Tag: Environmental Health

Residencias de adultos mayores quedan a oscuras en la lucha contra los incendios forestales

Un día, cerca de Boulder, Colorado, cuando las fuertes ráfagas de viento amenazaron con crear un incendio forestal, la mayor empresa de servicios públicos del estado cortó la electricidad a 52,000 hogares y empresas, incluida Frasier, una residencia para adultos mayores y centro de enfermería especializada.

Era la primera vez que Xcel Energy cortaba la electricidad en Colorado como medida para prevenir incendios forestales, según un responsable de la empresa.

Esta práctica, también conocida como cortes de energía de seguridad pública, se ha arraigado en California y se está extendiendo a otros lugares como forma de evitar que los tendidos eléctricos caídos y dañados provoquen llamas y alimenten los incendios forestales más frecuentes e intensos del oeste del país.

En Boulder, el personal y los residentes de Frasier se enteraron del apagón por las noticias. Un funcionario de Frasier llamó a la compañía eléctrica para confirmarlo y en un primer momento le dijeron que el suministro no se vería afectado. Tomás Méndez, vicepresidente de operaciones de Frasier, explicó que la compañía volvió a llamar para informar que la residencia iba a sufrir un apagón. Aquel 6 de abril, les dijeron que tenían 75 minutos antes de que Xcel Energy cortara la luz.

El personal se apresuró a preparar el campus de 20 acres que alberga a casi 500 residentes. Los generadores mantuvieron en funcionamiento las máquinas de oxígeno, la mayoría de los frigoríficos y congeladores, las luces de los pasillos y la conexión de Wi-Fi para teléfonos y computadoras.

Pero el sistema de calefacción y algunas luces permanecieron apagados mientras la temperatura nocturna bajaba hasta los 30 grados fahrenheit.

El suministro eléctrico se restableció en Frasier al cabo de 28 horas. Durante el apagón, el personal cuidó a los residentes del centro y de la residencia asistida de mayores, muchos de ellos con demencia, explicó Méndez.

“Estas personas dependen de nosotros para todo: comidas, cuidados y medicamentos”, dijo.

No saber cuándo volvería la luz, incluso 24 horas después de la crisis, fue estresante y costoso, incluyendo el costo de recargar combustible para dos generadores, agregó Méndez.

«Nos sentimos afortunados porque nadie sufrió ningún tipo de daño ni ninguna dolencia grave, algo que puede ocurrir cuando se producen cortes de electricidad, esperados o inesperados. Y eso pone en peligro a todos”, apuntó Méndez.

A medida que se generalizan los cortes de electricidad preventivos, las residencias de adultos mayores se ven obligadas a evaluar cómo prepararse. Pero no debería depender sólo de las residencias, según autoridades del sector y académicos.

Una mejor comunicación entre las compañías de electricidad y estas residencias, y su inclusión en los planes regionales de preparación ante catástrofes, son fundamentales para mantener la seguridad de los residentes.

“Tenemos que priorizar a estas personas para que, cuando se vaya la luz, sean de los primeros a los que se les restablezca la electricidad”, afirmó David Dosa, jefe de geriatría y profesor de medicina de la Facultad de Medicina de la Universidad de Massachussetts (UMass).

Restablecer el suministro eléctrico a hospitales y residencias de adultos mayores fue una prioridad durante el vendaval, escribió el vocero de Xcel Energy, Tyler Bryant, en un correo electrónico. Sin embargo, reconoció, los cortes de energía de seguridad pública pueden mejorar, y la empresa de servicios públicos trabajará la comunidad y la Comisión de Servicios Públicos de Colorado para ayudar a los centros de salud a prepararse adecuadamente para cortes de energía prolongados en el futuro.

Cuando el pronóstico del tiempo anunciaba ráfagas de viento de hasta 100 millas por hora el 6 de abril, Xcel Energy puso en marcha un corte de energía de seguridad pública. Casi 275,000 clientes se quedaron sin electricidad a causa del vendaval.

Las autoridades estaban preparadas, después que el incendio de Marshall matara a dos personas y destruyera o dañara más de 1,000 viviendas en Boulder y las comunidades vecinas de Louisville y Superior, hace dos años y medio. Dos incendios convergieron en esa catástrofe, y una línea eléctrica de Xcel Energy que se desprendió de su poste a causa de los vientos huracanados “fue la causa más probable” de uno de ellos.

“Un apagón preventivo causa temor porque no sabes cuándo se restablecerá el suministro eléctrico. No te dicen la duración”, explicó Jenny Albertson, directora de calidad y asuntos regulatorios de la Colorado Health Care Association and Center for Assisted Living.

Según un estudio publicado el año pasado, más de la mitad de las residencias de mayores del oeste del país se encuentran a unas 3 millas de una zona de alto riesgo de incendios forestales. Sin embargo, las residencias con mayor riesgo de incendio en las regiones de las Montañas del Oeste y del Pacífico Noroeste fueron las que peor cumplían con las normas federales de preparación ante emergencias.

Las directrices federales establecen que las residencias deben contar con planes de respuesta ante catástrofes que incluyan el suministro eléctrico de emergencia o la evacuación del edificio. Estos planes no incluyen necesariamente contingencias para los cortes de energía de seguridad pública, que han aumentado en los últimos cinco años, pero siguen siendo relativamente nuevos. Y las residencias del oeste del país se apresuran para ponerse al día.

La Asociación de Centros de Salud de California estima que una ley más estricta para adecuar el suministro eléctrico de emergencia de las residencias de mayores costará más de $1,000 millones. Pero el estado no ha asignado fondos para que estos centros cumplan la ley, según Corey Egel, director de asuntos públicos de la asociación. La asociación ha pedido a las autoridades estatales que retrasen la aplicación de la ley cinco años, hasta el 1 de enero de 2029.

La mayoría de estos centros operan al filo de la navaja en términos de reembolso federal, indicó Dosa, y resulta increíblemente caro adaptar un edificio antiguo para estar al día con las nuevas regulaciones.

