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Marci Layton had come to work early that morning. She was giving three speeches in Canada the next day, and she wanted to get her slides in order. The workload in the New York City Department of Health was so intense that she knew she would have no spare time once the daily round of calls and meetings started.
Layton was one of the department’s assistant commissioners and the chief of its bureau of communicable diseases. She had just passed 40, a slender, energetic woman with curly, center-parted light-brown hair and huge blue eyes. She was a graduate of Duke Medical School who had done residency in Syracuse and an infectious-disease fellowship at Yale; in between academic stints, she had volunteered in clinics in Nepal, Thailand and Alaska.
The New York health department was housed in a 10-story while marble pile decorated with pylons and columns on the outside and elaborate Art Deco detailing inside, down to octagonal brass door handles embossed with “City of New York.” It faced south across a small park toward City Hall and Wall Street; the World Trade Center, eight blocks away, filled the view. Layton had worked there for nine years, since arriving in the summer of 1992 as an EIS officer. Her predecessor in her Yale fellowship had been assigned there and persuaded her to ask for the slot after him. In New York, he said, every disease she had seen in the Third World would show up on her doorstep.
The health department lies in a part of the city that is seldom quiet. Trucks rumble by day and night, heading for the Manhattan and Brooklyn Bridges. A subway line runs directly underneath the building. Planes on approach to LaGuardia and Kennedy pass constantly overhead. Still, the boom that shook Layton’s office about an hour after her arrival was disorientingly loud. It sounded, she thought, as though a plane had crashed.
Shortly afterward, her phone rang. It was her parents in Baltimore. They wanted to be sure she was okay.
She listened to what they were describing, and then she put down the phone and walked to the other side of the building, to windows that faced southwest. She saw the gaping holes in the sides of the towers and the fires bellying out of them. Bodies were falling from the floors above.
The next time she had a moment to look out the window, it was 2 a.m.
In the panic that followed the attacks, it was hard to get a grip on what was happening. TV reception went out when the buildings fell. Electrical power was patchy; cell phone reception, too. The landlines died at 2 p.m. The health department assumed the towers’ collapse would bring thousands of people streaming into emergency rooms. They sent staff out to walk to the closest hospitals, to log the injuries and see what extra staff and supplies were needed.
The answer was, very little. Over two days, four ERs and a burn center would see only 1,688 patients. Most arrived within 8 hours of the attacks; three-fourths were able to walk into the ER and to walk away afterward. The injured were mostly not survivors from the towers; they were passers-by, or first responders who had rushed downtown. Thousands of people had made it out of the buildings, but they mostly worked on floors below the crash sites. The vast majority trapped above, on 17 floors of Tower One and 32 floors of Tower Two, had died.
There seemed to be no wave of trauma victims that would overwhelm city hospitals, so the health department turned to the next set of problems: air quality, water safety, getting care to the homebound elderly and disabled. Restaurant customers and staff in the financial district had fled leaving food on the tables; it was a buffet for rats and insects emboldened by the lack of people in the stores and streets. And there was a further lurking concern. Since the first World Trade Center bombing in 1993, law enforcement, the health department and the city’s emergency management office had war-gamed possible terrorist attacks. They had predicted that a conventional assault would be followed by a second, unconventional one, something insidious, something that would be masked by the chaos and disruption. Bioterrorism was their best guess.
Fourteen hours after the towers collapsed, at 2 a.m. on Sept. 12, Layton and her colleagues met to figure out how to detect a bioterror attack before it spawned an epidemic. They assumed it would come with a whimper, not a bang — not a hundred cases of disease in a single place, but a few patients in one emergency room and a single case in another, or in a doctor’s office, or in a street-corner clinic. Those were places that would have no connection to each other and would never recognize they were part of a brewing outbreak. Layton needed a way to identify those potential victims, no matter where they were in the city, as soon as they sought help.
New York already had a system that detected public health anomalies, a computer program that analyzed ambulance-transport records to spot emerging trends. But ambulances too had been disrupted by the chaos in the city. Patients who arrived at emergency rooms were not riding in ambulances, but were getting there on their own.
The only alternative would be actually putting health department representatives into emergency rooms, to gather data from doctors while they were evaluating patients. It had been tried before, at the Olympics and at political conventions; it seemed to be effective, though there had never been a bioterrorist attack to test it against. But it was cumbersome and hugely labor-intensive. The health department had nowhere near enough personnel to make it work. Layton called the CDC in Atlanta, and asked it to send any EIS officers it could spare.
Next:The disease detectives fan out across the city, looking for signs of a covert attack.