October 12, 2001, ABC News, NBC News Worker Has Anthrax, diigo,
October 13, 2001, New York Times, page A1, Anthrax Found in NBC News Aide, by David Barstow,
October 13, 2001, New York Times, FBI Did Not Test Letters to NBC Or Immediately Notify City Hall, by Jennifer Steinhauer and Jim Dwyer,
October 13, 2001, St. Petersburg Times, Brokaw's aide tests positive; Suspicious letters to NBC, N.Y. Times sent from St. Petersburg, authorities say, by David Ballingrund, Mike Brassfield and Wes Allison, Saturday, Archived,
October 13, 2001, Newsday, America's Ordeal; 'Gatekeeper' Is Infected, by Verne Gay, Staff Writers,
October 13, 2001, Washington Post, Fourth Case of Anthrax Is Identified; NBC Employee in N.Y. Tests Positive Weeks After Opening Letter from Fla., by Michael Powell and Ceci Connolly, Archived, diigo,
October 14, 2001, New York Times, page B1, Anthrax Reports Widen, but No Link Is Found, by Eric Lipton, with Jim Rutenberg,
October 14, 2001, Newsday, Postmarked Trenton, N.J.; Letter to Brokaw traced, by Joshua Robin and Rocco Parascandola, Staff Writers,
October 14, 2001, Newsday, Postmarked Trenton, N.J.; Letter to Brokaw traced, by Joshua Robin and Rocco Parascandola, Staff Writers,
October 14, 2001, Newsday, Mixed Signals Over Testing; Conflicting information troubles NBC workers, by Bryn Nelson, Staff Writer,
October 14 2001, Associated Press, Letter Sent to NBC Contained Anthrax,
October 15, 2001, New York Times, Missteps Cited In Responding To NBC Scare, by Eric Lipton,
October 15, 2001, ABC News, Brokaw May Have Been Exposed to Anthrax, diigo,October 16, 2001, New York Times, C.D.C. Team Tackles Anthrax, by Lawrence K. Altman, M.D.,
October 17, 2001, New York Times, On a Day of Jitters, City and F.B.I. Differ Over Anthrax Sweep at ABC, by Eric Lipton,
October 18, 2001, New York Times, Pataki Quits Manhattan Office After Anthrax Is Found, by Eric Lipton,
October 18, 2001, New York Times, NBC; Doctor in City Reported Anthrax Case Before Florida, by Lawrence K. Altman,
October 18, 2001, New York Times, Testing Links Anthrax In Florida and at NBC, by Andrew C. Revkin,
October 22, 2001, Newsweek, Anxious About Anthrax; A Few Cases Do Not An Epidemic Make. But They're Unprecedented; Worry Over What's Next Is Contagious, by Sharon Begley and Michael Isikoff,
October 25, 2001, Associated Press - Newsday, New Anthrax Case in Virginia, Probable Cases in NY, NJ,
November 5, 2001, New York Times, An Energized Brokaw Is in the Middle of the Story, by Bill Carter,
December 26, 2001, New York Times, page A1, Tracking Bioterror's Tangled Course, by Eric Lipton and Kirk Johnson,
October 7, 2002, Newsday, Questions Linger a Year After Anthrax Mailings; Unknown dominates probe, by Laurie Garrett, Staff Writer,
October 8, 2002, Newsday, The Anthrax Crisis; How a suspected case in NYC threaded its way to diagnosis despite initial CDC uncertainty, by Laurie Garrett, Staff Writer,
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October 12, 2001, ABC News, NBC News Worker Has Anthrax, diigo,
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October 13, 2001, New York Times, page A1, Anthrax Found in NBC News Aide, by David Barstow,
(Saturday)
An assistant to the NBC anchor Tom Brokaw has tested positive for anthrax infection more than two weeks after she handled two threatening letters addressed to Mr. Brokaw, one that contained a white powder and the other a sandlike substance, officials and NBC executives said yesterday.
Even as law enforcement officials were cordoning off Rockefeller Center, the newsroom at The New York Times was evacuated when a reporter opened an envelope that also contained a white powder.
The substance was still being tested last night, as investigators explored potential links between the two incidents. The letter to The New York Times and at least one of the letters to NBC were mailed from St. Petersburg, Fla., and had similar handwriting, according to law enforcement officials.
The reports of possible bioterrorism caused widespread anxiety in New York and across the country. People depleted supplies of antibiotics at drugstores and besieged their doctors. Offices were evacuated after a spate of threats, and companies made emergency adjustments to the way they received mail. [Page B9.]
The NBC case marked the second time an American has been stricken with a form of anthrax since the Sept. 11 terror attacks. In the other case, a man died last Friday after he contracted an inhaled form of the disease at a newspaper office in Boca Raton, Fla. Two other people at the office were exposed.
The NBC case was different, involving a less dangerous form of the disease contracted through the skin. It was not clear, the authorities said last night, how Mr. Brokaw's assistant, Erin M. O'Connor, 38, had become infected.
Vice President Dick Cheney said last night in an interview with Jim Lehrer of PBS that there could be links between the anthrax cases and Osama bin Laden. "We know that he has over the years tried to acquire weapons of mass destruction, both biological and chemical weapons," he said. And while cautioning that there was not enough evidence to positively establish a connection, Mr. Cheney said, "I think the only responsible thing for us to do is proceed on the basis that it could be linked.
President Bush, speaking in Washington, urged that life go on as normal. ''Our government is doing everything we can to make our country safe as possible," he said.
At Rockefeller Center, one of the great landmarks of New York City, health officials immediately began tests yesterday on hundreds of employees, many of whom were being given antibiotics as a precautionary measure. Officials emphasized, however, that anthrax is not contagious.
The authorities also sealed off the main NBC newsroom on the third floor of the company's headquarters at 30 Rockefeller Plaza as environmental tests were conducted to determine whether traces of anthrax remain in the building. The mailroom and security offices were sealed as well.
Even as officials took these steps, questions were raised about the response of the F.B.I. After the agency was notified about the envelope containing white powder on Sept. 25, it never analyzed the powder itself, nor did it attempt to take tissue samples from Ms. O'Connor, officials said. The test was prompted only after her doctors notified city health officials that they suspected she had anthrax.
"If there was a problem, it was in the way they first investigated it," a New York Police Department official said of the F.B.I.'s performance.
Mayor Rudolph W. Giuliani, meanwhile, found himself in a familiar role, seeking to calm a frightened and stressed city facing new threats.
"People should not overreact to this," he said during a news conference at NBC. "They should realize that, given all the events that have occurred, particularly Sept. 11 and the things after that, when we have situations like this, everybody wants to go the extra length, particularly all of the health agencies, to make sure that there are no problems."
On Thursday, the F.B.I. issued an urgent warning that the United States had received information that there may be additional terrorist attacks within the next several days. But the agency said it did not have information about specific targets. "I don't believe the statement yesterday specifically related to the situation that we're dealing with today," Mr. Giuliani said.
There were other scares at media companies yesterday. At the Los Angeles Times, the building was quarantined when a powder-like substance was discovered, but the authorities determined it was not anthrax. And at The Columbus Dispatch in Ohio, four employees were placed in quarantine after one found powder in a Halloween card. Tests showed that the powder was not toxic.
In New York, Gov. George E. Pataki announced several measures to improve the state's response to future incidents. The State Health Department, for example, will issue guidelines on how to handle suspect letters, and a toll-free number is being established to give guidance to health professionals. He promised new legislation to make acts of biological or chemical terrorism punishable by life in prison without possibility of parole.
Although investigators cannot say what if any connections the anthrax cases have to the terrorists who planned and carried out the Sept. 11 attacks, there are several geographic coincidences. The anthrax contamination in Boca Raton occurred within miles of some of the places where the suspected hijackers lived and took flying lessons earlier this year. At least two of the hijackers were known to have taken flight lessons in Venice, less than 60 miles to the south of St. Petersburg.
A spokesman for the F.B.I. said investigators in New York were speaking with investigators in Florida to determine whether there were any similarities with the anthrax discovered at the Boca Raton company, American Media, which publishes several major tabloids, including The National Enquirer.
Unlike the Florida cases, where the employees were found to have inhaled anthrax, Mr. Brokaw's assistant was diagnosed with cutaneous anthrax, a less dangerous form. Cutaneous anthrax, which is found on the skin, is easily treated with antibiotics. Ms. O'Connor was described by doctors as being in good health. She was being treated with antibiotics and was expected to make a full recovery, they said.
In a separate incident this week, a columnist at The St. Petersburg Times received a threatening letter on Wednesday that contained a powder substance. It, too, was mailed from St. Petersburg, and it was postmarked on Oct. 5, the same day as the letter received yesterday at The New York Times. The letter, written with an unsteady hand, mentioned Oklahoma City, officials at the paper said. The substance was later found to be harmless, Florida officials said.
The letter to The New York Times was sent to Judith Miller, a reporter who has written extensively about chemical and biological weapons. She is co-author with two other Times reporters of a new book, ''Germs: Biological Weapons and America's Secret War.'' (by Judith Miller, Stephen Engelberg, and William Broad.)
According to Ms. Miller, the letter "contained future threats against the United States." It mentioned the Sears Tower in Chicago and President Bush, she said.
NBC received its letter on Sept. 25., officials said. According to executives at NBC, who asked not to be identified, some of the powder -- described as resembling talcum -- landed on Ms. O'Connor when she handled the letter.
A second letter, received and opened the same day at NBC, contained a sandlike substance, an NBC executive said. Addressed to Mr. Brokaw, it, too, included a threatening note, although one NBC executive said it was not clear whether both letters had come from the same place.
Three NBC executives said the letters contained threats against Israel. The date of Sept. 11 was scrawled across the top of one.
The F.B.I. was alerted about both letters, a senior NBC official said.
Yesterday, however, law enforcement officials made no mention of a second letter containing sandlike material. It is not known whether the F.B.I. has subjected this material to any testing.
As for the envelope with white powder, Barry W. Mawn, the agency's assistant director, acknowledged that his agency did not test the powder. The delay happened, he said, because agents wanted to interview Ms. O'Connor first, but "the individual was unavailable."
He gave no further details, nor did he explain why other media organizations were not notified of the letter.
After handling the envelope, Ms. O'Connor developed a rash on her chest, health officials said. The rash worsened, her skin turned almost black, and she developed a low-grade fever. On Oct. 1, she visited a doctor, who immediately placed her on Cipro, an antibiotic that is effective in treating anthrax.
Samples from her skin were tested for anthrax, but at first, Mr. Giuliani said, test results were negative. The powder itself also tested negative, he said.
It was unclear yesterday how she became infected with anthrax. "I don't have the answer to that,'' Mr. Giuliani said. "The powder has been tested; the powder tested negative.''
According to health officials, her condition improved soon after she began taking antibiotics, but subsequently she developed a dark-colored sore on her chest. The Centers for Disease Control and Prevention conducted a biopsy on the sore, and samples were sent to the U.S Army Medical Research Institute of Infectious Diseases in Fort Detrick, Md.
Those tests detected anthrax, and the results were reported to Tommy Thompson, secretary for the federal Department of Health and Human Services, at 3:25 a.m. yesterday. Mr. Giuliani notified Robert C. Wright, the chairman of NBC, at about 9 a.m. yesterday, and NBC executives shut down ventilation systems on some floors at Rockefeller Center.
Across town, sometime between 9:30 a.m. and 10:30 a.m., Ms. Miller opened a plain white envelope that was addressed to her. Powder, white and smelling like talcum, fell out, landing on her face, hands and sweater, she said.
"What I thought you can't print," she said. "What I said you can't print."
Security officials were alerted and the newsroom was evacuated. Employees were allowed to return to the newsroom early yesterday afternoon after tests for radioactive and chemical substances were negative. Results from a third, more definitive test for anthrax DNA performed by state and federal laboratories were expected over the weekend.
State health authorities also tested 32 Times employees who worked near Ms. Miller, who, along with many of her colleagues, was taking antibiotics as a precaution.
Photos: Mayor Rudolph W. Giuliani after a news conference yesterday at NBC, where he tried to calm new fears that were raised by an anthrax case. (Reuters)(pg. A1); Above, a man was helped after leaving a tour of the NBC Building, which had an anthrax evacuation. Below, investigators prepared to enter the offices of The New York Times, where a suspicious letter was found. (Steffen A. Kaplan - The New York Times); (Peter Morgan/Reuters)(pg. B9)
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October 13, 2001, New York Times, FBI Did Not Test Letters to NBC Or Immediately Notify City Hall, by Jennifer Steinhauer and Jim Dwyer,
Even the Correction Needed a Correction.
Correction: October 14, 2001, Sunday A front-page article yesterday about the F.B.I.'s handling of suspicious material that figures in the anthrax investigation at NBC misstated the number of letters reported belatedly to New York City officials. (A comment based on that error also appears today in the Liberties column, on Page 13 of The Week in Review, which went to press before this section.) Only one letter was the subject of such a delay; the second was not initially known to the F.B.I. New details appear today on Page A1.
Correction: October 16, 2001, Tuesday A front-page article on Saturday about communications between the F.B.I. and other agencies in the anthrax investigation misstated the number of suspicious letters received at NBC News that were delayed at the bureau before being tested and reported to city officials. The article also misstated the length of the delay, and a correction in this space on Sunday dealt with the errors incompletely. (A comment in the Liberties column on the Op-Ed page on Sunday reflected both errors in some copies.) One letter -- postmarked Sept. 20 at St. Petersburg, Fla. -- was received at NBC on Sept. 25, turned over to the F.B.I. on Sept. 26 and tested on Oct. 1 by the New York City Health Department, which had learned of its existence from an NBC employee's private physician. Thus the delay in testing was five or six days, not "nearly two weeks," and it affected only one letter, not two. That letter tested negative for anthrax. A second letter -- postmarked Sept. 18 at Trenton, N.J. -- was received sometime between Sept. 19 and Sept. 25 at NBC but failed to arouse suspicion of anthrax contamination and was set aside there. The F.B.I. and the New York police both learned of it on Oct. 12, and on the 13th it tested positive for anthrax.
Although the F.B.I. was notified on Sept. 25 about suspicious letters sent to NBC, neither the letters, nor the powder residue inside them were tested until nearly two weeks later, and then only because a private doctor notified city public health officials about a troubling skin condition in the news assistant who had handled the mail, officials acknowledged yesterday.
In fact, the F.B.I. laboratory neither performed nor sought any tests on the powder or the skin samples taken from the employee, identified as Erin M. O'Connor, a 38-year-old assistant to Tom Brokaw.
"That, unfortunately, did not take place," said Barry W. Mawn, assistant director in charge of the F.B.I.'s New York office.
He also said the agents had intended to interview Ms. O'Connor soon after they learned of the case, but did not, for reasons he did not explain.
F.B.I. officials said investigators picked up the envelopes on Sept. 26, the day after NBC security officials called the agency. New York City officials were not informed of the preliminary inquiry until days later.
Indeed if the Health Department had not been alerted to the case by a private doctor, it might well have hibernated in the F.B.I. files.
Mr. Mawn said yesterday that the agency had to investigate dozens of threats, scares and false alarms, and that is how this case was initially treated. Since Sept. 11, when the two planes slammed into the World Trade Center, city and federal law enforcement officials have received hundreds of reports of menace and foul play ranging from bomb threats to chemical attack scares.
The discovery of a case of apparently deliberate anthrax poisoning in the heart of New York City is just the latest in a string of terrifying events that have challenged the law enforcement and health care infrastructure in the last month. It pushed health care officials to nail down a pathogen that most of them had no experience with.
And it once again tested the fragile relationship that has always existed between the New York City Police Department and the F.B.I., agencies that are forced to work in tandem on unprecedented and constantly evolving crimes.
"Information sharing between the F.B.I. and the N.Y.P.D. has always been poor," said one person who has worked closely with both agencies. "There is often a lack of willingness on the F.B.I.'s part to share information, although it is getting better. As they move forward, clearly the F.B.I. is going to have to be more forthcoming."
In this case, Mr. Mawn said, the gravity of the situation was not fully appreciated by the federal authorities until recently.
On Sept. 25., Ms. O'Connor handled a letter postmarked from St. Petersburg, Fla., filled with white powder, according to law enforcement officials. She also handled a second letter containing a sandy substance. Network officials, immediately suspicious, called the F.B.I., which picked up the letters the next day.
Then, the agency began to prepare a cover letter for its own laboratory indicating that the substances needed to be tested, but the letter was never completed and the evidence was never sent from the F.B.I.'s office in New York to its laboratory, said Joseph Valiquette, an F.B.I. spokesman.
He added that some delays happened because investigators were unable to interview Ms. O'Connor to supplement the cover letter. "We wanted to send a complete package to the laboratory," said Mr. Valiquette. So none of it was sent. Mr. Valiquette said he did not know why the F.B.I. could not speak with Ms. O'Connor, who works in Rockefeller Plaza and lives in the metropolitan area.
On Sept. 28, Ms. O'Connor developed a strange sore on her chest. Nervous, she went to see Dr. Richard Fried, a Manhattan infectious disease specialist, said Dr. Annetta Kimball, the doctor covering for Dr. Fried, who could not be reached last night.
Armed with the description of the rash — which she described as central scarring surrounded by a lot of swelling — the doctor likely consulted his textbooks to nail down what was going on. Dr. Kimball said that Dr. Fried suspected that his patient had been exposed to anthrax, and immediately prescribed Cipro.
"There is a good chance he had never seen anthrax before," said Dr. Kimball. "This is New York City, not an agricultural area." He also took cultures from a wound Ms. O'Connor developed, but those swabs were negative for anthrax, she said.
At some point, officials and Dr. Kimball said, the patient visited a dermatologist. One of those doctors notified the city's Health Department on Oct. 6 of a possible case of anthrax. The city has among the most sophisticated epidemiologists and public health labs in the country. Mr. Valiquette said that the F.B.I. learned from the city's Health Department that "this was an issue." The substance eventually made its way to the Centers for Disease Control and Prevention in Atlanta, which went to unusual lengths to identify it. There was little powder to work with, and a power failure in the lab halted the work for nearly a day, said Dr. James M. Hughes of the C.D.C.
"None of this ever did go to the F.B.I. lab," he said.
One of the Ms. O'Connor's doctors ordered a skin biopsy, which was sent to the C.D.C. But by the time the tissue was taken, the patient had begun taking an antibiotic to counter possible anthrax. As intended, that drug degraded the cellular structure of the bacteria. On Wednesday, (Oct. 10) the city was informed of the case under investigation. The C.D.C. was able to identify the spores of anthrax, and officials were informed of the results early yesterday morning.
Mayor Rudolph W. Giuliani announced the first confirmed case of anthrax yesterday morning at NBC. (Fri., Oct. 12)
He was described by a person who was with him early yesterday as being "three feet off the ground" when he learned that the F.B.I. had not brought word of the developments to city officials earlier.
Mr. Mawn acknowledged that investigators revisited the case after learning of the concerns of the health officials. "A second notification came through to the Department of Health, at which time the evidence response people and the F.B.I. also became involved with it. It was initially assigned to two agents that just covered the lead. And upon that, it was immediately submitted for tests. As you know and as the mayor has talked about, those tests were initially negative."
Yesterday, The New York Times received a letter filled with white powder that was addressed to a reporter, Judith Miller. The Times notified the mayor's office, and city and F.B.I. officials responded immediately. Tests for radioactive and chemical substances were negative, and results from a more definitive test for anthrax DNA by state and federal labs were expected over the weekend.
Coordinating the efforts of the various law enforcement and public health officials is proving tricky — there have been dozens of bomb and other threats around the city since Sept. 11, and the city, which investigates each case, cannot inform the public or other agencies about each one. Just yesterday, the city heard of about a half dozen cases of suspicious powder or envelopes that it is investigating, the mayor said.
"If there was a problem, it was in the way they first investigated it," one Police Department official said of the F.B.I.'s performance.
But there was some concern last night among health care experts about the delay in the testing. The inability of the agency to identify the substance was "not very comforting," said one C.D.C. official, who spoke on the condition of anonymity. "That is a little disappointing, to say the least."
Anthrax spores, if kept under appropriate conditions — sealed and unexposed to lots of light — can be preserved for years, said Jerome M. Hauer, the former director of the Office of Emergency Management and currently managing director of Kroll Inc., an investigation firm. He added: "You don't want them sitting around. In this environment, you hope there is good information sharing, especially when it involves biological agents."
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October 13, 2001, Washington Post, Fourth Case of Anthrax Is Identified; NBC Employee in N.Y. Tests Positive Weeks After Opening Letter from Fla., by Michael Powell and Ceci Connolly, Archived, diigo,
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October 14, 2001, New York Times, page B1, Anthrax Reports Widen, but No Link Is Found, by Eric Lipton, with Jim Rutenberg,
Officials in New York, Florida and Nevada reported new incidents or information involving anthrax yesterday, heightening concerns nationwide but demonstrating no links among the cases.
In New York, investigators announced that they had located the source of the anthrax that sickened one, and perhaps two, NBC employees at Rockefeller Center: a letter mailed to the television network from Trenton on Sept. 18.
That finding meant a sharp turn for an investigation that until yesterday had been focused on a separate set of three letters, all postmarked from St. Petersburg, Fla., and sent to NBC, to The New York Times and to The St. Petersburg Times. Tests on those letters have been negative, leading health officials in New York to all but dismiss the possibility that they posed a health threat.
"We're very confident that at this point we're ruling it out," New York City's health commissioner, Dr. Neal L. Cohen, said at an afternoon news conference with Mayor Rudolph W. Giuliani and officials from the federal government and NBC.
In Nevada, Gov. Kenny Guinn and other state officials said that tests had shown that pictures contained in a letter sent from Malaysia to a Microsoft office in Reno were contaminated with anthrax. Several people at the office may have come into contact with the letter, but no one has tested positive for exposure, officials said. [Page B2.]
In Florida, five more employees at American Media tested positive for anthrax exposure. Three employees of the Boca Raton publishing company had previously tested positive, including one who died. [Page B3.]
The New York Times reported yesterday that both letters sent to NBC, from Trenton and St. Petersburg, were turned over to the F.B.I. on Sept. 26.
But Barry W. Mawn, the assistant director in charge of the F.B.I.'s New York office, said yesterday that the bureau did not learn of the Trenton letter until Friday, when investigators went to the network's studios at 30 Rockefeller Plaza following confirmation that an assistant to the NBC anchor Tom Brokaw had tested positive for anthrax. They picked it up and turned it over to health officials who tested it and confirmed the presence of anthrax.
"Now we have identified the missing link, so to speak, the actual cause of the anthrax that created this whole situation," said NBC's chairman, Robert Wright. "So we are no longer dealing with an unknown time, date and place and that is very important."
