​Fall/Winter 2021

​On August 5, the United Nations Intergovernmental Panel on Climate Change issued its Sixth Assessment Report, where it stated, “It is unequivocal that human influence has warmed the atmosphere, ocean and land.” Public health laboratories, particularly environmental health professionals, have been noticing the effects of climate change in their daily work for quite some time. And it may be up to public health laboratories to help clarify its effects for state and federal decision makers.

Globe-colored sand in an hourglass, with sand running out

by Melanie Padgett Powers, writer

Each decade, the Earth’s temperature continues to rise. Ocean temperatures have increased. Seasons have shifted, with mosquitos and ticks—and their vector-borne diseases—showing up earlier or later in the year. States where people have rarely needed air conditioners are experiencing record-breaking heatwaves. Rain can be erratic, with areas facing droughts, followed by intense rainfalls that speed up water runoff and cause flash flooding. Hurricanes and winter storms have increased in frequency and intensity.

NASA reports that the Earth’s temperature has increased about 2.12 degrees Fahrenheit since the late 19th century, with most of the warming in the past 40 years. In fact, 2016 and 2020 are tied for the warmest year on record.

On August 5, the United Nations Intergovernmental Panel on Climate Change issued its Sixth Assessment Report. On the first page of the Summary for Policymakers, it states: “It is unequivocal that human influence has warmed the atmosphere, ocean and land. Widespread and rapid changes in the atmosphere, ocean, cryosphere and biosphere have occurred.”

Climate change affects human health in a variety of ways, from a decrease in air and water quality to temperature changes that lead to illness and death. Climate change is even connected to COVID-19: A Harvard University study found that those who lived in areas with higher levels of the dangerous air particles known as PM 2.5 were associated with higher death rates from the virus.

Public health laboratories, particularly environmental health professionals, are also noticing the effects of climate change in their daily work. As seasons and weather patterns change, laboratories are experiencing changes in the timing and types of testing requested.

These climate change connections to environmental health and human health provide an opportunity for public health laboratories to become equal partners in discussions around climate change and environmental health issues, says Julianne Nassif, MS, APHL’s director of Environmental Health.

Rather than only running tests when requested, public health laboratories can lead and partner on programs that monitor and track environmental health trends over time and then work to develop programs to study or mitigate effects.

“We’re really at the inception of this, and this is a big opportunity,” Nassif says. “There are technical and financial resources being distributed to the federal agencies, and we need to show them that there’s value to what the public health laboratories can offer.”

The data that public health laboratories collect on environmental changes can be connected to larger climate change trends and health effects.

“I’m not sure the federal agencies are aware of all of the testing that’s done,” Nassif says. “We need to think about a system that would integrate environmental monitoring data, some disease prevalence, physical and chemical measures of weather and temperature, and have it all integrated into a single system so that we could look at it.”

Different Projects, Same Purpose

In Minnesota, the Environmental Laboratory Section of the state’s public health laboratory has been involved in a couple of pilot projects examining water quality. Minnesota has warmed one to three degrees Fahrenheit within the past 100 years, according to the US Environmental Protection Agency (US EPA). Floods are more frequent, and ice cover forms later and melts sooner on the state’s 12,000 lakes. In 2021, the state is experiencing a significant drought despite a “mega-rain” event over 6-12 hours in July that dumped 6-10 inches of rain in some parts.

“As a laboratory, we are aware that the seasons are changing,” says Sara Vetter, PhD, assistant division director and CLIA laboratory director at the Minnesota Public Health Laboratory Division. “For example, tick season starts a little earlier and goes a little longer. So when it comes to our ‘normal surveillance,’ we are noticing that we get more samples in over a longer period of time through the year.”

Typically, it is not possible for the laboratory professionals to analyze any patterns because samples are given a unique number—and a new number each year—and not identified by the water source’s location.

“To get historical data from the lab’s point of view is difficult,” says Jeff Brenner, laboratory supervisor at the Minnesota Public Health Laboratory Division. “You sometimes get a feel that it seems like we’re having higher results, but it’s difficult to tell [in the laboratory] if it’s from the same location or if it’s a new location.”

However, a few years ago the environmental health laboratory professionals partnered with the Minnesota Pollution Control Agency on a project examining the ability to reuse stormwater. In 2008, the state passed the Land and Legacy Amendment, funded through a sales tax increase. As part of the clean water activities, the Amendment paid for a full-time chemist at the state public health department.

As part of a proof-of-concept pilot project, the Environmental Laboratory Section collected stormwater and determined whether it could be cleaned up enough to test for different compounds. They were successful, showing that the water could be examined to the extent that decision-makers could decide whether certain stormwater collections were safe enough to be reused for things such as irrigating athletic fields without introducing chemical containments to the area.

