Remembering 9/11 and Anthrax: Public Health’s Vital Role in National Defense

Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) released a new report, Remembering 9/11 and Anthrax:  Public Health’s Vital Role in National Defense, featuring more than 30 firsthand, on-the-ground accounts of public health professionals who were directly involved in the response to the September 11, 2001 and anthrax tragedies.

The stories recall how:

• On September 11^th, in a period of uncertainty, officials activated a range of responses, including readying the Strategic National Stockpile, and providing services, including mental health counseling, in the aftermath; and
• Public health officials were at the lead of the anthrax response – diagnosing and treating victims and running more than a million tests on approximately 125,000 samples around the country.  The report contains a timeline of the anthrax attacks and investigation.

The stories also reflect how these events marked the first time that public health came to be considered central to emergency response and national security on a wide-scale basis – and the stories reflect how these officials were working without adequate resources or training to respond to these types of attacks.  A summary of how public health preparedness has evolved in the past 10 years is also included in the report.

“The biggest threat to bioterrorism preparedness today is complacency.  If a health threat does not happen, be it naturally occurring or deliberate, we tend to make it a lower priority.  The worst thing we can do is to make something a priority after it happens.  After it happens is too late; you are playing catch-up.  Preparedness for a threat must be a priority before it happens.”  — Anthony S. Fauci, M.D., Director, NIAID/NIH

Some contributors include Anthony Fauci, M.D., Director NIAID/NIH; Senator Tom Daschle, former U.S. Senator from South Dakota and former U.S. Senate Majority Leader; Isaac Weisfuse; M.D. MPH, Deputy Commissioner of the Division of Disease Control of the New York City Department of Health and Mental Hygiene; Sara T. Beatrice, PhD., New York City Public Health Laboratory; Georges Benjamin, M.D., FACP, FACEP (E), FNAPA, Hon FRSPH, executive director of the American Public Health Association and former Secretary of the Maryland Department of Health and Mental Hygiene; and stories from a range of officials at the U.S. Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and state and local public health officials in New York, Washington, D.C., Virginia, Florida, Connecticut, New Jersey, Arizona, Maryland, Missouri, North Carolina, and Washington State.  There are excerpts and highlights of the stories included at the end of the release.

“In 2001, we experienced the unimaginable.  In 2011, we know we need to expect the unexpected.  Over the past decade, we’ve made smart, strategic investments in preparedness, and there’s been a lot of progress to show for it.  We can be proud of the improvements.  Of course, there is a lot left to be done, which will require further effort.  But, regardless, the field of public health preparedness was forever changed 10 years ago, and we should never forget why,” said Governor Lowell Weicker, Jr., former three-term U.S. Senator and Governor of Connecticut and President of the Board of Directors at TFAH.

The following includes a series of excerpts and highlight from the stories

9/11 Response

“Over the next couple of hours, it became clear that it was going to be a recovery mission… that there wouldn’t be any survivors.  The hardest phone call I ever had to make was to the hospital telling them to stand down the emergency response.”  — Dan Hanfling, Special Advisor on Emergency Preparedness and Disaster Response to the Inova Health System in Northern Virginia and Board Certified Emergency Physician

“The expectation was that large numbers of people had been injured by the crash and collapse of the buildings.  When the sad realization was that hospitals would not be receiving injured survivors because most victims had perished, the CDC team’s attention was also directed to occupational health.  Soon attention turned to environmental health concerns, such as air quality, food and water safety, and rodent control.”  — Q&A from CDC 

Anthrax in Florida

“In 2001, I was the director of the Florida State Public Health Laboratory in Miami which responded to the first anthrax attack in the history of the United States….  The hardest part of dealing with the anthrax attack in 2001 was the lack of resources and personnel to support the excessive number of samples that ended up in laboratories.”  — Segaran Pillai, Chief Medical and Science Advisor, Ph.D. MSc, SM (AAM), SM (ASCP), Science and Technology Directorate, Department of Homeland Security

“I received that specimen around noon on October 3, 2001.  I immediately started the analyses that I had been taught at CDC….  Following a press release, on October 8, 1,114 people who worked in or had visited the [American Media Inc.] building during the previous 60 days presented at the Palm Beach County Health Department…”  — Phil Lee, Biological Defense Coordinator, Molecular Biology, Florida Department of Health Bureau of Laboratories

“Ready or not, the Florida anthrax event thrust public health and bioterrorism to the front of the line….  CDC and public health as a whole had limited science or past bioterrorism experience to draw upon beyond basic laboratory and epidemiological understanding.”  — Q&A from CDC

Anthrax in New York

“On October 12, 2001, we received our first Anthrax laden letter which was mailed to the office of NBC News here in NYC.  The ensuing investigation and media coverage resulted in our Public Health Laboratory receiving thousands of clinical specimens and environmental samples for testing… coffee tables from a department store, suitcases from the airport, dollar bills that had been rolled up, you name it.”  — Sara T. Beatrice, Ph.D., Assistant Commissioner, New York City Public Health Laboratory

Anthrax in Washington, D.C. Metro Area

“The patient said he delivered mail from the Brentwood postal facility.  At the time, Brentwood had no special meaning to anyone….  [the doctor] did an X-ray which just didn’t look right, and then followed that with a chest CT Scan that was demonstrable for the telltale sign of inhalation anthrax…  Later that same night, another of our emergency department physicians… took care of another postal worker from Brentwood.  He came in because he said he had the worst headache of his life.”  — Dan Hanfling, Special Advisor on Emergency Preparedness and Disaster Response to the Inova Health System and Board Certified Emergency Physician

