After the exposure scare at NBC studios, bioterrorism was on our minds. Fortunately, for the volunteers, they had not been exposed to anthrax. But this did not mean that the issue of bioterrorism—or of terrorism in general—was no longer a concern. On the contrary, the officers vocalized a huge concern about how they could become better prepared to face future possible attacks—bioterrorism and other wise.
The events at NBC had not spurred my first conversations about bioterrorism in New York. Three weeks earlier, as I slept with the rescuers in the Police Academy building, several officers who were responsible for training had lamented their lack of experience in dealing with anthrax if it became a problem. Many of the Hazardous Material (HazMat)- trained staff had been killed in the collapse of the Twin Towers. The officers worried that they would not have the materials or methodology to rapidly train the entire department if necessary.
There was no system in place, and no experts to call on. As Dr. Roberts and I planned the next steps for the screening of the officers in the future to track if any of the abnormalities were permanent, I mentioned that I had planned to share with them an overview of how computer-based training could train the department to deal with anthrax, and how telemedicine could be used to supervise a disaster scene and its initial management. One officer came in and asked, “Are you the anthrax expert?” I said that I was not, but that I was networked with people who were as close to experts as there are. It is important to note that at this point here was no doctor alive in America who had practical clinical experience with an actual case of inhalation anthrax.
With that answer, he told me that I was to “be isolated and quarantined” until the training staff from the NYPD could arrive from headquarters. These are not words a doctor discussing anthrax likes to hear, especially after the exposure scare some had at NBC two days earlier.
The NYPD was desperate, asking if we could get an expert on camera for an instructional video that was to be made that evening for AM release to the precincts at the direction of the Chief. They did not have faith in their own medical staff to find such an expert and allowed Archie and me to get out our cell phones and make some calls. My first call went to the CDC. They referred me to a New York expert, whom I called, and left a message. The call was never returned. Dr. Archie Roberts called a friend of his at a major New York medical center, who said that could not respond to Archie’s queries on such short notice. Tensions, obviously, were running high.
Dr. Ed Rosenow encouraged me to call Dr. Greg Poland, Mayo’s bioterrorism expert. He immediately responded that he could be available to the NYPD via video conference. We were once again thanked for pitching in for the department. We set up a meeting to talk about helping the department with upgrading its training technology, capabilities, and expert content.
We put together a training web site and training program for the NYPD. We lined up more than $100,000 in support for the department and did a presentation for the Deputy Commissioner regarding anthrax, other bioterrorism agents and ways to upgrade the department’s training methods. It takes a full year to properly in-service New York’s 40,000 officers in a new technique or piece of equipment.
After an initial positive reaction, our efforts were placed on hold until after the first of the year, when a new Mayor and Police Commissioner were to take office. The potential gravity of a serious bioterrorism attack had not been fully grasped. I felt that we were lucky that a major assault on New York or any other city did not occur. At the time of this writing, the follow-up meetings are pending.
In the meantime, the NYPD officially responded to the screening by writing a “thank you” letter to Dr. Roberts that encouraged the Living Heart Foundation to cease its activities and let the officers do their own routine follow-up with their family doctors.
The unions wished to hold many screenings on an ongoing basis. The 1,756 officers we screened were only a tiny fraction of the officers we found with significant Ground Zero exposure. When word got out that the program was ending in two days, hundreds showed up, creating a chaotic situation. The officers were upset with their management and were disillusioned. They believed that officials were covering up the type of exposure, and also the severity of that exposure. The NYPD, they sensed, seemed to fear that we were lackeys for the union who were trying to get thousands of brave men and women disability and early retirement—an act that could eventually bankrupt the city and leave it vulnerable to criminal activity.
According to some sources, some local doctors were upset with the attention our effort received. It embarrassed them to be asked why volunteers from around the country responded, when many nearby hospitals did not assist at all with the efforts. Doctors at major New York medical centers ignored requests for help in staffing, and even ignored our requests to become New York state-licensed interpreters of the tests.
