For many months now, the city of Milwaukee has been grappling with a lead poisoning crisis that has forced at least four schools to temporarily close and dozens more to undergo rigorous inspections.

It began on January 13, when Milwaukee first notified parents at one grade three to five school that a child had tested positive for high levels of lead in their blood. Local health officials determined the lead exposure did not occur at the child’s home, which left their school as the obvious culprit.

City investigators found chipped lead paint and lead-laden dust throughout the school building; press and government reports indicate that the school district has struggled to keep up with paint maintenance requests, due to a lack of funding and manpower. Local officials soon realized they had a big problem on their hands, as the vast majority of the city’s school buildings (roughly 125 out of 150) were built before 1978, when lead paint was banned.

Lead, a dangerous neurotoxin that can lead to development problems in children after prolonged exposure, has now been detected in at least nine public schools, and at least four students have tested positive for high lead levels in their blood. So far, no children have been hospitalized for acute lead poisoning, which can be life-threatening, but the affected kids continue to be monitored. Several buildings have been temporarily closed so workers can do a deep clean. Milwaukee has been inspecting all of its public schools for lead, with the goal of completing the review by September.

Normally, cities navigating such a crisis could depend on the Centers for Disease Control and Prevention for federal support. When the lead poisoning was first detected in January, at the tail end of the Biden administration, city health officials were immediately in contact with the CDC environmental health team, which included several of the country’s top lead poisoning experts, Milwaukee health commissioner Mike Totoraitis told me. A group of federal experts were planning a trip to the city at the end of April.

But not anymore. In early April, the Trump administration denied Milwaukee’s request for support because there was no longer anybody on the government’s payroll who could provide the lead poisoning expertise the city needs.

On April 1, the lead exposure team within the CDC’s National Center for Environmental Health was laid off as part of Health Secretary Robert F. Kennedy Jr.’s massive restructuring of the federal health department. The planned trip was canceled, and no federal officials have stepped foot in Milwaukee since to aid in the response.

“We were talking to [the federal experts] multiple times each week,” Totoraitis said, “before they were let go.”

Milwaukee has pushed ahead with its own inspection and free blood testing clinics. The city reported on May 13 that it had replaced 10,000 lead water service lines, in an attempt to remove another possible source of exposure for local children. But they still have 55,000 more left to go, and local officials have said they would need state or federal funding to finish the job. (It is estimated to cost the city about $630 million.)

Ordinarily, Totoraitis said, the CDC experts would serve as the city’s subject matter experts, guiding them through their epidemiological investigations. Federal officials are especially adept at the detective work that can determine whether a child was exposed at home or at the school. Milwaukee officials had recent experience with lead exposures in homes but not in schools; they were relying on federal expertise to interpret lead dust levels that were found during the school inspections. Without them, they’ve been left to navigate a novel and dangerous health threat on their own.

“They were there for that sole purpose of having some of the best subject matter expertise on lead poisoning, and it’s gone now,” Totoraitis said. “Now we don’t have any experts at the CDC to reach out to.”

In this uncertain new era for public health, Milwaukee’s experience may become all too common: a city left to fend for itself amid an emergency. What in the past might have been a national scandal could become all too routine.

This is what happens when the federal government won’t respond to a health crisis

When I spoke with Totoraitis, he was already contemplating the next public health problem he would have to deal with. “If we have a new emerging health issue, that I don’t have internal expertise on and neither does the state, we don’t have anyone to call now,” Totoraitis said. “That’s a scary endeavor.”

He can’t be sure what kind of help he will be able to get from the federal government as the restructuring at the US Department of Health and Human Services continues. The department just rehired hundreds of health workers focused on workplace safety, but other teams, including the lead team, have not been brought back.

The turmoil makes it harder for local officials to keep track of which federal experts are still on staff, where they are located, and who has actually been let go. But the message is clear: President Donald Trump and his senior deputies want state and local governments to take on more of these responsibilities — without a helping hand from the feds.

The US public health system has been set up so that the state and local health departments are the front line, monitoring emerging problems and providing personnel in a crisis. The federal government supplies insights that state and local officials probably don’t have on their own. That is what Totoraitis was depending on; Milwaukee was inexperienced with lead exposures in large public buildings before this year’s emergency. (One of the laid-off CDC scientists has since sought to volunteer to help Milwaukee, as Stat recently reported; the person told me they were hoping to help with community engagement, which federal officials would usually assist with.)

Health crises happen all the time. Right now, there is a small tuberculosis outbreak in Kansas; a Florida town experienced the unexpected spread of hepatitis last December. A dozen people have been hospitalized in a listeria outbreak. And the US is currently facing its largest outbreak of measles in decades, with more than 1,000 people sickened. At one point, local officials said that the federal government had cut off funding for the outbreak response as part of a massive clawback of federal funds at the end of March, although the CDC has since sent additional workers to West Texas where the outbreak originated.

There used to be little doubt the federal government would step up in these scenarios. But Totoraitis warns that Milwaukee’s experience of the past few months, left to fend for itself in an emergency, could soon be repeated elsewhere.

“Let’s say next year this time, St. Louis is in a similar situation — they could call us, but we don’t have the bandwidth to consistently support them,” Totoraitis said. “This unfortunately is a great example of how quickly changes in the federal government can affect local government.”

Kids are being poisoned by lead. Trump is letting it happen.

Kennedy, Trump, and Elon Musk’s Department of Government Efficiency gleefully cut 10,000 jobs from US health agencies this spring. The cost of those losses will be felt every time a city is confronted with an unexpected health threat. Today, in Milwaukee, families are facing the fear and uncertainty of lead exposure — and they know federal help isn’t coming. As one Milwaukee mom told ABC News recently: “It really sends the message of, ‘You don’t matter.’”