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Bioterrorism Hits Home
For two hours that morning, we talked about bioterrorism in hypothetical terms. Now, suddenly, it was all too real.
An Associated Press reporter asked me to respond to the news that a letter containing anthrax had been delivered to the Washington office of my colleague, Senate Majority Leader Tom Daschle. An undetermined number of staffers in Senator Daschle's Hart Senate Office Building suite had apparently been exposed to the potentially lethal biological agent when the letter was opened. President George W. Bush just minutes before had told the nation about the letter during informal remarks following an event at the White House.
I was stunned. I had spent the morning hosting a roundtable on bioterrorism at the Tennessee Emergency Management Agency headquarters in Nashville. I listened carefully as about three dozen doctors, nurses, hospital administrators, firefighters, police, and other law enforcement, public health, and emergency personnel from all across the state talked about how unprepared they were for the growing threat of bioterrorism.
Little did I know at the time that this initial press question would be my initiation into seven days that would severely test much of what we thought we knew about bioterrorism. Seven days that would challenge our fundamental clinical understanding of anthrax—how to diagnose it, how to treat it, how to protect those who may have been exposed—and how to communicate with the press and the public about a public health emergency withshifting facts and a fluid, rapidly evolving scientific knowledge base.
The coming week also would bring sharply into focus the vital role our public health system plays in responding to such an attack. After all, this was part of the first biological attack on U.S. soil involving anthrax and was only the second known biological attack in the United States in at least a century (the first, in 1984, involved salmonella poisoning of restaurant salad bars by a cult in Oregon).
The lessons learned from the abstract discussions in Nashville on Monday morning, October 15, 2001, would come alive and be played out in vivid detail in Washington over the next seven days.
As I prepared to host the bioterrorism roundtable in Nashville, a Florida man already had died of inhalational anthrax, and an assistant to NBC News anchor Tom Brokaw had been diagnosed with skin, or cutaneous, anthrax. An additional case of each form of the infectious disease would be confirmed later in the day.
So everyone in that room knew that the threat we once considered remote was growing. Frontline responders, those who will answer that panicky phone call or first see a person with symptoms, lacked appropriate training and protective equipment. State and county public health laboratories lacked adequately trained epidemiologists and state-of-the-art facilities and equipment. Community hospitals had no system to share information with each other or with local public health facilities in a timely way.
Vanderbilt Hospital—one of Tennessee's premier teaching and referral hospitals, where I had worked for nine years as a transplant surgeon before coming to the U.S. Senate—acknowledged that it did not have a bioterrorism preparedness plan in place and had not done training exercises to deal with this emerging threat. Nor had any of the community hospitals.
From rural doctors to city police and firefighters to state public health officials, all the way up to the governor's office, the story was the same: They just weren't prepared to respond to what might happen.
Following the conference, I walked into an adjacent room for a press briefing, and the question was no longer about what might happen. It was about what had already happened.
When asked about the Daschle letter, I simply replied that I was unaware of the report but that it would have to be confirmed. To be honest, I minimized it a bit in my own mind because I recalled receiving an anthrax hoax letter three years before. If the report was correct, this would be the first witnessed exposure of multiple people to the release of airborne anthrax.
My next scheduled stop was a speech about bioterrorism to the Nashville Rotary Club at a downtown restaurant. Ironically, I had picked the topic three weeks earlier when the meeting was booked, before anthrax was on anyone's radar screen.
By the time I arrived at the Rotary meeting, we had been notified that my own Public Health Subcommittee staff was on the same floor in the Hart building just down the hallway from where the letter had been opened. We were told that there was apparently a large amount of a powdery substance in the letter and that nasal swab testing and distribution of a short course of antibiotics had begun for those in the Daschle suite. I sensed that the issue was escalating.
I was able to get periodic progress reports by telephone from my subcommittee staff. At this point, the Hart building remained open and people were still at work at their desks. In fact, the building would stay open for another day and a half. The risk of exposure was unknown at the time.
I returned to Washington that afternoon and was asked by Senate Republican leader Trent Lott to be the liaison for the Republican senators to the fledgling medical and law enforcement investigation into the anthrax exposure at the Hart building.
Already, those within Senator Daschle's suite had been given nasal swab tests along with a three-day course of antibiotics. And a public health command room had been set up by Majority Leader Daschle in the secretary of the Senate's office on the third floor of the Capitol. It was in this room that data were reported and shared and strategies to deal with the evolving public health and environmental issues were discussed and developed.