“I vividly remember the first report to me by my Chief of Staff, Pete Rouse, and my grave concern for each of the affected staff.  I remember the agony of calling parents, spouses and families of the exposed staff to inform them of what had happened and to share what little I knew about how we would address the situation.”  — Former U.S. Senator Tom Daschle

“We realized there was no cavalry coming to sort things out, we would have to manage most of this ourselves.”  — Dan Hanfling, Special Advisor on Emergency Preparedness and Disaster Response to the Inova Health System and Board Certified Emergency Physician

“The people in Virginia who contracted anthrax survived.  Part of the reason for the positive outcome was the responsive infrastructure developed through the Laboratory Response Network (LRN).  One patient went to the emergency room and was discharged after having a blood sample drawn for culture….  Within forty minutes of receiving the specimen… the patient returned to the hospital and was successfully treated with the appropriate antibiotics.”  — Jim Pearson, Virginia DGS Deputy Director for Laboratories, Director of the Division of Consolidated Laboratory Services

Anthrax in New Jersey

“Two perceptive local New Jersey physicians, having read news reports of the NYC cases, and the NJ postal center of origin, called our phone banks to report unusual, persistent skin illnesses in two postal workers….  It turned out it was over three years before [the Hamilton postal building] was deemed safe to reopen.”  George DiFerdinando, Jr., M.D., M.P.H., FACP, Director, New Jersey Center for Public Health Preparedness at UMDNJ-SPH Co-PI, New York-New Jersey Preparedness and Emergency Response Learning Center Adjunct Professor of Epidemiology, UMDNJ-SPH

Anthrax in Connecticut

“In March of 2001, I joined the State of Connecticut Department of Public Health as a Bioterrorism Coordinator in the Public Health Laboratory…. My role would drastically change in a matter of a few months, after Ottilie Lundgren, a citizen of Oxford, Connecticut, because the last known victim of the anthrax attacks.”  — Diane Barden, Bioterrorism Response Laboratory Supervisor, Connecticut Department of Health Public Health Laboratory

Thousands of Scares around the Country

“At the outset of the anthrax response, we were basically operating out of a closet.  We built a makeshift lab in an unoccupied office – this became our BioEmergency Response Lab.”  — Victor Waddell, PhD, Bureau Chief, Arizona State Public Health Laboratory, Arizona Department of Health Services

“Here was a typical scenario: a jittery and unnerved town resident would discover ‘suspicious’ white powder in his community. Immediate notification of the local police or fire department would trigger both the closing of the local post office and the sudden arrival of HAZMAT teams, bedecked in imposing space- suit paraphernalia. The teams would delicately handle the samples under the watchful eye of local media and news cameras. Then, those samples would be delivered to the M.D.PH state laboratory for analysis. A hastily-arranged press conference would feature harried state and local officials trying to explain the unfolding developments to an increasingly anxious public. And when testing in the laboratory subsequently yielded negative results for anthrax, that finding would prompt yet another round of news announcements as well. Multiply this situation by several thousand –and that was the Fall of 2001 in our state, and indeed, around the country.”  — Howard K. Koh, M.D., M.P.H., U.S. Assistant Secretary for Health, U.S. Department of Health and Human Services, Massachusetts Commissioner of Public Health, Commonwealth of Massachusetts

“The types of environmental samples received were variable to say the least.  From the obvious bulk mail from post offices, suspicious mail from homeowners and powder samples (including powdered doughnuts), to the more obscure airline seat covers, dead birds, body bags, teddy bears, disposable underpants, a Marilyn Monroe effigy and residential mail boxes together with post and concrete anchor… each presented a new challenge.”  — Phil Lee, Biological Defense Coordinator, Molecular Biology, Florida Department of Health Bureau of Laboratories

Legacy of the Tragedies for Public Health

“What stands out most to me about the 2001 anthrax attacks is the notion that from that point on, bioterror was a reality and no longer an abstract concept….  Today, we know and can dispassionately describe exactly what happened.  We know that of the people potentially exposed to anthrax in 2001, 22 people were infected, five of whom died.  We know now that the attacks were unlikely a concerted effort by a group or organization intended to broadly affect our society and large numbers of people.  We know that the attacks likely stemmed from the actions of a single individual who was probably mentally unstable.  Today we know the anthrax attacks had a relatively limited and short-lived impact in terms of morbidity and mortality.

However, at the time the entire event was surrounded by uncertainty.”  — Anthony S. Fauci, M.D., Director, NIAID/NIH

“The events were highly transformational – something had fundamentally changed in the field of public health after 9/11….  This was nailed home when the anthrax attacks occurred.  Quite simply, never in the history of public health had diseases we thought were in the past been reintroduced as a weapon.”  — Alonzo Plough, M.A., M.P.H., Ph.D., Director of Emergency Preparedness and Response, Los Angeles County Department of Public Health; Board of Director, Trust for America’s Health

“On this, the impending 10 year anniversary, it has left us reflecting on where we were at the time, what contribution we made to helping those directly impacted by this tragic event, and wondering what would happen if something similar happened again. For those of us who are disaster response leaders, it reinforces the importance of building a robust and prepared nation–recruiting, training, and sustaining a workforce, both volunteer and paid, that has the capability to be at the right place, doing the right things, at the right time.” — Jack Herrmann, Senior Advisor, Public Health Preparedness, National Association of County and City Health Officials (NACCHO)