Several people handled the Trenton letter when it was first received at NBC, perhaps as early as Sept. 19, including Mr. Brokaw's assistant, Erin M. O'Connor, and the woman who opened it, a clerical employee whom network and health officials would not identify. That woman, they said, has had a fever, a rash and swollen lymph nodes, symptoms consistent with anthrax exposure, and is being treated with antibiotics. Officials are awaiting results on a definitive exposure test, which should be available within the next day or two. Health officials said that like Ms. O'Connor, the woman was thought to have been exposed through her skin, not as a result of inhaling anthrax spores, and was expected to fully recover.
Officials at NBC have not been able to say definitively when the woman first opened the Trenton letter in the offices of NBC Nightly News on the third floor of 30 Rockefeller Plaza, only that it was between Sept. 19 and Sept. 25. The letter arrived in a white envelope with no return address. The president of NBC News, Neal Shapiro, said that when the clerical employee opened it, a brown granular substance fell out. The woman brushed much of the sandlike material into a trash can near her desk, he said, and the letter was eventually placed in another envelope and added to a stash of hate mail that the company collects and occasionally forwards to authorities. It is unclear when Ms. O'Connor came into contact with the Trenton letter, or if she was initially told of the substance that had fallen from the envelope.
Other than a small group of people who handled that letter, estimated at no more than half a dozen, health officials said yesterday that there appeared to be very little risk to other NBC employees and that they thought there was no remaining danger of infection at the building.
To ensure that no else has been exposed or infected, more than 400 NBC employees who had visited the NBC Nightly News offices around the time the letters were received have been tested, but the results of those tests were not yet available. Yesterday, NBC employees continued to line up at the network's offices to get the tests, which now are being recommended for anyone who may have been in the area between Sept. 19 and Sept. 25.
Last night, NBC News broadcast its evening news from the Today Show studio across the street from 30 Rockefeller Plaza, as employees were still being kept away from the ''NBC Nightly News'' offices.
"The public health risks associated with that building right now are minimum, and pretty close to negligible," said Stephen M. Ostroff, chief epidemiologist at the federal Centers for Disease Control and Prevention. "So people who work in that building, spend time in that building, should go about their business."
Health officials were awaiting a final round of tests on the letter sent to The New York Times, which was received Friday morning by Judith Miller, a reporter who covers bioterrorism. After opening that letter, which had been sent from St. Petersburg, a white powder dusted Ms. Miller's face, hands and sweater. But Dr. Cohen said he was very confident that these final tests would also come back negative, meaning that none of the letters sent from St. Petersburg are contaminated.
Since the first case of anthrax was confirmed in Florida earlier this month, dozens of reports of other possible cases have spawned investigations.
Many reports, though, turned out to be false.
Yesterday, passengers who had flown from Chicago were temporarily detained aboard their United Airlines jet after landing in San Jose when a passenger reported that a man had stood up in mid-flight and released a powdery substance from an envelope.
Fire department personnel boarded the plane, took the man off, stripped him of his clothing, washed him down with detergent and dressed him in a hazardous materials suit that prevents vapors from passing out of it. The substance turned out to be confetti that spilled out of a greeting card.
A suspicious powder at a post office in Parker, Colo., turned out to be pudding mix.
As reports of anthrax findings continued to spread, Tommy G. Thompson, the secretary for health and human services, convened a conference call yesterday with federal health leaders and public health directors around the country.
One person who participated, Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, described it as "an information-sharing update call," and said while such calls have occurred in the past, this is the first time he can remember that a cabinet official participated.
"The real number of letters with anthrax could continue; we don't know how long that will happen," he said. "The bigger risk right now to the system are the hoax letters in terms of just choking the system up."
Work has already started in New Jersey to try to determine the source of the anthrax sent to NBC. But an F.B.I. official there said that the Trenton postmark means that the letter could have come from a wide section of central New Jersey, since there is a regional postal center in Trenton.
"There are over 100 different collection boxes or post offices it could have come from," said Sandra Carroll, an F.B.I. spokeswoman.
Photo: Members of an F.B.I. team wore biohazard gear yesterday at the Florida building where anthrax was found. (Luis M. Alvarez/Associated Press)
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October 14 2001, Associated Press, Letter Sent to NBC Contained Anthrax,
NEW YORK (AP) -- A threatening letter mailed to Tom Brokaw from New Jersey one week after the Sept. 11 terrorist attacks contained the anthrax that infected the NBC news anchor's assistant, authorities said Saturday.
In Florida, five more newspaper employees tested positive for exposure to anthrax, but none showed symptoms of infection. And in Nevada, a letter sent to a Microsoft office also tested positive for the bacteria.
A second NBC employee had possible symptoms of anthrax, including a low-grade fever, swollen lymph nodes and a rash, health officials said.
The employee, who was not identified, was taking antibiotics, said Neal Shapiro, the network's news president. "She's fine,'' he said.
The NBC letter, postmarked Sept. 18 in Trenton, N.J., tested positive for anthrax, Mayor Rudolph Giuliani said. Initially, authorities believed a Sept. 20 letter sent from Florida might have carried the bacteria.
In Nevada, Gov. Kenny Guinn said a third anthrax test on a letter sent from Malaysia to a Microsoft office in Reno came back positive, but added that the risk to public health was ``very, very low.''
The anthrax scare began last week when a photo editor for The Sun supermarket tabloid in Boca Raton, Fla., died of the inhaled form of the bacteria, the first anthrax death in the United States in 25 years. The American Media Inc. building where Bob Stevens worked was sealed off after anthrax was found on his keyboard.
Two other employees turned out to have anthrax in their nasal passages, but neither has developed the disease. Both are taking antibiotics, and one has returned to work.
The company was notified Saturday by the Centers for Disease Control and Prevention that five employees had shown antibodies of anthrax in their blood, according to Gerald McKelvey, a spokesman for American Media.
"It means they had an exposure,'' he said. ``It doesn't mean they have anthrax.''
CDC spokeswoman Lisa Swenarski in Atlanta couldn't confirm the five employees had been exposed because testing was not complete. She said it would be another week before final results were in.
"The health department did advise individuals down there on preliminary results, which don't mean a whole lot,'' she said.
None of the five were sick or in the hospital, said Michael Kahane, the company's general counsel.
Health officials had been waiting for results of more than 35 anthrax tests checking employees and visitors to the company's headquarters, which investigators in white moon suits continued to search Saturday. About 20 postal employees who handled the company's mail were also awaiting test results.
On Friday, the FBI agent said test results of 965 people who were in the building recently found no new infections.
Investigators also were searching in St. Petersburg, Fla., for the origin of a letter containing a mysterious powder that made its way to NBC's New York newsroom, where Erin O'Connor, 38, was infected with the less aggressive anthrax of the skin.
It was initially believed that letter, received Sept. 25, could have infected O'Connor, but it subsequently tested negative for anthrax. Authorities said Saturday that the Sept. 18 New Jersey letter had tested positive for the bacteria.
The earlier letter was found at the network's Manhattan headquarters when city police and FBI officials searched the offices, said Barry Mawn, head of the FBI's New York office.
The anonymous letter, which bore no return address, contained an unspecified threat and a brown granular substance, Mawn said. Most of it was thrown away, but the letter -- one of several threatening ones the network received since the attacks -- was retained, he said.
The FBI could not immediately pinpoint where the letter was dropped because Trenton is a regional processing center for southern and central New Jersey, said Special Agent Sandra Carroll, a spokeswoman for the FBI's Newark office.
"There's over 100 different collection boxes or post offices it could have come from,'' Carroll said. FBI agents were interviewing mail carriers in Trenton on Saturday as part of a joint investigation with postal inspectors, she said.
In Florida, the FBI's hazardous materials team also tested various St. Petersburg post offices for anthrax, said Linda Walker, an inspector with the U.S. Postal Inspection Service in Tampa.
Officials stressed the NBC case was an isolated one. They also said there was no known link to the Sept. 11 attacks on the World Trade Center and the Pentagon or the far more serious inhaled form that killed the editor in Florida.
Still, spooked New Yorkers scurried to emergency rooms and pharmacies for anthrax tests and prescriptions for the antibiotic Cipro. Some drugstores ran out, or limited the amounts they would sell to customers.
At the Hilltop Pharmacy, a sign warned customers they could get only a five-day supply of 10 Cipro pills.
"We're filling it right now about 75 times more than usual,'' pharmacist Amy Sidney said.
A letter containing powder also was sent to The New York Times, but the newspaper said Saturday that the white substance in the envelope received by reporter Judith Miller -- who co-wrote a recent best seller on bioterrorism -- tested negative for anthrax.
Results from additional tests by the CDC were not expected until Tuesday, Times spokeswoman Catherine Mathis said.
Miller and about 30 co-workers in the area when the envelope was opened are taking antibiotics, and results of their anthrax tests will be released Monday, the newspaper said.
In Nevada, four Microsoft employees have been tested to date, with the results expected Monday or Tuesday, company spokesman Matt Pilla said.
"If the CDC results are positive for a disease-causing strain, there's still a very low risk for anyone outside the four who had direct contact with the envelope,'' Pilla said.
In Malaysia, federal police spokesman Benjamin Hasbie said authorities had begun investigating the matter, but they are waiting for U.S. intelligence through official channels.
"We realize that this is a serious thing,'' Hasbie told The Associated Press. "We are looking into this. We can give our fullest cooperation, but we need solid evidence to step up our investigation.''
An envelope with a powdery substance on the outside was found in the mail at CBS News' Washington bureau Saturday. The envelope was turned over to the FBI, and tests were negative for anthrax, CBS News spokeswoman Sandy Genelius said.
© 2001 Associated Press
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October 15, 2001, New York Times, Missteps Cited In Responding To NBC Scare, by Eric Lipton,
A New York City police detective and two Health Department lab technicians who were involved in the investigation of the NBC anthrax scare have tested positive for exposure to anthrax, Mayor Rudolph W. Giuliani announced yesterday. The findings led the city to alter how it responds to incidents that could involve such exposure.
The mayor, at an early afternoon news conference, was quick to say that neither the officer nor the technicians, whom he did not identify, were suffering from the flulike symptoms or skin rashes that characterize anthrax. Instead, he said, initial tests detected a very minute amount of anthrax spores in their nasal passages or on their skin.
Health Commissioner Neal L. Cohen said that the exposure presented "zero risk" to the three and that they had been given antibiotics as a precaution.
But the new exposure cases highlighted what city and federal officials have said were flaws in their initial response to the city's first confirmed bioterrorism case, which centered on two letters sent to NBC in September. One, from Trenton, was postmarked Sept. 18; the other, from St. Petersburg, Fla., Sept. 20.
The missteps listed by government officials touched a number of agencies: on Friday, a police detective who responded to the NBC office improperly handled the Trenton letter, which contained a brown sandlike substance later found to include anthrax spores; protective gear worn by the lab technicians testing the letter was not secure enough to prevent exposure; and Health Department and federal law enforcement officials were too slow to tell the mayor's office and the New York Police Department of the potential threat at NBC.
"What we're going to do is as we learn these things, we're going to move forward, recreate our procedures, do things differently," Mr. Giuliani said as he was flanked by Dr. Cohen, Police Commissioner Bernard B. Kerik and Richard Sheirer, the director of the city's Office of Emergency Management. "It's like three weeks ago if I got an envelope like this I would have passed it around to seven or eight people or 10 people. I wouldn't have known the difference. Now you know that you shouldn't." All the city officials expressed relief that despite more than 100 additional reports of possible biohazard incidents over the weekend, none were substantiated. Also, all four or five people exposed to anthrax or infected with it as part of the NBC case are expected to recover fully. Health Department officials objected to any suggestion that they did not notify the mayor's office about the NBC case quickly enough.
The inquiry into the origin of the contaminated letter sent to NBC from Trenton accelerated yesterday, with federal and local investigators trying to narrow the list of post offices it could have passed through and starting to examine videotapes from those offices in the hope that the sender did not use a mailbox.
The letter, which arrived at the NBC Nightly News office between Sept. 19 and Sept. 25, bore no return address. Yesterday, details of what happened between the letter's arrival at NBC and its retrieval on Friday by the F.B.I. and city police became clearer, based on interviews with officials at NBC, the mayor's office and the Health Department.
The NBC News staff member who received and opened the letter, and who has not been identified, swept most of the granular material into a trash can and placed the letter into a pile or file where hate mail received by the Nightly News's staff is routinely collected.
Not until Sept. 25, when the letter from St. Petersburg arrived bearing a white powdery substance, did NBC officials call the F.B.I. Federal investigators arrived the next day to collect it, but were not told about the Trenton letter.
City officials did not learn about either letter until Oct. 1, when a doctor who had been visited that same day by Erin M. O'Connor, an assistant to the NBC news anchor Tom Brokaw, called the Health Department to say that he suspected Ms. O'Connor was suffering from anthrax. The doctor also told the Health Department that Ms. O'Connor had handled the St. Petersburg letter and that it had been given to the F.B.I. Investigators say they believe that Ms. O'Connor also handled the Trenton letter, but do not know when.
The department got the letter from the F.B.I and within two days completed tests that showed no evidence of anthrax. Thus, city health officials said, they decided not to notify the mayor's office.
And the F.B.I. said that its New York office, busy investigating dozens of terrorist threats and scares, did nothing else with the envelope.
Last Tuesday, Ms. O'Connor, concerned that she had developed a dark sore on her chest, visited another doctor who took a skin biopsy, and with the Health Department's knowledge, sent the tissue sample to federal health officials for testing.
Coincidentally, about the same time, the NBC employee who had originally opened the Trenton letter remembered that she had put it aside and decided to alert NBC security. Company security sealed the Trenton letter in an envelope or plastic bag and moved it from the third floor to a security office elsewhere at 30 Rockefeller Plaza.
Last Friday, when Ms. O'Connor's skin sample tested positive for anthrax, the city police and F.B.I. were sent to NBC, where they first learned about the Trenton letter.
The unidentified NBC aide who opened the Trenton letter later developed symptoms including a rash and fever, but infection with anthrax has not been confirmed, health officials said yesterday.
A city detective at the NBC office, who was not wearing gloves or other protective gear, opened the envelope or plastic bag and examined the letter. As he did so, he was apparently exposed to a small amount of anthrax. The letter was taken to a Health Department laboratory, where the two technicians quickly determined the presence of anthrax.
Although the technicians were wearing gowns, masks and gloves, they, too, were exposed to the bacilli. Yesterday, Dr. John Kornblum, chief of the Health Department's molecular testing laboratory, said that their masks may not have been properly secured, or perhaps there were gaps in their gowns. "If you're smiling, maybe there's a little crease" in the face mask, he said.
City officials said yesterday that a variety of steps would be taken to avoid similar mistakes. "In hindsight," one police official said, "no one is going to disagree that there should have been more precautions."
Beginning immediately, a firefighter specially trained in hazardous materials and two police officers — all equipped with masks and gloves — will respond to initial, seemingly minor reports of possible biological or chemical threats.
Staff members who handle material brought to the Health Department for anthrax testing will work with the material only after it is placed in a sealed glove box, or they must wear protective gear that completely covers their face and shoulders. "We don't want to go to the space suits because it's just a little too cumbersome to work in the laboratory and it's a little too impractical," Dr. Kornblum said.
The Health Department will also notify the mayor's office of any possibly credible biohazard case, even one that has not been confirmed, said Mr. Sheirer, the director of the Office of Emergency Management. And officials said the F.B.I. had recommitted to immediately telling the Police Department, as it is routinely supposed to do, of any report of a possible biohazard case. "Even if it is nothing, we would rather know about it," Mr. Sheirer said yesterday.
NBC officials said they were not sure when they would be able to reoccupy the Nightly News offices or broadcast again from the regular studio.
As he has done for a month now, Mr. Giuliani urged New Yorkers to live their lives normally and not be intimidated by terrorists.
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October 15, 2001, ABC News, Brokaw May Have Been Exposed to Anthrax, diigo,_________________________________________________________________________________
October 16, 2001, New York Times, C.D.C. Team Tackles Anthrax, by Lawrence K. Altman, M.D.
Fifty years ago, the federal government set up an elite corps of medical detectives to counter a threat it hoped never to face. Now, with the emergence of anthrax, that corps, the Epidemic Intelligence Service, is facing the challenge of that mission: tracing the cause and stemming the spread of a disease that that may have been deliberately introduced -- in other words, a biological attack.
Summoned to action immediately after the destruction of the World Trade Center on Sept. 11, the Epidemic Intelligence Service has been working with the F.B.I. and state and local health departments to conduct its effort on two fronts.
One is directed at detecting any communicable agent that might have been released. After anthrax was detected in Florida, the epidemic service, which is based at the Centers for Disease Control and Prevention in Atlanta, set out to determine how the patient contracted the disease. The information is crucial in assessing the potential harm to other people.
The second front is informing the public of the anthrax cases, the steps the C.D.C. is taking to combat the threat to public health, and what people can do.
Much of the detection effort went well, though there were disturbing glitches like a power failure at the C.D.C. that delayed the detection of anthrax in an NBC employee in Manhattan. (The failure was caused by a short in a cable that was awaiting repairs.)
But there is ample evidence of distressing lapses in communication with the public that, if the illness had been more widespread, could have made the bad situation even worse.
The lapses were not entirely the fault of the C.D.C., which is the federal agency charged with controlling communicable diseases in this country and coordinating an early warning system for bioterrorism. The lapses underscore the need for the government to heed the advice of the epidemic service's first director, Dr. Alexander D. Langmuir. He advocated a system to monitor disease and rapidly disseminate information, as a prime defense against biological warfare.
But many experts have criticized the C.D.C. for remaining largely silent about the anthrax threat instead of providing more detailed information sooner to people who may have been exposed as well as to doctors and the public.
C.D.C. spokesmen have said they were restricted in disclosing information because of provisions of the Federal Emergency Response Act and because the F.B.I. was conducting a criminal investigation.
That was so, said the C.D.C. director, Dr. Jeffrey P. Koplan, even though the centers and the F.B.I. are conducting parallel public health and criminal investigations, and the centers are not under the bureau's direction. "If anything, we are under the direction of the Florida state health department, with whom we are there assisting," Dr. Koplan said in an interview.
The only other known bioterrorism act the epidemic service ever investigated was in 1984 in Oregon, where followers of Bhagwan Shree Rajneesh deliberately contaminated restaurant salad bars, leading to 751 cases of salmonella poisoning. That case was hardly a model of timely communication of health threats to the public. The C.D.C. delayed publishing a scientific report of the outbreak for 13 years, saying it did not want to aid in creating copycat episodes.
On Oct. 4, when Tommy G. Thompson, the secretary of health and human services (the C.D.C.'s parent agency), disclosed the first anthrax case, he said it appeared to be an isolated case in Florida, possibly linked to natural exposure to anthrax in the environment.
Last week, when the most pressing health problem was the degree to which the country was vulnerable to anthrax, the C.D.C.'s Morbidity and Mortality Weekly Report, the bulletin that doctors and health workers look to for information about communicable diseases, devoted only two paragraphs to the anthrax situation, providing only sketchy details of the first two cases and a description of anthrax symptoms.
As a former editor of the report, I know that it can quickly transmit needed health information. But this time, its current editor, Dr. John W. Ward, said the report "was out of the loop." Even the little that the bulletin was able to publish "was an achievement," he said.
At times, C.D.C. spokesmen have issued puzzling statements and have said they did not have access to information about developments in New York and Florida. In response to my questions, they have asked me to explain the science, saying they did not understand it or had not been informed.
Underlying the silence is a mind-set that has developed in recent years among scientists who have become accustomed to obeying embargoes imposed by journals that prohibit public discussion about scientific findings until publication. Even though journals waive embargoes for information of an urgent public health nature, some researchers still hesitate to discuss their work, for fear that the journals will then refuse to publish it.
In this vacuum, journalists and the outside experts they consulted could only speculate about what might be going on. The resulting news reports were often conflicting and occasionally inaccurate.
Communication from the C.D.C. is particularly important because anthrax in humans is rare in this country, with just 236 cases of all types reported between 1955 and 1999. Most doctors have never seen a case, and look to the C.D.C. for guidance.
Anthrax is one of the most difficult infections to trace and has often challenged the ingenuity of medical detectives in past generations who sought the source of cases.
For instance, anthrax cases among World War I aviators were traced to a natural source, helmets lined with wool from infected sheep. And when a man developed cutaneous anthrax in Philadelphia years ago, epidemiologists learned its source only after they tore apart his newly purchased wool coat and found Bacillus anthracis in one sleeve.
When Florida health officials called the C.D.C. to report that Robert Stevens, 63, had apparently developed inhalation anthrax, the centers deployed 15 epidemiologists and other scientists. In confirming the case and seeking its source, the Epidemic Intelligence Service has relied on traditional Sherlock Holmes-style sleuthing and the skills of colleagues in the laboratory, who use the latest genetic and other laboratory tests, Dr. Koplan said.
Mr. Stevens had traveled with his wife to visit a daughter and go hiking in North Carolina, but became ill on the drive back to Florida.
So while some epidemiologists examined Mr. Stevens and talked with his doctors about the evolution of his symptoms, others fanned across Florida and North Carolina, joining colleagues from those states seeking clues to where he might have acquired the illness.
In the investigation's initial stages, the epidemiologists could assume nothing, and the patient himself was unable to communicate -- he was in a coma when he arrived at the hospital in Atlantis, Fla., and died without regaining consciousness. So health workers had to interview his wife and family to reconstruct what he did during the preceding two weeks. Where did the Stevenses stop, eat and sleep on the trip? Was he exposed to a sick animal? Goat hair?
Mr. Stevens worked as a photo editor for The Sun, a tabloid sold in supermarkets and published by American Media Inc. in Boca Raton, Fla. Epidemiologists went there and to his home in nearby Lantana, where they asked what Mr. Stevens did in his spare time. Did he garden? Did he spent a lot of time outdoors? If so, where? With whom? They also collected samples of dust, soil and vents seeking a possible source of anthrax-contaminated materials.
While these investigators focused on possible natural causes, others looked at the more ominous possibility: that Mr. Stevens was the victim of an organized anthrax attack. They visited all hospitals in the area to talk with infection-control workers and other doctors, reviewing medical, microbiology and X-ray records of patients treated for meningitis, severe respiratory failure, septicemia, unexplained fevers and diseases like tularemia that can produce symptoms similar to those of anthrax. Might any have been been anthrax, but misidentified as something else?
Inhalation anthrax produces swollen lymph nodes in the mediastinum, an area between the back of the lungs and the spine. The swelling can show up on an X-ray. Did a radiologist miss the finding?
In all their work, the epidemiologists "found nothing that was suspicious," said Dr. James M. Hughes, a top C.D.C. expert who oversaw the investigation from Atlanta.
