I'm a physician and the Ohio train derailment has created a serious public health crisis

Two weeks ago, at 9 pm on February 3, a freight train operated by Norfolk Southern derailed in Ohio.

Two days after the derailment, news of a Chinese spy balloon on a surveillance flight across the United States captivated the nation, so the catastrophe did not receive significant media attention. 

It should have.

OHIO TRAIN DERAILMENT: GOV. MIKE DEWINE SAYS IT'S 'ABSURD' CARGO WASN'T CONSIDERED 'HIGH HAZARDOUS MATERIAL'

The freight train with 150 cars derailed in the town of East Palestine, population 4,700. Twenty of the train’s cars were carrying hazardous materials resulting in a chemical catastrophe. Local residents are now being told it is safe to go home.

I am not so confident. 

The derailment led to a huge fire. It also created the possibility of a massive explosion should the fire reach the highly flammable chemicals contained in some of the cars.  Such an explosion could have led to shrapnel and other sharp objects projecting across a large radius as well as releasing toxic gases into the air. 

Residents were told to evacuate on February 4, as officials decided to do a controlled spill and burn off some of the most dangerous chemicals.  

Five of the train cars were known to be carrying liquid vinyl chloride, which is a commonly used chemical to make hard plastic and other household goods, but it is also explosive and dangerous. Knowing the imminent danger of the spill, emergency workers breached the tanker, leaked the vinyl chloride into a large trench, and burned it before it could explode.

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Following the controlled burn, the EPA was closely monitoring the town’s air and water for signs of contamination. For days after the burn, large plumes of smoke containing vinyl chloride and other gases were emitted.  

The evacuation order for East Palestine residents was lifted four days after the controlled burn.

On February 10th, in a letter from the EPA to Norfolk Southern, it was noted that materials from the wreck were detected in various water samples and observed entering storm drains and seeping into the soil.
 
On February 12th, the EPA published a full list of the toxic chemicals that were spilled during the wreck and noted it had not detected any "levels of concern" of hazardous substances, though it said it was continuing to monitor the air and water.

"All of the readings we’ve been recording in the community have been at normal concentrations, normal backgrounds, which you find in almost any community," James Justice, a representative of the Environmental Protection Agency (EPA) said at an initial briefing.

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At Tuesday's press conference, officials announced waterways near the derailment site are still contaminated from the hazardous chemicals however insisted they are contained and not affecting water sources. They shared that no vinyl chloride was found in the tested water however remnants of the burn remain.  They also mentioned that the train was not considered a "high hazard material train" therefore state officials were unaware of the wreckage contents potentially leading to initial confusion and delayed action.

The decision to lift the evacuation order was based on monitoring data despite evidence of existing contamination.  

The question I care about as a physician is how safe is it for residents to return?
 
There have been reports of wildlife dying, including fish and frogs in local streams. People have reported sick and dead animals including, chickens, horses and dogs.

Ohio Department of Natural Resources officials told WEWS-TV, a Cleveland-based ABC affiliate, that it estimates approximately 3,500 fish died because of contamination approximately 7.5 miles south of the town.

OHIO TRAIN DERAILMENT: OFFICIALS SAY AIR MONITORING SHOWS LEVELS ARE SAFE AS CHEMICAL QUESTIONS ABOUND

Local news station WLWT reported that after the burn began, small amounts of the chemicals were identified in the Ohio river, which supplies more than 5 million people with drinking water.

Although there were many toxic substances released, vinyl chloride is potentially the most dangerous. It can be readily absorbed across all body compartments, including skin, eyes, mouth and respiratory, with inhalation being the most common following an explosion. Upon exposure, acute toxicity can lead to central nervous system and respiratory failure.  

However, there are also chronic carcinogenic (cancer-causing) effects from ongoing, low-level exposure over time.

Vinyl chloride exposure has been linked to several cancers, including a rare, but aggressive type of liver cancer. The Centers for Disease Control and Prevention warns that breathing vinyl chloride over long periods "may be connected" to brain cancer, lung cancers and leukemia.  

Much of the information on the cancer-causing properties of vinyl chloride, however, are from chronic occupational inhalation. There is little information on the long-term effects from a large initial exposure, as potentially received from the wreck, and whether the controlled burn will result in lingering noxious substances.

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The controlled burn and monitoring levels being reported are reassuring that this level of massive exposure to vinyl chloride is less going forward.

However, the metabolites of the exploded chemical may still be present.  

The EPA says it’s monitoring two other chemicals, phosgene and hydrogen chloride, which may have been released into the air by the controlled burn from the breakdown of vinyl chloride. Those substances themselves are highly toxic.

The trench that the chemical was burned in was lined with porous soil. The EPA says they are trying to clear out the contaminated soil however spread is inevitable.

For now, the EPA and local authorities are offering in-home air monitoring, well water testing and other services free of charge. How long that will last is anyone’s guess.

Ensuring clean air, water and food are basic essentials to everyday life.  Norfolk Southern and the EPA owe it to these victims to provide them for life, not short-term.

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Monitoring and continuing "to work with" are nice but residents living near the site of the derailment have good reason to be concerned about how safe their community is and may have been told it was safe to return too soon.  

The immediate danger may now be less, but the potential for long-term devastation remains high.  

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