New York Times
Just when it looked as if the nation's public health system was gaining control of the evolving anthrax crisis, incidents at two postal facilities have revealed gaps that need fixing. Alarmingly, a hospital in Maryland failed to correctly diagnose inhalational anthrax in a postal worker who returned a day later and died within hours. The man had worked at a big mail processing center in Washington, that handled the anthrax-contaminated letter sent to Sen. Tom Daschle.
Equally disturbing, public health authorities and postal officials were slow to recognize the dangers faced by many postal workers at facilities in Washington and New Jersey that had handled anthrax-contaminated letters. That some of the nation's top health experts and a local hospital could miscalculate so badly is less a cause for finger-pointing than it is a measure of the newness of this bioterrorism threat and the lack of certainty over how to deal with it.
The failure of the suburban Maryland hospital to initially recognize a case of inhalational anthrax, in a patient who had been stoically living with his symptoms for several days, is particularly alarming since the country has been convulsed by anthrax scares -- and supposedly on high alert for further cases -- since the first anthrax diagnosis in Florida in early October. The diagnoses are admittedly difficult. The initial symptoms of inhalational anthrax are much like those of the flu. But the presence of anthrax can be determined by laboratory tests of the blood, skin and respiratory secretions. There is obviously a lot more to do to educate front-line physicians in what signs to look for and what tests to administer. A prompt response can save some patients from death and point health authorities toward others who may have been contaminated.
The slow response of public health authorities to the menace at postal facilities is understandable. They believed, wrongly as it turned out, that there was little chance of anthrax escaping from a sealed letter since all previous cases of inhalational anthrax seem to have involved letters that were opened. They also reasoned that since initial environmental samples from a mail facility that handled the Daschle letter after it left the big processing center had tested negative, there was no reason to suspect that the main center had been contaminated. With the benefit of hindsight, the experts clearly guessed wrong, although it remains a mystery just how several postal workers got infected.
The one clear message from these postal incidents is that the Bush administration's plans to beef up the public health system to cope with bioterrorism are almost certainly inadequate. Tommy Thompson, the secretary of health and human services, announced last week that $1.5 billion had been requested in emergency relief funds to strengthen the nation's ability to respond to bioterrorism attacks. Most of that money, however, will go to buy antibiotics, vaccines and other medical supplies for the nation's emergency stockpile. Only $175 million of the emergency money would be allocated to state and local efforts to prepare for bioterrorism, and a further $88 million would expand the federal government's ability to respond to attacks.
It is difficult to determine how much preparation for bioterrorism is enough, and in a crisis atmosphere such as prevails today there is always a risk of throwing more money at a problem that can be usefully spent, inviting waste and even fraud. Sen. Edward Kennedy, a Democrat, has proposed $10 billion for the effort, including a whopping $5 billion in block grants to states and in money to upgrade laboratories -- already strained to capacity -- and hospitals. Sen. Bill Frist, a Republican, is said to favor an intermediate number. Supporters of the Kennedy plan need to come up with some solid justifications for their numbers. But whatever the ultimate price tag, one lesson of the recent postal incidents is that state and local authorities and the hospitals that interact with them are the front lines in the fight against bioterrorism. Assistance to them is now critical.
Atlanta Journal Constitution
Firefighters of New York, meet the mail carriers and sorters of the U.S. Postal Service -- yet more regular Janes and Joes performing acts of heroism merely by going to work.
With two dead from inhaled anthrax, two others hospitalized and several more battling the skin form of the disease, postal workers have borne the brunt of terrorism-by-mail. While members of Congress Tuesday publicly congratulated themselves for continuing to operate despite the anthrax scare, 10,000 edgy postal workers quietly went about their business.
But if their government doesn't begin to serve them better, and fast, one has to wonder how long they can keep it up.