Officials representing many agencies—the Centers for Disease Control and Prevention (CDC), the Capitol physician's office, the Defense Advanced Research Projects Agency (DARPA), the Senate sergeant at arms, the Capitol police, Senate leadership, the deputy surgeon general representing the Department of Health and Human Services, and the director of the District of Columbia health department—were almost always in that room for the next several days, coordinating among themselves and then reporting back to their home agencies.
To provide information to the Senate staff and the public at large, we held two press conferences on the first full day and then scheduled daily press conferences for the next week. But many staffers were still confused and anxious about their potential health risk.
Just a few doors from Senator Daschle's suite, my own health subcommittee staff members were experiencing firsthand the difficulty in obtaining helpful information during a public health emergency. Although they knew about the letter, primarily from press reports, almost nothing else was reaching them. Like the rest of the nation outside the walls of the building, their principal source of information was TV.
On that first day, staffers from Senator Daschle's offices turned to our health subcommittee staff with questions about anthrax and their own health risk, in part because they knew that my staff had been working on issues related to bioterrorism for a long time and in part because, as I am the Senate's only doctor, they knew that my staff and I are involved in most health-related issues. Is anthrax contagious? If I've been exposed, is my family at risk? However, no official word came from those conducting the investigation until later that afternoon, when a police officer visited my staff in the Hart building to confirm that a letter possibly laced with anthrax had been delivered to Senator Daschle's office.
In response, they were closing off a section of the Hart building. The officer would remain on duty outside my staff's door, but the primary reason was to ensure that the press did not bother them as they continued to work. Staffers moved in and out of that wing of the Hart building, totally unaware of any health concerns.
The ventilation system had been shut down within an hour of the incident to avoid potential spread of anthrax, and the staff was told to expect the offices to be warmer than usual. At that time, there was no discussion about their own health risk, and previous experience would suggest that they were not in harm's way.
Nasal swabs to determine how widespread exposure to the anthrax spores had been were eventually obtained from everyone in the Hart building. On Monday, only those present in the vicinity of the Daschle suite when the letter was opened were given preventive antibiotics pending results of the nasal swab tests.
When nasal swab test results confirmed the direct exposure to anthrax of twenty-eight people inside or immediately adjacent to the Daschle suite, anxiety across Capitol Hill soared. The innocent opening of a letter, a routine task that is done millions of times every day in offices across the country, suddenly escalated into a public health crisis that truly frightened many people who work on the Hill. Congressional mail was quarantined, and a month later, on November 16, 2001, a second anthrax-laced letter—this one addressed to Sen. Patrick Leahy—was discovered by government investigators.
Few of the office workers on that first day really understood what a positive nasal swab meant. What about those whose tests came back negative? Did they have anything to worry about? Why did some of them still have to take antibiotics? It seemed so confusing to everyone involved, including members of the press who were trying to interpret it all.
Anxiety was high. People were not getting the answers they needed. And it was only just beginning.
Staff members who had continued working in their fifth- and sixth-floor Hart offices through Monday were surprised the next morning to find a police barricade barring the entrance to the southeast corridor. They were told that they could not return to their offices and were directed to obtain a nasal swab test and more information from the medical crew.
Hundreds and hundreds of concerned individuals lined up for the nasal swab tests in the Hart building. It was difficult for the necessary medical supplies to be maintained. Several times, the line stalled owing to lack of the antibiotic ciprofloxacin (Cipro) or the necessary sterile cotton swabs. Anyone who wanted testing simply had to show up; no one was turned away. Hundreds of people from all over Capitol Hill came to be tested, even if they were not in the Hart building. Many people showed up to be tested out of confusion, others out of fear.
Everyone receiving a nasal swab that day was given a three-day supply of Cipro and told to return for the test results; at that time they would be told whether they would have to take the antibiotics for sixty days. Because of all the confusion, misinformation floating around, and the fact that very little information was then being made available, my staff and I immediately went to work to make the official Senator Bill Frist website a central place where anyone could go to find accurate, up-to-date, pertinent information both on anthrax generally and on the rapidly evolving situation in the Senate office buildings.
It was not the first time my office had to deal with bioterrorism. Three years earlier, after I received the hoax letter labeled "ANTHRAX," I addressed with my staff mail-handling protocols for any letter that appeared suspicious. We were able to go back and find these protocols and post them immediately on the website so everyone had access to the information. We were among the first sites—even before the postal service—to have practical information on what to do if you received mail suspicious for anthrax.