“It was just the idea of could we collect water? Could we clean it up enough to analyze it with some level of accuracy and to identify these compounds and things?” says Paul Moyer, MS, manager of Minnesota’s Environmental Laboratory Section. “So, it was very interesting, and we’re waiting to see if there’s going to be some follow-up opportunities.”

In another partnership with the state’s pollution control agency, the laboratory tests the ratio of bromide and chloride in aquifers, and the ratio is used to determine the origin and time it took for a sample to pass through the soil to get to the aquifer, Brenner says.

The concern surrounded increasing patterns of drought followed by extreme rainstorms, which can cause water to flow faster into the aquifers, potentially taking more chemical compounds with it. However, one of the challenges of these types of projects is that the laboratory didn’t hear back about the overall results and data analysis.

“We’ve tried to work with our partners a little bit better to have them come out and do presentations on our data,” Brenner says. In one instance, the pollution control agency did do a presentation on the laboratory’s data showing the effect of sulfate on wild rice. The state has a 10 milligram per liter sulfate limit for wild rice waters. The pollution control agency was studying whether the regulation was stringent enough and if it was connected to wild rice dying off in the northern part of the state.

“What they determined, through this multi-year study, was that it wasn’t actually the sulfate, but it really depended on the total organic carbon and iron concentrations also in the sediment,” Brenner says.

If the iron concentrations were low and the organic carbon was high, the bacteria in the sediment would use sulfate for respiration. The sulfate would be converted to hydrogen sulfide, which was killing the wild rice. However, when iron concentrations were high and organic carbon was low, the bacteria would use iron and the rice would survive. In April 2021, US EPA notified the Minnesota Pollution Control Agency that 30 rivers and lakes had sulfate levels beyond what is allowed.

In some parts of the country, it is harmful algal blooms (HABs) infiltrating waterways and potentially endangering health. HABs can lead to temporary closures of recreational lakes, preventing swimming, boating and fishing. In Pennsylvania, HABs have increased as warmer water temperatures have mixed with agricultural and urban runoff, according to a climate change session at the 2021 APHL Annual Conference. HABs decrease the oxygen available to other organisms in the water, killing them. They can also be a danger to fish, pets and humans.

The Pennsylvania Department of Environmental Protection (DEP) Bureau of Laboratories got involved by developing two new analyses to characterize HABs, explained Pamela Higgins, PhD, special assistant to laboratory operations at DEP, during the May 2021 session.

Light microscopy allowed for identification and enumeration of the different cyanobacteria in the water. ELISA cyanotoxin assays allowed for the detection of the four most likely cyanotoxins that might be released from the bacteria. The results showed complex blooms, with 3-11 different cyanobacteria present at any one time and a composition that changes depending on the location and time of year.

On the West Coast, one of the environmental concerns is air quality from the increased frequency and intensity of wildfires. 2020 was the worst fire season on record, but 2021 fires were on pace to beat that record. In 2020 in the US, 38% of cities had PM 2.5 levels that exceeded World Health Organization quality standards—an increase from 21% in 2019, according to Science X, a sci-tech news site. Wildfires were so constant that in September 2020, 77 of the world’s 100 most polluted cities were in the US, according to the site.

The California Department of Public Health’s (CDPH) Environmental Health Laboratory (EHL) is working on a couple of projects on the impact of wildfire smoke on firefighters and residents. EHL’s air quality group has studies to better characterize wildfire smoke and how its composition differs from other pollution, as well as interventions to achieve cleaner indoor air spaces. The biomonitoring group has collaborated on studies of firefighters that measure chemicals in their blood and urine to see if there are elevated levels due to their time spent exposed to heavy smoke.

Another CDPH laboratory project is examining the effect that the expansion of mosquitoes and ticks has on vector-borne disease, while another study is looking at cyanotoxin in drinking water.

System and Funding Challenges

One of the challenges environmental health laboratory professionals face is the hodgepodge of federal programs that don’t necessarily connect to one another or to the state public health laboratories. Federal programs that collect climate change data include the US Centers for Disease Control and Prevention’s (CDC’s) National Environmental Public Health Tracking Network, US EPA, National Oceanic and Atmospheric Administration and US Global Change Research Program.

The CDC National Environmental Public Health Tracking Network collects, integrates and analyzes non-infectious disease and environmental data from a nationwide network of partners. The purpose is to protect the US from health issues arising from or directly related to environmental factors, says Paul Schramm, MS, MPH, in an emailed statement to Lab Matters. Schramm is a health scientist in the Climate and Health Program, Division of Environmental Health Science and Practice at the CDC’s National Center for Environmental Health.