Los tres edificios de Frasier para sus 300 residentes en apartamentos independientes, tienen cada uno sus propios generadores, además de dos generadores para la vida asistida y la enfermería especializada, pero ninguno está conectado al aire acondicionado o la calefacción de emergencia porque esos sistemas requieren demasiada energía.

Mantener a los residentes en un ambiente cálido durante una noche a 10 grados bajo cero o que estén frescos durante dos días a 90 grados en Boulder “son el tipo de cosas en las que tenemos que pensar cuando nos planteamos un futuro con cortes de energía preventivos”, dijo Méndez.

Las auditorías federales sobre la preparación ante emergencias en residencias de mayores de California y Colorado detectaron deficiencias en las instalaciones.

En Colorado, ocho de 20 residencias presentaban deficiencias relacionadas con los suministros de emergencia y la energía, según el informe. Entre ellas había tres sin planes para fuentes de energía alternativa, como generadores, y cuatro sin documentación que demostrara que los generadores habían sido debidamente probados, mantenidos e inspeccionados.

Para Debra Saliba, directora del Centro Anna y Harry Borun de Investigación Gerontológica de la UCLA, asegurarse de que las residencias de mayores forman parte de los planes de respuesta a emergencias podría ayudarles a reaccionar eficazmente ante cualquier tipo de apagón. Su estudio sobre las residencias de mayores tras un terremoto de magnitud 6,7 que sacudió la zona de Los Angeles en 1994 motivó al condado de Los Angeles a integrar las residencias de mayores en los planes y simulacros de catástrofes de la comunidad.

Con demasiada frecuencia, las residencias de mayores caen en el olvido durante las emergencias porque las agencias gubernamentales, o los servicios públicos, no las consideran centros de salud, como los hospitales o los centros de diálisis, agregó Saliba.

En Colorado, Albertson señaló que trabaja con los hospitales y las coaliciones de respuesta de emergencia de la comunidad en los planes de preparación para desastres que incluyen a las residencias de adultos mayores.

Bryant indicó que el plan de Xcel Energy para los centros de salud no especifica si sufrirán un apagón durante un corte de energía de seguridad pública; sino la rapidez con que se restablecerá.

Julie Soltis, directora de comunicaciones de Frasier, contó que la residencia dispuso de suficientes mantas, linternas y baterías durante el apagón. Pero Frasier planea invertir en linternas frontales para los cuidadores, y durante una reunión comunal, se animó a los residentes de vida independiente a comprar su propia energía de reserva para teléfonos móviles y otros aparatos electrónicos, dijo.

Soltis espera que su centro se salve en el próximo corte de suministro de seguridad pública o que, al menos, tenga más tiempo para reaccionar.

“Con el tiempo y el cambio climático, no será la última vez que esto ocurra”, afirmó.

Esta historia fue producida por KFF Health News, una redacción nacional enfocada en el tratamiento en profundidad de temas de salud, que es uno de los principales programas de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo.

Nursing Homes Are Left in the Dark as More Utilities Cut Power to Prevent Wildfires

When powerful wind gusts created threatening wildfire conditions one day near Boulder, Colorado, the state’s largest utility cut power to 52,000 homes and businesses — including Frasier, an assisted living and skilled nursing facility.

It was the first time Xcel Energy preemptively switched off electricity in Colorado as a wildfire prevention tool, according to a company official. The practice, also known as public safety power shut-offs, has taken root in California and is spreading elsewhere as a way to keep downed and damaged power lines from sparking blazes and fueling the West’s more frequent and intense wildfires.

In Boulder, Frasier staff and residents heard about the planned outage from news reports. A Frasier official called the utility to confirm and was initially told the home’s power would not be affected. The utility then called back to say the home’s power would be cut, after all, said Tomas Mendez, Frasier’s vice president of operations. The home had just 75 minutes before Xcel Energy shut off the lights on April 6.

Staff rushed to prepare the 20-acre campus home to nearly 500 residents. Generators kept running the oxygen machines, most refrigerators and freezers, hallway lights, and Wi-Fi for phones and computers. But the heating system and some lights stayed off as the overnight temperature dipped into the 30s.

Power was restored to Frasier after 28 hours. During the shut-off, staff tended to nursing home and assisted living residents, many with dementia, Mendez said.

“These are the folks that depend on us for everything: meals, care, and medications,” he said.

Not knowing when power would be restored, even 24 hours into the crisis, was stressful and expensive, including the next-day cost of refilling fuel for two generators, Mendez said.

“We’re lucky we didn’t have any injuries or anything major, but it is likely these could happen when there are power outages — expected or unexpected. And that puts everyone at risk,” Mendez said.

As preemptive power cuts become more widespread, nursing homes are being forced to evaluate their preparedness. But it shouldn’t be up to the facilities alone, according to industry officials and academics: Better communication between utilities and nursing homes, and including the facilities in regional disaster preparedness plans, is critical to keep residents safe.

“We need to prioritize these folks so that when the power does go out, they get to the front of the line to restore their power accordingly,” said David Dosa, chief of geriatrics and professor of medicine at UMass Chan Medical School in Worcester, Massachusetts, of nursing home residents.

Restoring power to hospitals and nursing homes was a priority throughout the windstorm, wrote Xcel Energy spokesperson Tyler Bryant in an email. But, he acknowledged, public safety power shut-offs can improve, and the utility will work with community partners and the Colorado Public Utilities Commission to help health facilities prepare for extended power outages in the future.

When the forecast called for wind gusts of up to 100 mph on April 6, Xcel Energy implemented a public safety power shut-off. Nearly 275,000 customers were without power from the windstorm.

Officials had adapted after the Marshall Fire killed two people and destroyed or damaged more than 1,000 homes in Boulder and the neighboring communities of Louisville and Superior two and a half years ago. Two fires converged to form that blaze, and electricity from an Xcel Energy power line that detached from its pole in hurricane-force winds “was the most probable cause” of one of them.

“A preemptive shutdown is scary because you don’t really have an end in mind. They don’t tell you the duration,” said Jenny Albertson, director of quality and regulatory affairs for the Colorado Health Care Association and Center for Assisted Living.

