Weeks After Ohio Train Derailment, Health Concerns Mount

EAST PALESTINE, Ohio — When the railroad crossing gate lowered in front of Greg Mascher’s Chevy Tahoe, his youngest granddaughter shrank down in the back seat and pulled a worn American flag blanket over her eyes. She worried that the train was going to wreck — again.

“Tell me when it’s all over, Papa,” his granddaughter, Raylix, 7, pleaded as the rail cars rumbled through — ones much like the Norfolk Southern cars that had derailed here almost three weeks earlier, resulting in a toxic spill that appeared to cause symptoms of chemical poisoning in hundreds of households.

Mr. Mascher, 61, who is raising three granddaughters with his wife, Traci, had not sent them back to school since they had developed rashes, vomiting and headaches. He glanced at Raylix, still cowering under the blanket, in his rearview mirror.

“When it’s all over, huh?” he sighed, adjusting the crucifix around his neck. “Not sure anybody can tell you girls that.”

Mobile health clinics and camera crews have begun to pack up and leave this town of 4,700, but for the Mascher family and their neighbors, frightening questions remain: How could they know if they had been poisoned by the spill? Were toxins still lingering in the air, the water and the soil surrounding their houses? Would they develop lifelong health problems? And would the relatives who had evacuated the town — like Mr. Mascher’s daughter, her husband and their three daughters, cousins who are like sisters to Raylix — come back?

On Thursday, the chief executive of Norfolk Southern, Alan H. Shaw, encountered more angry questions, when he appeared before a Senate committee. He told the panel he was “deeply sorry” for the impact of the derailment on East Palestine residents butinsisted that “the air is safe to breathe and the water is safe to drink.”

In fact, it could be months or longer, if ever, before health officials know for sure whether the symptoms suffered by East Palestine residents are directly linked to the derailment, and whether they could yield long-term effects. In a tight-knit town that is already skeptical of the government, the lack of concrete information undergirds the growing anxiety.

Medical guidance is sparse. The long-awaited state health clinic sent to East Palestine weeks after the spill at first offered only questionnaires and did not have a doctor on hand. Local primary care physicians, booked for weeks, say that without more toxicology data, they aren’t equipped to diagnose chemical poisoning, so they are simply treating symptoms with ibuprofen and ointment.

“When you’re a physician, you have to call out that you just don’t know,” said Dr. James Kravec, an internist and the chief clinical officer of Mercy Health-Youngstown, which has a primary care practice in East Palestine. “With high blood pressure or diabetes, it’s pretty straightforward. Right now, doctors want to run a test — order something — and they can’t. That’s hard for them.”

Toxicology experts say that children are of particular concern when chemicals are burned and disseminated into the air, because they typically breathe faster and have smaller lungs. A dose of toxins that is negligible to an adult could have a significant impact on a child, said Dr. Mary Prunicki, a Stanford researcher focused on the health effects of air pollutants. If one of the gases causes bronchospasm or inflammation of the airway, a child “has much less leeway than a healthy adult,” she said.

The Mascher granddaughters are a prime example. The morning before the derailment, the three girls enjoyed their daily routine. Mr. Mascher’s daughter, Adyson Glavan — the girls’ Aunt Addy — dropped off her own three daughters at Mr. Mascher’s. He made breakfast for all six granddaughters while they fed the guinea pigs and practiced cartwheels in the front yard.

That night, the train derailed, and two days later, as smoke billowed from the railroad tracks, all six girls developed runny noses and bronchitis-like coughs. Raylix, Kayton and Brayla — whom Mr. Mascher cares for — broke out in rashes. Two of Ms. Glavan’s daughters, Vivian and Vayda, began to vomit. The sprawling family loaded into two S.U.V.s to temporarily evacuate.

Michael S. Regan, the head of the Environmental Protection Agency, said officials were “testing for everything that was on that train.” But, toxicology experts say, the chemical makeup of a spill changes over time as it ages and interacts with the atmosphere, the soil and the groundwater, creating copious new threats that cannot be easily profiled.

