1. 1 Toronto’s Management of Lead Service Lines Lead Colloborative Consortium Workshop, June 8, 2012 Howard Shapiro, Toronto Public Health

2. What is a Service Line / Water Service?

3. Overall Approach and Issues Health effects seen at levels of lead in current population Lead exposure should be minimized where possible However, issue portrayed as individual crisis Question for TPH was is significance of water lead levels that are slightly above drinking water guidelines Communication to public Management strategies

4. Situation Toronto City 2.7 million Very active media presence History of lead contamination in certain communities now largely resolved Lead not much of an issue in recent past Spring 2007 lead found in London, Ontario drinking water above drinking water standard in older homes due to lead services Toronto media asks about situation in Toronto

5. How Big a Problem? Samples from 5 Minute Flush

6. How Big a Problem

7. Early Messaging Desire to not counter extensive promotion of Toronto’s water Water leaving treatment plant very low in lead Water from Toronto homes within Ontario Drinking Water Standard for lead Homes built before 1955 usually have lead service and may have high lead in water Can find out by requesting free water test from Toronto Water While waiting use water filter

8. Early Messaging Tried to provide health context Effects of lead at this level in water would be subtle on intelligence of children but not detectable but parent or physician Water one source of lead but not only one Important in older homes with lead pipes since likely to have lead paint, lead in soil Takes place within trends of decreasing lead levels over time Developed TPH web pages for lead Very hard to distinguish between population and individual importance of lead

9. Early Program Focused on Replacement Of City side only Homeowner can pay to have their side done at same time When: At time of scheduled water main replacement During emergency repairs In response to high lead water test On request (long waiting period) Toronto Water reluctant to undertake corrosion control

10. Toronto Water Accelerates Program Estimated 65,000 lead services 28,000 already replaced Original plan 13 year time frame Accelerate replacement to 9 years Additional $19 million per year Mainly through increasing main replacement in area likely to have lead services

11. Province Introduces New Rules Requires twice yearly testing 2 X 1 litre samples 30 minutes stagnation after flushing 100 homes in large city such as Toronto Benchmark – 10 ppb 90 %ile Corrosion Control plan if fail 2 out of 3 consecutive rounds of testing

12. City Fails 2 nd Round of Testing

13. Changes to Approach Trained nurses doing neonatal visits in lead water issue Initiated development of filter faucet rebate program Sent postcard to approx. 50,000 homes in areas likely to have LSL

14. Changes to Approach

15. Existing and Developing Information Testing of water for lead not a good way to risk stratify individual homes Intermittent particulate release Impact of water on lead levels may be more significant than some studies suggested Replacing part of lead service with copper may be worse than leaving entire lead line

16. Sources of Lead In Drinking Water

17. Seasonal Variation in Water Lead

18. Further Developments Water Impact Edwards et al. Environ. Sci. Technol. 2009 Showed impacts of spike in DC water levels on BLL’s Incidence of BLL > 10 μg/dL increased 4 times for children ≤1.3 years during time of high lead water levels CDC Issues notice in 2010 about past MMWR Cross-sectional study of people with high water lead levels (> 300 ppb) in DC flawed Sampling time of blood and water not known Issue was a temporary spike in water lead levels in DC Also warned against partial replacement

19. In-house modelling (IEUBK)

20. Lead Levels Similar After Partial Replacement

21. Galvanic Corrosion can Increase Lead Levels Process used in batteries Occurs with metals of different electrical potential Results in corrosion of one metal With lead and copper results in corrosion of lead Lead levels can be higher than lead pipe alone

24. Additional Changes Accelerated LSL replacement discontinued Now only done as part of state of good repair (e.g. when replacing main) Water filter and information sheet left at each home after all LSL replacements Corrosion control is being implemented

26. Additional Changes Water testing de-emphasized for individual homes Not promoted for individuals to risk stratify People can request LSL replacement without water testing so long as commit to replacing their side Vulnerable groups are encouraged to use filter until lead service removed (no longer based on testing result) Re-evaluating communication strategy based on survey of homes with partial and full LSL replacements

27. Questions Howard Shapiro Toronto Public Health hshapir@toronto.ca 416-338-8562