This Tuesday, Oct. 4, marks the 10th anniversary of the announcement of the first deaths in the 2001 anthrax-letter attacks, the first successful, fatal bioterrorist attack in American history on American soil. The anthrax attacks were recognized in the midst of the grief and disquiet that swept the United States after the Sept. 11 World Trade Center attacks, and like those, they changed for good the US’s sense of its security and its role in the world.
The foot-soldiers of much of the government response to 9/11 and 10/4 were the Epidemic Intelligence Service, the rapid-reaction disease detectives of the Centers for Disease Control and Prevention. In recognition of the anniversaries of the two attacks, I’ve been running excerpts from my book Beating Back the Devil about the little-known, behind the scenes disaster response work performed by the disease-detective corps.
Beating Back the Devil was written in 2004. In 2008, the FBI acknowledged that for several years, it had incorrectly pursued a government scientist named Steven Hatfill as a “person of interest” in the letter attacks. That same year, another government scientist named Bruce Ivins committed suicide as the FBI was preparing to name him their chief suspect. But that did not bring the story to an end; as Wired‘s Noah Schachtman reported earlier this year, serious doubts remain about the FBI’s actions and Ivins’ role.
But in October 2001, all of that lay in the future. The CDC’s disease detectives were enmeshed in the aftermath of the World Trade Center bombings, and turning their attention to mysterious illnesses in Florida, New York, and Washington, DC.
Terrorism, 2001: New York City and Washington, D.C. (Part 4)
The ring of a telephone jolted Scott Harper out of a deep sleep. He fumbled for the bedside clock on the hotel nightstand. It was after 3:00 a.m.
“Good morning, Dr. Harper,” said the voice of Doug Hamilton, the EIS director. “This is your wake-up call.”
It was less than 18 hours since the letter from Trenton had been opened in Daschle’s office. Preliminary examination at the scene suggested the powder it contained was anthrax. Now a late-night test at USAMRIID, the government’s chief lab for biodefense research, had confirmed the powder’s identity. In Atlanta, a team of senior scientists had been wakened by middle-of-the-night phone calls telling them to be on a chartered plane at 6:00 a.m. One of those phone calls jarred Hamilton awake as well. He pored over lists of EIS members, trying to sort out who was still doing World Trade Center follow-up, or already at the anthrax investigations in New York and Florida. He found Scott’s name. Scott was not on any of the teams; he had been given a week off in Washington to take a review course for his board certification exams in infectious disease. It was his second try at the course. On his first attempt, he had been yanked away to work on an outbreak of Ebola in Uganda.
He was not going to make it the second time, either. Hamilton told him to get up, check out, and meet the CDC team by 9:00 a.m. They would be setting up emergency investigation space in the DC Health Department behind Union Station, a 10-minute walk from Capitol Hill.
Because of the New York cases, Hill staff had gotten hastily drafted training on how to handle suspicious pieces of mail. The intern who opened the letter sent to Daschle did has she had been told; she laid the letter on the floor and called the US Capitol Police, who got to the office within 5 minutes and confirmed that the powder was anthrax before a half-hour passed. Daschle’s office was a two-story suite that stretched from the fifth to the sixth floor of the Hart Senate Office Building. The powder in the envelope, so finely milled that it could barely be seen, spread rapidly through both floors, aided by a ventilation system that was not turned off until 10:30 a.m.
The scene was chaotic. FBI agents, first responders and staff from the office of the Capitol’s physician piled into the suite and a matching one next door that belonged to Sen. Russell Feingold, swabbing surfaces and handing out emergency 3-day packets of antibiotics to anyone who had been nearby. Staff were herded up to the 9th floor by first responders to be swabbed and tested, and then led back to the offices’ sixth-floor entrances before they were let go for the day at 3:00 p.m. More than 400 people in the two offices had been exposed.
There was already anxiety over the New York letters, but now it increased exponentially. Those had targeted members of the media elite, though the effects had fallen not on anchors and editors but on lower-level staff. This letter struck at the heart of the government, though with Daschle out of his office that morning, it also did not reach its intended target.
The CDC team reached the Hart building barely 24 hours after the letter was opened. They needed to establish as quickly as possible where the powder had spread and who had been put at risk. The southwest quadrant of the building where the offices lay had been closed already. By the end of the day, the rest of the building would be also. The Capitol physician offered nasal swabs and emergency doses of antibiotics to anyone who felt at risk. More than 2,100 people lined up, including six law enforcement members who went into Daschle’s office without putting on protective equipment.
“We needed to just get the basic epidemiology at first,” Scott said. “What did this complex look like? The person who opened the letter, where had she been sitting? Who else was working nearby? We spent a lot of time talking to the CDC to determine what the best advice was to give these people — there was so little data about exposures like this — and a lot of time talking to the staff themselves, trying to answer their questions.”
The pressure was intense. Mail delivery stopped throughout the Capitol for fear that other letters might be lurking. Tour stopped. On Oct. 17, the House of Representatives voted itself out of session and shut down. The Senate pointedly remained in session, though it closed two more buildings temporarily for testing.
