Anthrax spread baffles investigators

WASHINGTON, Oct. 31 (UPI) -- Public health systems in all 50 states have been put on a heightened state of alert for anthrax, Health and Human Services Secretary Tommy Thompson said Wednesday.

Thompson said he conducted a one-hour teleconference with state public health directors and afterward told reporters: "We continue to aggressively examine all cases (of anthrax) and exposures. We're also on the lookout for anything suspicious."

Anthrax cases continue to be diagnosed in New York and New Jersey and anthrax spores now have been found at an Indianapolis postal site and in at least one overseas U.S. embassy that received mail from the State Department.

At least 17 locations in the Washington area, connected to the government and postal service, have tested positive for anthrax, including one building housing HHS offices. Additional anthrax spores also have been located in additional South Florida postal stations.

A New York woman died of inhalation anthrax Wednesday and the medical and law enforcement community is baffled and frustrated by the continuing spread of the apparently mail-borne disease, according to U.S. Surgeon General David Satcher.

The New York woman, the fourth to die of the disease, had no apparent connection with previous victims of either the inhalation form or the less-deadly skin type of anthrax. She worked in a hospital stockroom next to a mailroom in New York, but tests have turned up no signs of anthrax spores.

"There is a lot we don't know about what the attacker is doing, and that's the difficult part," Satcher said on CNN's "Larry King Live." We don't know what the attacker is doing or what the attacker is going to do next in terms of strategy. We're used to dealing with infectious diseases, but we don't have a lot of experience dealing with terrorists."

Someone, somewhere is making the high-grade spores, Satcher said, and "the FBI, of course, is looking into that very closely as to what is the source of this anthrax and who is behind it."

"And hopefully, with all of the work that they're doing, we will know that answer soon. That is the only way we can prevent a continuation of this," he said.

Medical officials confirmed 16 cases of anthrax -- so far.

"We are responding to the medical crisis," Thompson said, defending the government's actions by saying until just a few weeks ago, only a handful of people at the Centers for Disease Control and Prevention or elsewhere in HHS knew anything at all about anthrax. "Clinical information was decades old," he added.

Thompson said the CDC has 25 epidemiologists on the case in Washington. There are an additional 11 CDC staffers in Florida, 15 in New Jersey, 33 in New York City and 85 in Washington. Nearly 100 public health officers are working to dispense antibiotics to thousands of people as a precautionary measure.

Thompson called the cooperation in HHS and among other agencies involved in the investigation "exceptional " and said a special situation room had been established in HHS and at the CDC headquarters in Atlanta to handle coordination efforts.

"I instructed people to issue a memo today to all federal agencies on how to respond, from the CDC," said Thompson, who has spent the week operating HHS out of the CDC offices in Atlanta.

"We're very concerned that we really don't know how (the fourth) person was infected, and the reason we're so concerned about that is because that will tell us who else might have been exposed in the same situation at the same time or near the same time," Satcher said. "So our major concern now and our major investigations are surrounding trying to understand how this person became infected.

"It's very strange. They have not found any evidence yet as to the nature of her exposure. They haven't found any in that mailroom. So, hopefully, very soon we will discover where she contracted anthrax, because that means that other people have been or are being exposed probably in the same place," Satcher said.

"There is no link, and that's what really has us concerned. We need to find out how she was infected. A lot of investigations are going on as we speak. The epidemiologists from CDC, and working with the local health department, are looking very intensely into this case. We need to find out exactly where and how she was exposed."

CDC Director Dr. Jeffrey Koplan, said the agency is learning more from each new anthrax case and is already making some interesting observations, including one that those getting the more serious inhalation anthrax infections seem to be older. He said it was important to keep in mind it still is only a handful of patients but "some of the sicker patients have been older." He said that the age factor potentially could be related to a decrease in the immune system's ability to fight off infection.

Koplan and Thompson said nothing is being ruled in or out of the investigation, including the possibilities that the U.S. postal system is more broadly contaminated than first believed or that this is just the beginning of an anthrax scare that will develop over time.

"We don't rule out any of the options ... " Koplan said. "It's not an outbreak, it's a purposeful attack."

He repeated his belief that while the risk to the public of cross contamination of the mail was "not zero" it was "very low."

There are 16 confirmed cases of anthrax infection, including six cutaneous and 10 inhalation. Three cutaneous were in New York and three were in New Jersey. Inhalation infections included two in Florida, one in New York, two in New Jersey and five in Washington. There also are five suspected cases of cutaneous infection, three in New York and two in New Jersey.

Satcher said the medical community now knows a lot about anthrax, the disease, but are perplexed about how it has been spreading.

And the public, too, is perplexed and has been frustrated at the flow of what at times has been contradictory information.

"I imagine if this were a major snowstorm we would probably know more information to share than we know now," Satcher said. "I think we have tried to be very forthcoming with information. CDC is reporting as rapidly as it can, as we get new information, but we're very careful not to give information that would be misleading, that's inaccurate.

"So I know that people would like to know more sooner, but I think people want accurate information. And people must understand that we're learning together," Satcher said. "This is new. We have not faced a bioterrorist attack before with anthrax or bioterrorist attack at all, so we are learning together."