No safe level of lead in the body has been identified. Adverse neurodevelopmental and intellectual outcomes have been observed with blood lead levels (BLLs) as low as 1 µg/dL.1, 2 Environmental regulations have dramatically reduced environmental, commercial, and residential sources of lead over the past 50 years, however, recent evidence suggests that more than half of children in the United States have detectable BLLs.3 The burden of lead poisoning is not uniform – Families residing in older housing are disproportionately affected, particularly low-income, racially-minoritized, and immigrant populations due to the disinvestment in communities subjected to historical housing discrimination.4, 5, 6

The early phases of the COVID-19 pandemic caused significant disruptions to pediatric primary care.7 Regular assessment of BLLs in children is critical to mobilize public health resources for families at risk for lead poisoning, however the extent to which the pandemic impacted BLL testing has not been well-characterized. In addition to changes in clinical practice, COVID-19 introduced sweeping measures to mitigate the community spread of disease.8 Social distancing and shelter-in-place orders resulted in increased time spent at home, potentially magnifying residential lead exposures for already vulnerable children.

Towards this end, we conducted a study of BLL testing and results in three urban medical center sites in Boston, Massachusetts during the COVID-19 pandemic. We hypothesized that rates of lead testing would precipitously decline at the onset of the public health emergency, with a gradual recovery to pre-pandemic levels, and that the community burden of detectable and elevated BLLs would increase in populations with known risk factors.