Vinyl chloride, for example, the chemical that was carried in five of the cars, can cause toxic fumes made up of new compounds like carbon monoxide, hydrogen chloride and phosgene, a substance classified as a lethal chemical weapon in World War I, according to Dr. Prunicki. Burning vinyl chloride can also produce dioxins, which are known to cause cancer, infertility, Type 2 diabetes, ischemic heart disease and immune disorders.

“There are hundreds of chemicals that could be at play at this point, and we absolutely have the tools in academia to test for most all of them,” said Dr. Kari Nadeau, the head of the environmental health department at Harvard, who studies the toxicological effects of smoke in air pollution, including burning plastics. But Congress allows the E.P.A. to monitor for only a limited list of contaminants in the environment, and even with approval, the bureaucratic process of validating and deploying each of the assays could take years.

Instead, air monitors are hanging on stop signs and trees — wrapped in plastic bags to protect them from rain, an impediment that Dr. Nadeau called “concerning.”

Another key force that is often overlooked in toxin surveillance: gravity. Even once the air and surface resources appear to be clear, chemicals tend to seep downward into soil and deep municipal water sources, even some that have previously tested safe, toxicologists say. And as water sources become diluted over time, toxin levels could simply fall below regulation thresholds, giving a false sense of purity.

“With toxicology, it’s both the dose and the passage of time” that matter, said Dr. Nadeau, who also practices medicine and treats children with sensitivities. “We are only as good as our assays.”

The Mascher family has been a fixture in East Palestine since Mr. Mascher’s great-great-grandfather opened a jewelry store in 1876 on Market Street, down by where Gorby’s sandwiches and an antique shop are now, and later became mayor. The granddaughters are eighth-generation residents. But on the night they returned from the evacuation, they also became an illustration of a painful reality: When trauma strikes, not everyone can flee.

When Vivian, Ms. Glavan’s 8-year-old, broke out in new rashes, she turned her car around. Her household has since moved to Homeworth, Ohio, about 30 miles west.

“You know I can’t bring them back there, Dad,” Ms. Glavan said to Mr. Mascher over the phone. He nodded silently.

But Mr. Mascher, who relies on Social Security checks and is not in a position to move, feels trapped. “Who would want to buy this house?” he said. “Who would want to live in East Palestine now?”

Mr. Mascher finds himself with no appetite and unable to sleep, unsure of whether his granddaughters’ headaches and coughing are due to the flu or to a chemical poisoning that will worsen the longer they stay. He wonders whether raising the girls here could lead to birth defects for their own children later on.

Indeed, while the physical health effects of the crisis are plagued with uncertainty, the mental health consequences are clearer.

“What is happening in East Palestine has all the hallmarks of an environmental disaster that can lead to long-term mental health consequences,” said Dr. Salma Mohamed Hassan Abdalla, a researcher at Boston University who studied the impact of the 2014-16 water crisis in Flint, Mich., in which officials switched the source of the city’s water and then responded slowly to elevated lead levels and reports of sickness.

The scene in East Palestine is reminiscent of Flint, where the authorities offered shifting narratives and thin assurances to low-income families who had few options but to stay and hope. There, as in East Palestine, pallets of bottled water were stacked onto porches as neighbors exchanged advice about how to safely brush their teeth and bathe their children.

Almost one in four adults in Flint, Mich., met the criteria for post-traumatic stress disorder in the years following the water crisis, according to surveys, and many of them attributed the burden to worries about their children’s futures. Stress among caregivers was deeply intertwined with that among young people, who saw months of television ads for personal injury lawyers and political campaigns leveraging the crisis.

“In a town like East Palestine, you have a lot of people already vulnerable because of socioeconomic status — already most susceptible to mental health issues — even before they’re hit with disaster,” Dr. Abdalla said. As the uncertainties mount, those groups are also the least likely to have access to support services. “I worry about increasing mental distress as time goes on.”

When the fourth-grade girls’ basketball team finally gathered in the elementary school gymnasium for its first practice after the derailment, the court was still covered with cots, boot tracks and dusty debris left by the railroad cleanup crews who had encamped there. The players and their coaches, including Mr. Mascher, stood at half-court, hugged one another and cried.

Mr. Mascher did not yet have the courage to tell Raylix that Ms. Glavan’s household wasn’t coming back to live in East Palestine. The railroad that cuts their town in half every 15 minutes has also split their family.