CLUES, OVERLOOKED, TO A COMING THREAT
10 Dec 2002
Source: New York Times, December 3, 2001.
Clues, Overlooked, to a Coming Threat
By ANDREW C. REVKIN and LAWRENCE K. ALTMAN
The more investigators learn about the anthrax mailings, the more they realize their attitudes about this once-obscure bacterium and its potential as a weapon of terror were based on presumption as well as fact.
And some presumptions have proved wrong.
At first, health officials said reassuringly that only people directly exposed to an opened envelope faced significant risk.
But when postal workers who never touched a poisoned letter developed black blisters or lung infections and two of them died, investigators took a crash course in the high-speed mechanics of sorting machines and the porosity of paper.
Suddenly, the United States Postal Service was recognized as a spore- spreading system.
In the last three days, even the most enigmatic of the five anthrax deaths -- the cases of a Connecticut widow and a New York City hospital worker -- have been shown to have possible links to the mail.
Letters that passed through a Hamilton, N.J., sorting center within seconds of the tainted letters sent to two senators on Oct. 9 had gone to the neighborhoods of these two victims, investigators discovered.
It is possible that those letters that went on to Connecticut and New York became dusted with spores and passed them along -- like cold germs spread at a square dance -- as they brushed against other mail.
"We've been learning a lot more about the Postal Service, and that there is cross-linkage, obviously, with every post office in the country at some level, and every one of our homes and businesses," Dr. Jeffrey P. Koplan, the director of the federal Centers for Disease Control and Prevention, said in a briefing on Friday.
Unless a startling finding emerges showing that Ottilie W. Lundgren, 94, of Oxford, Conn., and Kathy T. Nguyen, the 61-year-old hospital worker from the Bronx, somehow inhaled large amounts of spores with nary a trace left around their homes, the cases of these two women also puncture the notion that many spores are required to kill.
In rare instances, "it is conceivable that you may get down to a very low number," Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Disease, said on Friday.
As they review medical journals, investigators and anthrax experts are realizing that past cases foreshadowed consequences that instead took them by surprise. The journals present case histories in which unlikely victims were killed by the kind of long-distance contamination seen now.
This was true in Manchester, N.H., where in 1966, nine years after a fatal outbreak in workers at a wool-processing mill, Norbert Lemoine, a 46- year-old employee of a machine shop across an alley, died of an anthrax lung infection.
And it was true in Philadelphia in 1948, 1951 and 1957, when two homemakers and a furniture factory worker died of inhaled anthrax even though they were never directly exposed to a source of spores. They lived or worked near businesses that handled hides or wool, but they had never set foot in them.
This evidence supported the idea that spores could disperse to unintended targets if someone spread the bacteria through the mail, said Col. Arthur M. Friedlander, a senior research scientist at the Army's bio defense laboratory at Fort Detrick, Md., which is involved in the anthrax investigation.
If these cases had been more familiar, they might have better shaped the response of crisis managers when the anthrax mail assaults began to surface in mid-October.
Officials responding to the anthrax crisis over the last six weeks were also hampered by the lack of insight into how the postal system was ideally suited to spreading havoc and fear with just a few grams of spores and a handful of prepaid 34-cent envelopes.
Hoax anthrax mailings in recent years exposed a potential route of bioterrorism attack, but counter terrorism exercises focused on events like aerial releases of biological agents over cities or in subways.
Some government analysts took note of the postal threat, but the authorities said they never foresaw the widespread consequences of a real postal assault: the undermining of the operations and popularity of the postal system; the sealing of the offices of half of the Senate; and, most chillingly, the secondary spread of spores from letter to sorting machine to letter and -- in the end -- to the skin and lungs of unlikely and unintended victims.
Investigators have noted that the carefully taped seams on the most heavily poisoned letters speak of a desire for the spores to infect the addressees, Democratic Senators Tom Daschle, the majority leader from South Dakota, and Patrick J. Leahy of Vermont.
Yet the five people who have died were all exposed through unexpected routes.
Many conundrums posed by the postal assaults will not be resolved quickly, officials said.
And in some cases short-term solutions are likely to lead to other unexpected problems.
Those problems include the realization that irradiation of the mail, which is rapidly being expanded by both the Postal Service and private businesses, is damaging all manner of goods, including computer disks, CD's, film and electronic musical greeting cards.
Another issue is the cleanup.
In the contamination of the Hart Senate Office Building, environmental and health officials faced the need for a prompt sterilization of a huge building. Teams began fumigating and scrubbing this weekend, but environmental officials have never established a safe level for residual spores.
At least a few of the lessons learned in the response to the anthrax assaults have been encouraging.
One is the realization that prompt antibiotic treatment and other measures to remove toxins from the blood can sharply lower the death rate from the inhaled form of infection.
The search for clues prompted postal inspectors and the Federal Bureau of Investigation for the first time to use the bar codes on postmarked letters as a tracing mechanism.
This led them to the possible explanations for the cases in Connecticut and in the Bronx.
"This has really turned out to be an effective law enforcement tool," Daniel L. Mihalko, a spokesman for the Postal Inspection Service, said yesterday.
Even so, Mr. Mihalko said, the link between the letters sent from Trenton and the most recent anthrax inhalation cases remained indirect.
And, more important, the technique only works tracing a letter forward from its postmark point.
There is still nothing leading investigators back toward the source of the anthrax, Mr. Mihalko said.