Mr. Stevens's co-workers were given a phone number to call if they developed any symptoms. Epidemiologists also set up a system to monitor any unexplained pulmonary illness in hospitals serving the area.
Meanwhile, C.D.C. workers sought advice from Dr. Philip S. Brachman, an expert in anthrax epidemiology and a former director of the Epidemic Intelligence Service who now works at the Emory School of Public Health, next to the centers' campus.
Dr. Brachman said he reviewed his records from his days as an officer with the epidemic service in the late 1950's and early 1960's, when he investigated anthrax cases that developed among workers exposed to contaminated goat hair and wool at three mills in North Carolina and one in South Carolina.
The mills are now closed, but given how long anthrax spores can live in the environment, Dr. Brachman wondered if Mr. Stevens could have contracted the disease in one of the cities where the mills had been. Had the mills been renovated for a new use? Was one a motel? If so, had Mr. Stevens stayed there?
But when Dr. Brachman asked the epidemic service officers these questions, he was frustrated. "They say, 'We cannot say,'" Dr. Brachman said. "They have strict orders."
Dr. Brachman is among the health leaders who have criticized the C.D.C. for not making an investigator regularly available to reporters. He said: "The media is an extremely important part of the public health team in providing education. If you turn them off, what is the media going to do?"
On Oct. 7, the investigation took a new twist when anthrax was identified in a swab of Mr. Stevens's co-worker Ernesto Blanco, 73. Because anthrax is not contagious, the finding immediately heightened suspicions of a bioterrorist attack.
Mr. Blanco developed a fever, severe pneumonia involving at least two lobes of his lungs, and bloody fluid in the pleural lining. He needed a mechanical respirator to help him breathe. B. anthracis has not been identified in cultures of the fluid and sputum. His symptoms are atypical for inhalation anthrax, and there may be no way of knowing if his symptoms were caused by anthrax, Dr. Hughes said. Blood tests taken over the next few weeks to detect antibodies to anthrax and other infectious agents may help clarify the diagnosis. Meanwhile, Mr. Blanco is recovering.
Epidemiologists talked to Mr. Blanco to learn everything he did for the preceding two to three weeks. Was he an avid gardener like Mr. Stevens? Did they share a garden plot? Had they bought fertilizer or bone meal from the same distributor? What, if anything, did Mr. Blanco and Mr. Stevens do together outside work?
Because Mr. Stevens and Mr. Blanco were co-workers, epidemiologists asked about recent construction or renovation at American Media. Could someone have dug up soil that contained spores from a cow that died of anthrax many years ago?
They swabbed dust in cracks, under the desks and from ventilation ducts and filters. Anthrax spores were found on Mr. Stevens's keyboard. Spores also were detected in samples from work surfaces in the mailroom at American Media, the C.D.C. said.
The exercise was repeated several times, after anthrax was identified in other people.
Anthrax was cultured from the nose of Stephanie Dailey, 36, who worked with Mr. Blanco in the mailroom. Then attention turned to New York City when Erin M. O'Connor, an assistant to Tom Brokaw at NBC headquarters, developed cutaneous anthrax after opening two envelopes, one containing powder and the other a granular substance.
The initial skin lesions from anthrax can resemble an insect bite, and a doctor who examined Ms. O'Connor initially thought she might have been bitten by a brown recluse spider, Dr. Hughes said. Luckily, however, an infectious disease specialist who had worked in areas of the world where anthrax is endemic suspected it was the cause of the sore on her skin and a dermatologist then took a biopsy of the lesions and sent a sample to the C.D.C.
Special staining and immunologic tests performed at the centers identified anthrax as the cause of the skin lesion, but the organisms have not grown in the laboratory, presumably because the antibiotics Ms. O'Connor had already been taking destroyed them, Dr. Hughes said.
Tests on Ms. O'Connor's biopsy were among thousands of others that C.D.C. and state and local health laboratories have performed in the search for the source of the anthrax.
Cultures from swabs of noses and environmental sources may grow several microbes. So scientists may have to repeat the tests before they can confirm anthrax. Newer laboratory techniques based on DNA, like the polymerase chain reaction, have allowed more rapid detection of microbes. But such successes have also created overly optimistic expectations. When it is necessary to grow microbes in the laboratory, the process cannot be speeded up, Dr. Koplan said.
In recent years, many public health leaders have warned that the country was ill prepared to detect anthrax and other diseases that only a few American doctors have seen. Yet the quick detection of anthrax in New York and Florida suggests that doctors may be better prepared than expected to respond to the threat, Dr. Koplan said.
Dr. Martin E. Hugh-Jones, an anthrax expert at Louisiana State University, said: "Official agencies have learned they must talk to each other. We've for years been trying to get doctors to understand what to look for. Now everyone knows."
Photos:
Employees of American Media waited to be tested for anthrax exposure last week in Delray Beach, Fla., after an infected co-worker died. (Gary I. Rothstein for The New York Times)(pg. F7);
Dr. Alexander D. Langmuir, the first director of the Epidemic Intelligence Service of the Centers for Disease Control, helped establish guidelines for tracking outbreaks. But he also emphasized communicating the results to the public. (Associated Press);
To determine the source of an outbreak, investigators take samples from the environment. These health workers are removing materials from the office where Mr. Stevens worked. (Agence France-Presse);
In some cases, medical sleuths work in concert with law enforcement officials. A firefighter, right, decontaminates an investigator from the F.B.I. (Agence France-Presse);
Dr. John Agwunobi answers questions about the investigation in Palm Beach County at a press conference. Some experts say too few public health officials have been willing to talk to the press.; Bacillus anthracis (Photo Researchers); (Associated Press)
(pg. F1) Chart: "The Hunt for Clues" On Oct. 4, doctors determined that Robert Stevens of Lantana, Fla., had contracted inhalation anthrax. Concerned about the possibility of bioterrorism, health officials from federal, state and local agencies embarked on a standard series of steps to pinpoint the source of the anthrax.
THE PATIENT Send epidemiologists to trace evolution of patient's illness by talking with doctors, patient and family. In the Stevens case, the Centers for Disease Control and Prevention dispatched 15 investigators to Florida and to North Carolina, where Mr. Stevens had been visiting his daughter.
THE TIMELINE Reconstruct patient's travel, work and leisure activities over the likely period of incubation. The normal incubation for inhalation anthrax is one to seven days; the C.D.C. retraced Mr. Stevens's previous two weeks.
THE ENVIRONMENT Collect samples of air, dust and objects from home, workplace and other areas patient visited. Anthrax spores were found on Mr. Stevens's keyboard at work.
THE HOSPITALS Canvass doctors, hospitals and local health authorities for similar cases that may have been misdiagnosed, and set up system to report any new cases. A co-worker is found to have anthrax spores in his nose.
THE HYPOTHESIS Construct theories based on information collected and results of laboratory tests. In the Florida case, the C.D.C. says evidence supports the hypothesis that the anthrax was introduced through the mail. (pg. F1)
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October 17, 2001, New York Times, On a Day of Jitters, City and F.B.I. Differ Over Anthrax Sweep at ABC, by Eric Lipton,
The inspection of ABC News offices for traces of anthrax was delayed yesterday as federal investigators and New York City officials disagreed over just how extensive the survey needed to be to ensure that the hundreds of workers at the West 66th Street building were not at risk, network executives said.
The Federal Bureau of Investigation had argued for a much more extensive survey, the executives said, alarmed perhaps after federal investigators in Washington learned that the anthrax spores discovered at Capitol Hill on Monday were extremely refined and potent.
But city officials have insisted that there is probably little danger at the offices now, two weeks after the 7-month-old son of an "ABC World News Tonight" producer fell ill, because no adults have shown obvious signs of infection since then. Dragging out the process longer would only add to the public's fear, they argued.
Citywide yesterday, police dispatchers continued to field calls about suspicious packages, with a total of about 120 by the end of the day. Thirty-one packages were picked up for analysis by health officials. The Postal Service, meanwhile, announced that it would send a card to all households in the United States to outline procedures for handling suspicious packages.
At Bloomberg News's New York office, an employee found a suspicious-looking envelope. The area was evacuated and the employee was sent to a hospital for tests, along with others who may have come into contact with the envelope. The company also temporarily suspended all mailroom operations.
At ABC, after hours of hand-wringing and rising tempers among the network's executives, Mayor Rudolph W. Giuliani, according to the executives, took an extraordinary step: he had the city police take over the inspection task from the F.B.I.
"The mayor assures me this shift will speed things up considerably," said an internal ABC e-mail message sent yesterday afternoon by David Westin, the ABC News president, to other top network executives.
Thomas Antenen, the deputy police commissioner for public information, said there was not, in fact, a rift, but "a discussion of different approaches, and ultimately they agreed upon a plan together."
By the end of the day, after inquiries from reporters about the rift, Mr. Giuliani and Barry W. Mawn, the assistant F.B.I. director in charge of the bureau's New York office, held a joint news conference at which they talked about how well they were working together.
"This is also a cooperative effort," Mr. Mawn said. "It's been together for 20 years; we expect it to be together for the next 20 years. It is going very well."
The mayor said, "Everybody is performing their roles."
But by last night, the complications were still playing out.
While testing anthrax bacteria samples collected from "NBC Nightly News" offices last week, the City Health Department accidentally contaminated one of its laboratories, and two of its technicians were exposed to the bacteria. For that reason, the city laboratory could not be used to test the samples from the air within the ABC building and from surfaces in the mailroom and areas where the infant was on Sept. 28. Many of the samples had to be sent by helicopter to a state lab for testing.
But when the material arrived there, it was not immediately accepted, as the lab insisted that the ABC material had to be reconfigured to deal with the possibility of contamination, a network official said.
"It was the gang that couldn't shoot straight all day long," the ABC executive said.
But one city official, while confirming the basics of the account, added, "I think it's kind of exaggerated."
Despite the complications, there was some real progress yesterday. More than 200 employees at ABC News were interviewed, and others who came into contact with the infant were being asked to submit to interviews today. Health officials last evening were also planning to test about 100 employees who had been in the offices on Sept. 28. But as of last evening, there was still no word as to what might have been the source of the anthrax bacteria that the authorities suspect infected the child during his visit to the ABC offices.
Over at NBC, where a contaminated letter was found on Friday, there was some good news: the woman who opened the letter, which was mailed from Trenton on Sept. 18, and who then brushed a granular substance into the trash, was not infected. City officials said last week that the woman, who has not been identified, had symptoms suggesting that she had anthrax of the skin. More than 1,000 NBC employees have been tested, but as of yesterday only one, Erin M. O'Connor, an aide to the anchor Tom Brokaw, had tested positive, and she is expected to fully recover from her skin infection.
Executives at NBC and ABC News tried to soothe their jittery employees yesterday as they raised questions about the networks' response to the cases of anthrax reported in the last week.
Numerous NBC staff members questioned why the company's security office did not move more quickly to turn over the envelope containing the anthrax spores to law enforcement officials. Yesterday, Andrew Lack, president of NBC News, sent a memo to staff addressing questions about the company's response to the anthrax cases.
"I want to take a moment to address a question I have heard from a few of you," Mr. Lack said, according to an employee who read the memo aloud. "The question is: 'If NBC is really concerned about our health or safety, why didn't we receive any alert or words of warning when the suspicious letter was received?' We are all of us Monday-morning quarterbacking at this point -- and that is a good thing to do."
He explained that until Friday, when the aide to Mr. Brokaw was found to be infected, the network had no confirmation that anthrax bacteria might be present at the offices.
Photos: News crews were gathered outside ABC's offices on West 66th Street in Manhattan yesterday after a producer's son was found to have anthrax. (Suzanne DeChillo/The New York Times); Mayor Rudolph W. Giuliani and Dr. Neal L. Cohen, the city health commissioner, yesterday before they gave an update on anthrax cases. (Associated Press)
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October 18, 2001, New York Times, Pataki Quits Manhattan Office After Anthrax Is Found, by Eric Lipton,
Gov. George E. Pataki and his staff evacuated his Midtown Manhattan office yesterday and immediately began taking antibiotics after preliminary tests found anthrax spores in an area within his office where his state police security detail is based.
There was no immediate explanation for the possible origin of the contamination and no one has been diagnosed as having been infected or exposed, although testing of at least some of the 75 workers on the 38th and 39th floors of the state offices at 633 Third Avenue is under way.
"We are going to continue to run the state government from here and run it well," Mr. Pataki said during a news conference at the Jacob K. Javits Convention Center, where the office has temporarily been relocated.
A letter that the governor's secretary in Manhattan opened late last month had initially been suspected as a source of the bacteria. But as of yesterday, investigators had all but ruled out this letter, even though they reluctantly acknowledged that they were not sure where it was.
Given the small levels of anthrax found, Bernard B. Kerik, the city police commissioner, said it is "very possible" that state police accidentally carried anthrax spores back to their office after recently escorting the governor to ABC and NBC news offices, where the bacteria has been found or was suspected to be present.
The developments in Washington and the governor's office inspired broadened testing of major government facilities throughout the state. The Capitol, City Hall, the city's police and fire department headquarters, and other government offices were all to undergo tests.
"We're doing mail rooms, we're doing places and desks where we feel mail may come into those buildings or offices," Mr. Kerik said. "It's strictly precautionary."
The state police officers assigned to the office where the anthrax spores were found are also being tested for exposure. But Mr. Pataki said he has no plans to be tested.
"I don't believe it is necessary," the governor said. "I honestly believe that the likelihood of any contamination is very slim."
At NBC News, where the first city anthrax infection case surfaced last Friday, executives announced that results on 850 of the 1,304 people tested were complete and all were negative. There is still only one confirmed positive case, Erin M. O'Connor, an aide to the news anchor Tom Brokaw.
Tests from inside the 30 Rockefeller Center offices -- where an anthrax-laced letter mailed from Trenton on Sept. 18 was opened -- found some remaining evidence of anthrax spores in the isolated areas where the letter had been carried, Andrew Lack, NBC News's president, said.
These areas will need to be thoroughly cleaned before they can be reoccupied, including the replacement of carpets and furniture and repainting the third floor NBC newsroom. City and federal health officials said the hazard was over elsewhere in the building, and that there was no current threat to staff at NBC's New York headquarters.
"We can all breathe a collective sign of relief," Mr. Lack said in an e-mail message to NBC employees. "It is safe to work at 30 Rock."
At ABC, there was also some good news. Tests on filters taken from the air ventilation system came back negative, although the results of dozens of other tests were still not available as of yesterday evening. About 150 employees had been tested as of late yesterday afternoon for possible anthrax exposure and more were expected to be tested. The results were not yet available.
The 7-month-old boy who tested positive for anthrax after visiting ABC News on Sept. 28 continues to improve, his mother said yesterday.
The traces of anthrax found at the governor's office were isolated to a small room on the 39th floor where state police officers are stationed. Tests in the mail room; the governor's personal office, also on the 39th floor; his secretary's office; and the ventilation system were all negative.
Suspicion first surfaced at the governor's office after his secretary became ill and then remembered an unusual letter she had opened, postmarked Sept. 25. She turned the letter over to the state police unit and she and several other employees in the office were tested for exposure, tests that proved negative.
On Monday night, after the NBC and ABC cases were disclosed, the governor's office decided to do tests in the office, the results of which were available yesterday morning.
State officials said that they were not sure now where that letter has gone -- it was sent from within New York State -- but that they knew who had mailed it and had interviewed the person and were confident it was not the source of the anthrax.
"The state police and the F.B.I. will do what they do very well, which is investigate all of the possible sources," Mr. Pataki said.
All the testing, and the closing of the city health department's lab, have put intense stress on the state Health Department's Wadsworth Laboratories near Albany.
"We are not going to be able to have instant results," the governor said. "But we don't see a serious backlog developing."
Photo: Dr. Antonia C. Novello, left, the state health commissioner; Katherine N. Lapp, the state's criminal justice coordinator; and Gov. George E. Pataki at a temporary office at the Jacob K. Javits Convention Center. (Ozier Muhammad/The New York Times)
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October 18, 2001, New York Times, NBC; Doctor in City Reported Anthrax Case Before Florida, by Lawrence K. Altman,
Three days before anthrax was first detected in Florida, a Manhattan doctor called the New York City Department of Health to report a suspicion: one of his patients might have contracted anthrax.
The doctor, Richard P. Fried, said his concern was based on the irritating skin lesion that his patient, Erin O'Connor, an NBC employee, had developed on her chest after powder from an envelope had spilled on her at work.
"I expressed my concerns about what this could be" to the health department, Dr. Fried said. He stated those concerns, he said, first on Oct. 1 and in later conversations with a health department epidemiologist, but the department did not notify the Centers for Disease Control and Prevention or send specimens there.
Dr. Marcelle Layton, an assistant commissioner in the health department's communicable disease bureau, confirmed the gist of the account by Dr. Fried, a specialist in infectious diseases. The C.D.C. was not notified, Dr. Layton said, because the initial culture tests performed on Ms. O'Connor and on the letter showed no evidence of anthrax.
"Everything Dr. Fried did was right and reasonable," Dr. Layton said, but the initial situation "did not reach a level of concern because it was too early to do so."
Ms. O'Connor's case of cutaneous anthrax was diagnosed on Oct. 9, rattling the city and setting off an intense investigation into its source.
Dr. Fried said that on Oct. 1, after he first examined Ms. O'Connor, he told her she might have an infected spider bite or Lyme disease, but he did not mention anthrax. "I just did not want to alarm her," he said.
Nevertheless, Dr. Fried said he took the precaution of prescribing Cipro in the event that Ms. O'Connor did indeed have the disease.
Dr. Fried said he re-examined Ms. O'Connor on Oct. 3 and on Oct. 8, when the lesion had developed into a black crust, which is characteristic of cutaneous anthrax. But Dr. Fried and the health department were perplexed because anthrax did not grow on the culture taken from the skin lesion.
News reports of anthrax in Florida raised Ms. O'Connor's concern, and she sought other opinions.
The second infectious-disease specialist, who asked not to be identified, had seen many anthrax cases while working in a developing country. When he saw Ms. O'Connor's chest, he said, the lesion "was as classic-looking as you can get."
Ms. O'Connor then went to Dr. Marc Grossman, a dermatologist at Columbia-Presbyterian Center, who had never seen a case of anthrax. But on Oct. 4, when the first case of anthrax was reported in Florida, Dr. Grossman had readied and given a lecture on cutaneous anthrax to young doctors at the school.
So when Ms. O'Connor came to his office on Oct. 9, the diagnosis was obvious, he said.
The source of her anthrax became evident only when it was found in the powder from a different envelope.
Ms. O'Connor did not wish to be interviewed, an NBC spokeswoman said.
Photo: Dr. Richard P. Fried told the city health department on Oct. 1 that a patient might have anthrax. (Carol Halebian for The New York Times)
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October 18, 2001, New York Times, Testing Links Anthrax In Florida and at NBC, by Andrew C. Revkin,
Correction Appended
Preliminary DNA tests show the strain of anthrax that caused a skin infection in an employee of "NBC Nightly News" appeared to be identical to the anthrax involved in the incident at the offices of American Media Inc., federal health officials said yesterday.
They said the results implied that the Florida and New York incidents were related, but they emphasized that more definitive genetic tests were not yet completed.
Nor have genetic tests been completed on the bacteria that spilled on the floor in the Washington office of Senator Tom Daschle of South Dakota, but it arrived in an envelope almost identical to the one received at NBC.
The growing evidence supported the notion that the bacteria were being used in a coordinated way. But Dr. David W. Fleming, the deputy director of the Centers for Disease Control and Prevention, said none of the bacteria in the three incidents were resistant to antibiotics.
"I'm glad we're not dealing with somebody who's developed a resistant strain," said one federal scientist involved in the investigation, who spoke only on the condition of not being named. "That's a possibility that would've been very worrisome."
Though more tests remain to be completed, some scientists involved in the investigation, and others familiar with testing techniques involved, said it was likely that the authorities knew much more than they were saying publicly. They spoke on condition of anonymity.
Health and Human Services Secretary Tommy G. Thompson said as much in a telephone conference call with reporters yesterday. "Some things may not be able to be released because of the criminal investigation ongoing at the F.B.I.," he said.
Despite the tentative links that appear to exist between the cases, there are puzzling differences. In the Daschle case, officials said yesterday, more than 30 people were exposed to anthrax spores when an envelope was opened on Monday. Officials said the substance had been produced in such a fine form that it was easily spread through the air.
In Florida, far fewer people appear to have been exposed, even though officials believe that the anthrax also arrived in a letter. Health officials say only three people have been proved to have been exposed: the photography editor who died early this month, and two mail room employees of the publishing company where the editor worked. Inhalation anthrax has been diagnosed in one of them; the other appears healthy.
In addition, several other employees of American Media have shown antibodies to anthrax in their blood, but officials are conducting new tests to determined whether they were truly exposed.
There is no trace of any anthrax-containing letter at American Media, but employees there remember a letter that was passed among several people, including the photography editor, Robert Stevens, that contained bluish powder and a Star of David. Several employees say the letter, which was addressed to the actress Jennifer Lopez, in care of one of American Media's publications, arrived on Sept. 19. The letters sent to Mr. Daschle and Mr. Brokaw were postmarked Sept. 18.
In Miami, health officials and a spokesman for the family of a person being tested said yesterday that an 8-year-old boy and a former American Media intern being tested for possible anthrax exposure now appear not to have come in contact with the bacteria.
The anthrax bacteria found at NBC has been traced to a letter sent from Trenton to the anchor Tom Brokaw on Sept. 18. Inside the envelope was a threatening letter and a brown substance. The letter was opened on the third floor of NBC's 30 Rockefeller Plaza offices from Sept. 19 to 25.
The woman who opened the letter brushed the substance into the trash. A second woman, Erin M. O'Connor, apparently also handled the letter, which was put into a pile of threatening mail.
Last Friday, tests showed that Ms. O'Connor had been infected. That same day, police picked up the letter from NBC, which had been moved last week from the third-floor NBC newsroom to the NBC security office.
More than 1,300 NBC employees have since been tested for anthrax exposure or infection. So far, about 850 of those test results are available, including tests of Mr. Brokaw and the employee who actually opened the letter, and in every case so far, the tests have come back negative for infection. The results of the remaining tests are expected soon. Anthrax spores have been found at certain places at the NBC building, including one air filter, but those areas are closed off and are set to be cleaned starting on Thursday, while the rest of the building has been deemed safe.
Scientists' ability to identify distinct genetic subspecies or strains of the microbe Bacillus anthracis improved tremendously last year when several anthrax experts published a method for discerning telltale patterns in certain segments of the bacterial DNA.
