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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

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