More than half of nursing homes in the West are within 3.1 miles of an area with elevated wildfire risk, according to a study published last year. Yet, nursing homes with the greatest risk of fire danger in the Mountain West and Pacific Northwest had poorer compliance with federal emergency preparedness standards than their lower-risk counterparts.

Under federal guidelines, nursing homes must have disaster response plans that include emergency power or building evacuation. Those plans don’t necessarily include contingencies for public safety power shut-offs, which have increased in the past five years but are still relatively new. And nursing homes in the West are rushing to catch up.

In California, a more stringent law to bring emergency power in nursing homes up to code is expected by the California Association of Health Facilities to cost over $1 billion. But the state has not allocated any funding for these facilities to comply, said Corey Egel, the association’s director of public affairs. The association is asking state officials to delay implementation of the law for five years, to Jan. 1, 2029.

Most nursing homes operate on a razor’s edge in terms of federal reimbursement, Dosa said, and it’s incredibly expensive to retrofit an old building to keep up with new regulations.

Frasier’s three buildings for its 300 residents in independent living apartments each have their own generators, in addition to two generators for assisted living and skilled nursing, but none is hooked up to emergency air conditioning or heat because those systems require too much energy.

Keeping residents warm during a minus-10-degree night or cool during two 90-degree days in Boulder “are the kinds of things we need to think about as we consider a future with preemptive power outages,” Mendez said.

Federal audits of emergency preparedness at nursing homes in California and Colorado found facilities lacking. In Colorado, eight of 20 nursing homes had deficiencies related to emergency supplies and power, according to the report. These included three nursing homes without plans for alternate energy sources like generators and four nursing homes without documentation showing generators had been properly tested, maintained, and inspected.

For Debra Saliba, director of UCLA’s Anna and Harry Borun Center for Gerontological Research, making sure nursing homes are part of emergency response plans could help them respond effectively to any kind of power outage. Her study of nursing homes after a magnitude 6.7 earthquake that shook the Los Angeles area in 1994 motivated LA County to integrate nursing homes into community disaster plans and drills.

Too often, nursing homes are forgotten during emergencies because they are not seen by government agencies or utilities as health care facilities, like hospitals or dialysis centers, Saliba added.

Albertson said she is working with hospitals and community emergency response coalitions in Colorado on disaster preparedness plans that include nursing homes. But understanding Xcel Energy’s prioritization plan for power restoration would also help her prepare, she said.

Bryant said Xcel Energy’s prioritization plan for health facilities specifies not whether their electricity will be turned off during a public safety power shut-off — but how quickly it will be restored.

Julie Soltis, Frasier’s director of communications, said the home had plenty of blankets, flashlights, and batteries during the outage. But Frasier plans to invest in headlamps for caregivers, and during a town hall meeting, independent living residents were encouraged to purchase their own backup power for mobile phones and other electronics, she said.

Soltis hopes her facility is spared during the next public safety power shut-off or at least given more time to respond.

“With weather and climate change, this is definitely not the last time this will happen,” she said.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

Heat Rules for California Workers Would Also Help Keep Schoolchildren Cool

SACRAMENTO, Calif. — Proposed rules to protect California workers from extreme heat would extend to schoolchildren, requiring school districts to find ways to keep classrooms cool.

If the standards are approved this month, employers in the nation’s most populous state will have to provide relief to indoor workers in sweltering warehouses, steamy kitchens, and other dangerously hot job sites. The rules will extend to schools, where teachers, custodians, cafeteria workers, and other employees may work without air conditioning — like their students.

“Our working conditions are students’ learning conditions,” said Jeffery Freitas, president of the California Federation of Teachers, which represents more than 120,000 teachers and other educational employees. “We’re seeing an unprecedented change in the environment, and we know for a fact that when it’s too hot, kids can’t learn.”

A state worker safety board is scheduled to vote on the rules June 20, and they would likely take effect this summer. The move, which marks Democratic Gov. Gavin Newsom’s latest effort to respond to the growing impacts of climate change and extreme heat, would put California ahead of the federal government and much of the nation in setting heat standards.

The standards would require indoor workplaces to be cooled below 87 degrees Fahrenheit when employees are present and below 82 degrees in places where workers wear protective clothing or are exposed to radiant heat, such as furnaces. Schools and other worksites that don’t have air conditioning could use fans, misters, and other methods to bring the room temperature down.

The rules allow workarounds for businesses, including the roughly 1,000 school districts in the state, if they can’t cool their workplaces sufficiently. In those cases, employers must provide workers with water, breaks, areas where they can cool down, cooling vests, or other means to keep employees from overheating.

“Heat is a deadly hazard no matter what kind of work you do,” said Laura Stock, a member of the Occupational Safety and Health Standards Board. “If you have an indoor space that is both populated by workers and the public, or in this case by children, you would have the same risks to their health as to workers.”

Heat waves have historically struck outside of the school year, but climate change is making them longer, more frequent, and more intense. Last year was the hottest on record and schools across the U.S. closed sporadically during spring and summer, unable to keep students cool.

Scientists say this year could be even hotter. School officials in Vicksburg, Mississippi, last month ended the school year early when air conditioners had issues. And California’s first heat wave of the season is hitting while some schools are still in session, with temperatures reaching 105 in the Central Valley.

Several states, including Arizona and New Mexico, require schools to have working air conditioners, but they aren’t required to run them. Mississippi requires schools to be air-conditioned but doesn’t say to what temperature. Hawaii schools must have classrooms at a “temperature acceptable for student learning,” without specifying the temperature. And Oregon schools must try to cool classrooms, such as with fans, and provide teachers and other employees ways to cool down, including water and rest breaks, when the heat index indoors reaches 80 degrees.

When the sun bakes the library at Bridges Academy at Melrose, a public school in East Oakland with little shade and tree cover, Christine Schooley closes the curtains and turns off the computers to cool her room. She stopped using a fan after a girl’s long hair got caught in it.

“My library is the hottest place on campus because I have 120 kids through here a day,” Schooley said. “It stays warm in here. So yeah, it makes me grouchy and irritable as well.”