Once a sample arrives at the appropriate laboratory, the bacteria must be cultured to provide enough DNA to test, but an Air Force research laboratory recently developed growth media -- essentially bacteria food -- tailored to accelerate the growth of anthrax bacteria, but not other varieties. Several companies now sell equipment that can extract DNA from the cultured bacteria in minutes.
Using the new fingerprint-style method, scientists can compare certain DNA segments isolated from the bacteria to a library of DNA samples from known strains or from other incidents.
"Once you have the DNA, we're talking hours," said Dr. Theresa M. Koehler, an anthrax expert and microbiology professor at the University of Texas medical school at Houston who did not participate in that research.
The analytical work is under way at a far-flung set of research centers, including Northern Arizona University, the Los Alamos National Laboratory and the Centers for Disease Control and Prevention. Scientists there have consistently refused to discuss their findings.
Altogether, out of more than 1,200 known strains of anthrax, more than 400 variants have been identified by the geneticists and microbiologists who devised the new DNA-matching technique, with anthrax archives established at several universities and federal research laboratories.
Correction: October 19, 2001, Friday Because of an editing error, an article yesterday about similarities between the strains of anthrax found in Florida and in a letter to Tom Brokaw of NBC News in New York misstated the date of the postmark on another contaminated letter, sent to the Washington office of Senator Tom Daschle of South Dakota. The letter to Senator Daschle was postmarked Oct. 8, not Sept. 18.
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December 26, 2001, New York Times, Tracking Bioterror's Tangled Course, by Eric Lipton and Kirk Johnson,
There was no commotion, no outcry. Except for the blond woman in the black dress sitting by herself in a back pew, no one knew that anything unusual had happened.
Johanna C. Huden, a 31-year-old editorial assistant at The New York Post, had first noticed the strange blister on her right middle finger the day before, Sept. 21. She had not thought too much about it; surely it was just a bug bite or a cat scratch.
Now, though, as she sat in the Long Island church, half-distractedly watching the wedding ceremony, the finger began to itch. She reached down and rubbed it gently against the coarse linen of her dress. Suddenly, a watery white liquid bubbled out across the cloth.
"Ee-yew," Ms. Huden recalls saying to herself. "That is just really bizarre."
The conventional understanding of America's first-ever anthrax attack says Ms. Huden was a bit player -- a victim of skin, or cutaneous, anthrax who fully recovered and got on with her life. As anthrax spores spread through the mail, and events blurred across six states and the District of Columbia, hers became no more than a name in the middle of a long list of victims.
Yet the conventional understanding is wrong. In the light of hindsight, scientists can now see that the outbreak actually began that September afternoon.
Ms. Huden was the anthrax index patient -- the pivot point upon which every outbreak investigation is based, the crucial clue that every medical investigator hopes can be found, and fast. But on that muggy day at Mary Immaculate Church, she suffered her mysterious wound very much alone.
No one knew.
Those words have become the theme of the medical investigation of the anthrax attacks, a refrain of epidemiological regret.
Certainly, the medical investigators have done much to contain the outbreak and save lives. Yet the inside story of that inquiry -- pieced together from interviews with many of the lead investigators and other health-care officials -- is also a tale of missed cues, misread evidence and erroneous assumptions that led scientists and decision makers to misjudge the threat to postal workers and, through the mail system, to the American public.
For weeks, primary-care doctors individually struggled to diagnose a disease they had never seen and never imagined they would see. In that uncertainty, medical investigators could never quite discern the sequence of infection that began with Johanna Huden. And only through the bitter experience of 5 deaths and 18 other confirmed or suspected cases did they learn how much they did not know about how anthrax spores traveled and infected their victims.
Of course, the medical inquiry is just one of several intertwined strands of the government's still unresolved investigation of the attacks. In recent weeks, in fact, the other aspects have taken center stage, as microbiologists try to pinpoint the nature and source of the mailed anthrax and criminal investigators search for a suspect.
But underpinning those efforts, at every point, are the epidemiologists, the medical detectives on the ground, tracing how the infection spread and whether the underlying pattern of cases can offer up some revelatory clue from the haze.
They can see now that Johanna Huden arrived first in that place of fear and fog. For weeks after the wedding, despite repeated visits to doctors and emergency rooms, her infection worsened and the cause of her illness was missed. And no one knew.
Florida: A First Case To Investigate
Every disease outbreak tells a detective story. The epidemiologist's job is to piece together the narrative threads -- to work back to the beginning and so hasten the end.
Assume nothing; let the evidence speak for itself. That gumshoe credo was very much on Dr. Bradley A. Perkins's mind as the chartered jet roared toward South Florida on the afternoon of Oct. 4, carrying his 12- member team from the Centers for Disease Control and Prevention in Atlanta.
Dr. Perkins, a boyish-looking 42, chief of the centers' special pathogens branch, sat at a small conference table, chatting with the adrenaline-pumped scientists and passing around the latest papers on anthrax. But mostly he tried to concentrate on telling himself not to think about terrorists.
Everyone at the centers, of course, had been worrying about just that since Sept. 11 -- planning for attacks of everything from sarin gas to smallpox to anthrax, perhaps the most widely developed bioweapon in history. But at that moment, all anyone knew was that a tabloid newspaper editor named Robert Stevens was dying of inhalation anthrax in a Palm Beach County hospital.
Perhaps Mr. Stevens had been infected deliberately -- the first periscope glimpse into a mass bioterror attack. Perhaps. It was also possible that the bacteria had been picked up naturally, from a sick cow, even one long dead; anthrax spores could lie dormant in the ground for decades.
For now, this was just a medical case, though Dr. Perkins knew well that on his word a huge criminal investigation would be unleashed. The fear of being wrong was intense. "You don't pull the bioterrorism trigger lightly," he would say later.
Let the evidence speak for itself. That's how epidemiology had always worked. It was a rhythm of science, intuition and observation -- an art essentially unchanged since the 1850's, when a doctor named John Snow stunned the medical world with the insight that every family with cholera in his London neighborhood drew water from the same pestilential well.
Dr. Snow took off the well's pump handle and became a legend. His cholera-cluster maps became the motif of a new science, premised on the belief that disease, in the dawning age of the germ theory, could be chased from the shadows of superstition and hunted to the ground.
Now, flying to Palm Beach, Dr. Perkins and his team planned the hunt for the handle of this latest pump. They would meet with county health officials, then fan out, testing as they went -- Mr. Stevens's home, office, whatever made sense -- with swabs that would pick up any errant anthrax spores.
By the time they landed, Dr. Perkins felt satisfied that he had pushed as hard as he should the admonition to leave no stone, quite literally, unturned.
But then, leaving the airport, he saw something that tested his assumptions all over again. Flight Safety International, the pilot school where some of the Sept. 11 hijackers were thought to have trained, had a flight simulator right at the airport. Could it be coincidence that here, of all places, and now, of all times, anthrax would just happen?
As he drove his rental car past the building, he had more or less the same thought that had flickered across Johanna Huden's mind two weeks before.
"This is weird," he said to himself.
The Northeast: Though Unreported, Patients Accumulate
Actually, up North, seven people were already mysteriously ill.
Teresa Heller, a letter carrier assigned to West Trenton, N.J., had checked into a hospital with an infection on her arm.
Richard Morgano, a maintenance worker at the mail distribution center in nearby Hamilton Township, had a similar lesion on his arm.
In Manhattan, the infant son of an ABC news producer was in a hospital, gravely ill with a high fever and an ulcerated arm.
Erin M. O'Connor and Casey Chamberlain, assistants to the NBC News anchorman Tom Brokaw, had skin lesions -- Ms. O'Connor on her collarbone, Ms. Chamberlain on her leg.
Claire Fletcher, a CBS News aide, had two small infected pimples on her face.
And Johanna Huden had been to two emergency rooms and seen more than half a dozen doctors. Ultimately, on Oct. 1, a surgeon at New York University Medical Center had cut the dead skin out of her finger. Ms. Huden left the hospital with a large bandage on her hand but no better idea of what had made her sick.
None of those cases -- misdiagnosed and misunderstood -- were reported into the medical surveillance system on which epidemiology depends.
Without realizing it, Dr. Perkins and his team were starting in the middle. The Stevens case, they believed, was the index case. And that misperception was the first of many to guide the investigation -- in Florida and then up North -- in the coming days.
The next morning, Oct. 5, the scientists fanned out, checking things out, including the vacuum-cleaner bags in Mr. Stevens's house and the ventilation system on the roof of the American Media International building, where he worked.
They went to a store where he bought spices in bulk; the store kept live animals, they had been told, and had to be checked as a possible source of natural contagion. They visited his favorite fishing hole and traced his Sunday bicycle route. A separate team went to North Carolina, where Mr. Stevens had first felt ill while visiting his daughter.
All trails led nowhere. The dead-cow vector, even as a remote hypothesis, faded. Mr. Stevens died that day, unable to help them.
Various pieces of evidence, though, eventually pointed toward the company's mailroom. Tests of a mailroom worker, Ernesto Blanco, hospitalized with a still-undiagnosed illness, turned up an anthrax spore in his nasal passage. Spores were also found on Mr. Stevens's computer keyboard.
But when the investigators first arrived in the mailroom late on the afternoon of Oct. 5, they realized to their horror that, in their exuberance or thoroughness, they had used up all but one of their cotton swabs.
One small swab to test the whole room -- it seemed like the wildest shot in the dark.
So the scientists stood amid the postage meters and scales and argued the point: Though they could get more swabs, this was it for the day, and at a time when every hour felt laden with portents and pressures, the decision seemed enormous. Finally, they decided to use the last swab on a bin holding letters and packages for the photo department, where Mr. Stevens had worked.
The results came back the next day with a direct bull's-eye. The mail bin was heavily contaminated, and the conclusion, Dr. Perkins said, was unmistakable: Mr. Stevens had been the victim of a criminal act.
The finding sent a shock wave through the nation and changed everything about the case. This was not simply a medical investigation anymore. The F.B.I., which, like the disease control centers, had been preparing for bioterror attacks since Sept. 11, took over.
For the epidemiologists, the discovery was as if a fog had lifted just long enough to see that they were headed out into uncharted, and uncomfortable, territory. They were not just hunting an organism with genes and biological logic that could be tracked the traditional way. This was a weapon, deliberately wielded, with an exponentially increasing number of possible sources. That mixture --- the biological and the psychological, the genetic and the perversely pathological -- fundamentally altered the task at hand.
"Usually we're talking about trying to define normal biologic transmission," Dr. Perkins said. "This is a terrorist transmission route."
Investigators followed that route from the mailroom to the delivery truck, to the Boca Raton post office and through the county's mail system, finding spores all along the way.
What they did not find were any sick postal workers. They had no reason to connect Mr. Stevens to Teresa Heller and Richard Morgano and the others up in New York, because they did not yet know they existed.
The postal system, they now knew, had been used as an instrument of attack, an important finding. But it went only so far. Since no postal workers seemed even remotely affected, the postal connection was treated as one clue among many, not the sure, single pathway suffused with risk.
On Oct. 9, President Bush told an edgy nation that the Florida case appeared to be "an isolated incident."
But Dr. Perkins, the epidemiologist, recalls feeling "extremely uncomfortable."
"We know someone is out there with the ability to cause disease, but we don't know how much mail is out there or whether the mode of delivery is going to change," he recounted. "We're operating on data that are inadequate for the situation."
New Jersey: Delayed Recognitions Of Cases Missed
"You heard about Hamilton?"
That was the question Dr. Michael Dash's wife yelled out as he arrived home Saturday afternoon, Oct. 13, on what was to have been a quiet weekend with the family.
She had been checking the headlines on the Internet that afternoon when she happened upon a news bulletin: an anthrax-laced letter had been found in New York that had been postmarked at the Hamilton Township mail- sorting center near Trenton.
"Oh no," Dr. Dash thought after reading the story. "That is what that man had."
That man was Richard Morgano, 39, a barrel-chested maintenance worker at the Hamilton postal center, who had come into Dr. Dash's New Jersey office on Oct. 1 with a strange infection.
Mr. Morgano had scratched his arm on Sept. 20 while reaching into a Hamilton mail-sorting machine. A blistered wound had formed, oozing a yellowish liquid around back spots of dead skin. His arm was twice its normal size, his lymph nodes swollen and his hand unbendable.
At that first meeting, Dr. Dash put Mr. Morgano on a strong dose of antibiotics and, after checking a reference book, asked Mr. Morgano a line of questions fearing he was facing a condition he had never before seen.
"You doing any hunting recently? You've been working with pelts? Been around goats or any farms?" Dr. Dash asked, checking possible natural causes of anthrax.
But Dr. Dash had never imagined that a postal worker in central New Jersey would be the victim of a terrorist attack. So when Mr. Morgano answered "no" to each of the questions about natural sources of anthrax, Dr. Dash had ruled it out.
Dr. Dash was far from the only physician who had a sudden and disturbing realization that weekend. The discovery in New York of the anthrax-contaminated letter, which had infected an NBC News employee, evoked a series of calls to local and federal authorities in New York and New Jersey.
In fact, on the same day Mr. Morgano was at Dr. Dash's office,Ms. Huden and the ABC producer's baby were just eight floors apart at the New York University Medical Center.
"I kick myself when I think about it now," Dr. Douglas Yoshia, the attending physician on duty when Ms. Huden showed up at the emergency room.
Like Dr. Dash, upon hearing about the NBC case and the Hamilton letter, Dr. Yoshia immediately realized Ms. Huden had had anthrax. But he had one more complication to overcome: He could not remember her name. It took a few days of searching through hospital records to track it down and by the time he reached Ms. Huden, her case was already being investigated.
It was only once these cases bubbled to the surface that the true pattern of the outbreak started to become apparent. And, perhaps most important, health officials now had hard evidence that postal workers were, at a minimum, at risk of cutaneous anthrax.
Even so, the full significance of this discovery was not initially recognized. It took five days to confirm that Mr. Morgano and Ms. Heller, the West Trenton letter carrier, had anthrax.
By Oct. 18, when these cases were confirmed, seven other postal workers -- three in New Jersey and four in Washington -- had begun to feel sick, most with the more serious version of inhalation anthrax. The second wave was under way, this time from poisoned letters postmarked at Hamilton on Oct. 9 on their way to Capitol Hill.
In this wave, a few of the cases would be identified quickly, and the postal employees would recover. But again, some doctors who encountered these sick postal workers would not make the anthrax connection. And this time, the implications would be fatal.
District of Columbia: The Medical Becomes Political
It was still dark and silent that Saturday morning, Oct. 20, when Dr. Michael S. A. Richardson picked up the telephone in the hallway of his Washington townhouse to call the office. During the night, he had received a message on his new cellphone -- issued to go with his new job as an acting senior deputy director at the District of Columbia Department of Health -- but no one had taught him how to retrieve messages.
Now, as he realized what he had missed during the night, he stretched the phone cord into the living room, perched on the arm of a chair and scribbled notes as fast as he could.
A worker at the Brentwood Road postal center in Washington, Leroy Richmond, had been tentatively diagnosed with inhalation anthrax. The implication was staggering.
"We are in the middle of this," Dr. Richardson recalled thinking. "And it's a huge deal."
Washington is where the anthrax story became political, social, even racial, theater. And it is where the assumptions of the investigation -- woven from decades of conventional scientific wisdom and weeks of evidence and missed cues -- all unraveled.
When he picked up the phone that morning, Dr. Richardson did not know about the second wave. What he -- and the rest of the nation -- did know was that just five days earlier, on Oct. 15, ananthrax-laced letter had been opened in the Capitol office of Tom Daschle, the Senate majority leader. And though reports conflicted, suspicions ran deep -- and had been played in banner headlines -- that the material in this letter was dangerously different. Many of the government's bioweapons experts were saying that the anthrax spores seemed much smaller, perhaps capable of staying airborne longer, and thus far more likely to penetrate deep into the lungs.
Even so, Dr. Richardson knew of no postal worker who had developed the life-threatening inhaled form of the disease, despite the trail of spores across the postal system. And the disease control agency had said that only people in the immediate vicinity when a poisoned letter was opened were at risk.
Dr. Richardson also knew that an initial test at Brentwood Road, where the Daschle letter had been processed, had turned up no evidence of contamination. And there was the curious case of the worker at the P Street station, who had tested positive for inhalation-anthrax exposure immediately after the Daschle letter, but then, after retesting, was put back on the negative list. Both those results seemed to reinforce the conventional wisdom.
Now it was all dreadfully wrong. Postal workers were in direct and dire danger. Sealed envelopes could leak. The inhalation case at Brentwood had presented, literally overnight, a new signature of threat.
What was clear, too, was that the full implication of tinier, airborne spores had not been thought through; early hints, like the P Street worker, had become missed opportunities rather than signal flares suggesting that more testing might be needed. In Atlanta, it would be another week and a half before the C.D.C. opened what turned out to be a very prescient e-mail -- a warningfrom Canadian researchers, sent Oct. 4, that tests had shown that anthrax spores could leak through envelopes.
Dr. Richardson has no illusions that an earlier grasp of the dangers of the Daschle anthrax could have kept Mr. Richmond or the three other infected Brentwood workers from getting sick; they had already been exposed. But it might have meant faster diagnosis and faster treatment. With physicians on the alert, the words "I work for the postal service" would have opened doors and minds in doctors' offices everywhere.
"Everybody and their mother would have known that a postal worker is potentially at risk," Dr. Richardson said. "And so that famous tape of this man Morris, saying that he went to his doctor and the doctor told him don't worry, would probably not have happened." Thomas Morris Jr., a Brentwood worker, died on Oct. 21; Mr. Richmond recovered.
The flawed assumptions had other consequences. Because postal workers had not been considered at risk, only people at the Capitol were tested and given the anthrax antibiotic Cipro after the Daschle letter was opened. Now, Dr. Richardson saw, a huge intervention -- running late and behind the curve -- would have to begin.
And in Washington, where conflicts of race and class simmer even in the best of times, a late start would have its own costs and consequences.
The city's health commissioner, Dr. Ivan C. A. Walks, faced it first-hand when the congregation at an African-American church peppered him with questions about why postal workers, many of them black, were being treated differently than people at the Capitol. While some postal workers ultimately were tested with nasal swabs, the process was stopped, epidemiologists said, because the technique was unreliable.
"'The folks on the Hill got swabbed, now you're not swabbing us,'" said Dr. Walks, who is black, recalling the uncomfortable questioning in the church. "'White people got swabs, black people didn't get swabs.'"
People also questioned the switch from Cipro to doxycycline -- a far less expensive, but equally effective, antibiotic.
"The white folks got Cipro -- we're getting doxy," Dr. Walks said, replaying the exchange. "They got the expensive drug -- you're trying to save money with us."
It was not just a matter of anger. The shifting understanding of anthrax also created doubt about just how much the epidemiologists should be trusted or believed.
Dr. Richardson saw the doubt that Sunday night, as health officials distributed antibiotics to postal workers downtown. Around 10 p.m., Dr. Richardson was approached by a distraught man who said the disease agency was wrong to believe that only a directly poisoned letter was a threat. The man said he worked at Brentwood and knew how mail got tossed around in the sorting machines.
"You don't know, it's not one place, things get mixed up," he said. "There has to be cross-contamination." In other words, even mail that came in contact with poisoned letters might not be safe.
"I had no idea what he was talking about," Dr. Richardson said. He told the man to share his information with the C.D.C.
Atlanta: Debating Public Policy At the C.D.C.
The national cerebrum of the anthrax crisis was a small conference room at Centers for Disease Control headquarters plastered with bioterror versions of Dr. Snow's cholera maps. There were detailed floor plans of newsrooms and Senate offices, and now, the shop floor at Brentwood Road, all color-coded to indicate the different paths the spores had traveled.
Most of the room was taken up by a rectangular table with a speakerphone that linked the center's scientists with the other players in the investigation -- the F.B.I., the postal service, the homeland-security bureaucracy and local law-enforcement officials across the nation. The scientists found themselves exercising some unfamiliar mental muscles. Dr. Perkins says he thought that a Cliff Notes compendium of fictional bioterror plots would have come in handy.
It was in that conference room, on Monday, Oct. 22, that centers officials began debating what they say were among the most difficult questions the agency had ever addressed: Was the postal system itself contaminated? Should it be shut down? Such a decision, the officials knew, would rip through the economy, not to mention the delicate psyche, of a nation under siege.
"Is there a health hazard here of such a magnitude that it would warrant that type of action?" asked Dr. Julie L. Gerberding, the centers' acting deputy director of infectious disease, who two decades before had seen the AIDS epidemic emerge in San Francisco.
The magnitude of the anthrax hazard certainly seemed to be growing. Two Brentwood workers had died; two others were in intensive care. In New Jersey, a postal worker appeared to have the state's first case of inhalation anthrax. Four days earlier, state health officials closed the Postal Service's regional distribution center near Trenton.
But there was also a conundrum underlying the debate. In an atmosphere of rising crisis, Dr. Gerberding and others felt huge pressure to act decisively, even as events in Washington had made it clear to them that decisiveness was hardly warranted.
What's more, they were in an unaccustomed, and uncomfortable, position of power. While the agency could only recommend shutting the system down, officials knew their advice would carry great weight. The debate became a test of leadership, science and nerve, all bound together by constant stress and sleepless nights.
Dr. Walks, the Washington health commissioner, who participated in some of the discussions by speakerphone, said it had become hard to discern the line between the need to be confident and the need to be right.
More than once, he said, as he stood alongside public officials at news conferences in Washington in mid-October, he inwardly groaned because old answers about anthrax were still being given and he realized that even information a week or two old could no longer be trusted. Some officials were still saying, for example, that a certain number of spores -- 8,000 to 10,000 was the commonly quoted figure -- were needed to contract inhalation anthrax. Given what was now known about the dangers for postal workers, perhaps that old assumption was no longer true either.
"I think it's time for us to stop needing to say we know and let people know what we don't know," he recalled thinking at the time. "Because if we don't do that they won't believe us when we come to say we know stuff, and that's critical."
The verdict was to keep the system open — not because it was deemed clean and uninfected, C.D.C. officials said, but because there simply was not enough evidence of widespread contamination. The finding did little to ease anxieties, though. Closing the system would have affected millions of people; not closing it might, too.
New York: A New Victim. A New Wave?
Dr. Stephen M. Ostroff's darkest hour came sometime before the dawn of Oct. 30. New York, he'd come to believe through a long, sleepless night, was under attack, and as the chief epidemiologist at the C.D.C.'s National Center for Infectious Diseases and the agency's point man for the city, the list of things he didn't know seemed endless.
"It was my worst moment," he said.
He had just learned from the city's Department of Health that a 61-year-old stockroom clerk at a Manhattan hospital, Kathy T. Nguyen, was on a respirator and declining quickly from inhalation anthrax.