After the discovery of an anthrax-tainted letter in Sen. Tom Daschle's office Oct. 15, investigators traced its route and discovered spores in the Senate mail room. They then checked the Postal Service distribution center for congressional mail and, at first, found no evidence of the bacteria. That seemed to indicate it was unnecessary to move another step back, to the Brentwood Road facility.
Postmaster General John Potter then held a news conference last Thursday at the Brentwood office, pronouncing its workers safe because the Daschle letter "was extremely well-sealed." It would be virtually impossible to contract the inhaled, lethal form of the disease through an envelope --- if that were the only possible source.
But there was no reason to think, then or now, that only one tainted letter had passed through that facility. The FBI knows that other letters are likely, and has warned as much. Do these people talk to each other before they make these precipitous decisions?
Health officials are rightly cautious about prescribing antibiotics without evidence of an exposure risk. Unnecessary use of those drugs depletes supplies for the truly sick and can contribute to creating antibiotic-resistant germs. But testing for the presence of anthrax spores creates no such risks. There was no reason to fail to test workers and worksites at every point along the tainted letters' likely route.
More failures of this sort could so undermine trust in the government's ability to manage this crisis as to create genuine panic. It is absolutely critical that this not happen.
No government official can foresee every twist in the convoluted plot lines of the terrorism tale. But the involved agencies must react more quickly and comprehensively to emerging crises. The first step is to provide clear, consistent and regular information.
Some doctors complain they are unable to get up-to-date information from the Centers for Disease Control and Prevention here in Atlanta. The CDC's public comments are frequently all but inscrutable.
Even the basic facts on the lethality of anthrax have appeared to change. Because cases of inhaled anthrax had been so rare -- the last American death before this year was in 1976 -- disease experts weren't sure how effective today's antibiotics might be. Based on recent experience, some experts now believe that pulmonary anthrax is survivable if cases are diagnosed quickly and treated aggressively with antibiotics.
That's great news, and helps to take the edge off the frightfulness -- if people are made to know it. On that front and every other in this terror war, the government must be seen to be acting aggressively to protect its citizens. It's the best inoculation against a pandemic of fear.
The reach of the anthrax attacks widened yesterday, as officials reported a presumed new case of inhalation anthrax in New Jersey and revealed that evidence of anthrax contamination has turned up in a military facility that handles mail for the White House. The deaths of two workers from the District's Brentwood facility, already suspected to have resulted from the disease, were confirmed as anthrax cases. Health officials were adjusting their responses, broadening the reach of treatment in Washington and promising to react aggressively to any new sign of anthrax spores in the mail. "We are going to err on the side of caution in making sure people are protected," Health and Human Services Secretary Tommy Thompson told a House subcommittee hearing. "When a case of anthrax does emerge we will immediately move in at any and all postal facilities that might have handled that piece of mail." The Post Office is changing its procedure for cleaning mail-handling machines and is investigating technology to sanitize mail before it goes through postal facilities. These are the right kinds of reactions to a threat to postal workers that has emerged as more serious than officials initially anticipated.
Meanwhile, hoping to generate new leads as well as help warn people what to look out for, the Justice Department released copies of the anthrax bacteria-laden letters mailed to NBC anchor Tom Brokaw, Senate Majority Leader Tom Daschle and the New York Post. FBI officials said they will be running their investigation through the agency's headquarters here, instead of as separate probes in four different cities. The move is aimed at improving coordination not only within the anthrax investigation but between that inquiry and the pursuit of the terrorists involved in the Sept. 11 attacks. White House and congressional officials continue to say they suspect a link between the two, but Attorney General John Ashcroft said yesterday that investigators still don't have enough information to either establish that connection or rule it out. Though they say they gain information with each day, investigators still seem distressingly far from conclusions as to who is responsible. As the toll of the attack spreads, the urgency of tracking down the culprits only grows.
