Amerithrax (21 page)
The time between exposure and infection was anywhere from two days to six weeks for inhalational anthrax. Spores could hide in lungs for days or weeks before multiplying. It takes time to hamstring the ability of white blood cells to
fight off disease and allow the bacterium’s toxin to freely ravage the body.
Morris had a remote history of sarcoidosis, a mild disease in which abnormal collections of inflammatory cells com- monly form in organs of the body, most frequently the lungs. It struck mostly African American men, like Morris, causing aching joints, a slight fever, shortness of breath, and enlarged lymph nodes. Unfortunately these were also symp- toms of inhalational anthrax. Morris had been free of sar- coidosis for the past twenty-five years.
Morris told a nurse practitioner he thought he had an- thrax, but the nurse and physician supervisors reportedly told Morris he only had a virus, the flu. They told him to take Tylenol for his aches and pains and sent him home. No chest X ray was performed nor were antibiotics prescribed. (All of this was according to Morris later.) A hospital spokeswoman later said the nurse called Maryland health authorities about Morris and followed their recommenda- tions, and Morris was sent home with a diagnosis of a viral syndrome.
A fourth nightshift Brentwood employee, forty-seven- year-old Joseph Curseen, worked in the same sorting area as Morris, but in another section. Curseen had a wonderful mustache. It lifted like the wings of an eagle. While not as magnificent as a handlebar or military mustache, it was won- derful all the same. He had a slight goatee that underscored a full lower lip and set off his high forehead and heavy- lidded eyes. Like his three compatriots, Curseen developed a mild nonproductive cough, nausea, vomiting, and stomach cramps.
In New Jersey, Patel appeared at her local emergency room. She labored to breathe. A chest X ray revealed a moderate mass to the right and minimal left pleural effu- sions. Her antibiotics were altered to azithromycin and cip- rofloxacin, but Cipro was discontinued twenty-four hours later. On Friday, her chest X ray showed increased soft tis- sue in the mediastinum. Her doctor added clindamycin and ceftriaxone to her medication. Patrick O‘Donnell, Patel’s co- worker, was in stable condition and responding well to an- tibiotic treatment. He was found to have skin anthrax.
Temperature 38.4
°
C, heart rate 120/min, blood pressure 159/95 mm Hg, and respiratory rate 18/min. She ap- peared ill with increased respiratory effort, had decreased breath sounds at both bases, and had a 0.5- to 1.0-cm healing scab on the anterior neck. Initial WBC was nor- mal except for elevation in neutrophil band forms. Blood for
B. anthracis
DNA by PCR was positive, as were immunohistochemistry studies for
B. anthracis
cell-wall and capsule antigens from pleural fluid cytology prepa- rations. Her chest X-ray showed bibasilar infiltrates and a small right pleural effusion but no mediastinal widen- ing. Initial differential diagnosis included atypical pneu- monia versus inhalational anthrax.
On October 18, the USPS dispatched a
NEWS Talk Spe- cial Edition
to its Postal Supervisors and Postmasters. The three-page letter cautioned against “overreaction,” and stated:
The following is a mandatory stand-up talk that must be read to your employees. Three decision trees are at- tached... 1. Possible room or area contamination by air- borne gas. 2. Open mailpiece with suspicious powder spilling onto surface. 3. Discovery of suspicious un- opened/sealed envelope or parcel. Managers are required to discuss the three decision trees in the context of local emergency action plans and resources. Make copies of the scenarios and distribute them before the talk so that em- ployees can make notes. The decision trees provide guid- ance on immediate actions to take in the event of three scenarios involving the potential release of anthrax spores. They have been coordinated with the Inspection Service.
Please also make it clear to employees that over- reaction to deposits of various powders and dusts not
The Postal Service’s previous policy, issued in 1999, called for evacuating any postal facility upon discovery of a suspicious letter. New USPS guidelines, issued on October 19, stated that discovery of a “suspicious unopened/sealed envelope” should trigger postal supervisors to shut down equipment, evacuate and cordon off the area.” The CDC said it left Brentwood open (in violation of its own written emer- gency regulations) because it was confident that tiny anthrax spores couldn’t pass through a sealed envelope. CDC spokesman Llelwyn Grant told UPI the agency’s response “was based on the science that we knew at that time. There was nothing to suggest that anthrax could be a threat as far as anyone coming into contact with a closed letter.”
Later, according to Judicial Watch (a conservative watch- dog public interest law firm), a log thought to be from a Brentwood supervisor suggested the Postal Service more than suspected the facility was contaminated—they knew it was—and had identified a specific machine that had sorted the Daschle letter, No. 17. An entry dated October 18 alleg- edly said the Postal Service had arranged for a company called URS to test the facility for anthrax. CDC officials were informed of this and a positive reading for anthrax when they arrived at Brentwood the next day.
The CDC wrote that, “most, if not all, bags, envelopes, and the like are not acceptable outer shipping containers.”
By Friday, October 19, after considerable debate and a brief shutdown of the regional processing center in Hamilton Township (so the FBI could take samples), employees there and in Ewing Township, twenty miles away, began a week- long regimen of antibiotics. The thirteen hundred nasal swabs taken so far had tested negative. But those results were not definitive. Spores could be lost during the simple act of nose blowing. Officials increased the regimen to thirty days, then sixty.