Between Trenton and the Capitol, the Daschle letter had passed through two postal processing facilities, one in New Jersey and another in Washington, DC, that was known as the Brentwood facility. The Daschle letter had been sealed with tape on all its seams; the CDC thought that meant no anthrax could have escaped during its trip through the postal system, and therefore no one in the centers was at risk or needed testing or treatment. The agency consulted the Postal Service; disinclined to shut down such huge facilities, it agreed.
On Oct. 18., the CDC’s Atlanta lab confirmed two cases of cutaneous anthrax in workers at the New Jersey center. The New Jersey health department shut it down. Two days later, a doctor at Inova Fairfax Hospital in northern Virginia called the CDC’s new anthrax hotline with a report of a patient who was severely ill with inhalational anthrax. He was a 56-year-old man named Leroy Richmond. He worked at the Brentwood center.
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Richmond was conscious. Scott was hurriedly dispatched to interview him. The FBI beat him to the hospital, and they stayed by Richmond’s bedside while Scott examined him. He was a big man, a nonsmoker, who had previously been healthy. For several days, h had been feeling as though he had the flu, with chills and fever, nausea and night sweats. When he arrived at the ER the previous evening, he had looked only slightly ill; he had some shortness of breath and a fast heart rate, but his temperature and his blood work were normal, and the doctors who saw him noticed nothing seriously amiss.
A chest X-ray and CAT scan changed their minds. The tests showed a widened mediastinum, enlarged lymph nodes, and fluid in both lungs. Now he was feverish, coughing up phlegm and having difficulty speaking. But he was awake and alert, though the toxins produced by the anthrax bacteria were wreaking havoc in his system.
Scott talked to Richmond about how he had been feeling. He went over the past 12 hours with Susan Bersoff-Matcha, the attending physician, and Thom Mayer, the emergency department chief. He studied the X-rays and the CAT scan images, noting the opaque areas where the lymph nodes in the center of Richmond’s chest were filling with blood and dissolving as the tissue died. Finally, he checked a culture of Richmond’s blood that the ER had started the night before. It had been cooking long enough for bacteria to grow, if there were any. Under the microscope, it revealed the distinctive long chains of anthrax.
The Fairfax doctors had done good work, but the CDC needed to confirm the diagnosis. Scott took a series of swabs and samples from Richmond and packed them with blue ice into a Styrofoam container. He had to get the samples to a borrowed corporate jet that was landing in an hour. The FBI summoned a Virginia state trooper for him.
“I got in the car, and said to the driver — big stoic guy, early 20s, maybe — ‘You know what this is, right?'” Scott said. “And he said, ‘Oh yeah. Do you want the lights and sirens on?’ I didn’t think that was necessary. He did, though. So we raced, lights on and sirens blaring, all the way to the airport.”
The jet the CDC had borrowed dropped off more staff members from Atlanta. The team had started out with 11 people and now had more than 20. They were needed. The day Scott met Richmond, one of the man’s co-workers, also 56, checked into the same hospital with similar symptoms: three days of headache, chills, low fever and nausea, followed by drenching sweats and a cough. Chest X-ray and CAT scan showed findings similar to Richmond’s — widened mediastinum, engorged lymph nodes, fluid collecting in the lining of the lungs — and anthrax grew from the man’s blood.
Early the next morning, Oct. 21, the CDC’s Atlanta labs called with the overnight confirmation from the samples Scott had rushed to the airplane. Richmond had inhalational anthrax. Faced with confirmation that the bacteria had leaked from the sealed letter, the CDC changed its recommendation: Everyone who worked in the Brentwood center should be checked for exposure and put on antibiotics to short-circuit any developing infection. The Postal Service agreed. Brentwood was shut.
It was too late. At 8:45 that night, Brentwood worker Thomas Morris Jr., 55, died at Greater Southeast Community Hospital in Washington, less than 15 hours after calling 911 because he had been feeling ill. At 9:30 the next morning, Brentwood worker Joseph Curseen, 47, died at Southern Maryland Hospital Center, 6 hours after collapsing in the bathroom at home. They were the second and third fatalities of the anthrax attacks, but not the last.
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Brentwood had more than 2,400 employees. It covered 500,000 square feet. More than 60 million pieces of mail had gone through its high-speed sorting machines since the Daschle letter passed through on Oct. 11. Health authorities had no way to know how far the letter’s contamination might have spread. Every person, machine and working area in the center would have to be checked.
The CDC deployment expanded and expanded again, from 20 to 30 to approximately 80. They spread out across an entire floor of the DC health department, crammed into borrowed offices, cubicles and conference rooms. The center of the encampment was a windowless “situation room,” a training classroom that came pre-stocked with computers and now was strewn with phones, charging cradles and empty PowerBar wrappers. Taped to the walls there were handwritten posters listing temporary computer passwords, cell phone numbers, and contacts at every local health department and the 49 major local hospitals. A scrawled note pinned to one wall instructed: “Shred everything.”
