Amerithrax (32 page)

1. On November 5, Attorney General John Ashcroft warned
   

   that America could come under attack at any time—but he did not know when or where or how exactly. He did not know what anyone could do about it. At the week’s end, the alert was extended indefinitely. One month after the death of Robert Stevens, the nation’s first victim of inten- tional murder by anthrax, new tests at the quarantined AMI building revealed a pattern of pervasive contamination that mystified investigators. Such findings pointed to an ex- tremely dangerous kind of anthrax preparation, with small particles that could easily float in the air. The CDC rec- ommended heightened surveillance for any unusual disease occurrence or increased numbers of illnesses that might be associated with terrorist attacks.
   

   Postal officials denied to the
   New York Times
   that the letter described by Thomas Morris Jr., the Brentwood mail- worker who had died on October 21, was responsible for infecting him, saying it had been turned over to the FBI after discovery and had tested negative for the deadly mi- crobe. When Morris’s 911 tape was released to CNN on that day, the Postal Service made the statement that it “grieves the loss of Mr. Morris.” The Postal Service defended its handling of the anthrax outbreak, shifting blame to the fed- eral Centers for Disease Control and Prevention, which had told the Postal Service its workers were safe. “From the day the [Daschle] letter was opened until Mr. Morris’s death, public health authorities unanimously assured the Postal Ser- vice that workers in the Brentwood Road facility were not at risk.”
   

   Postal Service senior vice president Deborah Wilhite told the
   Times
   that her agency was familiar with the letter and did not think it was the source of Morris’s anthrax. She said a supervisor gave the letter to a postal inspector who gave it to the FBI to be tested for anthrax contamination. “It tested negative,” Wilhite said. She explained that supervisors at Brentwood told employees about the negative results “in a standup talk.”
   

   Suspicion grew that the letter to Senate Majority Leader Tom Daschle opened in his office had been the source of the infection at the Brentwood facility. It just hadn’t been proven yet. And what of the millions of other letters that
   

   passed through Brentwood—not yet sent for decontamina- tion, not yet examined for anthrax outbreak? Since the first contaminated letter was traced to Florida in September, an estimated fourteen thousand workers had been treated with Cipro or other antibiotics. Thousands of others had been tested and tested negative.
   

   Though ER doctors caught most of the cases early, the anthrax mailings demonstrated how ill-prepared the govern- ment was in the face of a massive bioterror attack. Dark Winter, a CIA computer-generated biological exercise, had been carried out at Andrews Air Force Base the previous June. Former CIA director James Woolsey, advisor David Gergen, and health-policy expert Dr. Margaret A. Hamburg had gathered together with twenty-four other decision mak- ers to test their ability to contain a simulated smallpox at- tack. According to the simulation, patients in Oklahoma, Georgia, and Pennsylvania came to hospitals complaining of aches, fevers, and strange rashes. The organizers realized how little they knew about containing such an attack.
   

   Earlier, in March 2000, Project TOPOFF had conducted a simulated plague outbreak in Denver. Within a week a hypothetical plague had spread to other states and as far away as Britain and Japan, with an estimated two thousand deaths. Both military drills demonstrated a lack of crucial information and sufficient vaccine supplies. During both the Dark Winter and the TOPOFF exercises, health care facili- ties were overrun and in each it was unclear who was in charge.
   

   President Bush, letting Tom Ridge handle the anthrax problem, approved new funds for smallpox vaccines and security at the Postal Service. Bush may have gotten a mil- itary vaccination for anthrax, since he said flatly, “I don’t have anthrax.” The next year he would get a smallpox in- oculation. The President publicly discounted the 9-11 ter- rorists as the originators of the anthrax letters. If a state were behind the mailings, he said, that state was Iraq.
   

   “WE
   feel we need to be accommodated in a more human fashion by the government and the Postal Service,” com-
   

   plained Steve Bahrle, president of Local 308 of the National Postal Mail Handlers Union. The Route 130 post office, closed and scheduled for decontamination in the fall, was not scheduled to reopen until spring 2003. Hamilton had been closed for decontamination since October 21. Parts of both the main Princeton post office, called the Carnegie Center in West Windsor, and a smaller post office on Palmer Square in downtown Princeton were closed briefly for the removal of anthrax found there. “These three centers,” said Dan Quinn, a spokesman for the Postal Service said, “were determined to be a possible route mail from Princeton could have traveled.”
   

