ER symptoms ‘consistent’ with MCHM exposure
Hundreds of West Virginia residents who sought emergency-room care in January were treated for symptoms that were “consistent” with exposure to MCHM, the primary chemical that leaked from the Freedom Industries tank farm into the region’s Elk River drinking-water supply, according to a review made public Wednesday.
The review, which examined medical charts from area hospitals, also showed that the most common way injured residents were exposed to the chemical was through skin contact while bathing, showering or washing hands — routes not considered in the 1-part-per-million “screening level” touted as safe by state and federal officials.
“There is every reason to believe from these data that hundreds of people, if not more, were directly affected by exposure to MCHM-contaminated water,” said Richard Denison, an Environmental Defense Fund scientists who has closely followed the leak and its impacts. “The state seems intent on minimizing any connection, while the data strongly suggest there is one.”
Department of Health and Human Resources officials released the medical chart data just a day after Kanawha-Charleston Health Department Director Rahul Gupta made public a different analysis of reports from doctor’s offices that projected roughly 100,000 people in the region likely experienced symptoms, with the vast majority never seeking any medical attention. Gupta has said the review of hospital charts “grossly underestimates” the true public health effects of the leak, which contaminated the drinking-water supply for 300,000 residents in a nine-county area around Charleston.
The report released by the DHHR continued to downplay the leak’s impacts on public health, saying that most people who visited emergency rooms had symptoms that were “mild and resolved with no treatment.” It cited intravenous fluids after episodes of vomiting or diarrhea and medications for nausea or itching as examples.
“This analysis found that the symptoms reported by people exposed to MCHM in water appeared to be mild and short-lived, which were resolved with minimal or no treatment,” said Loretta Haddy, director of the DHHR’s Office of Epidemiology and Prevention Services.
DHHR spokeswoman Allison Adler said the six-page report was a joint project of her agency’s Bureau for Public Health and the federal Agency for Toxic Substances and Disease Registry, which is a sister agency to the Centers for Disease Control and Prevention, which devised the controversial 1-ppm screening level for MCHM in the hours after the Jan. 9 leak.
In the wake of the leak, Bureau for Public Health Commissioner Letitia Tierney and other state officials suggested that symptoms that were sending residents to the hospital could turn out to be related to the flu, driven by anxiety over the leak, or were no more serious than sunburn.
However, the review of 584 medical charts from emergency rooms found that only 45 cases involved people who were given a diagnosis, such as the flu, strep throat or shingles, “that was considered a more likely explanation for their illness,” the report released Wednesday said.
Federal and state officials did not include those cases in their final analysis. They also did not include 110 emergency-room records for cases in which the medical charts “did not record exposure to the contaminated water.” Three cases involved people in which no symptoms of illness were recorded.
Another 16 cases involving residents who sought emergency care a second or third time were counted only once.
The result was a database of 369 emergency-room cases. The report said 194 patients were exposed by bathing, showering or other skin contact, 162 were exposed by eating, drinking or swallowing the water, and 54 by breathing mist or vapor. The report indicated that some patients could have more than one route of exposure listed in the medical records but did not provide details of those cases.
The most comment symptoms were nausea, rash, vomiting, abdominal pain and diarrhea. Other symptoms were headache, itching, sore throat, eye pain and cough.
“These data cannot ‘prove’ that MCHM caused the reported symptoms,” the report said. “However, these data are consistent with what is known about MCHM from animal studies.”
The new report includes emergency-room visits from Jan. 9 through Jan. 23, although previous documents released by the DHHR indicated the agency had no information about residents who sought care on Jan. 9 and 10, the day of and the day after the leak.
In the narrative of the report, federal and state officials noted that the number of emergency-room visits “went down during the second week after the chemical spill.”
However, the narrative made no mention of the trend, shown on one of the report’s charts, of hospital visits going back up on Jan. 15 and 16, after water for most of the region was declared safe and residents were in the midst of “flushing” out their home plumbing systems by running taps for a prescribed period of time.
During a conference call with reporters, state officials attributed that bump in symptoms to residents being exposed either through inhalation or skin contact during the flushing process.
The official flushing “guidance,” distributed by state officials and West Virginia American Water, included no warnings about any dangers from skin contact or inhalation during the flushing process, and the CDC considered only ingestion — not inhalation or skin contact — in setting the 1-ppm screening level for MCHM.
Adler said the DHHR released the report as it was provided by federal officials. The state reviewed and edited it for accuracy, Adler said. For example, she said, the initial report referred to the West Virginia Poison Center as the West Virginia Poison Control Center.
Reach Ken Ward at firstname.lastname@example.org or 304-348-1702.