Part of Dr. Ostroff's anxiety stemmed from the fact that Ms. Nguyen -- the city's first inhalation case -- fit no previous pattern. The first wave of anthrax-contaminated letters in mid-September had been aimed at news organizations; the second in early October had been sent to political leaders. Was she the sentinel patient of a third wave, focused on the health care system?
But he was also haunted that morning by the long shadow of Washington, and the presumptions that he and other epidemiologists had been so wrong about. Dr. Ostroff had been one of those playing down the threat to postal workers from sealed letters. "None of us, to our eternal dismay, would have ever imagined that an unopened letter could do what they did," he said. Would Ms. Nguyen's illness reveal yet another missed link in the chain of reasoning and evidence?
Dr. Ostroff was hardly a novice. In 15 years at the disease control agency, he was one of the agency's most trusted detectives, helping to respond to the outbreak of hantavirus among American Indians in the Southwest, West Nile virus in New York, Ebola in Reston, Va.
Now, on the morning of Oct. 30, preparing to help the city respond to this new threat, Dr. Ostroff anxiously arrived at City Hall so early that the night-duty police officer had to let him in. He was escorted to the mayor's anteroom, where he fell asleep on a couch. The mayor woke him up when he arrived for the 8 a.m. meeting about the Nguyen case.
"We are about to see a lot of sick people in New York," Dr. Ostroff kept thinking.
New York -- hardest hit by the Sept. 11 attacks -- still seemed deeply vulnerable, both to attack and to panic. The city's health department, only a few blocks from the still smoldering ashes of the World Trade Center, had been intently preparing for a bioterror attack that might send tens of thousands of acutely ill people to city hospitals all at once.
But as the inquiry intensified, the mysteries only deepened. Investigators could not find even a single spore of anthrax near Ms. Nguyen's home in the Bronx, or at the Manhattan Eye, Ear and Throat Hospital, where she worked. No one else got sick, which eased anxieties at the health department but also added to the sense of incomprehensibility.
Ms. Nguyen, who died Oct. 31, was not the harbinger of a feared new mass attack -- but neither, it seemed, would the evidence about her infection provide the break in the investigation that Dr. Ostroff and others had hoped for. One F.B.I. theory had been that Ms. Nguyen might have crossed paths with the bioterrorist. Now, all they knew for sure was that she had somehow been infected with anthrax in a place health officials could not find and in a way that had left no trace.
Connecticut: Revising the Textbook, One More Time
Dr. Joxel Garcia, Connecticut's health commissioner, had been working almost nonstop for six days to unravel the death of Ottilie Lundgren, the 94-year-old widow from Oxford, Conn., who on Nov. 21 became the nation's fifth fatality -- and his state's first -- attributed to inhalation anthrax.
Investigators had been sent to her favorite neighborhood dinner spot, her hairdresser, her bank, her church, her library and, of course, her local post office and her home. Nothing so far had turned up.
But on the evening of Nov. 27, Dr. Garcia's staff had made a discovery that at first seemed like wild coincidence: An 85-year-old man who had lived in the town of Seymour, about a mile and a half from Mrs. Lundgren, had also recently died. And he had lived right next door to a family that Postal Service officials said had received a letter postmarked in Hamilton, N.J., at nearly the same instant that the toxic letter to Senator Daschle had been processed.
Perhaps, this new evidence suggested, a letter that merely crossed paths with an anthrax-laced envelope could pick up enough spores to kill. If so, maybe that was how Mrs. Lundgren caught the disease, and her elderly neighbor, Oscar B. Haines -- and Ms. Nguyen in New York as well.
The implications were disturbing. Hundreds of thousands of letters -- perhaps millions -- had passed through the postal system since the anthrax mailings, and might now be contaminated with small amounts of anthrax that, if the theory held, might be lethal under certain conditions.
Dr. Garcia immediately called Gov. John Rowland, then the F.B.I., then the state's chief medical examiner. The first question on everyone's mind was as ghoulish as it was simple: Where was Mr. Haines's body now?
An F.B.I. agent and three state epidemiologists were dispatched to wake up the Farkas family, which had received the Hamilton letter, and swab their mailbox for spores. H. Wayne Carver II, the chief state medical examiner, tracked down the funeral home director who had Mr. Haines' body and ordered it sent over immediately to the state laboratory for examination.
Two months after the first anthrax victims like Ms. Huden had suffered in anonymity, the nation's sprawling investigation had come to this: a desperate search in the night for the body of a man who might or might not have had the disease, and who in any case could no longer be helped, but who might still bear silent witness for the prosecution.
The autopsy, begun at 2:47 a.m., revealed that Mr. Haines did not have anthrax. His heart had simply failed. Dr. Carver called Dr. Garcia at about 4 a.m. with the news.
But when the investigators arrived at the Farkas's house on Great Hill Road in Seymour, they found to their astonishment that the letter postmarked in Hamilton on Oct. 9 had, for other reasons, been saved.
By Nov. 30, the investigators had the results -- the letter was positive for spores, and the news quickly spread out across the United States, once again changing the state of science about anthrax.
Cross-contamination was definitely possible. An innocuous letter, passing through the labyrinth of the postal system at the wrong moment, could become dangerous, as the Brentwood postal worker had insisted to Dr. Richardson weeks ago. Though it had not killed Mr. Haines, cross-contamination still might explain Mrs. Lundgren's death.
Epidemiologists were still confused. How could anthrax that had merely settled on a safe envelope suddenly get back into the air so it could be inhaled, causing the more serious form of the disease? That spores could become airborne again in the whirring tumult of a mail-sorting machine now seemed perfectly reasonable, but on a kitchen table? The answer had been found when they went through Mrs. Lundgren's trash -- clue-hunting of the sort Dr. Snow himself would smile on.
Mrs. Lundgren, it turns out, was quite particular about her mail. Again and again, she tore her letters precisely in half before throwing them in the trash, an act that could easily send any dust or anthrax spores flying back into the air.
The epidemiologists still did not know if in fact a cross-contaminated anthrax letter had arrived in Mrs. Lundgren's mailbox, and for all that they had learned, they didn't know whether, in the end, tearing such a letter in half had actually made a difference. But by then the idiosyncrasies of a little old lady seemed to be all they had to go on.
"In science, we keep the door open for everything," Dr. Garcia said then, two months and counting into the nation's anthrax inquiry.
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October 13, 2001, St. Petersburg Times, Brokaw's aide tests positive; Suspicious letters to NBC, N.Y. Times sent from St. Petersburg, authorities say, by David Ballingrund, Mike Brassfield and Wes Allison, Saturday, Archived,
[AP photo]
Barry Mawn, left, head of the FBI office in New York, addresses the media as New York Mayor Rudolph Giuliani looks on today at NBC headquarters in New York. Mawn said two suspicious letters were sent from St. Petersburg. Police Commissioner Bernard Kerik is at center background.
A broadening national bioterrorism investigation turned toward St. Petersburg late Friday after NBC officials disclosed that a New York employee has contracted anthrax.
A woman who opens the mail for news anchor Tom Brokaw was diagnosed with a skin form of anthrax several days after she opened a letter that contained white powder and was postmarked from St. Petersburg.
The New York Times on Friday received a letter with a white powder and the St. Petersburg Times received one earlier in the week. All three letters were postmarked in St. Petersburg.
Federal law enforcement officials said late Friday that all three letters postmarked St. Petersburg tested negatively for anthrax.
Still, the case of the NBC worker hit a nerve and touched off a new investigation in Florida.
Late Friday, postal officials converged at the main post office in St. Petersburg, saying they were working with the FBI and others in the early stages of an investigation. They would not address specifics of the investigation or what inspectors could do to pinpoint the origin of the letters.
"The Postal Service does not have the means to track an individual letter to its source," said Linda Walker, spokeswoman for the U.S. Postal Inspection Service in Tampa.
Despite repeated government assurances Friday that investigators have found no definite link between the anthrax incidents and the Sept. 11 terrorist attacks, the letters fueled growing concerns about a possible biological attack.
Vice President Dick Cheney said Friday there may be links between U.S. anthrax cases and Osama bin Laden, the suspected mastermind of the Sept. 11 attacks.
"I think the only responsible thing for us to do is proceed on the basis that it could be linked," Cheney told Jim Lehrer of PBS. He said the United States has evidence that bin Laden's terrorists were trained in spreading chemical and biological toxins.
In developments Friday:
• An assistant to NBC anchorman Tom Brokaw contracted the skin-based form of anthrax after opening a "threatening" letter to her boss.
Officials quickly said there was no known link to either the Sept. 11 terrorist attacks or the more serious inhaled form of anthrax that killed a supermarket tabloid editor in Florida last week. The 38-year-old NBC employee was being treated with antibiotics and is expected to recover. The letter was postmarked in St. Petersburg on Sept. 20 and opened Sept. 25, authorities said.
[AP photos]
Police officers gather outside the New York Times offices today, in photo above, as they investigate a letter sent to investigative reporter Judith Miller, below, that contained a powdery substance. Two floors of newspaper offices were evacuated.
• Within hours, another scare broke out at the New York Times' 43rd Street headquarters. Staff writer Judith Miller, the author of a recently released book on bioterrorism, received an envelope containing a powdery substance that smelled like talcum powder, said Kathy Park, a spokeswoman for the paper. Two floors of employees were evacuated but later returned to their desks.
FBI officials confirmed late Friday that the letters the NBC employee and Miller received were "business-type" letters, postmarked in St. Petersburg, and contained a similar powdery substance. Neither had a return address.
• In Columbus, Ohio, three employees of the Columbus Dispatch remained in quarantine late Friday after one of them opened a Halloween card and found a powdery substance. Steve Berry, an assistant features editor, said the card arrived in the mail with a Dayton postmark but no return address. The substance was taken to the Ohio Department of Health, where officials said a preliminary report was expected late Friday.
• Fox News Channel reported receiving a questionable envelope with a powdery substance and all mailroom employees were being tested for anthrax. The woman who received the envelope at Fox has tested negative for anthrax.
• In Nevada, a letter containing pornographic material that was sent from Malaysia to a Microsoft office in Reno was first reported as testing positive for anthrax, but state officials said later that was in error.
New organizations including CNN, the Los Angeles Times and the San Jose Mercury News also stopped accepting outside mail, and the Miami Herald continued to provide latex gloves to concerned employees, as it has since the anthrax fatality at American Media Inc. in Boca Raton.
The New York offices of Newsweek magazine, the Associated Press, ABC and CBS stopped mail deliveries to staff as a precaution.
In a briefing at the Pentagon, a senior defense official confirmed that al-Qaida, bin Laden's global network, is thought to have crude facilities in Afghanistan where it could produce chemical or biological weapons. If al-Qaida has biological warfare agents, they could include anthrax, said the official, speaking on the condition of anonymity.
Local postal workers report symptoms
Shortly after 10 p.m. Friday, paramedics were called to the mail processing center in St. Petersburg to check a few workers who were complaining of headaches or other symptoms.
The workers feared that they might have been exposed to something a couple of days earlier, according to paramedics at the scene.
A hazardous materials team also was called to the mail center to test for any contamination.
"We anticipate getting a clean bill of health," said Walker, of the postal inspection service.
Earlier in the day, federal authorities told the St. Petersburg Police Department that they were investigating multiple mailed envelopes that had St. Petersburg postmarks.
St. Petersburg police Chief Mack Vines confirmed reports that one of the suspicious envelopes was mailed to NBC and one to the New York Times, but would not comment on whether other such envelopes had been found.
Detectives with the St. Petersburg Police Department's intelligence unit came to Vines' office shortly after 5 p.m. to inform him of the development.
Vines said St. Petersburg detectives were working on the case with FBI, the U.S. Postal Service, and the Manhattan homicide squad of the New York Police Department.
"We're on top of the issue. We're working with the bureau to determine if we can identity any type of situation relating to the postmark," Vines said Friday night. "We're just trying to develop any kind of information that would tie in to something like that."
Vines said he could not say anything else about the ongoing investigation.
"We're working diligently on it," Vines said. "We'll see if we can trace some of these things back. That's the issue."
"The only thing we know for sure is that they (the letters) were postmarked in St. Petersburg," said Gary Sawtelle, Tampa postal spokesman.
"Until we examine them, there's no way to break down where they were mailed from," he said.
The St. Petersburg postmark is given to letters collected from mid Pinellas County to south St. Petersburg, he said. He could not immediately be more specific.
[Times photos: Jennifer Davis]
Firefighters and guards cover St. Petersburg Times columnist Howard Troxler's desk with plastic after he received an envelope, below, Tuesday with a substance like salt or sugar.
St. Petersburg Times columnist Howard Troxler opened his letter at his desk Tuesday. As he did so, a white powdery substance, resembling sugar or salt, spilled out. (Tuesday, Oct. 9)
Troxler stopped opening the letter. Authorities were called to the newspaper's offices in downtown St. Petersburg. Police put the envelope in an airtight container and drove it to a state health lab in Tampa for analysis. Firefighters covered Troxler's desk with a plastic sheet and yellow emergency-scene tape reading "caution."
Health officials found no signs of anthrax or bacteria in the powder. The envelope and a letter inside also tested negative.
The letter had no return address and was postmarked St. Petersburg. It bears a code 337, then a space, then 1.
Anything that is mailed in Seminole, Largo, Bay Pines, Gulfport, Pinellas Park or any St. Petersburg neighborhood goes through the main post office on First Avenue N and is stamped with a 337.
The cryptic letter misspelled Troxler's name and had little punctuation. It said:
"Howard Toxler ... 1st case of disease now blow away this dust so you see how the real thing flys. Oklahoma-Ryder Truck! Skyway bridge-18 wheels."
Postmaster General John Potter told CNN that the Postal Service investigates more than 80 threats involving anthrax every year.
"Until these incidents, we have never had anthrax delivered through the mail," Potter said.
He noted that the Postal Service delivers more than 208-billion pieces of mail every year.
Asked if there were ways to determine a letter's origin more precisely than just the St. Petersburg postmark, Potter said, "I'm going to leave that up to law enforcement."
This year, the postal service received about 60 threats or hoaxes, which included anthrax, hoof and mouth disease, the Klingerman virus hoax and others. Nationwide, in the past two years, authorities have received about 178 anthrax threats at courthouses, reproductive health service providers, churches, schools, and post offices.
Bioterrorism experts said anthrax can be grown in large batches, using routine commercial laboratory equipment. When the bacteria are dried and form tiny protective spores, anthrax turns into a white or beige powder.
To infect an entire city, large amounts would have to be spread by airplane or industrial sprayer after the spores are mixed with an inert chemical to keep them suspended in air. Small amounts capable of infecting a few people can be sprinkled in an envelope.
Microbiologists caution it is not easy or cheap to make effective biological weapons. Pranksters who want to spread fear rather than disease might use baby powder, cornstarch or another benign look-alike.
Anthrax spores measure between 1 and 5 microns in size - too small to see with the naked eye. Even trained biologists need the right equipment to distinguish an infectious agent from ordinary materials, so most suspicious envelopes should be investigated.
More information
• CDC Public Health Message Regarding Anthrax, Dated Oct. 12, 2001 [pdf file]
• CDC Anthrax FAQ Web page
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Four unnamed sources quoted and a spokeswoman (who) declined to comment, except to say, "We want to protect the privacy of this individual." Major league news organizations at work.
October 13, 2001, Newsday, America's Ordeal; 'Gatekeeper' Is Infected, by Verne Gay, Staff Writers,
The NBC News employee who is being treated for anthrax infection (case 2) is described as anchor Tom Brokaw's "gatekeeper."
The woman reportedly opened a letter with a powdery substance that was addressed to Brokaw.
The network, meanwhile, was volunteering nothing, except to confirm the basic facts: The victim is a 38-year-old woman who works at "Nightly News." A spokeswoman declined to comment, except to say, "We want to protect the privacy of this individual."
Her name is Erin O'Connor and she is a new mother, sources said.
O'Connor is Brokaw's most valued assistant, sources said, and a beloved fixture in the newsroom. As one source put it, O'Connor is the "gatekeeper" to Brokaw's world, through whom everyone, and everything, must pass.
Brokaw has a close relationship with O'Connor, and she has worked with him for more than a decade.
"This is going to make Tom angry as hell," a source said. "His family has been attacked [and] he really views Erin as one of his daughters."
At the conclusion of his newscast Friday, Brokaw said NBC employees' thoughts and prayers were with the victim. The incident is "so maddening, it is beyond my ability to express it," he added.
O'Connor's job is to not only screen Brokaw's calls, but also organize his calender and schedule his appointments - a difficult job because of his travel, numerous speaking engagements, and other activities.
But she also opens some of his mail. As one source said, Brokaw gets "tons and tons and tons" of mail, much of it related to his books, "The Greatest Generation," and "Album of Memories: Personal Histories of the Greatest Generation."
"There's no theory at all" why someone would send Brokaw a letter that ultimately infected O'Connor, said an industry source. "Tom gets envelopes all the time, and you know it's one of those instances where you know she wanted to make sure it was OK."
Most NBC staffers did not seem alarmed Friday afternoon.
"You just wish the best for (O'Conner]," said one employee taking a lunch break, who asked that her name not be published.
"The mood was calm and there wasn't much panic," said another staffer. "It did help that it wasn't the type of anthrax found in Florida."
Staff writer Devi Athiappan contributed to this story
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October 14, 2001, Newsday, Postmarked Trenton, N.J.; Letter to Brokaw traced, by Joshua Robin and Rocco Parascandola, Staff Writers, Sunday,
A letter postmarked Sept. 18 from Trenton, N.J., and containing sand-like granules is apparently the source of anthrax in an aide to NBC anchor Tom Brokaw, authorities said yesterday.
The disease did not come from white powder found in a hate-filled letter postmarked Sept. 20 from St. Petersburg, Fla., as authorities had speculated.
It instead came in another threatening letter Erin O'Connor (case 2) opened between Sept. 19-25, that was kept inside another envelope at NBC headquarters in Rockefeller Center until FBI agents discovered it Friday.
During the two weeks, the letter was handled by "a handful" of O'Connor's associates, who must now be tested, authorities said yesterday.
One employee, who sources said is a female intern, has shown symptoms of the illness, including a rash, fever and swollen lymph nodes. Dr. Neal Cohen, the city's health commissioner, said the unidentified individual is taking antibiotics and is doing well.
Cohen said a handful of other NBC employees who came into contact with the letter also are taking antibiotics. He emphasized it is safe for NBC employees to go to work. Officials said 358 people who work at the network have been tested.
"The public health risk associated with that building at this point is pretty close to negligible," he said.
It was unlikely that a white powder that fell on a New York Times reporter Friday contained anthrax, officials said. The letter to Judith Miller, postmarked Oct. 5 from St. Petersburg, also contained a hate-spewed missive. Another powder-filled letter postmarked from St. Petersburg and sent to the St. Petersburg Times also appeared unlikely to contain anthrax, officials in New York said.
Barry Mawn, the director of the FBI's New York City office, said agents retrieved the Trenton letter Friday while at NBC investigating the letter with the powder.
He would not release much information about the letter postmarked from Trenton, citing security concerns.
"All I'll give you on that is that there was no return address, it was an anonymous letter, white envelope," he said, adding that it was addressed to Brokaw. "There was a threat in the letter, but I'm not going to give you the wording." A source said the letter contained "general threats against America."
Although the brown granules had been discarded, the letter and envelope were tested Friday night, and health officials said a swab of the envelope was found to have traces of anthrax.
O'Connor, 38, is recovering, officials say.
"Now we have identified the missing link, so to speak," said NBC president and chief executive Robert C. Wright, who was at yesterday's news conference. Wright said a number of people at NBC News received threatening letters during the past several weeks. Not all of them were turned over to security officials, he said, even the one containing the granules.
Even though the envelope wasn't in an airtight container, it didn't necessarily pose a large public health risk, according to Dr. Stephen Ostroff, chief epidemiologist at the Centers for Disease Control and Prevention. "Simply keeping the envelope closed inside another envelope, which is apparently what happened - the risk associated with that ... is pretty close to zero," he said.
Investigators are still looking for those responsible for the hoaxes sent from St. Petersburg. "As far as we're concerned, these negatives ... are as serious [as the letter containing anthrax]," Mawn said.
Meanwhile, as word spread of what appears to be the city's first anthrax case, some New Yorkers with questions about the bacteria went to area emergency rooms, Mayor Rudolph Giuliani said yesterday at a news conference.
Outside Columbia Presbyterian Center in Manhattan yesterday, postal worker Gerson Carrathala, 35, there visiting his father, said he is worried and is wearing gloves at work. Still, he had not considered getting hold of Cipro, the anti-anthrax drug.
His wife, Martha, 41, said she has put her trust in the government.
"We have to try and lead a normal life," she said.
St. Vincent's Hospital Manhattan spokesman Bill McCann said 30 such people came to the hospital Friday with questions. The stream stopped when Giuliani appeared on television and told the public not to worry, McCann said.
Giuliani did the same yesterday during the news conference. "Right now, we have one case," the mayor said.
Staff writer Sean Gardiner contributed to this story.
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October 14, 2001, Newsday, Postmarked Trenton, N.J.; Letter to Brokaw traced, by Joshua Robin and Rocco Parascandola, Staff Writers
A letter postmarked Sept. 18 from Trenton, N.J., and containing sand-like granules is apparently the source of anthrax in an aide to NBC anchor Tom Brokaw, authorities said yesterday.
The disease did not come from white powder found in a hate-filled letter postmarked Sept. 20 from St. Petersburg, Fla., as authorities had speculated.
It instead came in another threatening letter Erin O'Connor (case 2) opened between Sept. 19-25, that was kept inside another envelope at NBC headquarters in Rockefeller Center until FBI agents discovered it Friday.
During the two weeks, the letter was handled by "a handful" of O'Connor's associates, who must now be tested, authorities said yesterday.
One employee, who sources said is a female intern, has shown symptoms of the illness, including a rash, fever and swollen lymph nodes. Dr. Neal Cohen, the city's health commissioner, said the unidentified individual is taking antibiotics and is doing well.
Cohen said a handful of other NBC employees who came into contact with the letter also are taking antibiotics. He emphasized it is safe for NBC employees to go to work. Officials said 358 people who work at the network have been tested.
"The public health risk associated with that building at this point is pretty close to negligible," he said.
It was unlikely that a white powder that fell on a New York Timesreporter Friday contained anthrax, officials said. The letter to Judith Miller, postmarked Oct. 5 from St. Petersburg, also contained a hate-spewed missive. Another powder-filled letter postmarked from St. Petersburg and sent to the St. Petersburg Times also appeared unlikely to contain anthrax, officials in New York said.
Barry Mawn, the director of the FBI's New York City office, said agents retrieved the Trenton letter Friday while at NBC investigating the letter with the powder.
