It’s been nearly a year since a massive Norfolk Southern train derailment in East Palestine, Ohio, by the Pennsylvania border that released toxic chemicals into the community.

In the first weeks afterward, doctors and health officials provided clinical assistance to residents who felt sick, but officials did not set up a public health infrastructure to confirm if those symptoms were from chemical exposures and to track future health impacts.

Public health experts say there should have been immediate testing of people for chemicals in their bodies, along with the creation of a large-scale community health registry. Without these, residents won’t know the long-term impacts on their health.

In this investigation, The Allegheny Front found out why doctors were advised not to test for chemical exposures and the consequences of that decision.

What happened that night?

On the evening of Feb. 3, 2023, 38 Norfolk Southern train cars derailed and a dozen more caught fire, close to people’s homes and businesses.

Eleven derailed cars carried hazardous materials, including vinyl chloride, butyl acrylate, ethylhexyl acrylate, isobutylene and ethylene glycol monobutyl ether, chemicals can cause burning of the eyes and skin, coughing and shortness of breath, headaches and nausea.

When these chemicals break down, they can change or react with things in the environment, creating new chemicals. Days after the derailment, emergency responders were concerned about an uncontrolled explosion of vinyl chloride in five railcars.

The governors of Ohio and Pennsylvania ordered an evacuation in a one-by-two-mile radius around the derailment site so that the gas could be released for a controlled burn. That led to explosions, a dark plume seen for miles around and ash throughout the community.

Giving the all-clear

Two days later, the U.S. Environmental Protection Agency (EPA) said its monitoring and sampling found chemicals in the air and water at safe levels and residents were allowed to return home.

But at a contentious town hall meeting in East Palestine the following week, Jamie Ervin was still scared to return home with her kids.

“I have a five-year-old, and he has rashes all over his body, almost like he has eczema, which he does not. They don’t have an answer for it, though,” she told The Allegheny Front.

Rebecca Dilts did return home when the evacuation was lifted, but her young daughter woke up with painful, itchy eyes.

“They were bloodshot, they were swollen down to her cheeks, and then whenever I took her to the doctor… she wasn’t sure how to treat it,” Dilts said.

Dr. Gretchen Nickell, chief medical officer at East Liverpool City Hospital, about 20 miles south, started seeing patients with similar symptoms that could be from chemical exposures.

“So when I have patients that say, ‘I’ve got a skin rash, I’ve got dermatitis, I’m having a hard time breathing,’ I’m diagnosing pneumonitis, eyes, ears, nose, throat irritation,” she said at a workshop held by the National Academies of Sciences, Engineering, and Medicine in November 2023.

Nickell says she wasn’t sure what to tell people about the chemicals.

“And knowing that we had VOCs [volatile organic compounds] and vinyl chloride, what, if any, kind of testing should we be doing?”

The decision not to test residents for chemical exposure

Many health officials were asking that same question: whether they should offer urine, blood or breath tests for people worried about chemical exposures. The tests might help people understand if they had the markers for any of these chemicals in their bodies and whether they needed to worry or not.

Officials did get guidance from the Centers for Disease Control and Prevention (CDC), but because there was political wrangling between the state and federal governments, it took two weeks for Ohio Governor Mike DeWine to request support from the CDC.

By the time the CDC and its Agency for Toxic Substances and Disease Registry (ATSDR) arrived in East Palestine on Feb. 20, 2023, more than two weeks later, officials said people in the affected area were past the point of acute chemical exposure from the initial derailment and burning of vinyl chloride.

“Volatile organic compounds, the class of chemicals most commonly associated with this incident, only remain in the body for a limited number of hours, not days,” said Ohio Department of Health spokesperson Ken Gordon in an email.

“From the beginning, there was no recommendation for universal testing [of residents] from the CDC/ATSDR. The guidance from ATSDR was that any blood or urine tests would need to be conducted very shortly after exposure, and even then, tests may not reliably determine the level of exposure,” he said.

The Pennsylvania Department of Health offered a webinar for medical providers in late February 2023. A recording was first made public after a request from The Allegheny Front.

In the webinar, Dr. Mike Lynch, a medical toxicologist at the University of Pittsburgh Medical Center and director of the Pittsburgh Poison Center, told area doctors that blood tests were not clinically useful and not recommended for patients.

“With confidence, you can tell [patients] that there is not a chemical test that they should be seeking either from you or elsewhere at this time that prove or disprove exposure, or would help with diagnosis, treatment or prognosis from any of these potential exposures,” Lynch said in response to a question during the webinar.

Lynch explained in a recent interview with The Allegheny Front that when deciding whether to recommend universal testing of residents, toxicologists depended on the results of air and water monitoring by federal and state regulators.

“And at that point, fortunately, we were informed that there was no elevation of things like vinyl chloride, in particular was a concern, above health levels that would be acceptable,” he said.