When it became clear that some grant or insurance dollars might become available, these same leaders of the community lined up with grant proposals and wanted access to the confidential records of the officers we saw. At least one was heard to start a rumor that this was not a volunteer effort, and that we were getting paid for the testing, when nothing could have been further from the truth.
It should be emphasized here that the volunteers from InnerLink and Living Heart did not receive any compensation for their efforts at Ground Zero. In the future, should any proceeds result from the sale of the material or the use of the products or services of Project Breathe that are referenced here, they will be put right back into making it the best smoking prevention and national health telemedicine resource it can be. What is planned for the NYPD at this time is not clear. Hopefully, the Mayor and Commissioner will make informed decisions on some of the lessons learned at Ground Zero.
It is our hope that the 1,800 officers will each schedule follow-up examinations in six months, and then yearly. If the group that had the worst exposure does not suffer permanent effects, then the rest of the city can “breathe” a sigh of relief. If certain conditions set in or appear later, then public health issues, including wider screening efforts, will need to be established.
What of the residents of Lower Manhattan and the exposures they endured and continue to experience? It becomes crucial that aggressive, follow-up testing of these officers and others with high exposure—such as firefighters—be conducted, for the rest of their lives, and in funded programs. What is learned from their cases will affect the care of officers who were not screened, as well as that of others in the city who have been exposed.
If these exposed victims do not go on to develop chronic conditions or higher incidences of cancers, then the rest of the population with much less exposure can relax. If they do have increased problems, then expansion of screening and treatment programs needs to include citizens who worked or lived in the cloud and its fallout. It will tell the medical community about these types of exposures, given that this problem has never before occurred and very well may happen again in this uncertain world.
An anthrax and bioterrorism education program that has the capacity to rapidly in-service the entire department must be put into place. Police officers who work at the collapse and fire sites do face risks and should be treated to the same privileges as firefighters. It is my belief that every public service worker should have baseline screening as part of the job.
Records need to be accessible and an electronic medical record is one very practical and affordable means to do this. A consensus statement from the participants in the NIOSH working group will create advice to the doctors treating patients in the New York region.
Conflicting opinions continue to be reported. In what I believe is the best summary publicly available at this point, (“Weighing Risks” by Max Maremont and Jared Sandberg, Wall Street Journal, 12/26/01), it is reported that the air is safe, but many people feel symptoms. More than four hundred firefighters are now on light duty, due to health complaints. Many citizens worry about the long-term effects and secondary exposure from improper cleanup of their buildings, offices and apartments. Dioxin, lead, asbestos, fiberglass, and other particulates have, at times, been found in higher than acceptable levels. The combination of these agents with volatile organic compounds (VOCs), which are chemicals emitted when computers, carpet, and assorted other contents of buildings are burned, may be uniquely irritating.
The City of New York and the Police Department have done a phenomenal job in responding to the most devastating plane crashes and building collapses on record. They responded in heroic and dramatic ways and have shown a resiliency that is nothing short of amazing. They have had to operate in an environment of laws, regulations, unions, contracts, and political limitations that still seem bizarre to me, as an outsider trying to help.
They did a lot right but were also woefully ill-prepared. What happened was previously unthinkable, so one cannot pass judgment on actions that were taken in response to the attacks, but they made some mistakes. I believe they were living in denial about what could happen next as these things became very real. They were lucky, in that additional physical attacks did not immediately occur, and that bioterrorism was more of a scare than a reality.
If one more significant attack or infection had immediately occurred, the city could easily have become a ghost town, as Manhattan residents became refugees to families and friends elsewhere. Some of the police I met said that in the event of a massive anthrax outbreak, they feared that drug stores would be robbed for medications and that ordinary, law-abiding citizens would consider using weapons to get antibiotics for their families, if that is what it took.
As one officer said, “If it took four days to get us adequate masks at Ground Zero, how will they get antibiotics to 200,000 people in two days? When people panic and leave the city, then some terrorists would be delighted that Americans are finally getting it and are experiencing what Palestinians have felt for a lifetime.”
All of these things are highly plausible today. Every community in this country needs to really think these scenarios through and be prepared for the time, as my police officer friends have chillingly said, “when the other shoe drops.”