The Anthrax Letters: The Attacks That Shocked America (20 page)

William Powanda, the burly gray-haired vice president at Griffin, recounted Ottilie’s relatively benign symptoms: low-grade fever, slight dehydration. “Classically, she would not have been admitted, but because of her age we decided to let her stay.” The remainder of that day and into the next Lundgren barely seemed ill. She joked with visitors and medical attendants; her initial tests suggested a possible urinary tract infection. On Saturday morning Dr. Lydia Barakat, one of the hospital’s infectious disease specialists, received a call from the intern on duty. Lundgren’s overnight blood cultures had grown bacteria that were rodlike and tested Gram positive. Barakat had not yet seen Lundgren, but she thought “elderly patient; probably clostridium.” She ordered Ottilie on antibiotics, vancomycin and ceftazidime, as she set off to the hospital to see the patient. Later she added oral Cipro and intravenous ampicillin to the treatment.

Clostridium bacteria, at least the type most often found in humans, are rarely life threatening. When Barakat arrived at the hospital around 10 a.m., she went to the laboratory, checked Lundgren’s reports, and looked at her chest X ray, which appeared normal. She peered through the microscope and saw the cultured bacteria—all consistent with clostridium. Barakat, an attractive young woman who attended medical school in her native Lebanon, had completed her residency at Griffin only 2 years earlier. That Saturday morning, the case hardly seemed extraordinary, certainly nothing to warrant interrupting the weekend of the hospital’s infectious disease chief, Howard Quentzel. Still, in the back of Barakat’s mind lay another truth: Gram- positive rods are also consistent with anthrax.

“I was thinking clostridium, but I had been hearing a lot about anthrax,” Dr. Barakat later said. She went to Ottilie’s room. While examining her, Barakat asked, “Did you receive any mail with powder in it?” Ottilie answered, “No.” She did not seem very ill and had no respiratory problems, and Barakat was reluctant to say “anthrax” to anyone else. “I did not want to make a fool of myself,” she told me. On Sunday Lundgren seemed more short of breath. A new chest X ray, unlike the earlier one, suggested that fluid might be present in one lung. By Monday morning, after more tests, it became clear that Ottilie’s infection was not from clostridium but from a bacillus.

The new tests showed that the bacteria were nonmotile and nonhemolytic—that is, they did not move spontaneously and did not destroy red blood cells. This ruled out
Bacillus cereus
, a treatable and rather common infective agent. Meanwhile, Barakat had briefed Dr. Quentzel about the patient, and he was eager to see her when he arrived at the hospital on Monday. Another chest X ray had just been taken, the third since Lundgren entered the hospital. This one showed fluid throughout both lungs, though no widened mediastinum.

Howard Quentzel, at Griffin for 13 years, had graduated from New York Medical College and completed his residency in infectious diseases at Lenox Hill Hospital. There he had worked under Dr. Michael Tapper, the man who, weeks earlier, had overseen the care of Kathy Nguyen. Quentzel’s slight build, high forehead, and large glasses present a scholarly appearance. Earlier he had reviewed his textbook to make sure which bacilli are nonmotile and nonhemolytic. The prime candidate:
Bacillus anthracis
. He and Barakat met to review Lundgren’s chart. He turned to her and said: “This is anthrax.”

“I’m relieved,” Barakat thought to herself. Barakat felt as though a burden had been lifted from her. Now someone else also accepted the seemingly preposterous notion that Ottilie Lundgren, this stay-at-home nonagenarian, could have anthrax. But what else could it be? Quentzel went to see Ottilie, who was still quite coherent. “Did you travel to New York?” he asked.

“No, I haven’t,” Ottilie said.

As did Barakat earlier, he asked, “Did you see any powder in the mail?”

“No.”

Barakat and Quentzel understood the explosive implications of their diagnosis. The country was already in turmoil over anthrax. The Lundgren case would add a new dimension to the fright. If someone so unlikely could become a victim, everyone might be at risk. If Ottilie’s illness were connected to a letter contaminated by an already cross-contaminated letter, the implications were profound indeed. Her letter then could have been part of an infective chain reaction. Third- or fourth-generation cross-contamination could have devastating implications everywhere. Even the limited comfort in knowing that anthrax did not spread from person to person could be undermined. Routine mail might become the anthrax equivalent of the contagious smallpox cough or the touch of a plague-infected hand.

An ominous comment in 1981 by Rex Watson, then head of Britain’s chemical and biological defense establishment, seemed almost an understatement. If Berlin had been bombarded with anthrax in 1945, he said, the city would still be uninhabitable. But he was speaking of massive quantities of spores. Now the United States seemed to be hostage to a few grams. The randomness, the far-flung locations, and the uncertainty of who might be next overshadowed the limited number of victims thus far.

Barakat and Quentzel knew their lives were about to be disrupted, as were those of others in the hospital, not to mention Ottilie Lundgren’s neighbors, friends, and family. They decided on a division of responsibility. Barakat would focus on taking care of her patient and try to disregard the inevitable distractions. Quentzel would notify the appropriate hospital authorities, state health officials, and the federal government through the CDC. “I was excited,” Quentzel acknowledged in reflecting on that moment. “I knew what this meant.”

Quentzel’s calls to state and federal officials were initially received with skepticism. “When I spoke to the EIS [Epidemic Intelligence Service] officer, he sounded surprised and just said, ‘OK, we’ll pick up the culture.’” The EIS was established in 1951, during the Korean War, when the United States worried that the Soviet Union might attack with biological weapons. An arm of the CDC, it was to serve as an early warning system against germ warfare. Through the years its investigators determined that several disease outbreaks were natural and not man-made. Now, after 50 years the EIS was dealing with something different. The country was facing a true bioterrorism siege.