Members of the letter carrier’s union received this letter:
Dear Brothers and Sisters: Brother Al Ferranto, NALC Director of Safety and Health, has been meeting with the Postal Service at the Headquarters level on a daily basis dealing with the concerns over possible anthrax in the
U.S. mail system. He has tirelessly worked to maintain up-to-date communication and to express NALC con- cerns... Letter carriers upon request will be provided with a filtering face piece and/or [hypoallergenic] gloves to protect them from possible contact with mail that has been contaminated with anthrax spores...
If it is determined that the mail in question is a viable threat, Letter Carriers should request... to be medically tested. If local management does not agree to allow Let- ter Carriers to be tested, please call my office immedi- ately so myself or my staff can get involved. Please encourage Letter Carriers to remain calm and deliver the mail in as normal a manner as possible and do nothing
Sincerely and Fraternally, Dale P. Hart, National Business Agent, NALC.
At Brentwood, the unidentified postal worker’s mild headache had not abated, but worsened. It was now constant and global. The postman could see no reason for the accom- panying muscle aches, nausea, feeling of oncoming illness, drenching sweats, and discomfort from bright light. He had a mild, dry cough, a feeling of fullness in his chest upon exertion, and pain on the surface of his lungs. Meanwhile, his coworker Leroy Richmond, a Stafford, Virginia, resi- dent, was experiencing the same familiar symptoms— including fever and chills. He was hot and achy, short of breath, and stoically taking aspirin to endure the discomfort. The thirty-two-year USPS veteran worked in a cubicle near No. 17, Joseph Curseen’s machine, the same machine that had processed the Daschle letter and had been spray-cleaned in Richmond’s presence. All day Friday, Richmond’s head- ache weighed him down. Finally, he went to see the Brentwood office nurse.
The nurse, suspecting flu or a severe chest cold, directed Richmond to Kaiser Permanente in Woodbridge, Virginia, for further examination. He arrived there in no acute dis- tress, but with decreased breathing sounds. Dr. Michael Nguyen, Richmond’s primary-care physician, ordered him to Inova Fairfax Hospital in Falls Church. Because of the recent Capitol Hill evacuation he also alerted county health officials. By the time Richmond’s wife, Susan, had driven him to the ER, his chest had tightened to a painful degree. His cough was mild and dry, like his coworker’s. His white blood count was normal. Though, Dr. Thom Mayer, head of the emergency room, observed no skin lesions, he had a hunch Richmond’s illness might be inhalational anthrax.
Upon Richmond’s arrival, attending ER physician Dr.
Cecele Murphy observed that the patient was:
afebrile and normotensive. Heart rate was 110/min, and he was not tachypneic. Serum albumin was decreased,
Richmond’s physical examination appeared unremarka- ble. His admission laboratory results were normal, except for elevated bilirubin and hepatic enzymes, low albumin, and hypoxia. Dr. Murphy listened to his decreased breath sounds at both bases. Then she scanned his X ray, which showed a widened mediastinum (especially in the right par- atracheal region). A small air space showed opaquely in his right lower lobe. Suspicious, Murphy asked her patient, “Where do you work?” “I handle mail at Brentwood,” Rich- mond said. Murphy ordered a more detailed CT scan. After the computer had analyzed the series of new X rays, the cross-sectional view revealed a widened area in the middle of the patient’s chest. A forest of enlarged, diseased lymph nodes (the largest node measuring 4.2 centimeters) had cre- ated a shadowy mass between Richmond’s lungs. There was bleeding and fluid within both lungs. Inhalational anthrax! She immediately put Richmond on Cipro, rifampin, and clindamycin.
At midnight she rang local health officials, who in turn notified the Senate Crisis Center and Senator Frist. Frist got the news around nine o’clock on Saturday morning and thus was the first top-ranking official to learn that anthrax in the city had probably “jumped” from the Hill. Frist was attend- ing a short briefing when he learned that the CDC team had been contacted by a local physician. A mailworker not con- nected with Capitol Hill had exhibited “shortness of breath, an abnormal chest X ray with enlarged lymph nodes, but clear lung fields.”
The X rays prompted a gut reaction in Frist, causing him to be “truly alarmed.” “I believed the information could por- tend a national catastrophe,” he wrote later. “Were postal workers safe? Would our mail system be shut down locally—or possibly nationally—just as the air transporta- tion system had been paralyzed a month previously by the terrorist attacks on Washington and New York? What was next?” A potential anthrax epidemic could cripple the Postal Service and gridlock the two billion pieces of mail it moved
He leaped up from the meeting and phoned former Penn- sylvania governor Tom Ridge, President Bush’s new Direc- tor of Homeland Security, informing him they had a potential national emergency, “with disease appearing and behaving like we had never seen before.” Within an hour Frist had set up a conference call with his command staff, HHS Secretary Thompson, Ridge, and other key leaders. He cautioned everyone to brace themselves and the country for “a national nightmare.” Each member of Frist’s public health team spoke for five minutes. Thompson listened gravely, then told Frist’s team to make a list of everything they would need. “You will have it,” he promised. He or- dered emergency antibiotic stocks broken out and delivered to health workers for distribution the next day. Within eleven hours Dr. Murphy’s patient’s admission blood cul- tures grew
B. anthracis.
At 5:00 p.m. Saturday, Brentwood workers routinely cleaned the three gigantic mail-handling machines with blowers, unknowingly spreading invisible contamination. Sorter No. 17, through which the Daschle letter had passed, was one of the machines cleaned by compressed air. The powerful blasts created air currents that created whirlwinds within the barnlike Brentwood facility, turning it into a death trap. Silently, there came a parade of illnesses in people who had been nowhere near the three sorting machines in Brent- wood. On Saturday Joseph Curseen had a syncopal episode at church, but did not seek medical attention.