Written by Emily Woods
Since August, the Georgia communities of Smyrna and Covington have been thrown into confusion and outrage by a threat to their health. The threat is not a new one, but residents were unaware of its danger until recently. It’s not a threat that can readily be seen. And it’s not a threat that is easily addressed. The threat is a colorless gas called ethylene oxide (EtO).
EtO is used for a variety of industrial purposes including production of other chemicals, agricultural fumigation, and medical equipment sterilization (1, 4). The medical sterilization plants Sterigenics in Smyrna and Becton Dickinson (BD) in Covington both use EtO in their processing (2).
EtO has been used for sterilization since the 1930s (5), so why is it getting so much attention now? In 2014, the National Air Toxins Assessment (NATA) showed increased cancer rates in areas of higher EtO levels (1). The cancers associated with EtO include non-Hodgkin lymphoma, myeloma, lymphocytic leukemia, and breast cancer (1). EtO can also cause lung injury, reproductive issues, and neurotoxicity (4). After a careful review of the 2014 data, the Environmental Protection Agency (EPA) decided to update their risk assessment of EtO (1). This revision underwent further review before being released to the public in August 2018 (1). Although this information was available to the public, the EPA did not issue a press release or directly alert residents in census tracts with elevated EtO levels (6). It was not until Georgia Health News and WebMD reported on the topic on July 19, 2019 that most residents in Smyrna and Covington became aware of the risk to which they were being exposed (6).
Since the release of that article in July, the Georgia Environmental Protection Division (EPD) has been working to address resident concerns, overseeing air sampling, and working with Sterigenics and BD to reduce emission levels (2). Modeling by the EPD suggests that residents in Smyrna and Covington have 1 in 10,000 risk of developing health consequences from EtO exposure (2). Monitoring has shown that both plants are compliant with the current EPA standards for EtO emissions (2), however the EPA is currently reviewing its current standards in light of the 2014 (1). Air quality monitoring in metro Atlanta at a site far from either of the plants was found to have elevated levels of EtO (3). The EPA and county officials are continuing to carry out air quality monitoring at various sites.
Concerned residents are demanding action, and both plants are making efforts to reduce emissions. Even before the story broke, Sterigenics was starting a process to install equipment to reduce EtO emissions (2). Amidst ongoing concerns, however, that work has been put on hold while local officials perform a safety evaluation of the plant (7). After a week of being inactive, 80% of air quality samples in the vicinity of the Sterigenics plant did not detect EtO (9). On the other hand, BD continues to operate and has dedicated $8 million for upgrades to reduce EtO emissions (8).
As the work to address this issue continues, so too do the questions around how these emissions were allowed to continue for so long after authorities became aware of the potential health consequences. For many, this story has raised questions about how regulatory agencies respond to, review, and disseminate data about health risks. It has also raised questions regarding the continued use of EtO for medical equipment sterilization when other, potentially safer, alternatives are available. Although neither company has announced any plans of moving, there is always the possibility that the current outcry could force these plants to move to a new community where residents are again unaware of the risks and may have less clout with officials. By the time the air is cleared from EtO, perhaps some resolution on these questions and concerns will have been resolved too.