Lynch said his office was getting information from the Pennsylvania Department of Health and the EPA.

According to an EPA document, “Vinyl chloride in the community has not been found sustained at or above the intermediate screening level (0.05 mg/m3) which is designed to protect public health.”

“Essentially, we were told that the only thing that rose above normal risk levels was particulate matter, which is essentially smoke, dust, fumes, but not necessarily chemicals that were known to have been on the train,” he said.

Many residents complained about the chemical odor, and irritations of the mouth, throat, nose and eyes, or about their asthma or chronic obstructive pulmonary disease being triggered.

These symptoms were consistent with elevated particulate matter and smoke, according to Lynch. So, the Poison Center recommended that doctors treat the symptoms.

“We weren’t recommending blanket toxicology or general lab testing under the auspices of concern for exposure,” Lynch said.

But were the regulators right?

At least one researcher is questioning the air monitoring and believes the evacuation order in East Palestine was lifted too soon.

“It is with that faulty information that the evacuation order was lifted. Residents and business owners were encouraged to go back into their contaminated buildings,” said Andrew Whelton, a professor of civil, environmental and ecological engineering at Purdue University.

Mark Durno, a response coordinator for the EPA in East Palestine, has defended the clean-up as following sound science.

Despite these assurances from the EPA, residents complained in public meetings and in interviews in the weeks and months afterward that they were still experiencing symptoms and their houses smelled of chemicals. Even CDC workers felt sick while going door-to-door in March.

The EPA Regional Administrator Debra Shore said residents’ symptoms could be related to stress and trauma.

The agency has refused to sample for chemicals in people’s homes, saying that some chemicals present in the derailment could also be present in household products and that outside air tests show no contamination.

Consequences of that testing recommendation

Several experts interviewed for this story, who focus on public health and research, say the advice not to do widespread biological testing was a loss for the community.

“Should they have done it, or should it have been offered in February? Yes,” Erin Haynes, a public health researcher at the University of Kentucky, said in April.

Haynes continued:

“We could have had these bio-specimens collected early on … Now [residents] don’t have an amount that was in their system, and many are experiencing health symptoms that are lingering.”

Molly Jacobs, an environmental epidemiologist at the University of Massachusetts Lowell who works with the Cancer and Environment Network of Southwestern Pennsylvania, wanted a response like the one in Seveso, Italy, in 1976.

Within two weeks after a chemical plant exploded there, health studies were being designed, and blood specimens were taken from thousands of nearby residents.

“And they used those specimens to help determine… exposure levels decades later, to link several health conditions,” Jacobs said. This even led to much of what is known about the human health impacts of exposure to dioxins.

To understand the health impact of a chemical event, responders need to act quickly, according to Dr. Maureen Lichtveld, dean of the Graduate School of Public Health at the University of Pittsburgh.

The key to an effective public health response, she says, is to teach health responders to gather as much data as possible from people who might have been exposed to chemicals. First, by finding out where a person was located during the incident, and how long they were exposed.

“And so the sooner you dare to capture the exposure, which is the first thing you want to do, the more we are equipped to know what the exposure was to then determine what the potential adverse health effects can be,” Lichtveld said.

She previously was director of health education and promotion at the ATSDR and designed public health research tools and protocols to guide national environmental health studies in communities near hazardous waste sites.

She was part of the response team after the terrorist attacks on Sept. 11, 2001, which caused releases of toxic chemicals when the Twin Towers collapsed, and the BP oil spill in the Gulf of Mexico.

Because chemicals like vinyl chloride move quickly through the body, one key to a public health response is to take samples of their breath, blood or urine, according to Lichtveld.

“If we’re not quick enough or early enough to capture that, we’re losing the opportunity to measure directly what’s happening in the people,” Lichtveld said.

Ohio’s two senators, Sherrod Brown (D-OH) and J.D. Vance (R-OH), also called for biological testing in a letter they wrote to environmental and public health agencies in late February 2023.

An opinion by Glenn Talaska, professor emeritus in Environmental and Public Health Sciences at the University of Cincinnati College of Medicine, was included in that letter.

He thinks emergency responders should be trained to take urine samples during that early, acute exposure period.

“You don’t even have to know what the chemicals are; take the urine samples, store them properly,” Talaska explained. “And then when you find out what the chemicals are, then you can do the analysis for it.”

The Ohio Department of Health said in an email that the state’s new training initiative for first responders does not include biological sampling.

Talaska’s research has been to develop biomarkers for human exposure to carcinogens, understanding how to tell from blood or urine samples if a person has been exposed to certain chemicals, and at what levels.

Collecting early data, he says, helps researchers to track the long-term health impacts of these exposures.

“This gives a sense of truth to who is truly exposed and which people should we really follow. Which people in that group will have the highest exposures that should be followed up and then which people don’t have to worry about it,” Talaska said.