A 2021 analysis by the Center for Climate Integrity suggests nearly 14,000 public schools across the U.S. that did not need air conditioning in 1970 now do, because they annually experience 32 days of temperatures more than 80 degrees — upgrades that would cost more than $40 billion. Researchers found that same comparison produces a cost of $2.4 billion to install air conditioning in 678 California schools.

It’s not clear how many California schools might need to install air conditioners or other cooling equipment to comply with the new standards because the state doesn’t track which ones already have them, said V. Kelly Turner, associate director of the Luskin Center for Innovation at the University of California-Los Angeles.

And a school district in the northern reaches of the state would not face the same challenges as a district in the desert cities of Needles or Palm Springs, said Naj Alikhan, a spokesperson for the Association of California School Administrators, which has not taken a position on the proposed rules.

An economic analysis commissioned for the board provided cost estimates for a host of industries — such as warehousing, manufacturing, and construction — but lacked an estimate for school districts, which make up one of the largest public infrastructure systems in the state and already face a steep backlog of needed upgrades. The state Department of Education hasn’t taken a position on the proposal and a spokesperson, Scott Roark, declined to comment on the potential cost to schools.

Projections of a multibillion-dollar cost to state prisons were the reason the Newsom administration refused to sign off on the indoor heat rules this year. Since then, tens of thousands of prison and jail employees — and prisoners — have been exempted.

It’s also unclear whether the regulation will apply to school buses, many of which don’t have air conditioning. The Department of Industrial Relations, which oversees the worker safety board, has not responded to queries from school officials or KFF Health News.

Libia Garcia worries about her 15-year-old son, who spends at least an hour each school day traveling on a hot, stuffy school bus from their home in the rural Central Valley community of Huron to his high school and back. “Once my kid arrives home, he is exhausted; he is dehydrated,” Garcia said in Spanish. “He has no energy to do homework or anything else.”

The California Federation of Teachers is pushing state lawmakers to pass a climate-resilient schools bill that would require the state to develop a master plan to upgrade school heating and air conditioning systems. Newsom last year vetoed similar legislation, citing the cost.

Campaigns to cool schools in other states have yielded mixed results. Legislation in Colorado and New Hampshire failed this year, while a bill in New York passed on June 7 and was headed to the governor for approval. A New Jersey proposal was pending as of last week. Last month, a teachers union in New York brought a portable sauna to the state Capitol to demonstrate how hot it can get inside classrooms, only a quarter of which have air conditioning, said Melinda Person, president of New York State United Teachers.

“We have these temperature limits for animal shelters. How is it that we don’t have it for classrooms?” said Democratic New York Assembly member Chris Eachus, whose bill would require schools to take relief measures when classrooms and buildings reach 82 degrees. “We do have to protect the health and safety of the kids.”

Extreme heat is the No. 1 weather-related killer in the U.S. — deadlier than hurricanes, floods, and tornadoes. Heat stress can cause heatstroke, cardiac arrest, and kidney failure. The Centers for Disease Control and Prevention reported 1,600 heat-related deaths occurred in 2021, which is likely an undercount because health care providers are not required to report them. It’s not clear how many of these deaths are related to work, either indoors or outdoors.

California has had heat standards on the books for outdoor workers since 2005, and rules for indoor workplaces have been in development since 2016 — delayed, in part, because of the covid pandemic.

At the federal level, the Biden administration has been slow to release a long-awaited regulation to protect indoor and outdoor workers from heat exposure. Although an official said a draft is expected this year, its outlook could hinge on the November presidential election. If former President Donald Trump wins, it is unlikely that rules targeting businesses will move forward.

The Biden White House held a summit on school sustainability and climate change in April, at which top officials encouraged districts to apply an infusion of new federal dollars to upgrade their aging infrastructure. The administration also unveiled an 18-page guide for school districts to tap federal funds.

“How we invest in our school buildings and our school grounds, it makes a difference for our students’ lives,” Roberto Rodriguez, an assistant secretary at the U.S. Department of Education, said at the summit. “They are on the front line in terms of feeling those impacts.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

Journalists Discuss Abortion Laws, Pollution, and Potential Changes to Obamacare Subsidies

KFF Health News senior fellow and editor-at-large for public health Céline Gounder discussed the consequences of restrictive and unclear abortion laws on CBS’ “CBS Mornings” on June 4. Gounder also discussed a recent report that found pollution is a greater health threat than war, terrorism, addiction, or disease on CBS News 24/7’s “The Daily Report” on June 3.


KFF Health News contributor Andy Miller discussed Affordable Care Act subsidy changes on WUGA’s “The Georgia Health Report” on May 31.


Schools Struggle With Lead in Water While Awaiting Federal Relief

PHILIPSBURG, Mont. — On a recent day in this 19th-century mining town turned tourist hot spot, students made their way into the Granite High School lobby and past a new filtered water bottle fill station.

Water samples taken from the drinking fountain the station replaced had a lead concentration of 10 parts per billion — twice Montana’s legal limit for schools of 5 parts per billion for the toxic metal.

Thomas Gates, the principal and superintendent of the small Philipsburg School District, worries the new faucets, sinks, and filters the district installed for roughly 30 water sources are temporary fixes. The high school, built in 1912, is likely laced with aged pipes and other infrastructure, like so much of this historic town.

“If we change faucets or whatever, lead is still getting pushed in,” Gates said.

The school in Philipsburg is one of hundreds in Montana grappling with how to remove lead from their water after state officials mandated schools test for it. So far, 74% of schools that submitted samples found at least one faucet or drinking fountain with high lead levels. Many of those schools are still trying to trace the source of the problem and find the money for long-term fixes.

In his Feb. 7 State of the Union address, President Joe Biden said the infrastructure bill he championed in 2021 will help fund the replacement of lead pipes that serve “400,000 schools and child care centers, so every child in America can drink clean water.”

