The Sept. 11, 2001 attacks on the World Trade Center permanently changed the landscape of New York City and the tenor of American society — and, at the same time, the jobs of the disease detectives of the Centers for Disease Control and Prevention, who are called the Epidemic Intelligence Service. The EIS started in 1951 out of fears that soldiers serving in the Korean War would unknowingly be exposed to biological weapons, and bring the organisms home to cause stateside epidemics. That prediction turned out to be unfounded, and over the decades, the EIS — and the rest of the US government — allowed concerns over bioterror to drift to the bottom of their priority list. Sept. 11 yanked that concern back the top of the list again. Oct. 4, 2001 — the day the first case in the anthrax attacks was announced — proved just how realistic a fear it was.
To mark the 10th anniversary of 9/11 and 10/4, I’m running excerpts from Chapter 12 of my book Beating Back the Devil, which tells the story of the EIS’s involvement in both disasters. Part 1 told their experience on Sept. 11. In this excerpt, it’s now Sept. 12. New York City is devastated, US airspace is shut down, and the CDC is struggling with whom to deploy, and how.
Terrorism, 2001: New York City and Washington, D.C. (Part 2)
Scott Harper had been in the Tuesday seminar when the images of the World Trade Center flashed on the screen and the auditorium fell silent. He had watched for a while, until the magnitude of the attacks became clear. By the time the call came to empty the CDC buildings, he had gone home to be with his wife Stephanie and their 2-year-old daughter. He had also started packing. He was a second year EIS officer, and he expected to be mobilized.
Harper was an infectious-disease physician, born in San Antonio and trained in Dallas and San Francisco. He and Stephanie, an audiologist, met in high school and had been together since college. After his residency, they had gone abroad for three years, working in clinics in Cambodia, India, Togo and South Africa, and then spending a year on London while Scott got a public health degree. Now he was 36, but looked younger. He had a rounded face and brown hair that flopped over his forehead, and he favored chunky sweater that rolled back on themselves at the neck and cuffs.
Two EIS officers and four other CDC staff members had dashed to New York within hours of the attacks, hitching a ride on a plane carrying a load of drugs and medical supplies. Dozens more volunteered to go next. On the evening of the 12th, EIS director Dr. Doug Hamilton sent out an email asking who could leave for New York in the next 24 hours. When he opened his mail the next morning, there were 50 replies in his inbox. Scott had sent one of them.
At the New York health department, Marci Layton did not need 50, at least not right now. She was mapping out how they might detect a bioterror attack if one started, and had decided to focus on 15 hospital sin the five New York boroughs, places where someone who was seriously ill might think to go for help. She asked the CDC for about 30 officers, two per hospital, to work 12-hour shifts. By the time the CDC got the EIS members to New York, the department would be ready with the questions they wanted asked in the emergency rooms.
The EIS needed to bring laptops, so patient data could be recorded on the spot and transferred easily to the health department. It was a simple-sounding requirement, but when the volunteers gathered Thursday evening to be briefed, it proved difficult to fulfill. The EIS’s Congressionally-set budget had been flat-funded for several years in a row, with no money for new equipment. The laptops the corps members had been given were old and balky. To make sure all the data they gathered would match, the officers all had to install the same program; one after another, though, the machines froze, crashed and choked on the download. Watching the IT workers struggle, Hamilton realized he had bigger technology problems. Most of the corps had cell phones, but they were going into areas of New York where cell networks were dead. A few had been given pagers by their offices, but none were two-way pagers. Hamilton had no time — and no money and no government-approved purchase order — to get them anything different. If the disease detectives ran into trouble while they were in the city, they would be on their own until they could find a working landline.
Getting them to New York proved to be the easy part. All US air travel had been grounded since the attacks, both commercial carriers and also the charters that the CDC sometimes relied on. Calling around Atlanta, they found a last-minute alternative. At the Lockheed Martin Aeronautics Co. plant in the northwest corner of the city, a C-130 that belonged to the Royal Australian Air Force had been receiving software upgrades. The crew who accompanied it had been appalled by the Sept. 11 attacks — and they were not bound by the restrictions on US fleets. They leaped at the chance to help.
The 30 volunteers left early on Sept. 14. Once they were in the air, the Australian pilots came back to greet them. President George W. Bush was on his way to New York to visit the Trade Center site, the crew said; but aside from Air Force One and its fighter escorts, the disease detectives were the only people in the air anywhere above America.
A few hours later, they were at LaGuardia. As they walked off the tarmac, Scott noticed that something felt wrong. It took him a minute to realize what the problem was. The usually bustling airport, normally one of the busiest in the country, was completely silent.
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The problem with detecting bioterrorism was that it was likely to look, at first, like any number of other illnesses. Infections that were caused by the viruses and fevers most likely to be used as weapons would start with fever, rashes, headaches or diarrhea before they revealed themselves as smallpox, botulism, tularemia or plague. Those initial complaints were so mild and nonspecific that any doctor anywhere might care for them without knowing. The challenge would be separating the innocuous cases from the ones that were hiding a dreadful secret, uncovering any bioterror outbreak as it was emerging.
