WV Chemical Spill Mountain State Symposium 5-9-14F

8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F

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Rahul Gupta, M.D., M.P.H., F.A.C.P.Executive Director and Health Officer

Kanawha-Charleston Health Department

Putnam County Health Department

RESPONSE AND RECOVERY DURING

ENVIRONMENTAL DISASTER: LEARNING FROM

ELK RIVER CHEMICAL S

PUBLIC HEALTH AND THE LARGEST CHEMICAL

DRINKING WATER CONTAMINATION INCIDENT

IN US HISTORY


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Presentation Overview

Introduction of the Incident

Public Health Response

Recovery Efforts Future Challenges


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Academic Partnerships and Contributio

Andrew Whelton, Ph.D., The Whelton Group,

WVTAP, and University of South Alabama (USA

Rajarshi Dey, Ph.D., USA

LaKia McMillan, USA


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The Incident January 09, 2014: Unknown

volumes of crude 4-methylcyclohexanemethanol(MCHM) release was detectedfrom a Freedom Industries facinto the Elk River, WV.

Detection via resident complaiof black licorice odor.

Spill occurred upstream from tprincipal WV American Waterintake, treatment and distribut

center.


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What is MCHM

Crude MCHM is a chemical foamused to wash coal and removeimpurities that contribute topollution during combustion.

While initially unsure, laterestimations placed at 10, 000 USgallons of crude MCHM leaked fra one-inch hole (and another inch) in the bottom of a stainless

steel storage tank capable ofholding 40,000 US gallons.


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Consisted of at Least 7 Different Chem


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Crude MCHM: How much do we know

>80,000 such chemicals in use; very little known OSHA: Hazardous

Carcinogenic effects? No data available.

Specific Target organ toxicity? No data available.

Mutagenic effects? No data available.

Aspiration Risk? No data available.

Developmental toxicity? No data available.

Bioaccumulation potential? No data available

No Human data available!

What is the acceptable level of MCHM in drinking water CDC: There should be no MCHM in drinking water.

(http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/mchm.asp)
http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/mchm.asphttp://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/mchm.asphttp://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/mchm.asphttp://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/mchm.asp


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The Response

City of Charlestothe West VirginiaState Capitol.

300,000 people

served by waterutility.

Many more visitFirst week of thelegislative sessio

9 counties serve


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Public Response


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Public Health Response


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Response contd

ICS immediately; Metro 911 (EOC) partnerships. 24/7 information & media updates; Provided input to Governo

Office.

Fielded approximately 5,000 calls.

~2,000 facilities; ~Almost 100 Schools.

Water distribution/Special needs populations.

Maintained syndromic surveillance and situational awareness

Partnerships with multiple organizations (old and new).

Assisted with SB 373 now state law; Accredited LHDs role.

Ongoing research activities. Multiple other activities while regular services continued.


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Incident Timeline by C&E News


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Continued with updates

Feb. 5 onwards: Almost

daily odor complaintsfrom schools and some

school closures become

norm for next several

weeks.

Mid to Late Feb.: WV TAP

scientists find persistent low

levels of MCHM in all homes

tested across 9 counties

leaving the plant, not entering.

Asks water co to conduct

testing of their facility.

Mar 21-22: Water Co

reveals intake from river

undetectable but water

leaving the plant for

homes has persistent

low levels of MCHM.

Apr. 1: WVTAP

scientists state

screening levels

for MCHM 8 times

more stringent

than CDC.

A

a

c

h

e

i


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Recovery Process

Our aim is to utilize credible science and data to infodecision making and assist the recovery process:

To explore, understand and address physical, sociocultural, psychological and economic impacts.

To accurately assess the duration of human exposu

To assure the dissipation of chemicals from ourplumbing systems.

To implement longitudinal population surveillanceprogram.


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Slide Title


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Recovery Science Development

Funding from Governor Tomblin to WV TestingAssessment Project (TAP) independent expert panel.

Partial funding from Kanawha-Charleston HealthDepartment.

Partial funding for Dr. Whelton from the NSF CBETRAPID grant program; Effort not part of the WV TAPproject.

Contributions from Dr. Rajarshi Dey, LaKia McMillan

from University of South Alabama.


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What Have We Learn From Data so fa

WVTAP (Testing Assessment Project) KCHD online survey

Home survey

Syndromic surveillance findings

Emergency visit findings

WV CAPS (Community Assessment

Population Survey). Release (5/12/14)

Si ifi t Diff b t


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Significant Differences between

CDC and WVTAP Screening Levels

Compound & AssumptionCDC WV TAP Expert Pane

4-MCHM (ppb) 1,000 120

PPH (ppb) 1,200 850

DiPPH (ppb)

1,200

250

Duration 14 days 28 days

Most sensitive population 1 year old child Formula fed infant

Exposure routes

Ingestion only

Ingestion, inhalation, der


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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Bathe Clean Cook Drink Other

Week of January 27th Week of February 3rd Week of February 10th Week of February 17th Week of Februar


Water Usage Survey

January 27th - March 1, 2014


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0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Jan. 27 - Feb. 2, 2014 Feb. 3 - Feb. 9, 2014 Feb. 10 - Feb. 16, 2014 Feb. 17 - Feb. 23, 2014 Feb. 24 - Mar 1, 2014

Less than $100 $100 -$250 $250 - $500 Over $500


Household Financial Impact of Water Contamination

January 27th - March 1, 2014


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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No

96%

4%

Do you feel the local health department should develop a surveillance

program to monitor the long term health impact of the chemical?