Anthrax and the threat of anthrax have had a profound effect on the nation's capital, even beyond the deaths and illnesses. The bioterrorism shut down Congress and has knocked the mail system for a loop, at least in this area. Businesses and government offices are having to adjust, and the economic toll of adjustment will be large. The next biological or chemical attack could claim many more lives. But this one, no matter who is ultimately proved responsible, has been enough to remind us of the folly of allowing such weapons to fall into the hands of malevolent despots abroad and of the need for more vigilance at home.
Yesterday, D.C. Mayor Anthony Williams confirmed that the two postal workers at the Brentwood facility who recently died under suspicious circumstances were victims of an anthrax attack.
This did not come as a surprise, considering that two other workers at Brentwood had been previously diagnosed with pulmonary, or inhalation, anthrax. In fact, it appears that the entire building, the District's central postal processing facility, has been contaminated with the anthrax-causing bacteria. As a result, the Brentwood building has been declared a crime scene and closed for decontamination. All District postal workers have been provided with antibiotics, and other precautions are being taken to protect them. Tragically, many of those workers may have been unnecessarily exposed to the anthrax.
The day after it became apparent that a letter to Senate Majority Leader Tom Daschle was laced with anthrax, Brentwood employees were told that anthrax testing was unnecessary. By contrast, Senate staffers were immediately tested and offered treatment for anthrax exposure, a course of action that may well have saved lives. The same pattern was repeated at the central post office processing center in Hamilton, N.J., where 900 postal employees are stationed. The postal center stayed open even after it was determined that the anthrax-laden envelopes that were sent to Tom Brokaw had been processed there, and even after it became clear that the anthrax-containing letter received by Mr. Daschle had been processed there.
A central problem appears to be that advisers from the Centers for Disease Control and Prevention simply assumed that the anthrax had not spread because the threatening letters had remained tightly sealed. Apparently, no one considered that other methods of attack would be employed, such as using non-threatening letters or lacing the envelopes themselves with anthrax. Nor does it appear that anyone considered that the air blowers routinely used to clean mail-sorting machinery of debris could areosolize anthrax spores, leading to the cases of pulmonary anthrax.
Such mistaken presumptions and assumptions were easy to make, since America is in the throes of the first large-scale attack by biological weapons. Added to that is the simple fact that epidemiology is often an inexact science, depending on exposures and index cases before proper preventative precautions can be taken.
However, now that there is a war on, there is no excuse for routine precautions not to be taken. When testifying before a House subcommittee yesterday, Health and Human Services Secretary Tommy Thompson pledged, "We're going to err on the side of caution in making sure people are protected." We should. Because of these biological attacks, an ounce of prevention may well be worth a pound of cure -- and the life of a postal worker. Indeed, the CDC must conduct its business as though the prevention part of its name is as important as the control aspect.
With anthrax confirmed as the killer of two postal workers in Washington, Americans and their government can no longer think of bioterrorism as an abstraction.
Anthrax spores were directed initially at print and electronic media outlets. But anyone who gets mail, not to speak of those who deliver it, falls within the sights of indiscriminate evildoers.
We are reluctant to think of ourselves as such, but we are all combatants and potential targets.
We are hurtling along the path of a new consciousness. We see the enemy operating far beyond the World Trade Center. What public official will now say something can't happen -- or is unlikely to happen, as officials did in the wake of anthrax-laced mail in Capitol Hill offices? We're way past mere vulnerability.
And yet leaders still must find a balance between information and action and the potential for panic. No one should question the gravity of that task.
We assume every effort is being made to learn who is responsible. That task may be as difficult as smoking Osama bin Laden from his lair. Yet it must be done as quickly as possible, or the government will lose credibility. Getting people to desist in stockpiling antibiotics, for example, would be more difficult. The specter of a nation under siege will grow.
This is among the objectives of the perpetrators. They want to kill and by so doing show how the carnage of Sept. 11 can engulf us all.
Homeland Security Director Tom Ridge points out that we are at war on two fronts: in Afghanistan against the Taliban, and at home against persons unknown. We knew this, of course, but if we had been more solidly situated along the domestic front, we might have closed the sorting station in Washington immediately and put more people on protective therapy.
