Water-related injuries related to crude MCHM exposure have seemingly stopped, and Dr. Rahul Gupta, Kanawha-Charleston Health Department director, said the county health department has turned its attention to a long-term population monitoring program.Gupta is calling the initiative the Community Health Providers Syndromic Surveillance Program. Doctors at 20 participating facilities will keep track of patients who experienced what they believed were injuries related to exposure to water or MCHM fumes."We're not following the people, we're following the providers," Gupta said. "We're following a number of clinicians that are sending us information. We have about 250 patients so far."Kanawha-Charleston tracked short-term health effects from the beginning of the spill. Though Gupta said the health department stopped receiving data from area emergency rooms on Jan. 24, he noticed some interesting trends from that data."We've clearly seen there was a double spike," Gupta said. "There was a second spike after people were told to flush their pipes on Jan. 13 and 14, but the cases have since dwindled."More than 500 people were treated at hospitals for symptoms possibly related to chemical exposure. The most common symptoms were skin irritation including rashes, eye irritation, nausea, diarrhea and some cases of vomiting and headaches."It's clear that the skin and eye irritation are more commonly self-reported than others," Gupta said. "These are more of chemical allergic type of reactions.The odor tends to result in some people's reactions, such as nausea, vomiting, cough and asthma as well."Gupta said although the state stopped collecting health data from emergency rooms on Jan. 24, the health department has continued collecting data on acute health effects from area physicians. Janet Briscoe, director of epidemiology for the Kanawha-Charleston Health Department, said participating physicians have filled out questionnaires on each patient.The questionnaires ask for patients' gender, age, symptoms, treatment administered, where and when the patient was exposed to water, whether the exposure occurred in a zone West Virginia American Water had cleared for flushing and how patients came into contact with water (drinking, bathing, etc.).Gupta said the earliest reported exposure time was Jan. 8, the day before the chemical leak was discovered at Freedom Industries.He said the latest reported exposure occurred Feb. 20.Gupta said a reasonable long-term medical monitoring program will have five important components. A patient registry, including patients' names and contact information, will need to be kept so that patients can be warned if any long-term health effects are discovered.Second, a population-based survey should be conducted among a sample of affected individuals, which includes tracking the individuals' health.Third, biomonitoring of patients will need to be conducted."You draw blood samples and other samples and freeze them for a long time, so if you need to, you can test them," Gupta said.Then, a longitudinal follow-up should be conducted. Gupta said this means an effort should be made to have as much of the affected population as possible fill out a questionnaire.Finally, relevant public health analysis and research will be conducted with all the data collected.Data reported by participating clinicians will be collected and aggregated by the health department.Gupta said that data can be collected and analyzed over time and could catch any potential trends in long-term health effects. For example, if a particular health effect was spotted among patients of a certain age, gender or with another health condition, proactive steps could be taken to protect others.Just because a person had a rash doesn't mean they will have long-term health effects, and just because a person didn't have a rash doesn't mean they can't experience long-term health effects," Gupta said."We need to make sure we discern the significance between short- and long-term health effects."One of Gupta's biggest concerns is funding. An amendment adopted into Senate Bill 373 - commonly known as the Water Bill - on Wednesday requires the Bureau for Public Health to study potential long-term health effects the chemicals might have on people in the affected area.The medical monitoring requirement had briefly been removed from the bill.Gupta applauded lawmakers for re-including provisions for long-term health monitoring, but said it cannot be done without funding."It's also equally critical to have funding tied in in order to have the ability to conduct it in a relevant manner," Gupta said. "It's going to take a degree of passion to ensure this can be done."Gupta said the health department has received no additional funding so far for any of the work it has done related to the chemical leak. He said further studies need to be done on animals to determine if there are any carcinogenic effects, and that if funding for long-term health surveillance isn't tied in with legislation, "there's no likelihood it's going to be done.""We have no funding as of right now," Gupta said."We are not giving up, but we have got to make sure the public knows without funding, nothing gets done, unfortunately."Contact writer Marcus Constantino at 304-348-1796 or email@example.com. Follow him at www.twitter.com/amtino.