Working with the Capitol physician and others involved in the situation, my staff gathered information from the command-room briefings and continually updated the postings. It was obvious that people were growing anxious for information about anthrax and developments on the Hill.
They tried to get on the CDC website, but it had crashed and no information was available on it. Where could they go to get information about their own personal health risk? Were the twenty-eight people who tested positive now infected with the most deadly form of anthrax disease, inhalational anthrax? (They weren't. The test merely confirmed that they had been exposed to the spores.) Why did some people around them have positive test results while their results were negative? How long would they be out of their offices? Should they go to work the next day?
People were desperate for information. And desperation can lead to frustration. And frustration can lead to anger. And they didn't know where to turn.
Forty-eight hours after the anthrax-laced letter was opened, information was still scarce. Staff continued to show up for work, and the testing site was moved to the Russell Senate Office Building because the Hart building was closed.
As thousands of Senate and House staff and those who had been visiting Senate buildings on Monday lined up for their nasal swabs and three-day Cipro supply, my staff busily printed out information on anthrax exposure that we gathered from my Senate website and others and handed it out to those who waited in line. They were understandably eager for information.
The Senate and House leadership met early Wednesday morning and received reports that environmental cultures from several locations had tested positive for anthrax, suggesting an even higher potential for contamination than previously thought. Decisions were made independently by the House and Senate leadership to close their respective office buildings to allow more comprehensive testing.
When the Senate leadership presented the decision to the full membership, though, they learned that senators felt strongly that their session on Thursday should go on as scheduled. During the meeting, I briefly addressed my colleagues, offering my views from a medical standpoint on the anthrax exposure so far. Our discussion seemed to reassure many of them.
After hearing from officials involved in the investigation, several senators made it clear that they believed Senate business should not be stopped, because it would be a sign of giving in to the terrorists. At the time, most felt that the events occurring on the Hill were likely related to the September 11 attacks. This was, many believed, round two of the assault on the nation's capital. A plane had struck the Pentagon and killed 189. Another that crashed in Pennsylvania, killing 44, almost certainly was headed for Washington. And now, many thought, came deadly anthrax, aimed at the highest-ranking member of the U.S. Senate.
In the end, we decided to close the Senate office buildings later that day but to stay in session in the Capitol building itself on Thursday. House members, in a separate meeting, decided to close their office buildings and to adjourn. The press made a big deal about the House leaving and the Senate staying. It was an uncomfortable situation for both houses, with accusations flying back and forth, mostly fueled by the press.
To me, this just reflected an initial miscommunication between the House and the Senate at the leadership level, in large part arising from the lack of certainty surrounding the interpretation of environmental culture results that were slowly coming back. Apparently, House and Senate leaders had left the earlier morning meeting with different understandings as to what they would do regarding closing the buildings. Policy decisions that could affect the safety of personnel had to be made on the basis of incomplete information and inadequate science. Such is the nature of bioterrorism.
Excerpted from WHEN EVERY MOMENT COUNTS by Bill Frist. Copyright © 2002 by Bill Frist. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
|1||Anthrax in the Capitol: Bioterrorism Hits Home||1|
|2||Safe at Home: A Family Survival Guide||21|
|8||Ebola and Other Viral Hemorrhagic Fevers||117|
|10||The Threat to Our Food and Water Supply||137|
|11||A Nation Prepared: Safeguarding Our Future||153|
|About the Author||183|
Posted April 6, 2004
This is a book written on bioterrorism by Bill Frist, US Senator and Doctor. Certainly, Bill Frist has the status to talk of these subjects but, to be honest, I think there are better treatments of this subject by people more familiar with the topic than Senator Frist. In recent times, Bill Frist has reduced the role he plays as Senate Majority Leader by involving himself in shameless partisan politics as in when he accused Richard Clarke of perjury. Bill Frist should realize that many great men held that position including Mike Mansfield who were classy enough to not lower the honor of being a Senate Majority Leader to the depths that he has by his baseless charges on Mr. Clarke. I just think that with the Richard Clarke episode that Bill Frist has reduced the prestige of being a Senate Majority Leader and that by doing so has weaken any ideas he has to promote. As a result, I'd say that one should pass on this book and to read treatments of the subject by more credible authors.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.