gy DeYT S30) eipil 4D Gud go AND §TOz STOR -PLOE PLOe-ET0E LOC ZEST CLOSE EOS TIOT-OTO?. ey, xxxEND_PAGE:dhhs02_b0860_2950_2953_3 ie) ive) foo) N fo} 3 xxxEND_PAGE:dhhs02_b0860_2950_2953_4

Attached please find the FAQ document that was discussed during the Flint water conference call today. Thanks! Heather Feuerstein Management Assistant to Maggie Pallone, Deputy Director and Brad Wurfel, Communications Director Department of Environmental Quality 517.284.6715 xxxEND_PAGE:deq14_b0523_1833_1833_1