Chris Cornelius stands in front of a filtered water bottle station in a school hallway.
Chris Cornelius, head custodian of Philipsburg Public Schools, stands at a filtered water bottle fill station that replaced a drinking fountain with a lead concentration of 10 parts per billion — twice Montana’s legal limit of 5 per billion.(Katheryn Houghton / KHN)

However, as of mid-February, states were still waiting to hear how much infrastructure money they’ll receive, and when. And schools are trying to figure out how to respond to toxic levels of lead now. The federal government hasn’t required schools and child care centers to test for lead, though it has awarded grants to states for voluntary testing.

During the past decade, nationwide unease has been stirred by news of unsafe drinking water in places like Flint, Michigan. Politicians have promised to increase checks in schools where kids — who are especially vulnerable to lead poisoning — drink water daily. Lead poisoning slows children’s development, causing learning, speech, and behavioral challenges. The metal can cause organ and nervous system damage.

A new report by advocacy group Environment America Research & Policy Center showed that most states fall short in providing oversight for lead in schools. And the testing that has happened to this point shows widespread contamination from rural towns to major cities.

At least 19 states require schools to test for lead in drinking water. A 2022 law in Colorado requires child care providers and schools that serve any kids from preschool through fifth grade to test their drinking water by May 31 and, if needed, make repairs. Meanwhile, California leaders, who mandated lead testing in schools in 2017, are considering requiring districts to install filters on water sources with high levels of lead.

As states boost scrutiny, schools are left with complicated and expensive fixes.

As it passed the infrastructure bill, Congress set aside $15 billion to replace lead pipes, and $200 million for lead testing and remediation in schools.

White House spokesperson Abdullah Hasan didn’t provide the source of the 400,000 figure Biden cited as the number of schools and child care centers slated for pipe replacement. Several clean-water advocacy organizations didn’t know where the number came from, either.

Part of the issue is that no one knows how many lead pipes are funneling drinking water into schools.

The Environmental Protection Agency estimates between 6 million and 10 million lead service lines are in use nationwide. Those are the small pipes that connect water mains to plumbing systems in buildings. Other organizations say there could be as many as 13 million.

But the problem goes beyond those pipes, said John Rumpler, senior director for the Clean Water for America Campaign at Environment America.

Typically lead pipes connected to public water systems are too small to serve larger schools. Water contamination in those buildings is more likely to come from old faucets, fountains, and internal plumbing.

“Lead is contaminating schools’ drinking water” when there aren’t lead pipes connecting to a municipal water source, Rumpler said. Because of their complex plumbing systems, schools have “more places along the way where lead can be in contact with water.”

Montana has collected more data on lead-contaminated school water than most other states. But gaps remain. Of the state’s 591 schools, 149 haven’t submitted samples to the state, despite an initial 2021 deadline.

Jon Ebelt, spokesperson with the Montana Department of Public Health and Human Services, said the state made its deadline flexible due to the covid-19 pandemic and is working with schools that need to finish testing.

Greg Montgomery, who runs Montana’s lead monitoring program, said sometimes testing stalled when school districts ran into staff turnover. Some smaller districts have one custodian to make sure testing happens. Larger districts may have maintenance teams for the work, but also have a lot more ground to cover.

Outside Burley McWilliams’ Missoula County Public Schools office, about 75 miles northwest of Philipsburg, sit dozens of water samples in small plastic bottles for a second round of lead testing. Director of operations and maintenance for the district of roughly 10,000 students, McWilliams said lead has become a weekly topic of discussion with his schools’ principals, who have heard concerns from parents and employees.

Several of the district’s schools had drinking fountains and classroom sinks blocked off with bags taped over faucets, signs of the work left to do.

The district spent an estimated $30,000 on initial fixes for key water sources by replacing parts like faucets and sinks. The school received federal covid money to buy water bottle stations to replace some old infrastructure. But if the new parts don’t fix the problem, the district will likely need to replace pipes — which isn’t in the budget.

The state initially set aside $40,000 for schools’ lead mitigation, which McWilliams said translated to about $1,000 for his district.

“That’s the one frustration that I had with this process: There’s no additional funding for it,” McWilliams said. He hopes state or federal dollars come through soon. He expects the latest round of testing to be done in March.

Montgomery said Feb. 14 that he expects to hear “any day now” what federal funding the state will receive to help reimburse schools for lead mitigation.

Back in Philipsburg, Chris Cornelius, the schools’ head custodian, has a handwritten list on his desk of all the water sources with high lead levels. The sink in the corner of his office has a new sign saying in bold letters that “the water is not safe to drink.”

According to state data, half the 55 faucets in the high school building had lead concentrations high enough to need to be fixed, replaced, or shut off.

Cornelius worked to fix problem spots: new sinks in the gym locker rooms, new faucets and inlet pipes on every fixture that tested high, water bottle fill stations with built-in filtration systems like the one in the school’s lobby.

Chris Cornelius is leaning over a sink examining a faucet which he has removed. In his other hand, he holds a wrench.
Chris Cornelius, head custodian of Philipsburg Public Schools in Montana, checks a faucet filter in a home economics classroom. Despite a new faucet and inlet pipes, this sink is one of several in the district that continue to show lead levels beyond the state’s threshold. (Katheryn (Katheryn Houghton / KHN)

Samples from many fixtures tested safe. But some got worse, meaning in parts of the building, the source of the problem goes deeper.

Cornelius was preparing to test a third time. He plans to run the water 12 to 14 hours before the test and remove faucet filters that seem to catch grime coming from below. He hopes that will lessen the concentration enough to pass the state’s thresholds.

The EPA recommends collecting water samples for testing at least eight hours after the fixtures were last used, which “maximizes the likelihood that the highest concentrations of lead will be found.”

If the water sources’ lead concentrations come back high again, Cornelius doesn’t know what else to do.

“I have exhausted possibilities at this point,” Cornelius said. “My last step is to put up more signs or shut it off.”

KHN correspondent Rachana Pradhan contributed to this report.

Sports Programs in States in Northern Climes Face a New Opponent: Scorching Septembers

BIGFORK, Mont. — On a recent afternoon, it was a crisp 70 degrees on the football field at the high school in this northwestern Montana community less than 200 miles south of the U.S.-Canada border.