What the CDC did do

ATSDR did an Assessment of Chemical Exposures, called an ACE survey, to learn how the chemical release was affecting the community’s health.

Soon after arriving in East Palestine, agency staff walked door-to-door to survey residents, and surveys were offered at a walk-in health clinic that Ohio opened a few weeks after the derailment. (As noted earlier, some of those federal workers reported symptoms such as sore throats, headaches, coughing and nausea.)

The survey questions focused on people’s chemical exposures, related health symptoms and whether they went to a doctor or hospital.

Of the 702 Ohio and Pennsylvania residents who responded to the survey, “they had headaches, coughing, difficulty breathing, stuffy nose or sinus congestion and burning nose or throat,” ATSDR’s Jill Schugart told residents at a public meeting in a church in East Palestine in June 2023.

One mother, Lori O’Connell of Darlington, Pennsylvania, said her 24-year-old daughter had been vomiting daily since the derailment.

She brought the results of biological testing done in May.

“My daughter’s benzene test just came back; her vinyl chloride test just came back. They are double what they should be,” O’Connell told CDC. “And you know what [her doctor’s] response to her was? ‘I don’t know what to do to help you.’”

Three residents who were at that meeting provided The Allegheny Front with their urine test results, which they said showed the markers for vinyl chloride in their bodies.

CDC Toxicologist Arthur Chang told them urine tests are often incorrect. While chronic exposure to vinyl chloride has been shown to increase the risk of liver cancer and other serious health problems, most studies are focused on workers exposed during chemical production or in making PVC products like pipes.

“And the reason why this [urine] test, even in occupational settings, is not used anymore is because there are a lot of false positives,” Chang said.

Instead of biological sampling, he advised them to carefully track their health with a medical provider in case they start to develop cancer.

“So that’s the reason why we’re saying go to your doctor so that you can get examined and get the proper test,” Chang said.

Chang continued:

“We know how to treat angiosarcoma (liver cancer). We may not know how to get rid of vinyl chloride from the body, but we know how to treat those cancers.”

Zsuzsa Gyenes’ jaw dropped. “I looked around the room. I was like, ‘Did I just hear that right?’”

Gyenes, who moved away from East Palestine after the derailment, brought results of her 9-year-old son’s urine test from April showing the markers for vinyl chloride.

“They came in and said, ‘These ACE surveys showed that you guys are sick and that the symptoms match chemical exposure,’ and then we’re just not doing anything about it,” Gyenes said in disbelief.

The CDC apologized to residents for what they were experiencing and said that if they are worried about positive urine test results, they should look for continuing exposure sources, like tobacco smoke.

Calls for a health registry

The National Academies convened public health experts in November 2023 to identify future research in East Palestine, and researchers are already working on small health studies, trying new methods to measure chemicals in people’s blood and tracking the health of a cohort in the community.

Misti Allison, who lives a mile from the derailment site, wants a larger effort to track the health of residents going forward. She wants to know if the rashes and respiratory symptoms her family suffered were caused by the derailment and if long-term health impacts will follow.

But at her two-year-old daughter’s annual check-up in October 2023, the doctor didn’t ask about possible chemical exposures.

“It was never brought up about us living in East Palestine — that was not documented in her chart with her two-year visit,” Allison said. So without this kind of follow-up, Jacobs, the researcher at UMass Lowell, says residents might never have answers to their future health questions.

Allison continued:

“Is my infertility that I’m experiencing, are the birth defects of my child, is my cancer related to this train disaster?”

To track long-term health consequences, health experts would need to start a registry, “working with the community just to set up an infrastructure, a cohort of individuals that they can follow year after year, nothing like that has been set up,” Jacob said. “And those are the key pieces that you need to study this going forward.”

Jacobs points to the terror attacks on Sept. 11, 2001, as an example of what’s possible with a health registry. Just two months after the collapse of the Twin Towers, New York City’s health department started documenting and tracking the health of people who inhaled toxins from the dust clouds and the psychological impacts of the event.

“It’s the biggest and longest standing health registry that is helping to understand both short-term, but also long-term health effects of this disaster,” Jacobs said.

In the 22 years since, the registry has given researchers data to identify long-term health problems that can be traced back to 9/11 like asthma, post-traumatic stress symptoms and heart disease.

Without something like this, and early biological testing data, Jacobs thinks companies like Norfolk Southern can dodge long-term responsibility for the damage they’ve caused.

“Basically, what it does is that the industry has the opportunity to say, ‘Look, nobody can find any conclusive connection between health effects and what happened.’ They can wipe their hands clean of that,” Jacobs said. “Because we don’t have the right tools in place to make those connections if they’re there.”

These experts are asking whether the country will be any better prepared to respond to the next devastating chemical accident.