Although she had been familiar with stories of lead poisoning for most of her life in Cleveland, Ohio, it wasn’t until March of this year when Marcie Gray-Forrest gained a stake in the issue.

Gray-Forrest, a former teacher in the Cleveland Metropolitan School District, founded lead remediation company No More Lead more than a year after the city council passed a law requiring landlords to remove the harmful element from their properties.

“Oh, I’ve been getting calls every week,” Gray-Forrest said. “Now that it’s on the landlords? It changes things.”

The law, which Cleveland’s city council approved in 2019, requires owners of homes constructed before 1978 to obtain a certificate showing their properties are lead-safe by 2023. The law was passed during a years-long push to address the toxic effects of lead in Cleveland, where children have lead poisoning at a rate more than four times higher than the national average. 

Young children, pregnant mothers, immigrants and adults who work in certain industries, like construction, have a higher risk of lead exposure. Low-income neighborhoods and communities of color are among those most at risk.

Lead poisoning can cause damage to the brain and nervous system, leading to lower IQs and poor school performance among children who are exposed.

Eliminating lead from homes, water and soil is an ongoing challenge in the United States, one exacerbated by the isolation caused by covid-19. 

Across the country, lead poisoning prevention programs have experienced a year of pandemic delays. In Indiana, a university’s lead testing program scheduled to begin last year just got off the ground in March, 11 months after its target start date. In Harris County, Texas, home to the Houston metroplex, canvassers working to prevent lead poisoning resumed all of their outreach efforts in February after spending 10 months in roles responding to the pandemic.

Lead experts worry that during a time when families have been tethered to their homes, exposure may have risen just as testing and inspections tracking the problem were on hold.

“All the reports point toward: more time at home, (the) higher the blood lead levels,” said David E. Jacobs, chief scientist at the National Center for Healthy Housing. “That’s more exposure to contaminated paint and soil. More exposure to contaminated toys, drinking water and the like.”

The number of children tested for lead fell by more than a third in the first five months of 2020 compared to the same period the year before, according to the Centers for Disease Control and Prevention (CDC).

Ever since the Clinton administration assigned a task force to investigate how to repair the ills of the lead paint era, mistrust of government officials has made lead removal more difficult, especially for low-income neighborhoods and communities of color.

“This issue of trust has to be rebuilt,” Jacobs said.

To raise awareness of Cleveland’s new ordinance and reach thousands of homes affected by lead, the Lead Safe Cleveland Coalition built a team of outreach workers and hotline staff.

The goal is to sweep the city with workers urging potentially affected residents and landlords to begin lead remediation, said Robert L. Fischer, co-director of the Center on Urban Poverty and Community Development at Case Western Reserve University in Cleveland.

As Clevelanders and other Americans spent more time in their homes thanks to virtual schooling, unemployment and working from home, their risk of exposure to household lead hazards has risen, Fischer said.

At a spring update for the coalition, Fischer said the decrease in lead testing was met with resigned acceptance.

“The overwhelming response was, ‘Yeah, this is basically what we expected,” he said. “Covid’s really thrown a wrench into things.”

Landlords have limited options when seeking financial assistance to remove lead hazards, which a 2019 analysis suggested could cost Cleveland property owners a collective $128.5 million, at up to $15,000 per rental unit. Without guidance and funding to cover abatement, Jacobs said, landlords will likely resort to budget-cutting tactics that impact renters.

“If their only choice is to raise the rent? To evict?” Fischer said. “Then they will.”

How outreach teams are working to build community trust

At the Lead Safe Resource Center in Cleveland, staffers regularly discuss the best tactics to survey peoples’ homes.

After they were no longer under a stay-at-home order, outreach workers began knocking on doors in the dead of winter “with masks and gloves and sanitizer at the ready,” said Fred Ward, community action program supervisor for the Lead Safe Resource Center. Since January, workers have visited thousands of residents and offered dozens of training seminars to landlords.

“It’s lead education 101,” Ward said.

Ward and the team are walking “ZIP code by ZIP code” to build trust with the community. That, and to provide a relatable face that he said “sits somewhere in a gap between the institution and the people.”

“I wanted people with lived experience to be able to talk to people who’ve been through it before,” Ward said. “It’s so they know: ‘Hey man, I know some of the struggles you’ve been through, because I’ve been through them myself.’ It becomes first person.”

In Texas, the Harris County Public Health Department has an outreach campaign similar to Cleveland’s. Last year, the program held 24 outreach events, down from 117 in 2019, and brochure handouts fell from about 5,200 to about 2,000, county data shows.

In April of 2020, the team was reassigned to covid data entry, testing and contact tracing. Although the team was able to continue some outreach efforts, it wasn’t until February that they could resume canvassing in neighborhoods at high risk of exposure.

“A lot of folks are still distrustful of the government: ‘If I have lead in my house and my kid tests positive, will they take my kid away?’” said Scott Jeansonne, compliance and environmental program manager at Harris County Public Health.

The CDC estimates that about 500,000 1 to 5 year olds have blood levels at or above the agency’s recommended blood lead level of 5 micrograms per deciliter.

In May, the National Center for Healthy Housing, American Academy of Pediatrics and other organizations sent a letter to Congress calling for $19 billion in infrastructure spending to go toward addressing lead hazards.

With funding from the US Department of Housing and Urban Development, lead poisoning prevention programs in Texas, Ohio, Indiana and other states are using grassroot efforts to inform residents and aid in sample collection.

In March, Indiana University-Purdue University Indianapolis (IUPUI) launched a testing program that relies on community players. The program, which was delayed 11 months due to covid, distributes lead testing kits to mostly Black churches in Indianapolis. Parishioners return the kits to their churches, where lab staff pick them up for testing.

“It’s my subversive way of getting into people’s homes without knocking on doors,” said Gabriel Filippelli, director of IUPUI’s Center for Urban Health. 

The key is meeting people where they are, especially after more than a year of Zoom calls and other virtual distractions.

“That’s one of the reasons we waited until churches opened up again fully,” he said. “I mean, when you’re at church, you’re not on your smartphone. You’re listening to what the pastor has to say, right?” 

At the Lead Safe Resource Center, Ward looks forward to going back to the same households they missed in the winter.

“Maybe some residents didn’t even want to answer the door. Maybe the snow messed up the flyer.” Ward said. “But guess what? We are coming back, and we are going to talk to you.”

Mark Oprea is a journalist based in Cleveland, Ohio. He’s contributed to NPR, OZY and the Pacific Standard.

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