Correspondence between

ATTO0002.htm Sent from my iPhone Begin forwarded message:

Forwarding to ensure ou all got this E Eden V. Wells, MD, MPH, FACPM Clinical Associate Professor, Epidemiology Director, Preventive Medicine Residency University of Michigan School of Public Health 1415 Washington Heights, Ann Arbor, MI 48109 Tel: 734-647-5306 Fax: 734-936-2084 ewells@umich edu Date: Sat, Dec 19, 2015 at 4:30 PM

Pro ok. with this.

Eden, GCHD has asked for it as well. I've asked for some guidance from the 6th/7th floor. Linda

Good morning, Please see the attached message that has been cleared for dissemination to Flint providers. Genesee County will blast fax and use their professional networks (GCMS, etc.) to disseminate to all providers. | have CC'd Dr. Mona Hanna-Attisha and Dr. Reynolds here, and they can distribute through their networks as well. Our Medicaid program will be working with the local health plans about lead screening recommendations based upon this message. This will also go out as a low-alert from our Health Alert Netowrk to appropriate Flint sites/providers, so | have CC'd Craig Henry. If there are any questions, please do not hesitate to contact me. Warm Regards, Eden xxxEND_PAGE:dhhs02_b1249_4708_4711_1 004709 Eden V. Wells, MD, MPH, FACPM Chief Medical Executive Michigan Department of Health and Human Services 201 Townsend Street, 5th Floor CVB Lansing, MI 48913 Phone: 517-335-8011 wellse3@michigan.gov

Thank you. Dr. Wells—please have your folks add this language to the HAN.

case management resources continue for families I think it’s a great idea. I would like to do a joint announcement once we have an agreement with the significant parties involved. I think this is the type of collaborative effort that can really make a difference for the children in Flint going forward, especially on the preventive side.

FYI only

All- A reporter with Bridge Magazine is requesting the statewide 2014 (and if possible, 2015} CLPPP data. Bob sent me the attached county-level info for 2014 which | have net shared yet, as it’s not the final report. We would like to touch base to make sure the data has been finalized and reviewed by epi before it's posted online. Eden ~ we'll reach out to you in the morning to discuss the media request. Beyond the data, the reporter is also interested in discussing home lead investigations. Jennifer Eisner Public information Officer Michigan Department of Health and Human Services Office: 517-241-2112 or EisnerJ@michigan.gov : Cell

Sent from my iPhone Begin forwarded message:

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Attached you will find the items | mentioned this morning that were forwarded to the Task Force yesterday. --A detailed MDHHS Action Plan on Flint Water Public Health --An overview provided by our Bureau of EMS, Trauma and Preparedness giving further detail on considerations for use of the Incident Command System or Community Health Emergency Coordination Center (CHECC) --Answers to the lead abatement questions posed to the department from the Task Force. Thanks--g xxxEND_PAGE:dhhs03_b0725_2535_2535_1

Geralyn--sorry, yesterday | was caught without my file--a slight correction (hope it is not too late) actual talking point from the first press conference about our data---note that below were doing a model: "Blood lead level rates among children under six years of age in the high risk Zip cades (48503, 48504} were 2.7 times higher than the rest of Genesee County before the awitch to Flint iver 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 2019-2013, 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. Other Zip codes in Flint Rates of elevated blood lsad 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<O.0001}, The magnitude of the elevated rate rernained roughly the sare during the neriod after the water source switch.“ However, when we look at percentages bu ip and by quarter, note that there are ways you can see doubling in certain zips, but there is a seasonal quality to the data so we have never said "rates doubled" in a certain area---but the Hurley folks have been. xxxEND_PAGE:dhhs03_b0302_1120_1120_1

1. EBLinvestigations: the investigation report, including the water information, should be provided to the MDHHS Healthy Homes Section within two weeks on average after the investigation is completed. This includes time for receipt of specimen test results (water, dust wipes, soil). 2. Elevated EBLs: there were 18 children with elevated EBLs shown in the summary report as of October 30, 2015. | have the more detailed age breakdown for the updated report which would show data from 10/1/2015 to 11/13/2015. There are 22 children with elevated EBLs. Of children < 6, 14 have levels 5 — 14, 2 have levels 15 —44. Among children 6 to 17 years, 5 have levels 5— 14 and 1 has a level 15-44. In summary, 19 children fall into the 5 — 14 category and 3 in the 15 -44 category. So most kids are in the 5 — 14 mcg/dL category if they have elevated EBLs. The table is attached. Epidemiology is not planning on sending these more detailed tables up to you routinely, but this table gives you a feel for the testing by age group and whether or not the test, if known, is venous or capillary. Corinne xxxEND_PAGE:dhhs02_b0600_2199_2199_1

Importance: High Good morning, Attached is an updated report that includes the MDHHS logo. Because that’s been added in, | had to shift the format a bit so when updating this report going forward, please use this version. xxxEND_PAGE:dhhs02_b0599_2193_2198_4 002197 Additionally, I've attached updated talking points for Flint which include points regarding this report on the first page. Please review these and let me know if there are any concerns. Thank you, Angela

We can do---I talked with Angela. Angela- This one pager is unable to portray seasonality, but the talking points can---such as: "it is important to note that lead exposure can vary by season regardless of where it is located in the environment. For instance, the third quarters (July-September) have the highest EBL proportions for 2014 and 2015 compared to other seasons of the year." Showing the chart can help too. Feel free to contact me---| know this is a difficult one for risk communication and readability for the general population! Eden

Great, Jennifer and Angela, please work with Eden and Linda to finalize some talking points associated with this so we can determine when we can move forward on releasing.

Importance: High Attached is the bicod lead testing report with the eclits Eden and | discussed in pdf and InDesign formats. xxxEND_PAGE:dhhs02_b0599_2193_2198_5 002198 Please keep in mine that the purpose of the report is to inform residents and other interested parties about blood testing efforts in Flint. It is not intended to be a technical report. Recent discussions with GCHD suggest that seme of the materials currently posted at are written at a level that is not accessible by city of Flint residents and I’m concerned that this report has already become far too busy for many people to take in the information. Atechnica! description of the background and data analysis methods is on the to-do list, but will require additional time to complete. | expect it will include a detailed description of the analysis comparing ELL before and after the switch, as well as the results of our current efforts and all the methods used. Linda xxxEND_PAGE:dhhs02_b0599_2193_2198_6

Attached is updated Flint Action plan for week ending 11-13-15. Highlights this week: e GCHD completed nurse case management training e Community awareness event held at Brownell School e Congressional Call re: Ready to Feed Formula e = Call with the Agency for Toxic Substances and Disease Registry (ATSDR) xxxEND_PAGE:dhhs02_b0308_1215_1215_1

The attached is hopefully the final draft of the bload testing report for the 10/4 to 10/30/15 time frame. Let Michelle Bruneau know # you'd Uke loga(s} added or if you want the infiesign file. Linda

lead exposure limited to fixtures

shows lead exposure limited to fixtures sticking to water

shows lead exposure limited to fixtures Sent from my iPhone Begin forwarded message:

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.