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Caught off guardBy BILL ADAIR and DAVID BALLINGRUD
© St. Petersburg Times,
At a hearing in Washington and a conference in Atlanta, officials said there have been so few cases of anthrax in the past century that they know relatively little about it. "We have some experience over the decades, but it's a case or two every two years," Jeffrey Koplan, head of the Centers for Disease Control and Prevention, told a Senate subcommittee. "You can only act on the information you have in hand." Koplan came to Capitol Hill in the wake of an outbreak of anthrax at the Brentwood mail center, which sorts incoming letters in the nation's capital. Two employees who worked there have died of inhalation anthrax, two are hospitalized with the same illness and an additional four have shown anthraxlike symptoms. Postal workers and some members of Congress have questioned how a system that was quick to act on Capitol Hill, when anthrax turned up in the mail of Sen. Tom Daschle, could have failed to protect postal workers who might have dealt with the mail along the way. Koplan indicated that the Brentwood cases caught the experts by surprise. "The public health system of the United States is severely challenged at this moment," he said. Some senators seemed to agree with that candid assessment. "I am very concerned about what CDC is doing and how they are operating," said Sen. Tom Harkin, D-Iowa. "Maybe I'm wrong, but it just seems to me that something broke down here. People are getting sick and people are dying." Other senators said they were concerned by a report that one postal employee died from anthrax after being sent home by a hospital emergency room over the weekend. "It does seem difficult to fathom here in the District of Columbia how a postal worker could show up in the emergency room with flulike symptoms -- and be sent home," said Sen. Mary Landrieu, D-La. The symptoms of anthrax are similar to those of the flu. But Koplan said epidemiologists had limited information about the spread of the disease because there are a small number of cases around the nation. In the United States, 224 human cases of cutaneous anthrax, the form that affects the skin, were reported from 1944 to 1994 -- and most of those involved people handling infected animal hides, Koplan said. Before this year, only 18 inhalation cases had been reported in the entire century. In the anthrax cases this month, Koplan said, epidemiologists have relatively few clues. He said the small number of confirmed cases indicates that inhalation anthrax, the most dangerous form of the disease, was spread when people opened letters in the offices of Daschle and NBC anchor Tom Brokaw. The CDC did not focus heavily on the Brentwood facility because no letters were opened there, he said. "The hypothesis we've been working with all along was that you had to have an opened letter," Koplan said. Before the current outbreak, "we had no cases of inhalation anthrax in a mail sorting facility," he said. "There was no reason to think this was a possibility." Experts in microbiology and bioterrorism say the Atlanta-based CDC, which has 8,500 employees and a $4.2-billion annual budget, was caught by a fast-changing situation in which some assumptions thought valid in the past turned out to be wrong. "Technically speaking, CDC is still on top," said microbiologist Raymond Zilinskas. But he said the CDC is having trouble telling the public and politicians how difficult the job is. "As far as the operations at the political level, they're obviously showing their ineptness." "The CDC is in a very difficult situation right now, constantly chasing after a moving ball," said epidemiologist Greg Evans, director of the Center for the Study of Bioterrorism and Emerging Infections at the Saint Louis University School of Public Health. "I don't know how the CDC or anyone could have done better." Koplan said that the CDC has launched a round-the-clock effort that includes 200 people in field investigations around the country working with state and local public health agencies. But the system, he said, "is stressed through years of neglect and underinvestment." "Labs are inundated with specimens. Epidemiological and investigative staff, where present, are being run ragged. Communications capabilities are strained, and cash-strapped states and localities are facing extraordinary unbudgeted costs," he said. Despite the workload, Koplan said, the public health system "has performed admirably." Meanwhile, in Atlanta, where about 12,000 members of the American Public Health Association have gathered to discuss global health issues, there were more questions than answers. How serious is the anthrax threat? What is a citizen supposed to do? Are public health agencies prepared? Health workers at the conference spent much of Monday and Tuesday thanking and praising one another for the work done since Sept. 11, but they had few answers to those questions. Dr. Philip Brachman, former director of the CDC's Epidemic Intelligence Service, began his address on Tuesday -- billed as "Anthrax: Past, Present and Future" -- by saying that his information had been gathered almost entirely from the news media. Kevin Yeskey, acting director of the CDC's bioterrorism preparedness program, promised his audience the CDC will be taking a more visible role in bioterrorism issues. But he then refused to take reporters' questions. Brachman blamed CDC's low profile on constraints from "higher up. It's a complicated situation politically," he said, because of the involvement of federal, state and local officials. "More importantly, the FBI is conducting a criminal investigation and is limiting the release of some information." Dr. Victor Sidel, a bioterrorism expert and distinguished professor of social medicine at the Albert Einstein College of Medicine in New York, described the public mood in response to the anthrax scare as a "mild panic." "If it's not panic, then it's certainly high anxiety," he said. "And it's already costing some of us our personal liberties. So, yes -- a victory for the bioterrorist." Brachman doesn't expect clarity to return any time soon. "I just hope," he said, "that after this terrible situation is over, we will be able to take a step back and understand that this is the way the world is now. We have to learn to live like this, with this uncertainty." Meanwhile, back in Washington, several officials pointed to changes in their outlook without acknowledging any shortcomings. Tommy Thompson, the secretary of health and human services, told Congress that from now on, any time a letter containing anthrax is received, his agency will immediately conduct tests at post offices through which it might have passed and offer antibiotics to everyone who worked there. That reverses a previous policy of giving medical treatment only to people in the immediate vicinity of contamination -- a policy officials had said was grounded in science. But experts say the science is shifting as they gain more experience. "We're going to err on the side of caution in making sure people are protected," Thompson said. Thompson said the government also is preparing for something beyond an anthrax attack. He added that the decision to do so was not based on specific intelligence but on a general need to "be prepared." Thompson, appearing before a subcommittee of the House Government Reform Committee, was asked by Rep. Dennis Kucinich, D-Ohio, whether the administration had "any information that the incidents of reports of anthrax are more widespread than the incidents that we've seen reported at various media outlets and in the Capitol here?" Thompson responded, "To the best of our knowledge, it is what we've seen so far. We have no (intelligence information) that's saying that this is going to be a wider-spread thing." A moment later, he added "That is the best of our information at this point in time. But we are preparing for something much more dramatic." - Information from the Associated Press, Knight Ridder, Cox News Service and the New York Times was used in this report.
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