And we cannot imagine that anthrax will be the last thrust of the terrorists. Yes, we are finding our way through shadowy and threatening terrain. The hard and unavoidable truth is we need both speed and sound judgment. We won't always get that in war, so the public must respond with understanding, trust and resolve. Those traits are foundation stones of our people and, as such, key targets for the terrorists.
We can be buoyed by the determination of postal workers to carry on with their vital work. We are all asked to live our lives with an active sense of our status as soldiers on the second front.
For most Americans, this country's conduct of warfare in Afghanistan inspires confidence. There's a sense Washington has a grip on the task at hand and is pursuing a logical strategy: to discourage global terrorism by taking out not only the provocateurs, but also those who finance or support them.
At home, though, the effort to get a grip on the spread of anthrax spores hasn't inspired the same confidence. Fright is driving many people to ask a thousand questions that all boil down to one: Why hasn't somebody solved this yet?
To many Americans, Washington seems disorganized, flustered. The temptation is to grade the Bush administration the way teachers grade underachieving students: Could do better.
Yes, there is one way the federal government could better ratchet down our discomfort.
But there also is a way for us to do the same. We need to accept some uncomfortable facts.
Transmitting anthrax by mail is either an act of war or of domestic terrorism. Given the suddenness of the assault and the senselessness of the evil, many of us are asking for more soothing assurances than we're entitled to. We are an impatient people. We want to deny the complexities here and have someone tell us we are safe.
This month's instances of inhalational anthrax are the first in this country in 23 years. And yet many of us unrealistically expect the case to be solved even as it's still unfolding. Remember, anyone smart enough to obtain anthrax spores is smart enough to develop a protocol for mailing them without being easily detected. Does anyone seriously think one or more perpetrators are hanging around a mailbox in New Jersey, waiting for the FBI to show up?
It's fine that Americans are asking whether the most dangerous anthrax has been mailed by a disciple of Osama bin Laden or by homegrown criminals. But what's more crucial to stopping the onslaught -- as opposed to explaining it -- is the chance that only one person is responsible.
Loners, or members of small but dedicated cells, are difficult to capture. Consider: After the first explosion of a device mailed by the Unabomber (May 1978 in Evanston), it took the feds 18 years to capture hermit Ted Kaczynski -- and then only with the help of a tip from his family.
The fact is, we are not safe -- and may not be soon. But then, neither are the young people we have asked to risk their lives on the barren soil of Central Asia. As it stands, their mission of toppling terrorists is far more dangerous statistically than is our mission of avoiding anthrax.
Here are the assurances we are entitled to: that the feds are doing everything they can, in an organized way, to solve a terrible crime. And that public health officials are coming up to speed as rapidly as they can to fight a new kind of menace.
There is much work to do on both fronts. What would help, though, is a more coordinated release of information. Too many officials are holding too many press conferences--and inviting too much suspicion that nobody is in charge.
Former Pennsylvania Gov. Tom Ridge, who now oversees homeland security, is a logical point person. He should be projecting the sense of order that Mayor Rudy Giuliani projected after Sept. 11 in press conferences where he was flanked by other officials who could resolve questions or inconsistencies in their messages.
One final assurance: Scary as it is, the anthrax case will, in all likelihood, be solved. But not because we focused more on our fright than on the sensible precautions that will limit its impact.
New Orleans Times-Picayune
It seems incredible now that federal health officials weren't more concerned about anthrax exposure at the sorting center that processes all Washington mail.
A letter addressed to Senate Majority Leader Tom Daschle that contained anthrax spores prompted a five-day shutdown of the U.S. Capitol; Senate and House office buildings remain closed for further testing. Congressional staffers and Capitol Police -- about 5,000 people -- were tested for anthrax exposure.