He would not release much information about the letter postmarked from Trenton, citing security concerns.
"All I'll give you on that is that there was no return address, it was an anonymous letter, white envelope," he said, adding that it was addressed to Brokaw. "There was a threat in the letter, but I'm not going to give you the wording." A source said the letter contained "general threats against America."
Although the brown granules had been discarded, the letter and envelope were tested Friday night, and health officials said a swab of the envelope was found to have traces of anthrax.
O'Connor, 38, is recovering, officials say.
"Now we have identified the missing link, so to speak," said NBC president and chief executive Robert C. Wright, who was at yesterday's news conference. Wright said a number of people at NBC News received threatening letters during the past several weeks. Not all of them were turned over to security officials, he said, even the one containing the granules.
Even though the envelope wasn't in an airtight container, it didn't necessarily pose a large public health risk, according to Dr. Stephen Ostroff, chief epidemiologist at the Centers for Disease Control and Prevention. "Simply keeping the envelope closed inside another envelope, which is apparently what happened - the risk associated with that ... is pretty close to zero," he said.
Investigators are still looking for those responsible for the hoaxes sent from St. Petersburg. "As far as we're concerned, these negatives ... are as serious [as the letter containing anthrax]," Mawn said.
Meanwhile, as word spread of what appears to be the city's first anthrax case, some New Yorkers with questions about the bacteria went to area emergency rooms, Mayor Rudolph Giuliani said yesterday at a news conference.
Outside Columbia Presbyterian Center in Manhattan yesterday, postal worker Gerson Carrathala, 35, there visiting his father, said he is worried and is wearing gloves at work. Still, he had not considered getting hold of Cipro, the anti-anthrax drug.
His wife, Martha, 41, said she has put her trust in the government.
"We have to try and lead a normal life," she said.
St. Vincent's Hospital Manhattan spokesman Bill McCann said 30 such people came to the hospital Friday with questions. The stream stopped when Giuliani appeared on television and told the public not to worry, McCann said.
Giuliani did the same yesterday during the news conference. "Right now, we have one case," the mayor said.
Staff writer Sean Gardiner contributed to this story.
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October 14, 2001, Newsday, Mixed Signals Over Testing; Conflicting information troubles NBC workers, by Bryn Nelson, Staff Writer,
Although health authorities are recommending preventive antibiotics for NBC personnel who may have been exposed to anthrax at the news agency's Manhattan headquarters, worried employees say they've received conflicting information from a company-sponsored hotline.
An NBC employee who called the hotline yesterday said she was told she could receive the test at any local hospital. After waiting in an emergency room for more than four hours, however, she was turned away.
According to New York City Department of Health guidelines sent to area hospitals Friday afternoon, only employees of NBC who were present on the third floor (where two suspicious letters were opened), the seventh floor (where they were carried to security), or in the mail room on either Sept. 18 or Sept. 25 are considered at risk and should take antibiotics as a preventive measure.
When a Newsday reporter called the NBC hotline yesterday afternoon, however, an operator said only third-floor employees should be tested, adding that the recommendation was not limited to any specific dates.
City health officials said that unlike in Florida, the potential anthrax exposure at NBC's headquarters is limited because of its defined source.
The NBC employee who sought the test works on the seventh floor, but was absent from the news agency's Rockefeller Plaza headquarters on both Sept. 18 and 25. She spoke on condition of anonymity.
An assistant to NBC anchorman Tom Brokaw working on the third floor received suspicious envelopes on those dates, each of which contained a powdery substance. The employee, identified as Erin O'Connor (case 2), 38, has contracted cutaneous anthrax but has been receiving the antibiotic Cipro for about two weeks and is expected to fully recover. Yesterday, Mayor Rudolph Giuliani said the letter received on the 18th tested positive for anthrax.
NBC did not return several calls seeking comment.
Nassau University Medical Center spokeswoman Shelley Lotenberg said the hospital has been following the New York City guidelines, and that only employees associated with the specific NBC sites will receive preventive antibiotics.
"If they come with flu-like symptoms, obviously they will be evaluated," Lotenberg said. "No one's ever turned away."
Richard Bagdonas, an attending physician in the hospital's emergency department, said a handful of area residents sought tests or antibiotics at the hospital on Thursday and Friday. The NBC employee who spoke to Newsday sought treatment elsewhere.
"There's a high vigilance now for any signs and symptoms," Bagdonas said. However, none of the individuals was symptomatic, he said.
Bagdonas said the hospital has also been following Nassau County guidelines, which state that no credible threat of anthrax has been found in the county after investigations by law and hazardous materials agencies at several sites on Thursday and Friday.
Doctors say one positive development may be the opportunity to educate the public about the risks and benefits of antibiotics such as Cipro, the drug of choice for treating anthrax. As a preventive treatment, Cipro is prescribed in doses of 500 mg twice a day for 60 days.
"Most of the side effects are mild, but people recognize that antibiotics being given for a length of time are potentially dangerous," Bagdonas said. "They're not just vitamin pills."
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October 22, 2001, Newsweek, Anxious about Anthrax; A few cases do not an epidemic make. But they're unprecedented; worry over what's next is contagious, by Sharon Begley and Michael Isikoff,
EXCERPT
On Oct. 12 in New York City, NBC News assistant Erin O’Connor (case 2) tested positive for cutaneous anthrax, apparently the result of exposure to a powder in an envelope she had opened three weeks before.
Although seemingly every sicko with a grudge had decided that there's nothing like an anthrax threat to strike terror in the heart of your target, the copycat threats that followed the Florida case seemed empty -- until Oct. 12. Before dawn that morning the FBI learned that the anthrax bug had hit New York. NBC, the FBI reported, had received a suspicious business letter addressed to "Nightly News" anchor Tom Brokaw. Postmarked St. Petersburg, Fla., it arrived Sept. 25, with no return address. When Brokaw's assistant, Erin O'Connor, opened it, she found white powder and a note: "The unthinkable. See what happens next." NBC's security office called the FBI, which picked up the letter the next day. Within days O'Connor, 38, developed a rash below her left collarbone. After it became more irritated, ulcerous and necrotic (filled with dead tissue), she saw a doctor. The Cipro he prescribed on Oct. 1 cleared the lesion. But it was a call from one of O'Connor's doctors to the city Health Department, reporting a possible case of anthrax, and a call from the city to the FBI, that lit a fire under the bureau. The FBI ordered tests on the powder in the letter O'Connor opened, as well as a skin biopsy from O'Connor, at the U.S. Centers for Disease Control and Prevention in Atlanta.
O'Connor tested positive for cutaneous anthrax. But the powder tested negative. When the FBI interviewed O'Connor more extensively, she recalled that she had gotten another letter, postmarked Sept. 18. She hadn't thought anything of it. But, she finally remembered, it did contain some kind of dark, sandlike powder. That letter, postmarked Trenton, N.J., contained traces of anthrax, the FBI reported over the weekend. The delay in identifying the powder, and O'Connor's lesions, confirmed fears that neither public-health officials nor law-enforcement agencies will recognize bioterrorism quickly. That would be especially horrific if the bug were a contagious microbe such as smallpox.
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Full Text Via sharon.begley.com:
(Sharon Begley, the senior health & science correspondent at Reuters, was the science editor and the science columnist at Newsweek from 2007 to April 2011, and a contributing writer at the magazine and its website, The Daily Beast, until December 2011. From 2002 to 2007, she was the science columnist at The Wall Street Journal, and previous to that the science editor at Newsweek.)
October 22, 2001, Newsweek, Anxious About Anthrax; A Few Cases Do Not An Epidemic Make. But They're Unprecedented; Worry Over What's Next Is Contagious, by Sharon Begley and Michael Isikoff,
At first, the anthrax scares popping up everywhere could be dismissed as the products of overactive imaginations. In Florida, where residents were already spooked by reports that last month's skyjackers had inquired about renting crop-dusters, authorities had received more than 100 calls about suspicious powders over the past few weeks; they all turned out to be innocuous substances such as plaster dust. In Trenton, N.J., two office buildings were evacuated early last week after employees reported opening packages containing a white powder. Tests found no traces of any pathogens. An Internal Revenue office in Covington, Ky., was sealed off and 200 employees briefly quarantined after powder was found in an envelope. It, too, was harmless--as was the brown powder found in an envelope sent to a state agency in Ohio, the powder in a Halloween card sent to The Columbus Dispatch and the yellow powder in an envelope that an Ohio couple opened exactly a month after the September terrorist attacks. That one also contained a note. "You are now infected with anthrax." They weren't. Nor was the divorce lawyer of a woman to whom a bitter husband sent a letter that, he warned, was impregnated with anthrax, the FBI told NEWSWEEK. Although anthrax is not contagious, fear of it was epidemic.
But if the FBI, intelligence officials, local police and--most of all--Americans who had vowed not to live in terror were tempted to dismiss these scares as hoaxes or hysteria, they were quickly brought up short. By midweek eight employees at American Media Inc. in Boca Raton, Fla., had been exposed to Bacillus anthracis; one, photo editor Robert Stevens, was dead as the result of inhaling thousands of deadly spores. On Oct. 12 in New York City, NBC News assistant Erin O'Connor tested positive for cutaneous anthrax, apparently the result of exposure to a powder in an envelope she had opened three weeks before. And the next day a letter received at a Microsoft office in Reno, Nev., tested positive for anthrax: the envelope, in which Microsoft had sent a check to a vendor in Malaysia, had been returned, with the check intact. It also contained pornographic pictures cut from a magazine, and dusted with anthrax spores. Suddenly, a hypothetical threat was all too real, and fears that had been bubbling under the surface for the past month burst into the open. In New York, Celeste Sharpe, a mother of two and former assistant district attorney in the Bronx, found out about the NBC anthrax through NYPD friends. Anxiously withdrawing cash from an ATM, she told a friend by cell phone, "I'm getting the hell out of the city."
President George W. Bush implored all Americans to live their lives as normally as possible. "Our government is doing everything we can to make our country as safe as possible," he said. But while everyone agreed that panic wasn't called for, prudence was. The U.S. Postal Service advised all Americans to monitor their mail carefully and to be suspicious of any envelopes without return addresses, with stains or odors or with too much postage (a hint that the sender really, really doesn't want it returned for insufficient postage). The State Department ordered all U.S. Embassies to buy and store three days' supplies of the antibiotic ciprofloxacin--as a precaution. Bayer, the German pharmaceutical giant, announced that it would increase production of Cipro, its trademark ciprofloxacin, by 25 percent beginning Nov. 1: wholesalers were running low on the drug throughout the United States.
The panic was understandable: people are much more afraid of exotic, seemingly uncontrollable risks like anthrax than they are of familiar ones like flu (which kills more than 20,000 Americans each year). Anthrax is nothing if not exotic, at least in America. It is caused by a bacterium, Bacillus anthracis. This rod-shaped microbe grows in soil, where it can be ingested by sheep, cows, horses and goats. That's why anthrax is labeled a veterinary disease, and why those most likely to contract it work with animals or animal products (such as wool). If growing conditions deteriorate, the bacteria form microscopic spores, which can remain dormant (and lethal) for decades. In the worst-known anthrax outbreak, at least 66 people died when spores were released from a bioweapons plant in Sverdlovsk, Russia, in 1979.
At every step in the anthrax investigations, officials were quick to minimize the threat. Yet those reassurances were eclipsed by other cases or by evidence that authorities are poorly prepared for a bioterror attack. When Bob Stevens was diagnosed with inhalation anthrax, his was an "isolated" case, Florida and federal health officials insisted, and almost certainly the result of accidental, natural exposure--even though anthrax has never been reported in animals or soil east of the Mississippi River and even though the United States recorded only 18 cases of inhalation anthrax in the 20th century and none since 1978. But when alert doctors found anthrax spores in the nose of AMI mailroom supervisor Ernesto Blanco, 73, who was hospitalized with pneumonia, "isolated" looked like it had company. FBI agents sealed the building two days after Stevens died, and agents in airtight jumpers and oxygen masks swarmed through AMI's offices, scouring it for traces of anthrax. The next day, Oct. 8, AMI's 700 employees and recent visitors lined up at the white annex building of the county Health Department in Delray Beach to have nasal swabs taken. By midweek AMI mailroom worker Stephanie Dailey, 36, had also tested positive for the presence of anthrax spores in her nose. Although hardly an official statement went by without the assurance that anthrax is not contagious, the message wasn't getting through in south Florida. In Boca Raton, when 3-year-old Alexander de Jesus got ready to climb into a barber's chair, the hair stylist showed him and his mother the door: she works one floor below The Sun, one of AMI's five supermarket tabloids.
Panic, and perhaps copycats, spread like a nasty flu. Early last week St. Petersburg Times columnist Howard Troxler received a letter warning, in unsteady handwriting, "Howard Troxler... 1st case of disease now blow away this dust so you see how the real thing flys." "This" was a white, sugarlike substance. By the weekend it had tested negative for the presence of anthrax and other pathogens.
Although seemingly every sicko with a grudge had decided that there's nothing like an anthrax threat to strike terror in the heart of your target, the copycat threats that followed the Florida case seemed empty--until Oct. 12. Before dawn that morning the FBI learned that the anthrax bug had hit New York. NBC, the FBI reported, had received a suspicious business letter addressed to "Nightly News" anchor Tom Brokaw. Postmarked St. Petersburg, Fla., it arrived Sept. 25, with no return address. When Brokaw's assistant, Erin O'Connor, opened it, she found white powder and a note: "The unthinkable. See what happens next." NBC's security office called the FBI, which picked up the letter the next day. Within days O'Connor, 38, developed a rash below her left collarbone. After it became more irritated, ulcerous and necrotic (filled with dead tissue), she saw a doctor. The Cipro he prescribed on Oct. 1 cleared the lesion. But it was a call from one of O'Connor's doctors to the city Health Department, reporting a possible case of anthrax, and a call from the city to the FBI, that lit a fire under the bureau. The FBI ordered tests on the powder in the letter O'Connor opened, as well as a skin biopsy from O'Connor, at the U.S. Centers for Disease Control and Prevention in Atlanta.
O'Connor tested positive for cutaneous anthrax. But the powder tested negative. When the FBI interviewed O'Connor more extensively, she recalled that she had gotten another letter, postmarked Sept. 18. She hadn't thought anything of it. But, she finally remembered, it did contain some kind of dark, sandlike powder. That letter, postmarked Trenton, N.J., contained traces of anthrax, the FBI reported over the weekend. The delay in identifying the powder, and O'Connor's lesions, confirmed fears that neither public-health officials nor law-enforcement agencies will recognize bioterrorism quickly. That would be especially horrific if the bug were a contagious microbe such as smallpox.
On the same day that O'Connor was diagnosed with cutaneous anthrax, The New York Times received a letter, postmarked St. Petersburg, on the same date as the letter sent to Troxler. It was addressed to Judith Miller, coauthor with three Times colleagues of the new best-seller "Germs: Biological Weapons and America's Secret War," and filled with white powder. There were "some similarities" in the handwriting on the letters to NBC and the Times, said Barry Mawn, head of the FBI's New York office. Although the substance contained no anthrax, the Times assured readers in a front-page box in its Saturday edition "that no copies of the newspaper are printed in [our] Manhattan headquarters."
To trace the postal anthrax, investigators are trying to identify the strain in the Florida, Nevada and New York cases. To do that, they first grow the suspected anthrax spores in a nutrient medium, such as beef broth, until they germinate into live, rod-shaped bacterial cells, says Calvin Chue, research scientist at the Center for Civilian Biodefense Studies at Johns Hopkins University. If anthracis is present, antibodies in a test kit bind to antigens on its surface. If they do--the test takes half an hour--the antibodies fluoresce. In Reno, however, the state lab tested directly for anthrax spores and got a hit. In the current criminal investigations, the FBI hopes to determine which of the hundred-plus genetically distinct strains of anthrax were sent to AMI, NBC and Microsoft. They have not yet succeeded, and it's not clear that doing so would help much. Many types of anthrax can be found at microbiology labs across the world. The Ames strain, for instance, named after an Iowa lab where it was first isolated half a century ago, "is a very common virulent strain that's used in every antibiotic and vaccine" study, says Martin Hugh-Jones of Louisiana State University.
If the science offers few leads, old-fashioned police work might. In Florida, investigators focused on a one-page, handwritten love letter addressed to Jennifer Lopez, NEWSWEEK first reported on its Web site. It was sent to The Sun, says a source, in Lantana, Fla. It reportedly arrived sometime after Sept. 17. Staffers laughed over it and passed it around the third-floor editorial offices. Enclosed was a small Star of David and a tablespoon or so of a bluish substance that resembled dishwashing powder. Bob Stevens was among those who handled the letter. As one staffer recalled to NEWSWEEK, "The only difference between Bob and those who watched him open it was that Bob [who had poor eyesight] held it up to his face." Stevens's spartan workstation--Macintosh computer, a mousepad decorated with photos of his friends, crayon drawings from a colleague's young son--was a hot spot of anthrax. So was a receptacle in the mailroom, where Blanco and Dailey worked. But how five additional employees were exposed (blood tests came back positive over the weekend) is a mystery: some work for The National Enquirer, whose offices are "way the heck down the hall and around the corner," says The Sun's Carla Chadick.
Even if anthrax reached AMI through a letter, it wasn't much to go on. "I'm not sure the FBI is ready for the amount of weird mail we get," says Grant Balfour, a Sun writer. When you write about alien abductions, celebrity brawls and the size of Osama bin Laden's private parts, you're not surprised when letters arrive with dirty underwear, human feces, claims to being a Romanov heir and other rants.
FBI officials are skeptical that the anthrax at NBC, Microsoft and American Media Inc. came from Osama bin Laden or any other known terrorist. The connections so far are circumstantial. This summer Mohamed Atta and Marwan Al-Shehhi, who piloted the planes that hit the World Trade Center, rented an apartment in Delray Beach, a few miles from the AMI building, and took flying lessons nearby. Last week the White House was calling the FBI every two hours one night after a report that the two skyjackers had asked a Delray Beach pharmacist for an antibiotic to fight anthrax. Rather than antibiotics, in fact, Atta asked for something to soothe an inflammation of his hands. The redness resembled the irritation caused by detergent or bleach. The pharmacist gave him a cream called acid mantle. The incident raised fears that Atta had been using caustic chemicals in a bioterror experiment: detergent effectively breaks up clumps of anthrax spores into smaller, deadlier particles.
Although the FBI has not ruled out a connection to Al Qaeda, says one senior U.S. official, "my instinct says it's a nut case." One death, one easily treated rash and seven symptom-free people with anthrax spores in their noses or antibodies in their blood are hardly what experts expected from terrorists wielding a bioweapon. Every scenario until now has envisioned anthrax spores being aerosolized--dried and turned into a powder--and then disseminated widely in the air, probably into an enclosed space like a building or airplane. The goal would be to spread the spores like an invisible, lethal fog, keeping the particles small enough so that they could be inhaled before settling to the ground. In addition, many bioweapons experts thought terrorists intent on mass murder rather than just mass panic would use an antibiotic-resistant strain. The Russians engineered anthrax strains resistant to penicillin, doxycycline and other antibiotics by splicing in genes from naturally resistant strains of, say, the common intestinal bacterium E. coli. The Florida strain was not genetically engineered, the CDC says, and is vulnerable to antibiotics.
But there is another reason law-enforcement officials have been at pains to emphasize that the anthrax cases have not been linked to Al Qaeda or any other terrorists. "Biological-weapons agents can easily be obtained," Ron Atlas, president of the American Society of Microbiology, wrote recently. "A survey of nearly 1,500 U.S. academic institutions indicates that 22 percent work with pathogenic microorganisms and toxins that could be used in biological-weapons development." You can't just walk into a lab and swipe a vial of anthrax, but researchers admit that nothing would stop a determined individual from hiring on at a lab, as a student or technician, and obtaining a starter culture. "We all use student workers who are 18 or 19," says LSU's Hugh-Jones. "Most of them don't even have any background you can check."
Until the Feds cracked down in the late 1990s, pathogens could also be bought. In 1995, white supremacist Larry Wayne Harris ordered three vials of freeze-dried bubonic-plague bacteria from the nonprofit American Type Culture Collection, for $240. The germs turned out to be an innocuous vaccine strain (weakened, or attenuated, so they don't give you the disease itself rather than trigger immunity to it). In 1986 ATCC sold three types of anthrax to the University of Baghdad, and in 1988 sold four strains to the Iraqi Ministry of Trade. All of ATCC's sales were legal. During the gulf war, however, American intelligence agencies became convinced that ATCC's strains were among those that Iraq used in its biological-weapons program. A 1996 law restricts sales of the most deadly microbes, including anthrax and Ebola, but if scientists are denied access to the bugs, research on vaccines and cures will stop.
The current anthrax cases have not changed one crucial reality: turning pathogens into weapons of mass destruction is hugely difficult. As far as intelligence agencies know, the group that put the greatest effort into bioterror was Japan's Aum Shinrikyo cult. In April 1990, members drove an automobile outfitted to disseminate botulinum toxin around Japan's Parliament building. In June 1993, they tried to disrupt the wedding of Japan's crown prince by spreading botulinum toxin the same way. They also tried, for four straight days that month, to spread anthrax from a rooftop in Tokyo. "Nine failures in nine attempts attest to the difficulty of actually deploying biological weapons to cause mass casualties," says Atlas. And Aum Shinrikyo had a war chest estimated at more than $300 million, as well as half a dozen labs and experienced biologists. Growing anthracis is hardly more difficult than growing sourdough starter. But turning bacteria into spores, the only form hardy and stable enough to be spread, requires the tricky step of shocking the bacteria with heat or chemicals without killing them. Perhaps the greatest hurdle is getting particles of the right size. Spores tend to clump. Yet particles must be between one and five microns to enter the lungs and trigger inhalation anthrax; it's not easy to get a sprayer to dispense such a fine mist, as Aum Shinrikyo found. Assassination by microbe, however, is a different story. In 1978 the Bulgarian secret police killed dissident Georgi Markov by injecting deadly ricin (derived from castor beans) into his thigh with a pellet shot from an umbrella. And someone killed Bob Stevens. It all seemed like a bad movie. "What are the chances?" asked Penny Robbins, who works in the Microsoft building. "Reno and anthrax?"
It would be foolish to think we can guess what criminals and terrorists will try next. But we might take note that, after 19 men turned planes into bombs, we ramped up airport security--just when people started sending anthrax through the mail. Now we treat our mail like toxic waste, planes with "mysterious powders" on bathroom counters get impounded and doctors bone up on anthrax. Perhaps, instead of fighting the last battle, it is time to anticipate the next. "If we just focus on anthrax," says Ken Alibek, a top scientist in the Soviet bioweapons program who defected to the United States, "we're going to get surprised." We saw the effects of surprise, all too horrifically, on Sept. 11.