January 27th - March 1st

714 responses


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Survey: 16 Residential Homes

30 minute interview Demographics

Building plumbing pipe material and age

Experiences before and after the do not use order

Means learned about the incident

Reported tap water aesthetics and health symptoms

Counties: Kanawha, Lincoln, Putnam

Towns: Cross Lanes, Elk View, Nellis, South Charleston,Charleston

23


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Residential Plumbing Systems are Comple

More than 1 pipe type waspresent at 31.3% of the homes

Partly or entirely contained..

Metal piping

62.5% Copper

12.5% Galvanized iron

Plastic piping

31.3% cPVC

18.8% PEX6.3% PB

24

n=15

Multiple Exposure Locations and Routes wer


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Multiple Exposure Locations and Routes wer

Found to be SignificantFactors (P-value and Odds Ratio) Symptom

Drinking (0.000, OR=3.48), Work (0.012, OR=4.52), Sex (0.052, OR=0.48)

Nausea

Drinking (0.000, OR=6.35), sex (0.023, OR=0.33) Vomitin

Drinking (0.000, OR=6.26), Food facility (0.008, OR=26.46), Work (0.013, OR=7.76),

Home(0.051, OR=8.03)Diarrhe

Onsetc1/peak 1(0.017, OR=2.28) Eye Irritat

Wash/Bath (0.000, OR=5.49), Onset2/peak2(0.001, OR=0.35), Drinking (0.074,

OR=0.53)Skin Irritat

Wash/Bath (0.003, OR=2.9), Drinking (0.053, OR=0.54) Rash

Work (0.003, OR=4.62), Food Facility (0.015, OR=5.85), Sex (0.096, OR=0.48)Headach

None

Cough

Drinking (0.002, OR=5.20), Flushed (0.00, OR=0.20), Sex (0.025, OR=0.17)Sore Thro

Odds ratios (OR) = probability of a patient reporting a symptom if the patient became ill during the first symptom reporting peak.


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After the Okay to Flush Order, Nearly All Residents Chose Not

Use Tap Water for Hygiene, Laundry, or Hydration Activities

0%

25%

50%

75%

100%

Drink Shower WashClothes

BrushTeeth

Cook Animals

Percentage

Water Use Activity

Be

Aft

n

Did not resume tap water use because did not believe the water was safe

Detected licorice tap water odor after flushing

Friends and media reported tap water was still making people sick

Syndromic Surveillance of Sentinel Providers f


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Syndromic Surveillance of Sentinel Providers f

Kanawha & Putnam Counties (Jan. 9-Feb. 9)

0

5

10

15

20

25

30

PatientsReportingSymptoms

Symptom Onset Date

Do Not Use Order Issued

Plumbing System Flushing Begins

Self-Reported Symptoms from the 10


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Self Reported Symptoms from the 10

Sentinel Medical Providers (n=224)

0

20

40

60

80

100

120

Count


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Source: ED Records review by CDC/WVDHHR released 4/23/14.

htt : www.bt.cdc. ov chemical MCHM westvir inia2014

Do Not

Use Order

Issued

Plumbing System

Flushing Begins
http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/


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Source: ED Records review CDC/WVDHHR released 4/2

http://www.bt.cdc.gov/che

M/westvirginia2014/
http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/


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Source: ED Records review by CDC/WVDHHR released 4/23/14.

http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/

http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/


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CDC and WVTAP Screening Levels

Compound & Assumption

CDC WV TAP Expert Pane

4-MCHM (ppb) 1,000 120

PPH (ppb) 1,200 850

DiPPH (ppb)

1,200

250

Duration 14 days 28 days

Most sensitive population 1 year old child Formula fed infant

Exposure routes

Ingestion only

Ingestion, inhalation, der


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Community Assessment Population Surv


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CAP Survey: Hardship


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CAP Survey: Economic Impact


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CAP Survey: Sources of water


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CAP Survey: Social Trust

F Ch ll


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Future Challenges

Document the complete dissipation of the chemicalsfrom our plumbing systems.

Encourage state and federal partners to conduct furtresearch.

Ensure impacted populations long term safety throulongitudinal population surveillance is conducted.

Ensure that public health plays a significant role inguaranteeing chemical safety and drinking water

protections at all levels: local, state and federal.


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Science and Public Health

Studies needed to be conducted:

Human/Animal

Chemical (Crude MCHM + PPH)

Conduction Systems

Qualitative Testing of Chemicals

Human and Animal Studies


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Human and Animal Studies

Longitudinal population surveillance studies:Registry, biomonitoring, environmental publichealth tracking, etc.

Occupational health studies.

Animal studies: Toxicology (plus metabolism,excretion, bioaccumulation, mutagenicity (in-vitro/in-vivo), teratogenicity, target organ toxicitetc).

Long term ingestion human health impact.

Chemical (Crude MCHM/PPH) Studies


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Chemical (Crude MCHM/PPH) Studies

True, in-vivo half life (in treated water).

Indoor air quality, partition/odor humanimpact issue.

Products formation (with treated water) incold and hot temperatures, their potentialfor harm, if any, oxidizing properties.

Combustion points (of chemicals andcompound products, if any).

Chemical stability, reactivity.

d i di


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Conduction Systems Studies

Home pipes (deposits of chemicals/compounds,leaching, adsorption, etc).

Water heater study.

Temperature difference and chemicals' behavior homes.

Peer review of established flushing protocols.

Impact of long term presence.

Qualitative Testing of chemicals


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Qualitative Testing of chemicals

Current quantitative tests can test at varyinglevels. Which ones are optimum? Lowest limitsof detection?

Inter-lab variability?

Inter-test variability? Inter-operator variability?

Test variability within same pipes and acrosspipes in homes?


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Thank You!

[email protected]

304.348.6494 Some material used in this presentation was

developed for Dr. Wheltons West Virginia

presentation delivered in New Orleans, March 2014
mailto:[email protected]:[email protected]

Documents

WV Chemical Spill Mountain State Symposium 5-9-14F