By contrast, the mail facility on Brentwood Road wasn't closed and the 2,000 workers weren't ordered to report for tests until Sunday, when a postal worker fell ill with pulmonary anthrax. On Monday, two more workers died from the same form of anthrax.
Postal employees are understandably upset that their risk was recognized so late, but that doesn't necessarily signal a lack of concern. What it does reveal is a dangerous limit to our understanding of this disease.
The U.S. Postal Service was following the advice of the Centers for Disease Control and Prevention, which said that it wasn't necessary to test Brentwood employees until evidence showed that anthrax was present there.
The CDC was operating on the assumption that anthrax spores could not escape from a sealed envelope in sufficient numbers to cause inhalation anthrax. That was wrong, and it cost lives.
While no one is sure exactly how spores escaped from the Daschle letter, or whether that letter was the only source of anthrax, possibilities are emerging. Mail at sorting centers gets shaken and jostled by hand and by machinery. Finely milled anthrax spores, which spread like a gas, could have been released through a small opening or imperfect seal.
What we do know for sure is that sealed envelopes are no protection against these deadly microbes. The U.S. Postal Service is looking for better measures, including technology to irradiate mail as it moves through the system, and that needs to be an urgent priority.
These incidents have yet to be linked to the events of Sept. 11, but the intentional release of anthrax is clearly a terrorist act, and the public, postal workers and the mail delivery system itself must be safeguarded from this threat.
Bioterrorism is new turf for everyone, including the CDC. But we don't have the luxury of learning slowly. This is a crash course.
Milwaukee Journal Sentinel
Hijacked airplanes and anthrax have put the United States on frighteningly unfamiliar terrain. It's no surprise that officials entrusted with national security, public transportation, the postal system and public health are scrambling to play catch-up with the terrorists responsible.
The proximate case in point is the spate of anthrax incidents in Washington. Last week, the focus was on Capitol Hill, where anthrax contamination via the mail resulted in thousands of people being tested and, in some cases, treated with antibiotics; meantime, the people who processed and delivered that mail were being largely overlooked - with dire consequences. Two employees of the Brentwood mail sorting facility are now dead, and two others affiliated with the station are being treated for inhalation anthrax, an especially dangerous form of the disease in which the spores lodge in the lungs.
On Tuesday, even more grim news: Tests confirmed the presence of anthrax at an off-site mail facility for the White House.
Is there a double standard, with people on Capitol Hill getting preferential treatment, compared with those at the Brentwood facility, where employees were not tested initially? It's a valid question. Equally disturbing, Brentwood remained open while the House was shut down and Senate offices were closed. Postal officials say they had been told by the Centers for Disease Control and Prevention that because the contaminated letter to Sen. Tom Daschle was well-sealed, postal workers were not susceptible to inhalation anthrax.
CDC is arguably the foremost public health agency in the world. The people who work there are extremely bright and dedicated and routinely risk their own health investigating and tracking down diseases, many of which are dangerous and, unlike anthrax, contagious.
Officials at CDC say they made the best decisions they could with the limited information they had about an extremely rare disease. These are extraordinary times, and the learning curve is steep and unforgiving, even for seasoned pros. Still, a thorough review is in order, not to cast stones but to prevent a big stumble - if, or more likely when, other bioterror episodes occur. Health and Human Services Secretary Tommy Thompson says his department, which oversees CDC, will handle things differently in the future.
The federal government must do everything possible to protect other postal workers and the postal system, which remains critical even in an era of e-mail and private delivery. Fortunately, officials are testing other postal workers, giving them antibiotics and checking to see if anthrax has spread to other post offices in the area.
But post offices around the country also should be randomly checked and, if anthrax is found, closed and decontaminated. Postal officials must take their cue from commercial aviation and dramatically step up security. If that means developing and installing new high-tech devices to decontaminate post offices and the mail itself, paid for with a nominal increase in postage, most Americans will gladly say yes.
People will put up with their mail being late - as long as it doesn't hurt them when it finally arrives.
(Compiled by United Press International.)