   After the Postal Service vacillated for several days on whether to expand its anthrax sampling, it finally tested for the presence of anthrax spores at three postal centers in New Jersey. The postal workers’ union said it was pleased with the decision to conduct wider testing, logical because mail from boxes in Princeton was routed through the three centers before it went to either the Edison or the Eatontown center for further processing. However, the Postal Service’s inde- cision created confusion among postal workers and rekin- dled their anxieties.
   

   Panic buying of Cipro continued. Sixfold runs on the broad-spectrum antibiotic caught wholesalers by surprise. The State Department ordered U.S. embassies to buy and stockpile three-day supplies of ciprofloxacin. A preventive vaccine was available to the military, but not yet approved for the general public. The U.S. Department of Health and Human Services assured the public that “under emergency plans, the government would ship appropriate antibiotics from its stockpile to wherever they are needed.”
   

   Thirty-two thousand Americans were on Cipro; at least, that many prescriptions had been written for the costly an- tibiotic. Black market Cipro must have accounted for many more. People self-prescribed the drug after buying it over the Internet or abroad. Online, an anthrax “prevention pack” sold for nearly three hundred dollars. Bayer AG, the German pharmaceutical leader that holds the patent on Cipro, had been combating possible moves to override the copyright. Bayer announced it would immediately increase production
   

   of its Cipro by 25 percent. Sales rose by 1,000 percent, at a cost of seven hundred dollars for a sixty-day supply. But the huge sales had their downside.
   

   Widespread and indiscriminate overuse and prescribing of such a potent drug could lead to more deaths from antibiotic-resistant infections than from the bacterium itself. Because Cipro was such a young drug, only fourteen years old, it could eliminate bugs that had developed resistance to older medications. Overprescribing any antibiotic breeds pathogens that can resist it and can make people vulnerable to other infections—gonorrhea, typhoid fever, meningitis, septicemia, and hospital-acquired pneumonia. Cephalospo- rins are the only antibiotic class to which anthrax is naturally resistant.
   

   “Here we have a situation where a very important broad- spectrum antibiotic is massively used,” Dr. Chris Willmott reasoned, “and we have the risk that more people can de- velop drug-resistant complications, which could lead to death, than would have actually been killed in the anthrax attacks.” Willmott, a professor at Leicester University in central England, cited Johns Hopkins research scientists who had modeled the impact of five thousand prescriptions of Cipro. The results of their study demonstrated that the drug would have prevented fewer than ten cases of anthrax. “At the same time,” said Willmott, “about two people per hour in American hospitals are dying of complications of drug- resistant bacteria. That equates to about seventeen thousand people a year. The frenzy whipped up regarding Cipro as the only cure for anthrax led to widespread and unnecessary self-prescription of ciprofloxacin. It remains to be seen if there is a significant increase in resistance-associated fatal- ities resulting from this unregulated misuse of a vital anti- bacterial drug.”
   

   The FDA recommended against Cipro as the first drug to treat any suspected case of inhaled anthrax. Most infec- tions, though, could be handled with penicillin or tetracy- cline once anthrax spores were evaluated by the lab. In place of Cipro, the CDC recommended doxycycline, a member of a different class of antibiotics.
   

   “Unless you have handled a package containing a pow- dery substance,” experts warned, “there is no reason to be tested or stockpile Cipro (taking the cure without the dis- ease). Overuse will exhaust its power against a range of bacterial menaces. If you think you’ve been exposed, call a doctor or your local health department. This will give emer- gency response workers a better chance of tracking down the source of exposure. Get the test—labs quickly diagnose anthrax by testing blood or nasal passages. Stay the course if prescribed Cipro, most respond to tetracycline [tetracy- cline and fluoroquinolones in children can have adverse ef- fects and must be weighed against the risk for developing life-threatening disease] and penicillin—sixty days of med- ication or thirty days of meds and a series of three vacci- nations.”
   