The group divided itself into teams: surveillance, to search public health labs and intensive care units for leads on possible new cases; epidemiology, tracking the post office and political workers who might have been exposed; the environmental team, supervising the sampling and cleanup of the Capitol Hill buildings, Brentwood and subsidiary post offices; a group handling relationships with the Postal Service; another group simply to keep track of the thousands of biological and environmental samples that had been shipped to the CDC and to other labs that had agreed to help.
Finally there was the clinical investigations team, 10 epidemiologists including Scott, his EIS classmate Kip Baggett, and Scott Fridkin, a former EIS officer now ascending through the ranks of the CDC. They were building a database of every recognized and suspected case of anthrax, cutaneous and inhalational, and everything that could be found out about them: what their exposure might have been, how long between exposure and when their symptoms started, which symptoms showed up first and which were the most serious, and what tests their doctors performed.
There were plenty of cases to keep them busy. By the day Curseen died, 19 people from the media, Capitol Hill and the Postal Service had developed symptoms that would later prove to be from anthrax infections. Many more who had been nowhere near the letters had gone to their doctors fearing they were sick; they looked like “worried well,” but needed to be checked and tested just in case.
The teams’ leaders met every morning at 7:30. The entire group met 12 hours later to share each teams’ findings with all the others. Afterward, they went back to work again, usually until about midnight. Twice a day, after morning meeting and before the close of the business day, Scott’s team performed what they called “running the list”: taking every lead they had gathered from the surveillance team or the CDC hotline and checking with doctors, hospitals and health departments for updates.
Late one afternoon in late October, the clinical team hunched around a speakerphone.
The voice on the other end, a staff member at the Maryland Department of Health and Mental Hygiene in Baltimore, said: “We have the wife of a postal worker. Her blood and urine cultures are negative.”
Scott Fridkin, who had been following that case, scribbled the results on a legal pad. “We think that is a low-probability exposure,” he replied.
“We have a woman with flu-like symptoms and a negative anthrax culture,” the Maryland official continued.
Dr. John Jernigan, the team leader, checked his list. “We can classify her as ‘no apparent disease,'” he said.
“We have a post office worker with a rash on the forehead and an ulcerated ear lobe,” the voice said. “Johns Hopkins University doctors cannot rule out anthrax.”
The CDC group fell silent. It was more than a week since the two Brentwood deaths, and the pace at which they were finding cases of anthrax had slowed dramatically, but they remained uneasy that there might be more. None of them could forget that the Brentwood cases had taken the CDC by surprise. They did not feel responsible — they thought that the recommendations on not closing Brentwood or testing the staff had been made on the best science available at that moment — but they were determined there should be no more illnesses or deaths on their watch.
The next day, Scott went up to Baltimore, to view photographs and lab results fom Curseen’s autopsy. He was not disturbed by post-mortems; his father was a pathologist who had brought interesting bits of tissue home at night to show him, and he had had a summer job in a pathology lab. Still, the experience left him somber.
“Because this is, really, a homicide,” he said a few hours afterward. “And because usually in an outbreak, when you see three or four or five of something, you know that’s the tip of an iceberg. And we have three deaths so far.”
The pressure to prevent any more deaths was relentless. Kelly Moore, who had been researching World Trade Center after-effects, joined the DC team on Oct. 23. She was assigned to help educate postal workers about their exposures, and to tracking down the employees of government agency mailrooms who might not have heard that Brentwood had been closed. On her way out of the health department early one morning, her supervisor stopped her.
“Kelly,” she said, “your job today is to make sure that no one else from Brentwood dies.”
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The known effects of the anthrax attacks came to a close on Nov. 21, with the death of a 94-year-old Connecticut retiree named Ottilie Lundgren. She was the 22nd person known to have been infected by the letter attacks, and the fifth to die of inhalational anthrax, after Stevens; Morris and Curseen; and Kathy Nguyen, a 61-year-old hospital worker in Manhattan. Nguyen and Lundgren were presumed to have been infected by anthrax contamination on mail that they handled, but a source for the spores that killed them was never found.
The remaining 17 victims — 11 with cutaneous anthrax and six others with the inhalational form — recovered, though some had long-term health problems. Larry Richmond survived.
The presumed first letter in the attacks, the one that would have infected Bob Stevens in Florida sometime in mid-September, was never found. The presumed last one was discovered Nov. 16, in a barrel of Capitol Hill mail that had been held in quarantine since the House of Representatives shut down on Oct. 17. It was addressed to Sen. Patrick Leahy. According to CDC and Defense Department analysts, the anthrax loaded into the letters became progressively more refined as the mailings continued, as though its creator were increasing his or her expertise with practice, or as a message.
More than 2,000 members of the CDC worked on the Trade Center and anthrax attacks. Of the 146 members of the EIS, 136 of them — everyone who was able to travel and had not been inadvertently trapped overseas — deployed to one of the crisis sites at least once. More than 40 deployed at least twice, and at least 10 of them four or five times.
By the end of 2001, they had all returned to their normal jobs, many of them changed for good.
“The enormity of the task was so incredible that we didn’t have time to mourn, or to react the way we would have had we been sitting on the sidelines,” Kelly Moore said. “But I’m glad I wasn’t on the sidelines. There wasn’t much time to think, but I remember very clearly thinking that we were involved in making history.”