What's happening in Ohio? An interview with a doctor who is assisting locals after toxic train derailment

When a Norfolk Southern train derailed in East Palestine, Ohio on February 3—leading to a toxic chemical spill and, subsequently, a controlled burn of substances—residents in the town of 4,700 complained of various health issues. They also raised ongoing questions around safety and potential future health consequences.

A letter from the Environmental Protection Agency said that several toxic chemicals were on-board the train. EPA administrators later said, however, that there were no “exceedances inside the homes or in the local air,” according to a New York Times article. 

Still, some residents and groups, like United for East Palestine, are concerned about the short- and long-term health risks, as well as the ways in which the incident was handled by federal officials. 

To provide some clarity for physicians around the health implications potentially associated with the derailment, we spoke to Beatrice Golomb, MD, PhD, principal investigator & director at Golomb Research Group and Professor of Medicine, Division of General Internal Medicine at the University of California San Diego.

Below is MdLinx's conversation with Dr. Golomb and her take on the current situation in East Palestine.

MDLinx: What are the potential short and long-term implications of this kind of situation? What sort of toxic chemical injury or chemical-induced chronic illness could potentially arise?

Dr. Golomb: The main short-term symptoms being reported are focused on headache, eyes, nose, throat, ears, sinuses, breathing, gastrointestinal, and skin irritation (itch, burn, red, etc.). The long-term health effects of such an exposure remain unclear because this particular chemical constellation is distinct from others.

However, consequences reported to be increased following some of the toxins released include:  

• Reproductive consequences, particularly in males (e.g., sperm number and quality), including following in-utero or infant exposure, apparently permanent

• Cancer dioxins are multisite carcinogens; vinyl chloride is tied to hepatic angiosarcoma

• Neurologic issues (neuropathy, vision)

• Organ-specific (heart, kidney, liver and for phosgenes, lung)

• Metabolic issues (diabetes, high blood pressure, high cholesterol), among other effects.

A purpose of initiating a longitudinal study is to collect information on whether any of the people affected by this exposure setting show elevated rates of any health problems—including but not limited to the above.

MDLinx: What sort of advice would you impart to physicians who might work with patients during or after this sort of incident? How can they test, treat and support patients who may be affected?

Dr. Golomb: I think it is important that blood samples be archived early for possible later assessment when/if funds become available—both to track how toxin levels from early samples may relate to later health outcomes and to track the evolution of blood markers over time. 

Clinical doctors may not have a setup for this, and we are working frantically to get something set up for blood testing and archiving. Regarding supporting those who have been exposed, the most important thing is to be a partner to them in their journey, fully support them, and do not disbelieve or minimize their symptoms and their experiences. 

A repeated problem with past environmental exposure “outbreaks” has been parties intent on dismissing or denying the problem, which has been a source of added anguish and stress to those affected. 

MDLinx: What should physicians know about lab testing for exposed patients? Are there lab tests available?

Dr. Golomb: That is a perennial thorny issue with chemical toxins, as there are not commonly-available lab tests that can address what is going on in many cases. That said, for these exposures, there is potential utility in tracking kidney and liver function, blood sugar (as well as blood pressure), and cholesterol/lipid profiles—all of which can be affected by these exposures with a not very clear time course. 

MDLinx: What sort of other barriers are there to diagnosis and proper care for these community members? 

Dr. Golomb: A barrier to “diagnosis” and proper care is that exposure like this is a bit of its own new experience. We are still in the phase where people are exposed, per the reports, to toxic air, water and potentially food. So, the most important step at this phase might be strategies to assist in avoidance. Here, the relatively lower-income status of the community, who cannot necessarily afford to stay elsewhere, have access to bottled or clean water for all needs, adequately filter the air in their homes, etc., adds to the challenges.

MDLinx: What sort of issues might physicians, specifically, be running up against in that community?

Dr. Golomb: Again, at this stage, it is especially important to mitigate continued exposure. What we have learned from other exposure settings is that additional days of exposure/more cumulative exposure can lead to more significant health complications downstream. The absence of adequate support for exposure avoidance in this community is heartbreaking.

MDLinx: What do you want your fellow medical community outside of Ohio to know about this? 

Dr. Golomb: First off, it is not only those very local to East Palestine that may be affected. There are reports [of symptoms] from Pennsylvania and even Ontario, Canada, and the toxic plume does not remain tightly localized. As with all toxin exposures, there are vulnerable subsets that may be affected even where the exposure is somewhat attenuated, and this must be borne in mind. 

Where toxins are concerned, one size does not fit all in terms of safe exposure. Also, if there are health professionals interested in getting involved in helping these residents, I would love to hear from them, as I imagine would local advocacy groups, like United for East Palestine.

MDLinx: Which sort of actions do you think need to be taken right away by both the government and the medical community? 

Dr. Golomb: As I understand, the independent testing by Purdue University indicates that the local water still has significant levels of toxins, and good quality independent testing of air and surfaces (such as rooftops, etc.) would be important. 

Even when that testing is conducted, it is important to be aware that not every chemical substance will have been tested for and that the synergistic impact of these chemicals is not known. 

The complexity of providing people clean water (not just for drinking, but for bathing, clothes washing, etc.) seems to me to make challenges insurmountable for keeping residents in the most exposed area in their present location while further testing and information—as well as clean-up—is awaited. For those who remain local, high-quality filtering of water, and at least of indoor air, seem to me to be of paramount importance—as well as access to uncontaminated food stuff.

MDLinx: How are you feeling personally? What has this experience meant for you?

 Dr. Golomb: In terms of how I feel personally, it is with sorrow that I see another group affected by toxic exposures. It does seem the default situation is, early on, a dismissal of the risks before the information could in any way permit such dismissal to be valid. Particularly when people are reporting continued symptoms and other indices suggesting a toxic milieu, it is heartbreaking that better support for them has not been forthcoming. 

There are parties who have been trying to step up to the plate, but resources are needed to pursue the necessary steps both for toxin testing in the area and for evaluation programs that will be important going forward.