For example, the online Data Explorer includes data on drought, extreme heat, precipitation and flooding, air quality, wildfires, community characteristics, population vulnerabilities and relevant health outcomes such as respiratory and cardiovascular disease. The data are free to view and download.

In partnership with the Climate and Health Program, the Tracking Network also developed the CDC Heat and Health Tracker dashboard to provide real-time heat data paired with local vulnerability data. Network health department grant recipients collect health surveillance data relevant to climate change and participate in a climate and health working group maintained by the Tracking Program.

“There is a growing need for more climate-focused surveillance, and more data is needed to make evidence-based decisions regarding climate and health,” says Schramm in a statement. “CDC can play a vital role in helping to address these issues.”

Getting the Data to Help Communities

APHL has long been advocating for big data modernization and connecting the patchwork of programs to each other and to the state health departments.

“The management of public heath data in the US is a mess and has always been that way, mostly because it’s never been funded,” says Peter Kyriacopoulos, APHL’s chief policy officer. Instead of one standard system, there are now over
100 systems to report public health data to CDC. Once the data arrives, only the people on the receiving end know about the data or have access to them.

“The first thing we’re trying to do is help CDC implement an enterprise-wide approach to the management of data so that you no longer have a myriad of ways of doing things and that everybody at CDC has access to all of the information,” Kyriacopoulos says.

In one example, CDC has developed a National Public Health Framework for the Prevention and Control of Vector-Borne Diseases in Humans. The project was developed through the collaboration of the CDC, US EPA and five federal departments.

The framework details the strategic priorities of the federal government to prevent and control vector-borne disease and calls for the formation of a multidisciplinary team of stakeholders that includes state health departments, health care providers, academic and industry partners, policymakers, public health nonprofits and patients.

However, the framework has not yet been funded. Kyriacopoulos estimates it will take at least $100 million to get it up and running. But in President Biden’s fiscal year 2022 budget request, only $42 million is allocated for vector-borne diseases.

The administration does acknowledge climate change and has addressed it in its Build Back Better Agenda, which would establish an energy efficiency and clean energy standard, expand and extend clean energy and electric vehicle tax credits, and enlist a new Civilian Climate Corps.

In addition, public health finally received some much-needed attention during the COVID-19 pandemic, including a substantial boost in funding as part of the American Rescue Plan passed by Congress in March 2021. The $1.9 trillion rescue package is designed to help the US recover from both the economic and health effects of the pandemic. APHL received almost $300 million from the plan to provide fellowships and internships to support the public health laboratory workforce.

“That is just a massive increase over any funding that APHL had ever gotten for fellowships and internships,” Kyriacopoulos says. “That’s another Biden initiative that was both very different from the way previous administrations had been thinking and also a very demonstrable increase in support for addressing public health laboratory workforce.”

Funding and staffing resources have always been a laboratory challenge in many states. Public health laboratories are often fee-for-service and don’t usually have the funds to create programs on their own. And those working on climate change-related projects, such as examining air and water quality, don’t immediately think of the laboratories as obvious partners, experts say.

With the American Rescue Plan funding, APHL is expanding its current fellowship program offerings and recruiting for two classes of fellows in 2022. One class will begin in January 2022. Recruitment is open now for a second fellowship class and a new internship initiative —both programs will begin in summer 2022. Applications are also open for laboratories to apply to host a fellow.

With a fellow or intern adding to their workforce, laboratories might consider allowing that individual to target a project related to climate change data and outcomes, Nassif says. “This would be a great fellow project—to have them come in and look at the environmental data, look at the health data, and make the connections for a very small geographic area. It could be a demonstration of proof of concept that could be then used to scale up at a larger level.”

Laboratories might also be able to get involved in projects related to the CDC Building Resilience Against Climate Effects (BRACE) framework, which provided grants to state health departments to develop strategies and programs to help communities prepare for the health effects of climate change. Even though CDC did not specifically point to public health laboratories as potential partners, APHL has been advocating for CDC to include public health laboratories in the next round of grants and is encouraging grantees to reach out to public health laboratory professionals.

It is also incumbent on APHL and its partner organizations to highlight the connection between climate change and harmful health effects so that overworked public health workers see the critical importance of considering climate change.

The challenge is for organizations such as APHL, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Council of State and Territorial Epidemiologists “to share the message about the health impacts of climate and the importance of working collaboratively to try and gather information and come up with solutions, or at least interventions,” Nassif says.

Nassif hopes to bring together a group of partners to discuss climate change collaborations, perhaps in 2022.

“This is a really exciting opportunity, and if we can bring that group together, and frame this appropriately, I think this could be an important program, with huge, positive impacts. We just need to wrap our heads around what the problem is, how we might be able to contribute to the solution, and start chipping away at it.”