The Anthrax Fumble
Did the FBI's customary secrecy and turf-consciousness cause innocent people to die of bioterror? In October, when the first anthrax-laden envelopes were received, the FBI froze the Centers for Disease Control and Prevention out of the high-profile investigation, according to CDC officials. That meant half the country's experts on bio-attacks and the only scientists with a special interest in public health were kept out of the loop. Then, to make matters worse, the CDC spread faulty information it had received secondhand. This all resulted in a fumbled response that put postal and media workers at serious risk. Consider: The US safety net against bioterror was porous because of a turf battle initiated by FBI autocrats--and five people died.
The main problem was that the CDC, the government agency charged with protecting the public from disease, was never permitted to see or examine the anthrax letters mailed to NBC News anchor Tom Brokaw, the New York Post and Senator Tom Daschle. Without direct access to these deadly envelopes, the CDC experts could not accurately assess a vitally important matter--the danger the letters posed to those beyond the people who opened the mail.
On October 12 Brokaw turned over an anthrax letter, postmarked in Trenton, New Jersey, to the FBI. The CDC never examined it. Dr. Mitchell Cohen, the CDC's director of bacterial diseases and liaison to the FBI for anthrax issues, says he saw only photographs of it. On the basis of media accounts and conference calls with the FBI--not direct examination of the evidence--the CDC determined that the Brokaw letter was "only risky to those who opened it." By October 18, though, several New Jersey postal workers had suspicious skin sores, and Teresa Heller, a West Trenton letter carrier, and Richard Morgano, a Hamilton postal worker, had confirmed cases of skin anthrax. New Jersey's Hamilton postal distribution center--which had processed the Brokaw letter--was closed as a result of these cases, and hundreds of workers there were given precautionary antibiotics. Had the FBI allowed the CDC to examine the Brokaw letter on October 12, the CDC would have been in a better position to make judgments and predictions that could have led to an earlier closing of the Hamilton facility. The CDC might well have learned that this anthrax could spread beyond its envelope. Unfortunately, the FBI did not perform tests for leakage on the Brokaw letter.
A comparable series of events occurred after Senator Daschle's office received an anthrax letter on October 15; it had been handled by the Brentwood postal facility in Washington. Again, the CDC was not invited to examine the letter, and its doctors were unable to observe just how easily the anthrax it contained could become airborne and spread. Nor could they run a test checking for cross-contamination by putting this envelope with other uncontaminated envelopes in a mail sorter.
The FBI did have the anthrax letters tested at the laboratory of the US Army Medical Research Institute of Infectious Diseases in Fort Detrick, Maryland. But according to a letter sent by CDC director Dr. Jeffrey Koplan to Senator Chuck Grassley, who is investigating the bioterror crisis, "no CDC staff went to the Army labs to observe the tests." The FBI informed the CDC of its test results regarding the Daschle letter, telling the CDC via conference calls, for instance, that the letter was "well sealed," Koplan says. But for a scientist, being told of a result is not the same thing as being there. How was the CDC supposed to issue accurate directives if its doctors and lab specialists were kept away from criminal evidence loaded with contagion?
On October 16, microbiologists at the Army lab counted more than a billion spores in the Daschle envelope and discovered the fine military grade of the powder, which should have alerted them right away to its potency. In a conference call that day with the FBI and the CDC, the Army scientists described the powder as "going poof," an indication that it could become airborne. Yet, according to the CDC's Cohen, the Army and FBI officials didn't express concern that this could lead to the spread of the more deadly inhaled form of anthrax. In fact, Cohen said that the Army scientists, having heard from FBI officials that the Daschle letter was supposedly well sealed, predicted limited spread--as they had with the Brokaw letter. Army scientists, who are not accustomed to making public health proclamations, wrongly reassured the CDC without sufficiently testing the spread potential of this dangerous anthrax. The CDC, in turn, blindly passed the information to the post office, noting that there was no risk to postal employees and that mail sorting equipment could be presumed safe.
The dangerous powder in the Daschle letter was already working its way through the Brentwood postal facility by the time the letter hit Daschle's office. If the CDC had been given the opportunity to see the powder firsthand, it could have anticipated the illnesses and deaths then under way at Brentwood, and, consequently, it could have acted more quickly in examining postal workers and providing antibiotics there. It might even have closed Brentwood days earlier. But Brentwood continued to operate until October 21, and two US Postal Service workers there--Thomas Morris Jr. and Joseph Curseen Jr.--died from inhaled exposure due to contaminated equipment. According to Cohen, the CDC "based our assumptions [concerning the Daschle letter] on limited epidemiological information from the letter to Tom Brokaw that the greatest risk was to those who opened the letters." Tragically, this misinformation wasn't corrected in time.
The FBI also kept another piece of crucial evidence from the CDC. On October 19 the New York Post turned over to the bureau an anthrax letter it had received. The letter had been stored unopened by a mailroom worker. Though this envelope was never unsealed, three Post employees acquired skin anthrax from handling the letter, which seemed to spread skin anthrax to anyone who touched it. Had the letter been shared with the CDC, its scientists could have tested seepage from the envelope and made predictions.