   Cipro’s negative side effects include interaction with the- ophylline for asthma, GI distress, and, in patients under eighteen, the drug might disrupt the formation of cartilage. Pregnant women and children were advised to avoid Cipro. After anthrax was found at Dan Rather’s office at CBS- TV, federal investigators began tracking anyone who had gotten a prescription for Cipro. It was difficult to believe that Amerithrax hadn’t taken the drug in advance to guard against accidental infection. As agents began tracing anyone who had sought prescriptions for Cipro in the weeks before
   

   the anthrax mailings, the effort quickly bogged down.
   

   “Do you know how many people take Cipro in this coun- try?” a frustrated official said, explaining that Cipro is used to treat a variety of ailments. Next, the FBI looked to the over one thousand companies that sold equipment that could be used to process the deadly spores. And they examined those that could have profited in some way from attacks— the makers of Cipro tablets or heavy investors in Bayer stocks. Amerithrax might have purchased stock in an effort to profit from the attacks. Fuad el-Hibri, a Lebanese foreign national with ties to Saudi Arabia, was one of Cipro’s major investors. All but four of the 9-11 terrorists had been Saudis. The USPS provided customers with bulletins such as: “What Should I Do if I Receive an Anthrax Threat by
   

   Mail?” They suggested: “Do not handle the mail piece or package suspected of contamination. Make sure that dam- aged or suspicious packages are isolated and the immediate area cordoned off. Ensure that all persons who have touched the mail piece wash their hands with soap and water.”
   

   Some of the top experts, though, said soap and detergent substances could increase the virulence of anthrax spores. They recommended to first wash hands and all unprotected skin with water for at least twenty seconds and avoid the use of soap until the spores were removed. “Notify your local law enforcement authorities,” continued the USPS bul- letin. “List all persons who have touched the letter and/or envelope. Include contact information and have this infor- mation available for the authorities. Place all items worn when in contact with the suspected mail piece in plastic bags and have them available for law enforcement agents. As soon as practical, shower with soap and water. Notify the Center for Disease Control Emergency Response at 770- 488-7100 for answers to any questions. The mail is safe! People shouldn’t stop using the mail because of these iso- lated incidents. The simple act of paying attention to incom- ing mail will go a long way in keeping it safe and viable. Everyone, in the mailing community, as well as the Amer- ican public, should exercise common sense.” They advised all Americans to monitor their mail and be suspicious of any unexpected envelopes with stains or odors. Not since the Unabomber had caused changes in air travel and the way we mailed packages had such an advisory been issued.
   

   In a flyer addressed to “Postal Customer” and illustrated with a thirty-four-cent stamp showing a waving flag and the legend “United We Stand,” the Postmaster General soon ad- vised: “The U.S. Postal Service places the highest priority on the safety of our customers and employees and on the security of the mail.
   

   “Please see the other side of this card for information about safety and mail handling. We want you to know we are doing everything possible to make sure the mail is safe, and we need your help. Your security and peace of mind are paramount to us.”
   

   The other side read, in stark black lettering,
   

   What should make me suspect a piece of mail?
   

   • It’s unexpected or from someone you don’t know.
     

   • It’s addressed to someone no longer at your address.
     

   • It’s handwritten and has no return address or bears one that you can’t confirm is legitimate.
     

   • It’s lopsided or lumpy in appearance.
     

   • It’s sealed with excessive amounts of tape.
     

   • It’s marked with restrictive endorsements such as “Per- sonal” or “Confidential.”
     

   • It has excessive postage.
     

     What should I do with a suspicious piece of mail?
     

   • Don’t handle a letter or package that you suspect is contaminated.
     

   • Don’t shake it, bump it, or sniff it.
     The USPS advisory was simple:
     STOP!!! DO NOT OPEN!
     

“Does Your Package or Envelope Look Like One of These?” The bulletin, in full color, pointed out envelopes with unknown or no return address, too much tape, or un- usually thick or heavy letters. If a package arrived marked with a threatening message, they advised, do not open; leave it and evacuate the room, keep others from entering, and notify the FBI and state police and your supervisor. “Contact your local FBI office,” the bulletin concluded. “Ask for the Weapons of Mass Destruction Coordinator or Duty Agent. Tell the FBI you have a possible threatening letter or pack- age. If it is aerosolized turn off local fans or ventilation units. Close door. Shut down the mail-handling system in the building.”