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October 25, 2001, Associated Press - Newsday, New Anthrax Case in Virginia, Probable Cases in NY, NJ,
A State Department mail handler lay ill with inhalation anthrax Thursday and the besieged Postal Service set up spot checks at facilities nationwide as the bioterror scare widened.
"We still don’t know who is responsible," said Homeland Security Director Tom Ridge.
The new anthrax case in Virginia was but one of several on Thursday:
- Postal Service says anthrax has been detected on four mail-sorting machines at a Manhattan processing station that handles millions of parcels a day.
- Health officials say a probable case of skin anthrax has been found at NBC, stemming from the same letter that is believed to have infected an assistant to news anchor Tom Brokaw.
- A second New Jersey postal worker may have the inhaled form of anthrax, health officials said. They urged hundreds of postal workers at two Trenton-area facilities to take antibiotics for 60 days instead of just seven.
"I want to reiterate, there is no indication of any new exposure at this time at these sites," he said.
The infected New York postal machines are in the Morgan Processing and Distribution Center, which covers two city blocks on Ninth Avenue between 28th and 30th streets and has more than 5,000 employees.
McGovern said the building would remain open. The postal service said health officials had advised earlier that it was safe to continue working.
Louie Nikolaidis, a lawyer for the New York Metro Area Postal Union, said the building should be closed and cleaned.
“What they should do is immediately shut down the facility. They should then proceed to test all remaining equipment and the workers,” Nikolaidis said.
No postal employees have tested positive for anthrax in New York, but two have died of the inhaled form of the disease in Washington, D.C.
At least two anthrax-contaminated letters, one to NBC and one to the New York Post, passed through the city's mail system, which handles about 20 million pieces of mail a day.
At NBC, the second case of skin anthrax has classified the case as “suspicious or probable" by the Centers for Disease Control and Prevention, the city Health Department said today.
City Health Commissioner Neal Cohen said the diagnosis was complicated because the NBC employee had been on antibiotics before a biopsy was taken, and the biopsy came up negative for anthrax.
But a blood sample, the employee's symptoms and the fact that she had handled the Brokaw letter persuaded officials to classify the case as probable.
"The bottom line is the woman is fine," said Kassie Canter, an NBC spokeswoman.
At a White House news conference, Ridge also disclosed that the anthrax contained in mail addressed to Senate Majority Leader Tom Daschle had been altered to make it more of a threat. “It is highly concentrated. It is pure and the spores are smaller,” he said. “Therefore they’re more dangerous because they can be more easily absorbed in a person’s respiratory system.”
Ridge said the type of anthrax used in the U.S. attacks is called Ames. Anthrax researchers have identified Ames, named for the city in Iowa, as the strain used in American bioweapons research. It also is used to test vaccines.
Three weeks into the nation’s unprecedented bioterrorism scare, lawmakers were permitted to return to several of their office buildings on Capitol Hill. And White House spokesman Ari Fleischer said there had been no evidence of anthrax exposure among officials who came in contact with mail that went through an offsite machine where anthrax was detected earlier in the week.
“We are here to conduct the nation’s business. We will not be frightened,” said Secretary of State Colin Powell as he appeared before a Senate committee.
But there were words of caution elsewhere. “We are very concerned about additional letters. We would be naive to think this is over yet,” said Dr. Julie Gerberding of the Centers for Disease Control and Prevention.
There was further jolting news, a disclosure from officials in New Jersey that a postal worker was being watched for suspected inhalation anthrax, and then the announcement from the State Department.
Dr. Ivan Walks, head of the Washington public health department, said the man was hospitalized in guarded condition with inhalation anthrax. Unlike other area residents who have been hit, this patient had been asked whether his job required him to go to the Brentwood postal facility that serves as the main mail processing center for the nation’s capital.
"His answer was 'never,'" Walks reported.
However, mail to federal agencies passes through the contaminated Brentwood facility.
That announcement came in addition to 12 confirmed cases of anthrax in the past three weeks, most of them linked to anthrax-spiked mail that has passed through New Jersey, New York or the nation’s capital.
One such letter was addressed to Daschle; others are known to have been sent to NBC News anchorman Tom Brokaw and to the New York Post. Anthrax has also been found in Florida, where one man died, although authorities have not yet found tainted mail there.
At his White House news conference, Ridge said tests on the anthrax found to date confirmed it is all of the same strain and responds to antibiotics, meaning that “people who are exposed can be treated.”
At the same time, he added, the substance in Daschle’s mail “has some different characteristics” that make it more easily taken into a victim’s lungs. He said that based on the latest lab reports, “It is clear that the terrorists responsible for these attacks intended to use this anthrax as a weapon.”
In all, 28 people were exposed to anthrax in and around Daschle’s office, and all Senate office buildings were shut down. The discovery of anthrax on a mail machine in a House office building prompted the closure of additional office buildings.
Daschle said one wing in the building that houses his office would remain sealed off for the indefinite future. "I am very confident that we will be able to seal it in a way that will provide us complete confidence that we can access the rest of the building without any hazardous exposure," he told reporters in the Capitol.
Officials learned Wednesday of additional anthrax in the same building when tests taken from a freight elevator turned out positive. Congressional sources, speaking on condition of anonymity, said the elevator is used routinely to convey express mail to the Hart Building, connected by underground tunnel to the Senate's main mail room in the building next door.
Thus far, an estimated 10,000 people have been given antibiotics as a precaution against contracting anthrax, many of them postal workers in New York, New Jersey and the nation’s capital. And in recent days, the Postal Service and Bush administration have launched an intensive effort to assure the safety of the mail system.
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October 7, 2002, Newsday, Questions Linger a Year After Anthrax Mailings; Unknown dominates probe, by Laurie Garrett, Staff Writer,
First of Two Parts (click here for second part) -- It came into the building in a letter. Somewhere along the way, Ernesto Blanco (case 7), an American Media company mail room clerk, handled it. The letter was opened near a stack of reams of paper for the 68,000-square-foot building's copy machines. Eventually, photo editor Robert Stevens (case 5) held the envelope, unwittingly sprinkling its contents onto his computer keyboard. It spread all over the three-story Boca Raton, Fla., office building as those reams of paper were inserted into copy machines that shuffled the pages about. Or so the Federal Bureau of Investigation would conclude a year later.
It was there, but nobody could have imagined its presence at the time. And nobody would, until Stevens was taking his final breaths and Blanco was lying in an intensive care unit, fighting for his life. Anthrax.
On Oct. 4, 2001, the world learned that Stevens was dying of acute inhalational anthrax disease, and with his death the following day a chain of events unfolded that would permanently imprint the word "bioterrorism" into the consciousness of Americans. It would shake up the country's public health system as nothing ever had. And it would test the resolves of thousands of health workers, the largest group of whom would be scouring the nation's capital and New York City in search of clues and answers.
A year later, those dogged disease detectives have scaled many obstacles, but still face a long list of unsolved mysteries. How two of the five anthrax victims -- including Bronx resident Kathy Nguyen (case 22) -- contracted the disease remains unknown. The FBI still is searching for the culprit or group responsible for the deadly mailings.
And officials at the federal and local levels still are struggling to reshape America's public health system, trying to mend the enormous holes in the nation's safety net that were revealed last fall. What became clear in the past year is the extent to which the public health system was overwhelmed by just seven known anthrax-laced envelopes.
On Oct. 2, 2001, Stevens, 63, was admitted to a West Palm Beach, Fla., hospital. He was in a terrible state. The American Media photo editor had been on a fishing vacation with his wife, traveling about the South, when he came down with what he thought was the flu, in North Carolina.
That was five days earlier, during which time his condition had worsened considerably. By Oct. 2, Stevens was nauseated and making little sense. He had no idea where he was, what year it was, or who was the president of the United States. Blood tests revealed a war was under way, with millions of white blood cells doing battle with some unknown invader.
While the nearby Jacksonville, Fla., public health laboratory tried to identify that mysterious invader in Stevens' blood, the hospital put him on massive doses of antibiotics. But the anthrax bacteria had long since made their way into Stevens' spinal cord and brain, triggering meningitis. As he lay in intensive care, the bacteria released three powerful toxins into his blood. It would be months before scientists, spurred by the urgency of the anthrax crisis, would study how these toxins kill.
One way, they learned, was by disabling Stevens' immune system, allowing the other two to wreak havoc inside cells all over Stevens' body.
Months later, scientists and clinicians would realize that giving antibiotics to patients as far gone as Stevens only worsens matters, as the drugs kill some anthrax bacteria, which break open, releasing their deadly toxins. The sudden toxic surge flooded Stevens' brain, causing a grand mal epileptic seizure. Were it not for a machine that pumped oxygen into his airways, Stevens would have died immediately.
By Oct. 3, the toxins began killing cells in Stevens' heart. He suffered a heart attack and then went into a coma. He never regained consciousness.
Months earlier, the federal Centers for Disease Control and Prevention in Atlanta had begun a poorly funded effort to upgrade the nation's public health laboratories in hopes of improving local capacity to diagnose rare infections, such as anthrax. A tiny cadre within the CDC, the Army and a handful of other institutions had long feared the potential use of biological weapons and was appalled to learn that most American health labs couldn't run reliable tests for a long list of likely germ weapons.
The gold standard for such lab work was set by CDC lab chiefs Richard Meyer and Tanja Popovic, who had trained several dozen local laboratory staffers before the Sept. 11 terrorist attacks. Yet nationwide, fewer than 100 health laboratories -- out of thousands -- had completed laboratory response network training and equipment upgrades, Meyer said.
Fortunately, one such trainee was Phillip Lee of Jacksonville, the man who grew anthrax from Robert Stevens' blood samples. Lee used the special stains and fluids Popovic had taught him would reveal the presence of anthrax in a fluid sample.
Peering through a microscope at a thousand-fold magnification, he saw Stevens' cerebrospinal fluid swarming with long thin rods, stained a deep purple, and lined up end to end to form chains -- classic attributes of anthrax bacilli. When he called Popovic on Oct. 3 to tell her what he found, the CDC scientist knew the result was solid -- America had anthrax on its hands.
The world's top DNA-PCR (DNA fingerprinting) lab and anthrax diagnostics facility is a two-tiered facility at the CDC. Meyer ran the first tier -- a section that conducted the primary screenings of samples, processing them both for anthrax DNA and as legally certified criminal evidence.
In a higher-security building, Popovic directed the lab that confirmed infection by growing living anthrax bacilli from a sample. Fortunately, Popovic's lab was housed in a brand-new building, completed just weeks before Sept. 11. A few months before, the dangerous work would have been performed in a World War II-era facility in which contamination could not have been easily prevented. By the time she received the fateful call from Jacksonville, Popovic and her tiny staff were working in a state-of-the-art facility, housed under security so strict that its innermost core could be entered only by a handful of people.
Meyer's DNA analysis could give a tentative answer within an hour or two, but Popovic's confirmation couldn't come any faster than the rate at which anthrax grows -- at least seven hours.
Back in Florida on Oct. 3, Lee's anthrax diagnosis was more a matter of puzzlement than anything else. Nobody then could anticipate the national chain of events that would unfold shortly. Lee didn't know that another patient -- mail clerk Blanco -- also was suffering from anthrax, or that the Florida cases were part of a bioterrorism event that had already led to skin infections in New York newsrooms -- infections that wouldn't be properly diagnosed for several more days.
On Thursday night, Oct. 4, the CDC's chief of meningitis and special pathogens, Dr. Brad Perkins, had just nestled in for his daughter's piano recital when his cell phone rang. The CDC caller told Perkins that a Florida man was hospitalized with inhalational anthrax. Fourteen hours later, Perkins was in Florida leading a CDC investigation to determine how Stevens got infected with a remarkably rare microbe. His first stop was the hospital where Stevens remained unconscious and was running a fever of 104 degrees.
"He was intubated, critically ill, unable to speak," Perkins recalled. "But I did not expect him to die that day. And actually the family was very hopeful that he was going to survive."
In Washington, Health and Human Services Secretary Tommy Thompson officially had announced the ailing Stevens' anthrax case to a nation whose nerves were still very much on edge from the Sept. 11 attacks. He said of Stevens' infection that it "appears that this is just an isolated case" and "there's no evidence of terrorism."
Proceeding on a scientific mission, Perkins took his team to the American Media building, where Stevens had worked for The Sun supermarket tabloid. As they met with editors who knew Stevens, the phone rang. It was the hospital, informing American Media that the photo editor had just died of anthrax poisoning.
"That was a fairly dramatic moment because we were sitting in a room with people who had known him," Perkins said. "This was a universally loved guy. Everyone was just in utter disbelief."
Stevens' Oct. 5 death brought grim urgency to a CDC investigation that spanned four states through which he had recently traveled. And it brought the world's media, numerous state and federal agencies and the White House into the picture.
Thompson once again faced the media, saying the anthrax case was probably of natural origin, based on something Stevens picked up from drinking from a South Carolina stream. Anthrax is not a water-borne organism, however, and the secretary's comment would haunt his department, undermining its credibility for months.
Thompson, a former governor with no scientific or medical training, issued orders that all information to the public and media come from his office, barring government scientists and health experts from providing expert advice or information.
In Florida, meanwhile, Perkins' job was to stay focused on leading a solid, scientific investigation.
He and his small staff meticulously scoured Stevens' home and office, as well as the American Media mail room, swabbing for anthrax spores.
In Atlanta, the CDC was eager to have autopsy results on Stevens, but nobody in Florida wanted to perform the procedure. Pathologist Sherif Zaki, the CDC's top medical examiner, flew to West Palm Beach on Saturday, Oct. 6, and headed straight for the morgue. He found the staff of the medical examiner's office understandably frightened, Zaki said, but willing to assist once he had explained safety procedures.
When they opened Stevens' chest, Zaki recalled, the team found "evidence of anthrax in literally every organ we touched," especially the man's disease-fighting lymph nodes. Those were so saturated with the toxins that they actually disintegrated as Zaki's probes touched them.
The next day, Perkins got word from the CDC's anthrax laboratory that swabs collected from Stevens' computer keyboard and the mail room tested positive for Bacillus anthracis. That finding triggered the FBI's criminal investigation. He also got CDC laboratory confirmation that there was a second case of the disease -- in someone who worked in the same building as Stevens -- and learned about Ernesto Blanco, fighting for his life in another hospital.
At that point, Perkins said, he decided to place thousands of American Media employees and recent visitors on ciprofloxacin antibiotics as a precaution. In coming days television footage of long lines of anxious Floridians queued up to get nasal swabs and pills would spark public anxiety and a demand for antibiotics. Within two weeks the nation's entire supply of ciprofloxacin would be sold out, with none available for treatment of genuine, and often serious, ailments for which it is normally used, such as children's ear infections.
In Atlanta, the CDC was deluged with calls asking who should be given antibiotics. In what doses? What are the symptoms of anthrax? Is the powder in my Alaska office a hoax or the real thing? The agency was in danger of being overwhelmed. And because of the directives from Thompson, most of the queries had to go unanswered.
"We needed information," John Auerbach, executive director of the Boston Board of Health, said recently. "Every kind of government report that we needed was delayed. We were getting information from journalists, for God's sake, not the CDC. There simply wasn't a good, accurate, timely internal communication system."
"We made a decision at CDC that the people who needed information in order to effectively respond should be our priority," Dr. Julie Gerberding recalled. Last fall she was the deputy director of the CDC's National Center for Infectious Diseases. Ten months later, her boss, Dr. Jeffrey Koplan, would be forced to resign and Gerberding would be named CDC director. Few could get information from the CDC for days, Gerberding would later concede, not even America's physicians, most municipal health directors or even members of Congress.
With the exception of New York City, where then-Mayor Rudolph Giuliani personally handled all public announcements related to terrorism, the nation's public health messengers were late in communicating. Public health officials learned that their communications systems -- computers, phones, faxes, video systems -- were woefully out of date. Their ranks of skilled speakers and information officers were thin, and their ability to control panic minimal.
A year later, the CDC has built the Health Alert Network, reaching every public health department, no matter how small or remote, in America. But that was a mere skeleton last October. "As events wore on, it became clear the CDC needed to be the primary source of scientific information," Gerberding said in an interview months later. "But once it was obvious to all that we needed to take the lead, we were in a reactive mode. And we are still catching up."
Within hours of the collapse of the World Trade Center, Dr. Kevin Yeskey, director of the CDC's Bioterrorism Response Program, had issued an alert to health departments nationwide "calling for enhanced surveillance, meaning, 'Please be vigilant for anything that might be suggestive of a bioterrorism event,'" Yeskey said. As word of the Florida case spread, health providers and public health officials all over America started remembering that alert, and anxiously sought information from Atlanta.
"I said, 'Let's set up an Ops Center here,'" Yeskey recalled. He sat down with a sheet of paper and drew a pyramid, with CDC director Koplan at the top and Infectious Diseases Director Dr. James Hughes and Gerberding just below. He drew a military-style chain-of-command map that connected Koplan to the field investigators then dispersed over the states tracing Stevens' movements and suspected additional anthrax cases.
Yeskey, a former military officer, marched into Gerberding's office, his chart in hand, and said, "We need a Special Ops Center. This is what it would look like. Field A responds to command leader A here in Atlanta, and Field B ... "
Gerberding stared at the piece of paper and thought it was a crazy idea. Slightly amused, she listened as Yeskey spun a web of desks and phones and chains of command. But under prior bioterrorism preparedness guidelines, she knew some sort of operational center was necessary, so she gave Yeskey the green light to implement what, in the back of her mind, remained a whacky concept.
Within 24 hours, Yeskey's team had transformed the CDC's auditorium into a command center, with portable walls erected according to the chart he had mapped out. In each space were CDC officers, drawn from their normal duties to handle emergency coordination. One desk was Florida. One desk soon would be New York City. As events unfolded, Washington, D.C., and other hot spots around the country got desks, staffed 24 hours a day by high-ranking CDC scientists whose job was to coordinate all the information and logistics in a given field location.
At another desk was a medical team that did nothing but answer questions from physicians. If doctors called in with suspected anthrax cases, that team had a list of questions and symptoms to walk the person through, aimed at winnowing out cases that obviously were not anthrax.
By mid-October, the Ops Center was a noisy beehive, coordinating activities all over the world -- indeed, a global liaison desk was added. Never in the history of the CDC had such a system been used. Of course, Hughes said, "Never in the history of the CDC have we dealt on so many fronts at the same time," even during serious epidemics.
A year later, the CDC is building a multimillion-dollar Special Ops center in Atlanta, and encouraging local health departments all across America to erect mini-versions of such communications and command centers. Looking back on October 2001, health officials shake their heads in wonder that Yeskey's primitive pyramid had somehow gotten them through the chaos of the anthrax crisis.
End of First of Two Parts (click here for second part)
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November 5, 2001, New York Times, An Energized Brokaw Is in the Middle of the Story, by Bill Carter,
Tom Brokaw walked into his office on the third floor of NBC's headquarters in the General Electric Building on Thursday, knowing he would find it empty, stripped of all his personal and professional mementos, the photographs of his daughter's wedding, his baseballs autographed by Jackie Robinson, Ted Williams and Joe DiMaggio, the wooden rocking chair his father had made with his own hands.
Still, when he saw the room, he was stunned. "Look at this place," he said, glancing around a room that looked as though it had been picked clean by someone digging for clues at a crime scene, which is exactly what it was.
It was the first day NBC reopened the area occupied by "Nightly News" after weeks of intensive cleaning by men in hazmat suits. The center of the activity had been Mr. Brokaw's office suite, and principally the outer office where his assistant, Erin O'Connor, had worked. That was where a letter filled with anthrax sat for some 10 days last month.
Only a few months ago, the 61-year-old anchor was far from that office, fishing and discussing drought and cattle prices with neighbors in Montana, where he owns a ranch. He was taking the longest vacation of his life, 10 weeks, an extended absence that raised questions that he might be preparing either to retire or to reduce his role. As one senior NBC executive put it, "He truly wanted to step off the train and look at his life, see what his priorities were for his future."
But now he is back on the air, in his 18th year as the chief anchor of NBC News, and in the middle of what he calls "the most difficult assignment I've ever had." He is dealing with the challenges of conveying information about threatening events without unduly alarming his viewers and trying to maintain professional distance in a story that contains both deeply emotional and deeply personal elements. And like other anchors and news executives, he is facing questions about whether the impact of network cutbacks over the years on international coverage has left his audience unprepared for the events of Sept. 11 and their aftermath.
He is also, much to his regret, part of the story.
Walking to a window with a view of 49th Street, Mr. Brokaw pointed to a spot — where a credenza stood behind Ms. O'Connor's desk. "It was right here," he said. The letter, with its block-letter threats about the need for "penacilin," was on top of a pile of hate mail.
"It was mostly politically conservative people writing," Mr. Brokaw said. "People saying, `How dare you not support the president in everything he's doing.' "
Of course, this letter was different. "I handled the letter," Mr. Brokaw said, remembering that he had picked it up at least twice. "When I saw it, I thought: if they're going to give me a death threat, they ought to at least know how to spell penicillin."
Ms. O'Connor was found to have cutaneous anthrax; she is recovering. Mr. Brokaw never had any manifestation of the disease. Still, the incident hit him hard. Steve Capus, the executive producer of the newscast, said, "It ripped him to shreds, what happened to Erin."
Mr. Brokaw said he had come to accept the idea that someone had been trying to kill him. "But if I let that work on me, I wouldn't go out," he said. "I climb mountains. I white- water raft. I live in New York. I drive my car too fast. I'm not careless about risk. I think risk is manageable. I'm trying to manage this risk as well."
Mr. Brokaw acknowledged being "roiled emotionally" on numerous occasions during this story, once after the first pictures of firemen raising a flag in the rubble of the Word Trade Center, when he simply could not go on for some time.
Because Mr. Brokaw, Dan Rather on CBS and Peter Jennings on ABC, have served as the chief news voices of their networks for an entire generation of viewers, the competition among them has usually been tight, and always fierce. But in the last four years, Mr. Brokaw has risen to pre-eminence, his weeknight newscast consistently drawing the largest audiences.
That position was further validated in the first few days after the terrorist incidents. On Sept. 11, Mr. Brokaw and NBC had 21.8 million viewers for the prime-time hours of 8 to 11 p.m. Mr. Jennings had an audience of 16.9 million. Mr. Rather was seen by 14.2 million.
Some at NBC see Mr. Brokaw's ratings edge on the evening news, and the fact that more Americans turned to him in that moment of national crisis, as evidence that he has become the leading network wise man, the Walter Cronkite of his generation. That is a view some analysts, and even Mr. Brokaw, deflect.
