9/11, Anthrax, and Life in Public Health: Part 1

By Scott J. Becker, MS, Executive Director, APHL

Part 1 of a three part series.

Everyone has a story of when their life changed forever.  It could be before kids or after kids – or a traumatic life event like the death of a spouse, or a happy event like graduating from university.  For an entire generation it was 9/11 and the anthrax events that soon consumed those of us in public health.

Like many of you, I remember exactly where I was when the towers fell.  I was on my way to deliver a keynote address to the Mississippi Public Health Association and the topic was Branding Public Health.  Upon landing in Atlanta, I called my hosts to let them know when I was due to land in Jackson, and heard that there was some “trouble” but that we should be in touch when I landed.  I then started to pick up snippets of conversation around me, words that sent a chill down my spine.  “Bombing… New York… Washington…” were just a few.  I jumped back on the phone to call my wife to ask her to please go pick up our 5 month old daughter, Sophie, at daycare.  You see, that very day was Sophie’s first full day in daycare, and the daycare center was a few blocks from the White House.  I caught my wife back at home in Bethesda, who immediately turned on the TV, and then headed back downtown.  I wandered the terminal for a minute or two, trying to wrap my head around what I was hearing and then called a colleague at CDC, realizing that I would be stuck in Atlanta.  He offered me his office and I headed up after encountering the longest taxi line I’ve ever seen (I was quick; I got out in 20 minutes.  Folks that waited longer were there most of the day).

Once I got to CDC it was apparent what had transpired.  And then CDC was evacuated, as it was deemed a possible target by the unknown enemies.  We had now moved into our new life, but were too numb to understand it.  Soon thereafter I checked into a hotel, and joined many others glued to a TV.  We were a new “family” of sorts, all of us stuck together in this unfolding national tragedy.  I was finally able to get a call back to my wife and was relieved to learn that she had gotten Sophie out of DC, even before the Pentagon was attacked.  Sitting there, I learned that my flight that morning left Dulles the same time as the one used by the terrorists that flew into the Pentagon.

Hearing that sent me into action; I needed to get home.  Through divine intervention and many phone calls, I secured a one-way car rental the next day.  Virginia’s lab director Jim Pearson, APHL staff Jeff Jacobs (now with ASCP) and I drove straight home.  No planes in the sky; no cars on the road; patriotic signs on many overpasses from Georgia to Maryland.  After 12 hours of travel we came over a small hill on 395 in Arlington and looked down on the smoldering black hole in the Pentagon complete with the American flag… and the quiet almost desolate city of Washington just beyond.

What I couldn’t quite grasp was exactly how our world was now completely different.  There were Humvees on every corner, security officers with guns and policemen… just about everywhere.  Our city, like New York, was transformed overnight.   So were our professional lives, particularly for those of us working in public health.

At APHL, we’d been focused on lab preparedness for terrorism since 1999, when we constructed the Laboratory Response Network (LRN) with CDC and the FBI. But on this day, September 12, 2001, the once obscure threat was palpable; it was real.  We worked with CDC to ensure that all the state labs had the tests, materials and equipment they needed in case a threat was made to human health in some sort of attack.  We made sure that all of the contact lists were accurate and that we knew with whom to consult if needed.   The LRN went onto a high state of alert – we were on the lookout for any suspicious samples or specimens.  Our members were told to report anything out of the ordinary, no matter how small it seemed.  Everyone was on edge, and for good reason.  News reports were issued daily (for weeks) and used terms like “biological or chemical warfare,” “possible use of bioweapons,” “biowarfare,” or “smallpox.” And then the question was being asked first privately and then publicly:  “Are we prepared?”  That question is still with us and always will be – the real question is for what and for how long?

Vice President Cheney was particularly concerned as President Bush had asked him upon his inauguration to take charge of overseeing intelligence matters and to conduct a study of the nation’s vulnerability to biological weapons and terrorism in general.  One vulnerability identified was access to dangerous pathogens such as anthrax, plague and pandemic strains of influenza viruses.  And public health labs had access.

On October 2nd, all the possibilities of bioterrorism became a reality.  It was on that day that an infectious disease physician recognized a possible case of inhalational anthrax in a man who was hospitalized in Palm Beach, FL.  The local health official immediately began an investigation which included having the patient’s clinical specimen sent to a lab for diagnosis.  The clinical lab couldn’t rule out anthrax, so according to protocol, they contacted Dr. Phil Lee, the Biological Defense Coordinator for the Bureau of Laboratories at the Florida Department of Health Lab in Jacksonville.  Once he received the specimen (On Wednesday October 3rd at noon) he began the analysis immediately.  The series of tests took less than 24 hours, and early on Thursday October 4th he confirmed what is now known as the index case of anthrax.  All eyes were on Florida as the index case worked and lived there, and CDC was sending investigators to his work place, AMI Media, to figure out how this could have happened.

Since the Florida anthrax case followed the 9/11 attacks so closely, it was unclear what we were dealing with, but we were at the ready.

To be continued… (Part 2 and Part 3)

There are 12 comments for this article
  1. Jody Lanard M.D. at 8:44 pm

    Hi Scott. I can’t wait to read parts 2 and 3. My professional life started to change because of 9/11 and anthrax, and then completely changed on March 12 2003 when news about the-outbreak-that-would-soon-be-named-SARS broke.

    APHL is a character in a True Life “are we prepared?” story I helped document. In June 2005, Peter Sandman and I were writing about a public health phenomenon we call “A Blind Spot for Bad Guys.”

    The example that stunned us was the APHL, CDC, and WHO response to a cascade of lab errors that had resulted in live H2N2 flu virus (the subtype that caused the 1957 pandemic) being sent to thousands of hospital and other labs worldwide. The unlabeled H2N2 virus was contained in influenza proficiency test kits used to make sure lab techs could identify influenza A in standardized samples.

    When the error was discovered, a senior APHL official notified all Public Health Lab directors, and some of them posted the notice on their Health Alert Networks’ scrolling marquees on computers intended to be visible 24/7. This happened late on a Friday afternoon, with the notice — marked URGENT — sitting around all weekend in many places. At that point, H2N2-contaminated test kits morphed from being a source of a potential lab accident to a potential bioterrorism WMD.

    Investigating this from a communications viewpoint, we couldn’t find any public health officials who had even considered that angle. If you have “A Blind Spot for Bad Guys,” (see: http://www.psandman.com/col/H2N2.htm ), you are far from prepared!

    Warm regards,

    Jody

    • APHL Author at 8:51 am

      Thanks for your comment, Jody. APHL works closely with the public health labs to make sure that the necessary systems are in place so that we are prepared when the next crisis strikes. I am extremely proud of their work and I do feel that they are prepared. Unfortunately deep budget cuts at the state and federal levels mean that many of the resources and staff that were present ten years are no longer there. Despite this fact, the public health labs continue to work to protect the health of all Americans.

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