about Epidemiology & the department

Epidemiology academic information

Epidemiology faculty

Epidemilogy resources

sites of interest to Epidemiology professionals

Last Updated

11 Jun 2003

Source: USA Today, November 19, 2001

Case of N.Y. anthrax victim intrigues officials

By Kevin McCoy and Charisse Jones, USA TODAY

NEW YORK -- In life, Kathy Nguyen was a solitary figure, a woman whose daily routines and even birth name were largely unknown even to her tight circle of friends, neighbors and co-workers. In death, she has been transformed into an enigmatic yet pivotal figure for a terrorism-anxious nation, the potential key to solving the anthrax attacks that have killed four and infected 13. Unlike with the other victims, investigators say there is, as yet, no evidence that the former Vietnamese refugee came in contact with anthrax-contaminated mail.

How she came into contact with the lethal spores has baffled scores of detectives, scientists and public health experts who have checked with her friends and neighbors, scoured her Bronx apartment, searched her Manhattan job site and tested her subway route.

"The frustration is such that we went back to the docs and asked, 'Are you absolutely sure that this woman died as a result of anthrax?' " said a high-ranking FBI official. "They came back and stood by their earlier findings."

So investigators have expanded their efforts, keenly aware that the absence of confirmed new infections since Nov. 3 offers no guarantee against more attacks.

This is no "naturally occurring outbreak" that "seems to have run its course," warned Centers for Disease Control and Prevention Director Jeffrey Koplan. "The course on this is only run when the criminal is apprehended."

Investigators have posted Nguyen's picture at subway stops, hoping a stranger or acquaintance might provide a clue.

They have checked her subway fare cards, trying to retrace her travels the two weeks before her Oct. 28 arrival at a Manhattan hospital emergency room.

Now, some are wishing aloud for a tipster. "We still have hopes that someone will come forth and say, 'I recognize her and we did this together' or 'I saw her here,' " Koplan said.

The public health stakes are enormous.

Nguyen could have come in direct contact with the anthrax killer or killers. She could have been infected in a way as yet unknown. She could have been killed by stray spores numbering well below the previously thought lethal dosage. Or, far-fetched as it might seem, "she could've been making it herself," the FBI official said. But no traces of anthrax were found on her clothes or at her home.

Misdiagnosed illness

Xinh Thi Nguyen was born April 26, 1940, in Vietnam. She later shortened her name to Kathy for English-speaking friends. She would tell them her mother had been a schoolteacher, and her family had rented rooms in Saigon to U.S. soldiers.

In 1975, as the South Vietnam capital fell to the Vietcong, the United States evacuated approximately 123,000 refugees. Nguyen was no doubt part of that group, although few records still exist, a State Department spokeswoman said.

Nguyen first went to Guam, and then arrived in San Diego with a refugee visa, immigration officials say.

She lived out West for a time, marrying a man she later told friends had died of cancer, and giving birth to a son she said died at age 5 in a car accident. By August 1980, she was living in New York City, where she became a US citizen, immigration officials say.

Jenny Espinal, a longtime friend and neighbor, said Nguyen moved more than a decade ago to a tidy apartment on Freeman Street in the Bronx.

Nguyen's Latino neighborhood, a short block from auto shops above Sheridan Expressway, was miles from the mid-Bronx Southeast Asian community. Her quiet building provided a circle of friends that became her family.

One flight down is Josefa Richardson. Upstairs is Anna Rodriguez. Next door are Espinal and her young children. A few blocks away is St. John Chrysostom Church, where Nguyen wore her Sunday best for the 10 a.m. English Mass.

"Guaranteed on Easter Sunday, she'd have a fancy hat on," the Rev. Carlos Rodriguez said. "I would compliment her, and she would always be a little embarrassed."

Friends say Nguyen introduced neighbors to Vietnamese food and shared their Latino cooking.

"She was always from her job to her house, from her job to her house," Espinal said. "She sometimes said she was tired from working all the time and just wanted to be home."

In May 1985, Nguyen landed a job at what was then New York Hospital. Nguyen worked there until May 1991, when she got a stockroom job at Manhattan Eye, Ear and Throat Hospital.

"You couldn't ask for a harder worker than Kathy," said co-worker Joseph Kreytak. "Instead of her 7 hours per day, it was 10 hours per day. We had to force her to take vacation. That's how dedicated she was."

But on Oct. 25, Nguyen became ill. For two days, she went to work anyway, fighting through muscle aches, chills and a hard cough that brought up traces of blood.

"She just said she was coming down with a cold," Kreytak said.

A Nov. 9 CDC report starkly chronicles the suffocating attack. Nguyen, a non-smoker whose only previous serious ailment was chronic high-blood pressure, was alert but had a fever when her apartment superintendent drove her to Lenox Hill Hospital on Oct. 28. Her heart was racing at 110 beats per minute.

Hospital physicians first suspected congestive heart failure. But when tests proved negative, the tentative diagnosis switched to pneumonia. She was treated with levofloxacin, a common antibiotic.

But Nguyen's breathing rapidly worsened. A CT scan found thickened mucous and massive bleeding in her lungs. On Oct. 30, doctors changed her medication to ciprofloxacin and three other bacteria-fighting drugs. But Nguyen died the next day.

Additional tests confirmed the suspicions of doctors: anthrax.

No leads to follow

More than 100 FBI agents, working with the CDC, the city health department and police, were assigned to trace her activities back to Oct. 14.

"The suspect here is not a person," said New York police spokesman Thoman Antenen. "You're not looking for fingerprints or a weapon. We know what happened."

Investigators began testing Nguyen's mail, but tests turned up no spores. Investigators interviewed dozens of people in her community, from Kiko's Laundromat down the block to a small supermarket on Westchester Avenue. Nothing.

They attended her Nov. 5 funeral and interviewed mourners for leads. Nothing.

Learning that Nguyen paid her bills with money orders, they checked post offices in the Bronx and Manhattan. Nothing.

Determining that Nguyen commuted to work on the IRT No. 6 subway, they tested several stops, from Whitlock Avenue near her home to East 68th Street, a short walk from her job. Nothing. They discovered Nguyen sometimes ate at Vermicelli, a popular Vietnamese restaurant on Second Avenue, owned by friends. Nothing.

Every shred of information is constantly entered into an FBI profile.

"I am struck at how difficult it is to get the kind of detailed information we need on day-to-day, hour-to-hour activities when someone lives alone and didn't have a lot of close confidants," CDC Director Koplan said. "There are things that any one of us do that aren't necessarily predictable, and you can't account for, and that's the stuff we need."

Now, the police-sealed door of Nguyen's apartment has become a shrine, decorated with ribbons. Until last week, neighbors and friends gathered each night at 7 on the third-floor landing to say the rosary.

"It's very scary," Espinal said, "because what happened to her could happen to anyone."

Contributing: Toni Locy and Kevin Johnson in Washington