Layton and her staff drafted a questionnaire for the EIS to use in New York’s ERs, a single page that asked about breathing difficulties, gut complaints, coughing and trouble breathing, headache and stiff neck, and rashes accompanied by fever. The health department workers met the volunteers at the airport, ferried them to the department’s temporary headquarters for a briefing, and then drove them out to the hospitals, stacks of pink paper questionnaires in hand.
The forms were designed to be filled out by nurses or doctors who saw ER patients, and then handed to the CDC staff to be recorded in a database. It did not go as planned. The ER personnel left the forms half-done or ignored them. After a few disappointing days, the EIS members started grabbing the patients’ charts themselves, paging through them for doctors’ notes on vital signs ad symptoms, and filling out the forms and the database entries on their own. At the end of every shift, they hitched a ride back downtown and handed the data over to be processed. Then they hiked back uptown, where the health department had found them an unoccupied hotel.
It was difficult, being in the city. Mass transit had been cut back, so there were few commuters, fewer pedestrians and no tourists. There were police or National Guard at every major intersection. As far north as Canal Street, streets were sealed off to vehicles. Light poles and bus shelters were papered over with flyers that family member had posted in the first chaotic hours, flyers that everyone soon understood bore the faces of the dead. At the tip of the island, the Trade Center site smoked and steamed. When the wind blew north, it carried smoke with it, and a bitter tang like a radio burning.
Some of the corps members were working at the site, checking the air quality and making sure rescue personnel were wearing protective gear. The rest tried to get there whenever they could, to help, to pay their respects, or simply to bear witness. There were body parts visible in the rubble, and on most days, corpses of firefighters who had rushed into the towers and been trapped in the collapse were solemnly brought out. On the way to his hotel one day, Scott stopped to allow a fireman’s funeral to go past. The coffin was loaded on a firetruck; a firefighter stood beside it, with one hand on the coffin and the other on his heart.
All over the city, it was quiet. It was quiet in the emergency rooms, too. In normal times, ERs are the doctors’ offices of New York, full of people with heart attacks and broken bones and flu. “They weren’t there,” Scott said. He had been posted to Elmhurst Hospital Center in Queens. “The people with the general maladies stayed home. It was like the rest of the city, quiet; it took a few weeks for the traffic to pick up again.”
It did pick up. Over four weeks, at 15 hospitals, the EIS members took down details on 67,536 patients. Every few days, the computer programs processing the data sounded an alert: eight times for a higher than expected number of cases of rashes and fever, respiratory infection and gastrointestinal illness; 16 times because there seemed to be too many cases in a single hospital; nine times because an unusual number of patients came from the same zip code. All were false alarms.
Layton began to be worried about the pace of the work. With the 12-hour shifts and the cumbersome commutes, some corps members were getting only four hours of sleep a night.”We were burning them out,” she said. “We decided to send them all home, and ask for more.”
On Sept. 26, Scott went back to Atlanta. The next day, 20 more CDC staff arrived to spell their colleagues. Kelly Moore took over Scott’s post at Elmhurst. Kelly was a first-year EISO, a pediatrician who had interrupted her residency to switch fields to public health. She was from northern Alabama, a slight strawberry blonde who joked that Yankees expected her to have a Bible in one hand and a rifle in the other. Her parents raised beef cattle on a farm so close to Huntsville that they could see the rockets at the Space Center from their front gate.
Kelly had only been in the US for a week. On Sept. 11, she had been in Cairo, Egypt, on her first EIS deployment, trying to uncover why half of the babies in a hospital’s neonatal intensive care nursery were dying of overwhelming bacterial infections. She and a colleague, Marion Kainer, suspected the babies’ IVs had been contaminated by nurses who did not wash their hands often enough. They found out about the attacks in an email message from a professor in New York who was sending them a recipe for homemade hand-sanitizing gel. “I guess you heard about our disaster by now,” he said.
They had not. They switched off the computer, turned on CNN, and sat on the bed and wept, for hours. Then they tried to get home, only to find that international flights were not being allowed into US airspace. They stayed and kept working — solving the outbreak but getting increasingly nervous about the atmosphere in Cairo — until the CDC shoehorned them onto a flight on Sept. 20.
By the time Kelly took over from Scott, the New York health department had cut the shifts back to eight hours, though it had kept the requirement that each shift’s worth of data had to be hand-carried to the statisticians. Kelly picked up where Scott left off, hectoring emergency doctors and nurses to make them fill out the pink sheets, and riffling through the patients’ charts herself when they did not.
She did that for a week, and then everything changed. Like a magician pulling off a magic trick, bioterrorism struck exactly where they were not looking.
Next: The anthrax attacks begin.