Tom Rosenstiel, an executive with the Project for Excellence in Journalism, said that all the network anchors had performed "extremely well" during the crisis, each bringing different skills. Of Mr. Brokaw, he said, "He had a knack for delivering the succinct sweeping phrase that put events in context, without ever going too far."
Mr. Brokaw said he had received a flood of comments in the days after the attacks. "People called and said, `You were so important to us; I never thought of you as a father- figure before.' And I said, `I was important to you because I was giving you reliable information.' That's what we do. I don't go into this thinking I've got to be the father-figure for the nation. That would be paralyzing for one thing and inappropriate for another."
But the intensity of the story has brought additional scrutiny. The networks have been criticized by some for scaring viewers with dire stories of bioterrorism. Mr. Brokaw feels "we have not gone too far in creating scenarios," he said.
Mr. Brokaw has also encountered accusations that he has not been sufficiently patriotic. "My patriotism is unalloyed," he said, but his reaction to the national push for patriotism has been more restrained than that of Mr. Rather, who went so far as to say publicly that all the president would have to do was tell him where to line up.
After a speech at Northwestern, a student asked Mr. Brokaw why he wasn't wearing a flag lapel pin. "I said, `I don't think it's appropriate for a journalist to wear a flag,' " he said. "It suggests that you approve of whatever the government is doing at that time."
Far less easy to defend, Mr. Brokaw acknowledged, is the penchant of television news to underplay international news in favor of subjects tied to some scandal, a trend that produced the exhaustive coverage of Gary Condit and O. J. Simpson.
David Halberstam, the author and one-time foreign correspondent, has argued that the cutbacks in foreign coverage, directed by budget-cutting corporate network owners like General Electric (NBC) and Walt Disney (ABC), have "trivialized the debate" of international issues on television.
"The network anchors have been saying, in effect: how did our security services, our intelligence sources let us down," Mr. Halberstam said. "I'm saying: `Guys, look in the mirror. You've been a critical part of the debate that hasn't been taking place.'"
Specifically, Mr. Halberstam, criticized Mr. Brokaw, citing the anchor's hugely successful best-selling book about the Americans who waged the Second World War, "The Greatest Generation."
"The thing that came out of the World War II generation was a commitment to internationalism," Mr. Halberstam said. "He has been the anchor at NBC at a time of the dissolution of NBC's foreign reporting. I am underwhelmed by this."
Mr. Brokaw said of Mr. Halberstam, "Don't get me started." Of the criticism he said, "It's simply not true." He said, "It implies a suggestion that if we had had more foreign coverage, people wouldn't have been surprised by the attacks, or this wouldn't have happened. That's crazy."
Mr. Brokaw ticked off a list of foreign issues NBC had covered, chiefly on terrorism, which he said was treated in numerous stories on the network. Indeed, his newscast has won four Overseas Press Awards since 1997. "I cannot defend the de-emphasis on foreign coverage in toto," Mr. Brokaw said. "I think the truth lies somewhere in the middle. The summer of Gary Condit was indefensible."
But he added: "Across-the-board interest in foreign developments was very low on the radar screen, not just among the general population, but among the political population. It didn't define the presidential election. I did a word search on the debates. Terrorism was mentioned twice, both times in passing."
There is no end in sight for this story, but Mr. Brokaw said he had already been discouraged by one television development. "As soon as there isn't some kind of bulletin news, down goes viewership," he said. "We're so diffused, so spread out on the electronic spectrum that there are so many other places to go."
Mr. Brokaw has other places he could go, as well, including the inviting Western range. His current contract expires next summer. "I've never played the contract game publicly before," he said. "But they know that I'm here to stay. This is where I work. This is what I love. I'm engaged and energized by this . I feel this is probably the greatest professional obligation I've ever had, to stay in the mix here in all the roles that I have, professionally and personally. That's going to be true for the foreseeable future."
Tom Brokaw walked into his office on the third floor of NBC's headquarters in the General Electric Building on Thursday, knowing he would find it empty, stripped of all his personal and professional mementos, the photographs of his daughter's wedding, his baseballs autographed by Jackie Robinson, Ted Williams and Joe DiMaggio, the wooden rocking chair his father had made with his own hands.
Still, when he saw the room, he was stunned. "Look at this place," he said, glancing around a room that looked as though it had been picked clean by someone digging for clues at a crime scene, which is exactly what it was.
It was the first day NBC reopened the area occupied by "Nightly News" after weeks of intensive cleaning by men in hazmat suits. The center of the activity had been Mr. Brokaw's office suite, and principally the outer office where his assistant, Erin O'Connor, had worked. That was where a letter filled with anthrax sat for some 10 days last month.
Only a few months ago, the 61-year-old anchor was far from that office, fishing and discussing drought and cattle prices with neighbors in Montana, where he owns a ranch. He was taking the longest vacation of his life, 10 weeks, an extended absence that raised questions that he might be preparing either to retire or to reduce his role. As one senior NBC executive put it, "He truly wanted to step off the train and look at his life, see what his priorities were for his future."
But now he is back on the air, in his 18th year as the chief anchor of NBC News, and in the middle of what he calls "the most difficult assignment I've ever had." He is dealing with the challenges of conveying information about threatening events without unduly alarming his viewers and trying to maintain professional distance in a story that contains both deeply emotional and deeply personal elements. And like other anchors and news executives, he is facing questions about whether the impact of network cutbacks over the years on international coverage has left his audience unprepared for the events of Sept. 11 and their aftermath.
He is also, much to his regret, part of the story.
Walking to a window with a view of 49th Street, Mr. Brokaw pointed to a spot — where a credenza stood behind Ms. O'Connor's desk. "It was right here," he said. The letter, with its block-letter threats about the need for "penacilin," was on top of a pile of hate mail.
"It was mostly politically conservative people writing," Mr. Brokaw said. "People saying, `How dare you not support the president in everything he's doing.' "
Of course, this letter was different. "I handled the letter," Mr. Brokaw said, remembering that he had picked it up at least twice. "When I saw it, I thought: if they're going to give me a death threat, they ought to at least know how to spell penicillin."
Ms. O'Connor was found to have cutaneous anthrax; she is recovering. Mr. Brokaw never had any manifestation of the disease. Still, the incident hit him hard. Steve Capus, the executive producer of the newscast, said, "It ripped him to shreds, what happened to Erin."
Mr. Brokaw said he had come to accept the idea that someone had been trying to kill him. "But if I let that work on me, I wouldn't go out," he said. "I climb mountains. I white- water raft. I live in New York. I drive my car too fast. I'm not careless about risk. I think risk is manageable. I'm trying to manage this risk as well."
Mr. Brokaw acknowledged being "roiled emotionally" on numerous occasions during this story, once after the first pictures of firemen raising a flag in the rubble of the Word Trade Center, when he simply could not go on for some time.
Because Mr. Brokaw, Dan Rather on CBS and Peter Jennings on ABC, have served as the chief news voices of their networks for an entire generation of viewers, the competition among them has usually been tight, and always fierce. But in the last four years, Mr. Brokaw has risen to pre-eminence, his weeknight newscast consistently drawing the largest audiences.
That position was further validated in the first few days after the terrorist incidents. On Sept. 11, Mr. Brokaw and NBC had 21.8 million viewers for the prime-time hours of 8 to 11 p.m. Mr. Jennings had an audience of 16.9 million. Mr. Rather was seen by 14.2 million.
Some at NBC see Mr. Brokaw's ratings edge on the evening news, and the fact that more Americans turned to him in that moment of national crisis, as evidence that he has become the leading network wise man, the Walter Cronkite of his generation. That is a view some analysts, and even Mr. Brokaw, deflect.
Tom Rosenstiel, an executive with the Project for Excellence in Journalism, said that all the network anchors had performed "extremely well" during the crisis, each bringing different skills. Of Mr. Brokaw, he said, "He had a knack for delivering the succinct sweeping phrase that put events in context, without ever going too far."
Mr. Brokaw said he had received a flood of comments in the days after the attacks. "People called and said, `You were so important to us; I never thought of you as a father- figure before.' And I said, `I was important to you because I was giving you reliable information.' That's what we do. I don't go into this thinking I've got to be the father-figure for the nation. That would be paralyzing for one thing and inappropriate for another."
But the intensity of the story has brought additional scrutiny. The networks have been criticized by some for scaring viewers with dire stories of bioterrorism. Mr. Brokaw feels "we have not gone too far in creating scenarios," he said.
Mr. Brokaw has also encountered accusations that he has not been sufficiently patriotic. "My patriotism is unalloyed," he said, but his reaction to the national push for patriotism has been more restrained than that of Mr. Rather, who went so far as to say publicly that all the president would have to do was tell him where to line up.
After a speech at Northwestern, a student asked Mr. Brokaw why he wasn't wearing a flag lapel pin. "I said, `I don't think it's appropriate for a journalist to wear a flag,' " he said. "It suggests that you approve of whatever the government is doing at that time."
Far less easy to defend, Mr. Brokaw acknowledged, is the penchant of television news to underplay international news in favor of subjects tied to some scandal, a trend that produced the exhaustive coverage of Gary Condit and O. J. Simpson.
David Halberstam, the author and one-time foreign correspondent, has argued that the cutbacks in foreign coverage, directed by budget-cutting corporate network owners like General Electric (NBC) and Walt Disney (ABC), have "trivialized the debate" of international issues on television.
"The network anchors have been saying, in effect: how did our security services, our intelligence sources let us down," Mr. Halberstam said. "I'm saying: `Guys, look in the mirror. You've been a critical part of the debate that hasn't been taking place.' "
Specifically, Mr. Halberstam, criticized Mr. Brokaw, citing the anchor's hugely successful best-selling book about the Americans who waged the Second World War, "The Greatest Generation."
"The thing that came out of the World War II generation was a commitment to internationalism," Mr. Halberstam said. "He has been the anchor at NBC at a time of the dissolution of NBC's foreign reporting. I am underwhelmed by this."
Mr. Brokaw said of Mr. Halberstam, "Don't get me started." Of the criticism he said, "It's simply not true." He said, "It implies a suggestion that if we had had more foreign coverage, people wouldn't have been surprised by the attacks, or this wouldn't have happened. That's crazy."
Mr. Brokaw ticked off a list of foreign issues NBC had covered, chiefly on terrorism, which he said was treated in numerous stories on the network. Indeed, his newscast has won four Overseas Press Awards since 1997. "I cannot defend the de-emphasis on foreign coverage in toto," Mr. Brokaw said. "I think the truth lies somewhere in the middle. The summer of Gary Condit was indefensible."
But he added: "Across-the-board interest in foreign developments was very low on the radar screen, not just among the general population, but among the political population. It didn't define the presidential election. I did a word search on the debates. Terrorism was mentioned twice, both times in passing."
There is no end in sight for this story, but Mr. Brokaw said he had already been discouraged by one television development. "As soon as there isn't some kind of bulletin news, down goes viewership," he said. "We're so diffused, so spread out on the electronic spectrum that there are so many other places to go."
Mr. Brokaw has other places he could go, as well, including the inviting Western range. His current contract expires next summer. "I've never played the contract game publicly before," he said. "But they know that I'm here to stay. This is where I work. This is what I love. I'm engaged and energized by this . I feel this is probably the greatest professional obligation I've ever had, to stay in the mix here in all the roles that I have, professionally and personally. That's going to be true for the foreseeable future."
_________________________________________________________________________________________________________________
October 8, 2002, Newsday, The Anthrax Crisis; How a suspected case in NYC threaded its way to diagnosis despite initial CDC uncertainty, by Laurie Garrett, Staff Writer,
Second of two parts (click here for first part)
A year ago, the nation's public health "surge capacity" was put to the test.
The culprit, anthrax, wound up infecting only 12 people, killing five of them. Yet, it utterly sapped the capacities of public health operations not only in targeted areas, such as New York City, but throughout the nation.
Last October the deadly white powder was seemingly everywhere.
"It was a national problem," Dr. James Hughes, director of the Centers for Disease Control and Prevention's National Center for Infectious Diseases, said in an interview in his Atlanta office. "All the state public health laboratories were overwhelmed with specimens, hoaxes. It was even true internationally."
Such emergencies call for rapid conversion of hospitals, fire departments, public health offices and, perhaps most vitally, diagnostic laboratories into crisis facilities that can process high volumes of material for a sustained amount of time.
"Surge capacity - imagine!" said Hughes. "If it was exhausted for us here at CDC - literally and figuratively - you can imagine what this means at the local level."
In New York as the anthrax crisis heightened, "there were immediate problems," said Dr. Isaac Weisfuse, the New York City deputy health commissioner. "There was an expectation of instant analysis. Doctors wanted answers now. The volume of material far exceeded our capacity. The NYPD was bringing stuff in at all hours, day and night."
The lab was prepared to handle "swab samples," he said, but wound up facing deliveries of easy chairs, briefcases and newspapers - all suspected of being tainted with anthrax. The health department's three bioterrorism-trained lab workers were toiling around the clock, processing hoaxes - a routine that would continue for four weeks.
New York's anthrax vigil had begun in early October, when the first cases were diagnosed in Florida. Even as fears and hoaxes were sending health department labs all over the country close to maximum capacity, the effect was more pronounced here because Dr. Marcelle Layton, head of the city health department's communicable disease section, had faxed a 13-page anthrax advisory to 65,000 physicians in the city, urging them to report suspected cases.
But Layton had a new concern: She was worried about the case of Erin O'Connor (case 2), assistant to NBC news anchor Tom Brokaw. O'Connor recalled that on Sept. 25 she opened an envelope addressed to Brokaw and noticed it contained a white powder. A few days later she developed an ugly, yet painless sore on her left collarbone.
Though a series of doctors and O'Connor herself felt certain she was the victim of an anthrax attack, neither the New York City Department of Health lab nor the U.S. Army's lab at Fort Detrick in Maryland was able to find any anthrax spores in the envelope or in O'Connor's skin biopsy.
Layton knew that if O'Connor had anthrax, evidence would be hard to find. That's because a tissue biopsy of the sore wasn't taken until several days after she had been placed on antibiotics by another physician. And effective antibiotic use makes it almost impossible to find intact Bacillus anthracis in the tissue of an otherwise healthy individual.
So Layton called Dr. Steven Ostroff, a Hughes deputy who had been the CDC's point man in 1999 during the West Nile virus outbreak. He was in Washington to address Congress about protecting the nation's food supply, and Layton reached him at the Willard hotel. She knew that the only facility in the world capable of finding anthrax in O'Connor's biopsy - if, indeed, it was there - was the CDC lab known as RRAT.
The Rapid Response and Advance Technology lab in Atlanta, where pathologists are affectionately referred to as "The RRATS," was the brainchild of Sherif Zaki, the CDC's top medical examiner. Over the years he had developed innovative techniques to find obscure organisms in human tissue. And last fall he hastily developed a new approach to identify anthrax: Using mice, he created antibodies to attack three specific proteins found on Bacillus anthracis, and chemically labeled the antibodies with dyes. If anthrax were in a sample of tissue, Zaki would see bright magenta, rod-shaped bacilli under his microscope.
Ostroff recalled that Layton "asked me if I could arrange to have specimens tested that were from an NBC employee. She called me directly, because she had already called the CDC lab and they had said, 'We're already overwhelmed with specimens from Florida.' She wanted a top priority test, no delays."
Ostroff agreed to the testing and the samples were sent overnight via Federal Express from Manhattan to Atlanta.
On the afternoon of Oct.11 - even as the three lab workers in New York were processing hundreds of pieces of paper and desk objects found in O'Connor's work area at NBC, and the envelope that she had opened was delivered to Richard Meyer, a CDC lab chief - the O'Connor biopsy sample reached Zaki's lab. His staff set about exposing it to the dyed antibodies, a process that would take several hours.
Submitting it to microscopic analysis would be a tedious process. The sample - initially in a wax block, roughly one inch square - had been sliced into hundreds of paper-thin pieces, each one separately mounted on a glass slide. And every one had to be viewed by Zaki and fellow pathologists Wun-Ju Shieh and Jeannette Guarner. The trio pored over a microscope that allows up to five people to scrutinize a slide at once.
As they began their night's work, they saw healthy blue-stained human cells against a white background. Here and there they spotted isolated fragments of magenta-colored material, but these were not identifiable as anthrax.
At 1 a.m. they reached some slides that bore significant numbers of magenta pieces. That could indicate antibiotic- destroyed anthrax bacteria. Or it might be something else altogether.
Frustrated and exhausted, they were reaching the bottom of their pile of slides when Zaki spotted a single, isolated, fully intact magenta rod standing out against a sea of blue cells. On the same slide, far away, was another.
He was sure it was anthrax. Shieh and Guarner concurred. But they were mystified at finding only two identifiable organisms in the entire sample. They were well aware the Fort Detrick group had examined tissue from the same biopsy, using a different technique, and found nothing.
"But I was sure," Zaki would say later.
Hughes, the CDC infectious disease center director, called Layton at 5 a.m. to report: "It looks like anthrax." An hour later Mayor Rudolph Giuliani was on the phone, demanding to know: Is it anthrax or isn't it?
"We think it is," Hughes said. Giuliani said he didn't like the uncertainty, but he decided to go ahead and make the CDC's pronouncement public.
On that morning, Oct. 12, the NYPD showed up at the city health department lab with a second envelope addressed to Tom Brokaw that O'Connor had received within a week before the first envelope. It had been in one of O'Connor's file drawers.
"They took it to our lab," Weisfuse said, "and the handling of it caused a contamination event at our lab" later that day. Anthrax powder puffed out of the envelope in clouds, spreading across the lab. Two of the three lab workers inhaled it. Unlike their counterparts at the CDC, they had never been offered anthrax vaccines. They immediately began taking the antibiotic ciprofloxicin.
Their noses were swabbed for signs of anthrax, and results of the tests they conducted on their own samples came up positive. No one would develop symptoms. For their bravery, the lab workers would receive awards from the American Society for Microbiology 11 months later.
But on that October day Weisfuse had a problem. Two of his lab technicians were too traumatized to work, and there were hundreds more samples to test. Worse, the lab was contaminated and had to be sealed shut. (It remains shuttered, despite several gas treatments. So far, nobody has determined how to clean the lab sufficiently to guarantee that no deadly spores remain.)
Late that day, Layton called the CDC to report that this second envelope to Brokaw tested positive for anthrax, confirming O'Connor's exposure. Zaki, relieved to have his diagnosis confirmed, fell into his first restful sleep in days.
But for New York City's lab workers, a nightmare had just begun. The bioterrorism-trained trio "was very, very, very upset," Weisfuse said. And specimens kept pouring in to the city health department. "We needed a good Biohazard Level 3 facility" - where scientists wear protective gear and shower and scrub before entering or leaving - "fast."
New York City, where all emergency response agencies had gone through bioterrorism drills for three years, had another urgent problem. The carefully coordinated working relationship between the Department of Health and the fire and police departments' hazardous materials teams were in tatters, because members of the highly trained teams had perished in the World Trade Center on Sept. 11.
"So the police didn't know how to handle samples," Weisfuse said. Entirely new lines of communication and understanding between the health department and NYPD had to be created even as both were in crisis mode.
"Communication is the key," Layton said. "And the issue that always comes up is: Who is in charge? There was no question who was in charge in New York City - it was the mayor."
Because Giuliani took command of all direct communication with the citizens of New York, Layton and her colleagues focused on improving lines of information within the health department and to local physicians and hospitals. They had several distinct advantages, Layton said, from their experience handling West Nile virus.
Amid public anxiety in the summer of 1999, the department learned the importance of a daily flow of honest information, separately tailored for the general public and for physicians. They learned to resist the temptation to issue constant reassurances that everything was under control.
"The press would say to the health commissioner and the mayor, 'Can you assure us?' and they said, 'No, I can't reassure you. I can just give you the information accurately,'" Layton recalled.
Every night until well after Thanksgiving, Layton, exhausted, worked into the wee hours writing clinical and epidemiologic summaries of the day's findings on samples and human cases. These bulletins were faxed every morning to hundreds of hospital emergency rooms, infectious-diseases departments and physicians throughout New York City and the suburbs. It was Layton's conviction that physicians would be the first to spot new anthrax cases and were the most credible voices of calm for the worried public.
This simple exercise, copying the effort used successfully for West Nile virus in 1999, cemented lines of communication between the medical community and the Department of Health. "That's the thing I'm most proud of, those broadcast alerts. Physicians were screaming for them," Layton recalled.
Today, having caught their breath, CDC lab chiefs Meyer and Tanja Popovic have tallied the anthrax laboratory toll. All 50 states wound up inundated with suspicious samples by Thanksgiving, Meyer said. In addition, laboratories in 66 nations requested assistance or advice in processing possible anthrax samples. More than 80,000 specimens were analyzed nationwide, 45,000 of them in Florida, New York, Connecticut and New Jersey.
Meyer's group processed 7,000 additional samples during the fall. "I missed the entire fall," Popovic said. "I never saw it."
By December, when the federal Department of Health and Human Services declared the anthrax episode over, 12 people had contracted the disease, and five had died of inhalational anthrax. Two cases - those of elderly rural Connecticut resident Ottilie Lundgren (case 23) and Bronx resident Kathy Nguyen (case 22), a hospital clerical worker - remain a mystery. Though it was assumed they were exposed to contaminated mail, no culprit envelopes or papers were ever found in their homes.
The credibility of HHS and its scientists suffered from their inability to explain basic aspects of anthrax. For two weeks early in the anthrax scare, they insisted a fatal case of anthrax required inhalation of some 10,000 spores. But the Lundgren and Nguyen cases forced reconsideration, and by the end of the fall many government experts were saying it was possible, at least theoretically, that inhalation of fewer than 10 spores could be lethal. With that, every aspect of cleanup of contaminated sites became excruciatingly complex, as workers and politicians demanded assurance that not a single spore would remain alive in exposed buildings.
One year and billions of dollars later, the nation has upgraded its public health system, labs, computers, scientific research establishment and training of hospital personnel. Surely, the nation has learned many lessons, insiders say.
But is America ready for another mass mailing of anthrax, or a worse contagious-disease attack?
"We have certainly taken some giant steps forward," the CDC director, Dr. Julie Gerberding, said in a recent news conference. But, she added, "we are not satisfied, we are not finished, we have got more expansion and more work to do."
1) ‘Communication is the key. And the issue that always comes up is: Who is in charge? There was no question who was in charge in New York City - it was the mayor.' - Dr. Marcelle Layton, head of the New York City health department’s communicable disease section
2) ‘There was an expectation of instant analysis. Doctors wanted answers now. The volume of material far exceeded our capacity. The NYPD was bringing stuff in at all hours, day and night.' - Dr. Isaac Weisfuse, New York City deputy health commissioner.
End of second of two parts (click here for first part)
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