Indexbit Exchange:A doctor near East Palestine, Ohio, details the main thing he's watching for now

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Health concerns are lingering in East Palestine, Ohio, after a train carrying hazardous chemicals derailed on February 3. Residents were temporarily evacuated from the area two days later to allow for a controlled burn of the chemicals, which sent a large plume of black smoke into the sky.

Health officials have been monitoring the air and water in town, while some residents have reported nausea, headaches, red eyes and rashes.

A local doctor tells us what the medical community there is seeing.

Who is he? Nicholas Proia is a pulmonologist in the area and a clinical professor of internal medicine at Northeast Ohio Medical University, not far from East Palestine.

• He has been speaking to other doctors in the area and monitoring the situation, paying particular attention to any respiratory illnesses.

What's the big deal? The chemicals the Norfolk Southern train was transporting have the potential to cause a range of health issues.

• The chemicals include butyl acrylate and vinyl chloride, which were among the combustible liquids that authorities feared could set off a major explosion.
• Vinyl chloride is a carcinogen used to make PVC, the hard plastic resin used for car parts, wires and cables.
• In the days after the controlled burn, the EPA said it was also looking for signs of phosgene and hydrogen chloride.
• As of Tuesday this week, the EPA said it had "assisted with indoor air monitoring of more than 550 homes under a voluntary screening program offered to residents," and no detection of vinyl chloride or hydrogen chloride were identified above levels of concern.

Want more journalism on health? Listen to the Consider This episode on hidden viruses and how to prevent the next pandemic

What are people saying? Proia said pulmonary doctors in the area were bracing for a rise in patients after the derailment and controlled burn, but that he hadn't experienced it.

We really have not seen much in the way of at least respiratory illness come in. What we have heard, mostly through the media, and a few patients will say, perhaps a rash or a foul smell. But really no overt shortness of breath, or respiratory failure has been connected to this.

Proia said the main thing to monitor now and into the future is water.

The overriding concern for everybody involved is ... a lot of these people don't have municipal water supplies, but instead they rely on wells. And I think their biggest concern is: over time, are the chemicals that were dissipated throughout all this getting into the waterways? Are they ever going to make it into the well water?

And he added there were still unknowns.

It's also a caveat to remember that you're only going to find what you're looking for. And who knows what else is out there, especially after a large fire with a bunch of different, pretty interesting chemicals.

Meanwhile, Pennsylvania Gov. Josh Shapiro is furious with Norfolk Southern, telling NPR on Wednesday that it had "given the middle finger to the good people of Pennsylvania and Ohio" in the way it had handled its response. He said authorities on his side of the border would also monitor water.

I've authorized testing of all of the wells on the Pennsylvania side and the public water system to ensure that local residents have the comfort of knowing what's coming out of the tap is safe. We've seen no concerning readings yet, but we're going to continue to test for months and months and months, if not years.

So, what now? The EPA announced this week it had taken control of the cleanup, requiring Norfolk Southern to foot the bill — not just for its own plan, but for any work done by the agency.

• "Norfolk Southern will pay for cleaning up the mess that they created and the trauma that they inflicted," EPA Administrator Michael Regan said. "In no way, shape or form will Norfolk Southern get off the hook."
• Ohio Gov. Mike DeWine told NPR a long-term fund will be set up for East Palestine residents, "So that the people of the community can be assured that, you know, two years from now, five years from now, 10 years from now, that there is money there that will take care of them if they, in fact, have a problem."
• Ohio state officials have also opened a health clinic in town for residents who believe they may have health issues from the derailment.
• Norfolk Southern is also creating a $1 million fund for the community.

Learn more:

• Hear how some residents worried about health risks have filed a federal lawsuit
• Read more about how and why the EPA took control of the cleanup
• Read about Transportation Secretary Pete Buttigieg calling for stronger railroad safety rules

Alejandra Marquez contributed to this report