It wasn't until the last week in October that the FBI thought to test the seepage potential by using DNA tracers, which tag the anthrax molecules and track where they go when the envelope is moved. The FBI discovered with an electron microscope that the anthrax could escape through tiny, 50-micron-wide holes in the envelope, and that it became airborne if the envelope was compressed, shaken or passed through a sorter.
In mid-November an envelope addressed to Senator Patrick Leahy and containing anthrax was discovered. It had been postmarked the same day as the Daschle letter but had apparently been sent to the wrong ZIP code. Again the CDC wasn't included in the FBI/Army examination, which once more discovered a super-aggressive bacteria. But this time the danger was obvious even to a nonscientist. The FBI's fancy molecular tests had already discovered the potential for leakage, but the Leahy letter demonstrated leakage without a single lab test. As the letter was carried from the FBI to the Army lab, some powder leaked from a hole in the envelope into the plastic bag containing it. Unfortunately, the results of this unintentional field test came too late.
Four possibly preventable anthrax deaths--including Kathy Nguyen's on October 31 and Ottilie Lundgren's on November 21--had already occurred as a result of the mailings. Earlier precautions at the post office could have kept the deadly cross-contaminated mailings from ever reaching the last two women who died.
The Army and the CDC have the only two top response (Level D) microbiology laboratories in the country. When a federal crime involving contagion occurs, as with the anthrax mailings, the FBI automatically alerts the Army lab. But the FBI has the power to expand the scope of the inquiry to include CDC experts. Last fall, the FBI erred by excluding the CDC specialists. What is missed by one scientist might be discovered by another. And while the Army's primary interest is biowarfare, the CDC is concerned with public health issues. In fact, Dr. Julie Gerberding, the CDC's acting deputy director for infectious diseases, told Senator Grassley's staff that the anthrax should have been seen before the CDC rendered public health predictions. The CDC's specialists, she said, would have tried to determine "the concentration of the bacteria, and the chemicals that have been added to the powder to aerosolize it." These factors, she explained, "affect the impact of the anthrax on humans."
If the CDC was left out, the Postal Service was ignored, not informed and woefully underprotected throughout the anthrax scare. According to Deborah Wilhite, senior vice president for government relations at the Postal Service, the post office learned from the media--not the FBI or the CDC--on October 12 and 15 that anthrax was arriving by mail in New York and Washington. After October 15, when a Mail Security Task Force was created, the CDC sometimes provided "guest experts" at meetings, but there continued to be no formal connection between the CDC and the post office. And the FBI/Army test results were not provided directly to the office. Wilhite wrote that "the different focuses of...law enforcement and health organizations...resulted in parties speaking different 'languages.'"
The FBI was in charge of the investigation, and the Army did the testing. The CDC was responsible for informing local health departments, working to decontaminate federal and media buildings, and preparing for the possibility of a larger attack. These were significant responsibilities for a group of scientists known around Capitol Hill as working for the "Rodney Dangerfield" of federal agencies. In fact, the CDC was not aware that the Army had been making its own anthrax, even after it was found that the anthrax in the mailings was probably domestic. The CDC learned this from media reports. If it had been informed about the powerful potential of this Army-made anthrax, CDC public health experts would have been better prepared to assess risk. The CDC also wasn't told by the Army lab testing the mailed anthrax that it was sensitive to multiple antibiotics. If the CDC had known this, it could have recommended the use of less expensive antibiotics with fewer side effects than Cipro, a move that would have saved millions of dollars in health costs.
In contrast to the real Rodney Dangerfield, the CDC did not complain. Overshadowed by the more powerful FBI, the CDC kept quiet out of respect for scientists they knew at the Army lab who were working closely with FBI agents. It is a convention among doctors not to bad-mouth other members of the club publicly. And the CDC fosters a culture of nonconfrontation. It clearly didn't want to ruffle FBI feathers while relying on it for information. But the CDC's Cohen admitted that "measured tests and longer experiments were necessary to make accurate predictions," and that underestimating the risk while the tests were being done by the Army was a mistake. All three agencies were guilty, he observed.
To this day, the CDC has never seen any of the anthrax letters. And the FBI didn't respond to inquiries as to why it largely ignored the agency tasked to protect the public from disease. CDC director Koplan has now announced his resignation in the wake of the anthrax fumble. But if he is to resign, why not the director of the Army lab or the FBI?
Cohen says that communication and cooperation between the FBI and the CDC are improving. "We never really worked together before this," he notes. With billions of dollars about to be spent on the new bioterror safety net, we can only hope that he's right. In the future, teamwork will be crucial in handling a bioterrorism public health crisis--particularly if it involves a contagious bug that spreads rapidly, like smallpox. "We will be there at [FBI] headquarters," he says. "Two different cultures, public health and law enforcement, forming a partnership. Scientists use data to form hypotheses, then test them. Law enforcement agents explore a crime scene for details, looking for patterns to develop leads. What one discovers could help the other to succeed."
Anthrax cost five lives (including tabloid photo editor Robert Stevens of Boca Raton), with eighteen others sick and recovering. In the world of bioterrorism, the lives of innocent people depend on cooperation. FBI secrecy and domination is far too costly.