WV Chemical Spill Mountain State Symposium 5-9-14F
Transcript of WV Chemical Spill Mountain State Symposium 5-9-14F
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
1/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
2/45
Presentation Overview
Introduction of the Incident
Public Health Response
Recovery Efforts Future Challenges
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
3/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
4/45
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.
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
5/45
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.
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
6/45
Consisted of at Least 7 Different Chem
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
7/45
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
8/45
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 -
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
9/45
The Response
City of Charlestothe West VirginiaState Capitol.
300,000 people
served by waterutility.
Many more visitFirst week of thelegislative sessio
9 counties serve
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
10/45
Public Response
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
11/45
Public Health Response
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
12/45
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.
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
13/45
Incident Timeline by C&E News
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
14/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
15/45
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.
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
16/45
Slide Title
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
17/45
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.
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
18/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
19/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
20/45
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
Kanawha-Charleston Health Department
Water Usage Survey
January 27th - March 1, 2014
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
21/45
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
Kanawha-Charleston Health Department
Household Financial Impact of Water Contamination
January 27th - March 1, 2014
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
22/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
23/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
24/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
25/45
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.
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
26/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
27/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
28/45
Self Reported Symptoms from the 10
Sentinel Medical Providers (n=224)
0
20
40
60
80
100
120
Count
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
29/45
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/ -
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
30/45
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/ -
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
31/45
Source: ED Records review by CDC/WVDHHR released 4/23/14.
http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/
Significant Differences between
http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/http://www.bt.cdc.gov/chemical/MCHM/westvirginia2014/ -
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
32/45
Significant Differences between
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
33/45
Community Assessment Population Surv
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
34/45
CAP Survey: Hardship
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
35/45
CAP Survey: Economic Impact
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
36/45
CAP Survey: Sources of water
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
37/45
CAP Survey: Social Trust
F Ch ll
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
38/45
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.
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
39/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
40/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
41/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
42/45
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
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
43/45
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?
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
44/45
-
8/10/2019 WV Chemical Spill Mountain State Symposium 5-9-14F
45/45
Thank You!
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]