As Quentzel began dealing with the outside authorities, Barakat thought, “Thank God he’ll be taking care of the phone. For me I was focused on wanting to help the patient.”

On Monday, Ottilie Lundgren was intubated, and that afternoon her chest was drained. “I was optimistic even until Tuesday,” Barakat said, “but then she developed multiorgan failure.” About the same time, on Tuesday, November 20, Quentzel heard from the EIS that Ottilie’s blood samples had been confirmed for anthrax both by the state and CDC laboratories. By then it was clear there would be no recovery. Ottilie Lundgren died the next day.

By the end of the following week, investigators had taken 83 swabs and samples at Ottilie’s home and scores more at places she had recently visited, including the Nu Look Hair Salon, the town library, Fritz’s Snack Bar, and Immanuel Lutheran Church a mile from her house. Early testing also included 29 samples from the post office in Seymour that serviced her home and 117 samples at the large postal distribution center in Wallingford. All tested negative for anthrax.

Investigators were becoming desperate for clues. The land around Lundgren’s house was scoured for anthrax spores. But, as with her mail, furniture, clothes, and other worldly goods, there was no sign of the bacterium. As with Kathy Nguyen, investigators wondered if she had somehow come into contact with a perpetrator posing as a friend. “Did she have any boyfriends?” an FBI agent asked Robin Shaw, Ottilie’s hairdresser and friend. “No,” said Robin, who was both startled and amused by the question. At age 94? Robin was astonished by how far the authorities were trying to reach.

In later weeks, a connection to the mail seemed more probable if not conclusive. Additional testing showed the presence of anthrax spores on four of the 13 high-speed sorters at the Wallingford center and trace amounts at the post office in Seymour. About a thousand postal employees in the area had been started on preventive antibiotic treatment. A computer printout showed that a letter that went to the Wallingford facility had come from the Hamilton center in New Jersey. The letter had been sorted 15 seconds after the Leahy anthrax letter and on the same machine. Addressed to Jack Farkas at 88 Great Hill Road in Seymour, the letter was found at his house and proved to have a trace of anthrax. No one in the Farkas home, which was 4 miles from Ottilie Lundgren’s, had become infected. But the presence of the letter heightened the possibility that cross-contaminated mail might have reached Ottilie’s home.

In March 2002, James Hadler, the Connecticut state epidemiologist, revealed that the contamination at the Wallingford center had been greater than previously suggested. Although three of the machines had small numbers of spores, the fourth was “heavily contaminated [with] approximately 3 million spores, roughly translated into 600 infectious doses.” Hadler believes the evidence is “strongly suggestive” that Ottilie was exposed through the mail. He says that 29 letters were recovered from her home. Six were first class letters that had been “cleanly opened along the top border” and had been processed only in Connecticut. But of 23 items of bulk mail, “all were torn in half and had been found in her trash.” All 29 pieces cultured negative for anthrax. Still, he believed that Ottilie was exposed to cross-contaminated bulk mail. How could this have occurred? Hadler conjectured:

Fear of anthrax had become compounded by the uncertainty of how Kathy Nguyen and Ottilie Lundgren had become infected. Could the source of their exposures have been so minute as to go undetected despite all the sweeps for evidence? Quite possibly. According to Donald Mayo, who worked with the Connecticut Public Health Laboratories during the anthrax outbreak, “You know, unless you swab every square inch, of course you may miss some spores. You cannot be sure that you’ve gotten every last one.”

The actual number of spores necessary to cause infection remains disputed. Before 2001, animal experiments and sparse information from human experience suggested that a person who inhaled 8,000 to 10,000 spores had a 50 percent chance of becoming lethally infected. After the outbreak, however, the issue seemed more murky. The “preferred interpretation,” according to James Hadler, is that Kathy Nguyen and Ottilie Lundgren received exposures from “small numbers of spores.”

Jeffrey Koplan, then the CDC director, was skeptical. “It would take a lot more than a few spores to cause inhalation anthrax,” he said. But Matthew Meselson, a Harvard microbiologist, disagreed: “There is no justification for assuming there is any threshold at all.” Although the chance is small, “a single organism has a chance of initiating infection.”

In 2001 the Defense Research Establishment Suffield (DRES), a Canadian government agency, produced a study that was remarkable in its timing. Titled
Risk Assessment of Anthrax Letters
, the study had been undertaken because “no experimental studies on which to base a realistic assessment of the threat posed by . . . ‘anthrax letters’ could be found.” The report of the study was dated September 2001, the very month the first anthrax letters were mailed in the United States. The impetus of the study was a letter received by a government office earlier in the year claiming to contain anthrax. That threat proved to be a hoax. But it inspired DRES to conduct a series of experiments.

Each trial involved placing a letter and a quantity of bacteria, ranging from 0.1 to 1 gram, in an envelope. After sealing the envelope with the flap’s adhesive, it was shaken and brought into a 10 × 18 foot chamber. There a tester in mask and protective outerwear “played the role of mail clerk.” He tore open the envelope and removed the letter. The relatively harmless bacteria (a simulant of anthrax bugs called
Bacillus globigii
) floated out. Culture plates, which could grow colonies from bacteria that settled on them, had been placed around the room to see how far the germs spread. The results were stunning: