Last Updated

10 Dec 2002

Source: Wall Street Journal, November 10, 2001.

Special Report: Aftermath of Terror

Doctor Who Treated Early Anthrax Case Criticizes Government's Initial Response

By LAURA JOHANNES, Staff Reporter of THE WALL STREET JOURNAL

The infectious-disease specialist who treated Robert Stevens says he believes the U.S. government lost critical time by initially minimizing the possibility that bioterrorism could be to blame for the Florida photo editor's illness.

Larry Bush, chief of staff at Atlantis Medical Center in Atlantis, Fla., termed "ridiculous" the government's initial statements suggesting that Mr. Stevens -- known as an outdoorsman to friends and family -- might have gotten the disease from a natural source. "It was the first inhalation anthrax case in 23 years, and there had only been 18 cases in the past 100 years. Everybody in Florida is outdoorsy, so why would he be the only person to ever get it?" Dr. Bush asked.

Dr. Bush chronicles Mr. Stevens's experience, from his arrival in the emergency room Oct. 2 to his death three days later, in a coming issue of the New England Journal of Medicine. The article, scheduled to be published on Nov. 29, was released early because of its public-health implications.

In an interview, Dr. Bush says federal health officials didn't talk to him before an Oct. 4 press briefing in which Secretary of Health and Human Services Tommy Thompson called Mr. Stevens's illness an "isolated case," and said there is "no evidence of terrorism." Mr. Thompson added that cases in the U.S. do occur sporadically, and that "it's entirely possible" that he could have gotten the disease from "wool or other things."

Tony Jewell, a spokesman for the Department of Health and Human Services, says Mr. Thompson briefed the press with all available information. Asked about Dr. Bush's statement, he adds, "Hindsight is 20-20."

Mr. Stevens, 63 years old and otherwise in good health, woke up in the middle of the night on Oct. 2, "vomiting, completely disoriented, and feverish," Dr. Bush says. His wife brought him into the emergency room, where doctors suspected bacterial meningitis, which causes similar symptoms, and put him on intravenous antibiotics.

Four days before his admission, Mr. Stevens had been suffering from fever, severe muscle aches and a general sense of malaise, according to the article. People with winter colds should note that he had no sore throat or upper-respiratory symptoms, Dr. Bush says. He did have swelling of the mediastinum, the center portion of the chest -- which is a red flag for anthrax. But, since none of the doctors present had ever seen a case of inhalation anthrax, "they didn't think anything of it," says Dr. Bush.

By around 7 a.m., four hours after his admission, Mr. Stevens was so ill he needed a ventilator, or artificial breathing machine, to keep alive. By now, he was unconscious, unable to give doctors any information that might help them diagnose his mysterious ailment.

Working on the assumption that he had meningitis -- an inflammation of the brain lining caused by infections -- doctors took a sample of the fluid from his spine to find out what was causing it. When doctors looked at the bacteria under the microscope, it had the distinctive boxcar shape of the bacillus family, to which anthrax belongs. Two other types of bacilli can cause severe illness, but they are rarely found in otherwise healthy people.

"I thought, 'Why not anthrax? Right here. Right now,' " says Dr. Bush, an infectious-disease specialist called in to help. His correct conclusion was that Mr. Stevens did have meningitis, but caused by anthrax -- not by typical bacteria such as listeria or pneumococcus.

At that point, doctors added another antibiotic, penicillin, to his therapy. Eighteen hours later, lab tests came back positive for anthrax. The identification was confirmed by more sophisticated tests at the state health department and the U.S. Centers for Disease Prevention, prompting the public announcement on Oct. 4.

But by the next day, Mr. Stevens' life was nearing its end. The antibiotics were tackling the anthrax bacteria, but the germs already had unleashed potent quantities of toxins into his bloodstream, which caused the inflammation of his brain lining. His kidneys were failing, his blood pressure dropped. His heart -- under tremendous stress -- stopped beating.