Vikings head coach Jim Benn was running his team through drills in the pristine fall weather, without much interruption. Just a couple of weeks earlier, though, players needed frequent water breaks as they sweated through temperatures in the low to mid-90s, about 15 degrees higher than average for the time of year.

Although temperatures have started to drop now that autumn is underway, Montana and many other states in the northern U.S. are getting hotter — and staying hot for longer. August is when many high school sports ramp up, and this year’s was either the hottest on record or close to it for many communities across Montana, according to the National Weather Service and other meteorologists. The heat wave stretched into September, and at least six Montana cities broke the 100-degree mark during the first half of the month.

This August was the hottest on record for the nearby states of Idaho, Washington, and Oregon. Nationwide, this summer was the third-hottest on record, according to the National Oceanic and Atmospheric Association.

Health experts and researchers say states — especially the states in the northern U.S., such as Idaho, Maine, Montana, and North Dakota — aren’t adapting fast enough to keep high school athletes safe. Students and their families have sued schools, accusing them of not doing enough to protect athletes. Many states that have taken action did so only after an athlete died.

“Between high school and college, we’re losing roughly six athletes each year to exertional heatstroke, and the majority of those are high school athletes,” said Rebecca Stearns, chief operating officer at the University of Connecticut’s Korey Stringer Institute, which is named after a Minnesota Vikings player who died from heatstroke in 2001. The institute studies and tries to prevent the condition.

The true number of heat-related deaths could be higher, she said, because death certificates aren’t always accurately filled out. Exertional heat illness is the second-leading cause of death for high school and college athletes, behind cardiac arrest, she said.

In Bigfork, Benn said he hadn’t seen one of his athletes experience an exertional heat illness — such as heat exhaustion or heatstroke, which can cause fainting, vomiting, and even death — during his nearly 30-year coaching career in Montana until last year. An athlete became overheated at an early summer football camp during the record-shattering 2021 heat wave.

“We immediately got water on him, got him cooled down,” he said.

The player recovered after he was sprayed with a hose. Benn said he didn’t have an immersion tub filled with ice water on hand, which is what Stearns said is the recommended treatment.

“It is exactly why we need standard policies that have medical best practices incorporated,” Stearns said.

The Korey Stringer Institute ranks all 50 states and Washington, D.C., based on how well they follow best practices for preventing and responding to exertional heat illness among high school athletes, as well as other health risks such as cardiac arrest. Montana is 48th on the list, followed by Minnesota, Maine, and California.

California is last, according to the institute’s report, because it’s the only state that doesn’t regulate high school athletic trainers, which are generally responsible for the health and safety of athletes. Stearns said the institute is working with California sports officials who are pushing for laws that require licensing of athletic trainers.

States in the northern U.S. dominate the bottom third of the institute’s rankings. Stearns said many states the institute has approached about improving heat safety think it isn’t an issue or resist some policies because implementing them could come with a hefty price tag.

But some of the efforts don’t cost a penny, she said. At Bigfork High School, for example, Benn has implemented a three-day acclimatization period, without football pads, when his players return to the field in early August. “That’s really low-hanging fruit, in my perspective,” Stearns said.

Stearns added that most heat-related illnesses occur during the first days of practice, which are typically the hottest and when athletes are not accustomed to exerting themselves in the heat. But she said the state’s high school sports association should mandate acclimatization periods.

Montana and many other states also don’t have a system dictating when practices need to be modified — for example, by removing pads or reducing the length and the number of workouts — or canceled altogether, said Stearns. Policies that require an emergency plan for responding to an exertional heat illness are lacking in many northern states, as well.

Stearns and other researchers, such as Bud Cooper at the University of Georgia, said states should use what’s known as the “wet bulb globe temperature” — which accounts for air temperature, humidity, and radiant heat from surfaces such as turf that absorb sunlight — to make those determinations, rather than the heat index. The heat index doesn’t account for radiant heat, which increases the risk of developing heat illness. The foundation of the National Federation of State High School Associations said in February that it was sending 5,000 of the special thermometers to high schools across the country.

Stearns said that research suggests acclimatization periods reduce the number of exertional heat illnesses by as much as 55% and that states that have used the wet bulb globe temperature to mandate changes to practice have seen an 80% reduction.

In Georgia, Cooper’s work documenting heat-related deaths among high school athletes led to sweeping policy changes in 2012. Since the policy shift, Georgia has gone from being the state with the highest number of heat-related deaths among high school football players to having no deaths.

Researchers such as Cooper have begun to provide regional policy guidelines based on the local average wet bulb globe temperatures to help states understand the risks for high school athletes and give them a starting point for making policy changes.

New Jersey was among the early adopters of the wet bulb system among states in the northern U.S. when it approved a law in 2020 requiring school districts to buy the thermometers. The state also requires hundreds of schools to put cold immersion tubs on-site when temperatures reach a certain level. The state is now second in the institute’s rankings of sports safety policies, behind Florida and ahead of Georgia.

In the Pacific Northwest, Oregon and Washington have policies that mandate changes to school sports practices based on the heat index, not the wet bulb globe temperature. Heat and sports safety researchers say that’s better than nothing.

The Montana High School Association, which regulates high school athletics, has implemented heat guidance that allows referees to call for extra breaks during football or soccer games, said executive director Brian Michelotti. The association also asks other sports, such as cross-country running, to schedule meets early in the day.

A photo shows members of the Bigfork Vikings football team practicing together on the field.
Players on the Bigfork Vikings high school football team run through drills on a crisp fall afternoon after practicing for weeks in record-breaking heat.(Aaron Bolton for KHN)

While Montana health officials say the state has never documented a death related to heat illness among the state’s high school athletes, the historic heat waves over the past two summers have athletic officials considering additional precautions. “It really has triggered us to have more discussions about that and really come back and revisit with some sport science committees,” Michelotti said.

He said any policy changes would have to be approved by the association’s seven-member board and wouldn’t happen until at least next year.

