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Last Updated

05 Feb 2003

Source: Reuters, October 4, 2002.

U.S. Officials Agonize over Anthrax Decisions

By Maggie Fox, Health and Science Correspondent

WASHINGTON (Reuters) - One year after a series of mysterious anthrax attacks killed five Americans, some top health officials say their agencies could have moved faster to protect the mail system.

Just days after a photo editor in Florida (case 5) became the first victim of the attacks, which eventually sickened 23 people with anthrax infections, some experts at the Centers for Disease Control and Prevention had concluded that the deadly spores must have been sent in the mail.

They urged their superiors to close the local Boca Raton post office, which would have handled the letter that carried the anthrax. But CDC officials decided not to act.

Recent interviews with top CDC officials show that this decision was not made lightly -- and not without a great deal of debate.

Even as Health and Human Services Secretary Tommy Thompson was assuring Americans that photo editor Bob Stevens (case 5) may have caught anthrax while traveling in the North Carolina countryside, some CDC experts were arguing that mail facilities could be contaminated.

But few at first believed that deadly anthrax spores could leak from sealed envelopes and no one appreciated that anthrax powder could act like an aerosol, floating long distances in the air, to infect bystanders.

The situation was initially confused. No anthrax-tainted letter was ever found in Stevens' office and the origin of his sickness was not immediately known.

But one top expert argues that had Boca Raton's facility been closed right away it would have set a precedent to immediately close post offices elsewhere when anthrax-laced letters were found later in New York and Washington.


"My immediate instinct was to close the Boca Raton post office," said the expert, who asked not to be named. "If we had closed the post office in Florida, it would have set a precedent to close Brentwood."

Eight postal workers were later infected by contaminated mail and two who worked at Brentwood mail facility in Washington died. A woman in Connecticut and a woman in New York also died, apparently from contaminated mail.

Many workers at Brentwood protested that not enough was done to protect them while drastic measures were taken to close offices and give antibiotics to workers in Congress where two anthrax-filled letters were opened.

"The risk to Brentwood facility employees by contaminated envelopes in transit was not recognized in time to prevent illness in four employees, two of whom died," Dr. Brad Perkins, the CDC's anthrax expert, wrote in the October issue of the CDC journal Emerging Infectious Diseases.

But CDC director Dr. Julie Gerberding, who took up the post earlier this year and who was involved in the anthrax response, said the picture was not clear at the time.

"There were lots of people participating in those details," she said in a recent interview. "You don't close the post office without a good reason."

Dr. Jim Hughes, head of the National Center for Infectious Diseases at CDC and a key participant in the decision, agreed. "There were a lot of things we thought we knew when the attack began," he said.


Anthrax had always been No. 1 on the list of potential terrorist agents, because it is deadly when breathed in, relatively easy to make into a powder and, compared to other agents, fairly simple to obtain.

Most anthrax hoaxes have involved letters mailed with a powder inside, so it made sense to suspect the mail.

What the CDC did not immediately suspect was that the envelopes could leak an aerosol that could be breathed in.

"The hypothesis that made sense from the scientific point of view was that ... if you handled one of the letters, you could have gotten skin anthrax," Gerberding said. "If you opened one, you could have acquired inhalational anthrax."

She added, "The skin form of anthrax, while something that people don't want to get, is treatable and not life-threatening."

But even at the time the agency stressed that no one had ever dealt with such an attack before and that infectious disease experts were learning on the fly.

The decision not to close post offices initially seemed vindicated, as there was no cross-contamination of mail from the Boca Raton facility. And when anthrax cases turned up in New York, they were, as predicted, all skin infections.

When a letter arrived postmarked Oct. 9 at the office of the Senate majority leader, South Dakota Democrat Tom Daschle, the CDC and other agencies moved in quickly, testing the air, swabbing the noses of staffers for anthrax spores and closing off the entire office building.


But based on their limited experience, they again made a decision not to close the Brentwood postal sorting office, a sprawling building that handles most of the mail in the nation's capital. And when workers there started getting sick, some were told they had flu and sent home.

Their doctors never suspected mail handlers risked getting inhaled anthrax infections. And the CDC now says it appears the spores use in the Daschle letter were much more deadly than earlier mailings.

Brentwood was closed on October 21, after Thomas Morris Jr. (case 15), 55, and Joseph Curseen (case 16), 47, who both worked there, died.

Later, traces of anthrax were found at several off-site mail facilities that serve government offices, including the space agency NASA, the White House and the Supreme Court.

Scores of technicians moved through buildings, testing surfaces for spores, but this did little to establish where they may have drifted, experts say, because they were too fine to have settled on any surface.

More than 10,000 people were put on antibiotics after the Daschle letter arrived, a move that almost certainly saved many lives. "Everybody in that room (the Daschle office) would have died without treatment," said one CDC official.

One year later, CDC and Health and Human Services Department officials say they will act very differently if -- or when -- another attack happens.

"It turns out it was not such a big deal to close a post office," said one official. Brentwood remains closed but other facilities are being used and Washington sends and receives mail normally.


"I think we all wish we'd closed the Brentwood facility," Gerberding said. "The lessons to be learned from this are not to blame or to second-guess, but to keep all possibilities open."

The CDC journal said the danger remains of another attack, as whoever sent the letters has not been found. "An attack using a greater number of spore-containing envelopes would likely lead to many more cases due to cross-contaminated mail," a team of CDC experts writes in a review of the case.

Hughes said the CDC has learned the importance of communication. One of the other hindrances early on in the anthrax case was the reluctance of law enforcement agencies to make information public, in effect gagging the CDC.

"I hope you have noticed that we are talking to the media a lot these days," Hughes said. "We clearly recognize the importance of talking to the public and professional groups."