Heat and sports safety experts such as Stearns at the Korey Stringer Institute said adding statewide policies and mandates saves lives by ensuring that all coaches and schools are following best practices before a death happens.

“One life is too much a price for all of the games in a season,” she said.

KHN’s ‘What the Health?’: A Big Week for Biden


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Health policy was front and center as Congress rushed to pass major legislation before leaving for its summer break. President Joe Biden signed a bill this week providing health benefits to military veterans who were sickened by exposure to toxic burn pits and will likely soon sign a measure allowing Medicare to negotiate the price of prescription drugs and extend enhanced subsidies for those who buy their insurance through the Affordable Care Act’s marketplaces.

Meanwhile, the abortion debate continues to rage around the country, with Indiana becoming the first state to pass a new ban since the Supreme Court overturned Roe v. Wade in June.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Sarah Karlin-Smith of the Pink Sheet, and Rachel Cohrs of Stat.

Among the takeaways from this week’s episode:

  • The Senate parliamentarian determines whether provisions in special budget legislation called reconciliation bills meet the requirements to not be subject to a filibuster and are instead eligible to be passed with a simple majority vote. With the Inflation Reduction Act, she forced Democrats last week to drop some of the drug pricing provisions that would have applied to consumers in the private health insurance market. That includes a plan that would have required drugmakers to hold any increases in the price of certain drugs to the rate of inflation.
  • Democrats were also disappointed that the parliamentarian denied their efforts to pass a price cap on insulin patients who are not covered by Medicare and that Republicans failed to support an effort to pass the measure. Several other bills designed to help keep the cost of the lifesaving medicine affordable are languishing in Congress and are unlikely to get a vote in the Senate this year.
  • But the bill still provides key guarantees for Medicare beneficiaries and is a major change in how the government will interact with drugmakers. Getting legislation like this — so strongly opposed by the industry — was an impressive feat for the Democrats in an evenly divided Senate.
  • If the bill passes the House on Friday, as expected, some of the changes to Medicare, including the price negotiations, will not take effect immediately. So consumers will have to wait to realize all the benefits of the new law.
  • Indiana’s new abortion law is set to take effect next month. But the legislative debate exposed tensions among anti-abortion groups over how strict to be about abortion access for those who may have been raped. In the end, Indiana lawmakers opted to leave in exceptions for rape and incest.
  • The new Indiana abortion law, however, prompted a statement by drugmaker Lilly, which is headquartered in the state, saying that the restrictions could hurt the company’s efforts to recruit workers and that the company will provide assistance to employees who need to go out of state for abortion care.
  • The Biden administration last week declared a public health emergency for monkeypox, and Health and Human Services Secretary Xavier Becerra this week gave the FDA authority to grant emergency use authorizations for monkeypox vaccines.
  • Concerns are growing about the large number of people in the U.S. who are afflicted with long-term health problems caused by covid-19. Yet there appears to be little interest on Capitol Hill in funding studies or programs to help this population.

Also, for extra credit, the panelists suggest their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Washington Post’s “For Sleep Apnea Patients With Recalled CPAP Machines, Restless Nights,” by Laurie McGinley

Rachel Cohrs: The Washington Post’s “Conservatives Skeptical of Coronavirus Vaccines Battle to Lead a Hospital,” by Tim Craig

Alice Miranda Ollstein: The AP’s “Study Connects Climate Hazards to 58% of Infectious Diseases,” by Seth Borenstein

Sarah Karlin-Smith: The Pink Sheet’s “US FDA Commissioner Califf Takes on Misinformation, Starting With ‘Rumor Control,’” by Sue Sutter

Also mentioned in this week’s episode:

The Washington Post’s “Abortion Bans Complicate Access to Drugs for Cancer, Arthritis, Even Ulcers,” by Katie Shepherd and Frances Stead Sellers

Politico’s “Republicans Turn on Each Other Amid Post-Roe Chaos,” by Megan Messerly and Alice Miranda Ollstein

The Indianapolis Star’s “‘A Slap in the Face’: Some Upset Lilly, Cumming Wait to Criticize Abortion Ban Until Holcomb Signed It,” by Binghui Huang and Lizzie Kane

NBC News’ “Pregnant Women in States With Abortion Bans Face the Reality of a Post-Roe World,” by Lauren Dunn and Kristen Dahlgren

Politico’s “Tim Kaine Has Long Covid. That’s Not Moving Congress to Act,” by Alice Miranda Ollstein


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‘Children Are Not Little Adults’ and Need Special Protection During Heat Waves

After more than a week of record-breaking temperatures across much of the country, public health experts are cautioning that children are more susceptible to heat illness than adults are — even more so when they’re on the athletic field, living without air conditioning, or waiting in a parked car.

Cases of heat-related illness are rising with average air temperatures, and experts say almost half of those getting sick are children. The reason is twofold: Children’s bodies have more trouble regulating temperature than those of adults, and they rely on adults to help protect them from overheating.

Parents, coaches, and other caretakers, who can experience the same heat very differently than kids do, may struggle to identify a dangerous situation or catch the early symptoms of heat-related illness in children.

“Children are not little adults,” said Dr. Aaron Bernstein, a pediatric hospitalist at Boston Children’s Hospital. 

Jan Null, a meteorologist in California, recalled being surprised at the effect of heat in a car. It was 86 degrees on a July afternoon more than two decades ago when an infant in San Jose was forgotten in a parked car and died of heatstroke.

Null said a reporter asked him after the death, “How hot could it have gotten in that car?”

Null’s research with two emergency doctors at Stanford University eventually produced a startling answer. Within an hour, the temperature in that car could have exceeded 120 degrees Fahrenheit. Their work revealed that a quick errand can be dangerous for a kid left behind in the car — even for less than 15 minutes, even with the windows cracked, and even on a mild day.

As record heat becomes more frequent, posing serious risks even to healthy adults, the number of cases of heat-related illnesses has gone up, including among children. Those most at risk are young children in parked vehicles and adolescents returning to school and participating in sports during the hottest days of the year.

More than 9,000 high school athletes are treated for heat-related illnesses every year.

Heat-related illnesses occur when exposure to high temperatures and humidity, which can be intensified by physical exertion, overwhelms the body’s ability to cool itself. Cases range from mild, like benign heat rashes in infants, to more serious, when the body’s core temperature increases. That can lead to life-threatening instances of heatstroke, diagnosed once the body temperature rises above 104 degrees, potentially causing organ failure.

Prevention is key. Experts emphasize that drinking plenty of water, avoiding the outdoors during the hot midday and afternoon hours, and taking it slow when adjusting to exercise are the most effective ways to avoid getting sick.

Children’s bodies take longer to increase sweat production and otherwise acclimatize in a warm environment than adults’ do, research shows. Young kids are also more susceptible to dehydration because a larger percentage of their body weight is water.

Infants and younger children also have more trouble regulating their body temperature, in part because they often don’t recognize when they should drink more water or remove clothing to cool down. A 1995 study showed that young children who spent 30 minutes in a 95-degree room saw their core temperatures rise significantly higher and faster than their mothers’ — even though they sweat more than adults do relative to their size.

Pediatricians advise caretakers to monitor how much water children consume and encourage them to drink before they ask for it. Thirst indicates the body is already dehydrated.

They should also dress kids in light-colored, lightweight clothes; limit outdoor time during the hottest hours; and look for ways to cool down, such as by visiting an air-conditioned place like a library, taking a cool bath, or going for a swim.

To address the risks to student athletes, the National Athletic Trainers’ Association recommends that high school athletes acclimatize by gradually building their activity over the course of two weeks when returning to their sport for a new season — including by slowly stepping up the amount of any protective equipment they wear.

“You’re gradually increasing that intensity over a week to two weeks so your body can get used to the heat,” said Kathy Dieringer, president of NATA.

Warning Signs and Solutions

Experts note a flushed face, fatigue, muscle cramps, headache, dizziness, vomiting, and a lot of sweating are among the symptoms of heat exhaustion, which can develop into heatstroke if untreated. Call a doctor if symptoms worsen, such as if the child seems disoriented or cannot drink.

Taking immediate steps to cool a child experiencing heat exhaustion or heatstroke is critical. The child should be taken to a shaded or cool area; be given cool fluids with salt, like sports drinks; and have any sweaty or heavy garments removed.

For adolescents, being submerged in an ice bath is the most effective way to cool the body, while younger children can be wrapped in cold, wet towels or misted with lukewarm water and placed in front of a fan.

Although children’s deaths in parked cars have been well documented, the tragic incidents continue to occur. According to federal statistics, 23 children died of vehicular heatstroke in 2021. Null, who collects his own data, said 13 children have died so far this year.

Caretakers should never leave children alone in a parked car, Null said. Take steps to prevent young children from entering the car themselves and becoming trapped, including locking the car while it’s parked at home.

More than half of cases of vehicular pediatric heatstroke occur because a caretaker accidentally left a child behind, he said. While in-car technology reminding adults to check their back seats has become more common, only a fraction of vehicles have it, requiring parents to come up with their own methods, like leaving a stuffed animal in the front seat.

The good news, Null said, is that simple behavioral changes can protect kids. “This is preventable in 100% of the cases,” he said.

A Lopsided Risk

People living in low-income areas fare worse when temperatures climb. Access to air conditioning, which includes the ability to afford the electricity bill, is a serious health concern.

A study of heat in urban areas released last year showed that low-income neighborhoods and communities of color experience much higher temperatures than those of wealthier, white residents. In more impoverished areas during the summer, temperatures can be as much as 7 degrees Fahrenheit warmer.

The study’s authors said their findings in the United States reflect that “the legacy of redlining looms large,” referring to a federal housing policy that refused to insure mortgages in or near predominantly Black neighborhoods.

“These areas have less tree canopy, more streets, and higher building densities, meaning that in addition to their other racist outcomes, redlining policies directly codified into law existing disparity in urban land use and reinforced urban design choices that magnify urban heating into the present,” they concluded.

This month, Bernstein, who leads Harvard’s Center for Climate, Health, and the Global Environment, co-authored a commentary in JAMA arguing that advancing health equity is critical to action on climate change.

The center works with front-line health clinics to help their predominantly low-income patients respond to the health impacts of climate change. Federally backed clinics alone provide care to about 30 million Americans, including many children, he said.

Bernstein also recently led a nationwide study that found that from May through September, days with higher temperatures are associated with more visits to children’s hospital emergency rooms. Many visits were more directly linked to heat, although the study also pointed to how high temperatures can exacerbate existing health conditions like neurological disorders.

“Children are more vulnerable to climate change through how these climate shocks reshape the world in which they grow up,” Bernstein said.

Helping people better understand the health risks of extreme heat and how to protect themselves and their families are among the public health system’s major challenges, experts said.

The National Weather Service’s heat alert system is mainly based on the heat index, a measure of how hot it feels when relative humidity is factored in with air temperature.

But the alerts are not related to effects on health, said Kathy Baughman McLeod, director of the Adrienne Arsht-Rockefeller Foundation Resilience Center. By the time temperatures rise to the level that a weather alert is issued, many vulnerable people — like children, pregnant women, and the elderly — may already be experiencing heat exhaustion or heatstroke.

The center developed a new heat alert system, which is being tested in Seville, Spain, historically one of the hottest cities in Europe.

The system marries metrics like air temperature and humidity with public health data to categorize heat waves and, when they are serious enough, give them names — making it easier for people to understand heat as an environmental threat that requires prevention measures.

The categories are determined through a metric known as excess deaths, which compares how many people died on a day with the forecasted temperature versus an average day. That may help health officials understand how severe a heat wave is expected to be and make informed recommendations to the public based on risk factors like age or medical history.

The health-based alert system would also allow officials to target caretakers of children and seniors through school systems, preschools, and senior centers, Baughman McLeod said.

Giving people better ways to conceptualize heat is critical, she said.

“It’s not dramatic. It doesn’t rip the roof off of your house,” Baughman McLeod said. “It’s silent and invisible.”