When the Daschle letter was received, the CDC believed that the odds of contracting inhalation anthrax through an unopened piece of mail were extremely low.  The envelope scenario had not specifically been tested, but it was not believed that a sufficient amount of anthrax spores could escape to cause the serious form of the disease.  This assumption was supported by the fact that there had been no reports of any type of anthrax related illnesses among postal workers in Florida and New Jersey to that point.  Also, the subject envelope had been heavily taped. 

As time passed, this assumption proved slow to change.  The initial analysis of the Daschle letter, conducted by Army medical teams at Fort Dietrick, included the caveat that investigators had been somewhat surprised by the nature of the anthrax, “that it was a fine powder, that it easily went into the air.”  Even so, previous experience and assumptions led the CDC to conclude that only those present during the opening of the letter were at legitimate risk of inhalation anthrax.  Accordingly, screening and treatment was focused on Capitol Hill.

US Postal Service (USPS) concerns grew in the coming days.  Later on the 15th, anthrax spores had been detected in a mail facility in Boca Raton, Florida.  Then on the 17th, it was detected in the Dirksen Senate Office Building, which the Daschle letter passed through.  The CDC reassured the USPS that the risk of inhalation anthrax in the Brentwood facility was extremely low, and testing was not needed. 

On October 18, a press conference was held at Brentwood, attended by the DC Department of Health, Mayor Tony Williams, and USPS Postmaster Jack Potter.  Based on the CDC recommendation, it was announced that “large scale testing was not necessary.

In reality, the ability of the powder to aerosolize was greater than anticipated, and the minimum amount of spores necessary to cause inhalation anthrax may be lower than assumed.  The rough nature of the mail sorting systems, which are cleaned with air hoses, increased the risk, leaving mail workers more exposed than had been believed. 

On October 19, Brentwood postal worker Leroy Richmond was admitted to Inova Fairfax Hospital in Virginia with flu-like symptoms and labored breathing.  Dr. Cecele Murphy alertly made the inhalation anthrax connection, and when initial tests supported her belief she notified the CDC and the DC Dept. of Health.  The CDC confirmed the case on the 21st and wide scale testing and antibiotics were arranged for postal employees, as well as those present at the Brentwood press conference.

The discovery came too late for Brentwood employee Thomas L. Morris.  He was admitted to Greater Southeast Community Hospital at 4:39 a.m. on the 21st with flu-like symptoms, and died later that day after receiving emergency treatment.  He had begun feeling the symptoms on the 18th, when it was believed that postal employees were not at risk.  There was still difficulty filtering the new information and changing protocols throughout the local medical community.  Later on the 21st, Brentwood employee Joseph Curseen was admitted to Southern Maryland Hospital with flu-like symptoms, but was sent home.  He returned on the 22nd when the threat to postal workers had become more clear, but perished the same day. 

Again, it is debatable and can’t be known for certain whether or not a better, more coordinated response could have saved the lives of the postal workers, but it is clear that communications could be improved, both with the public and within the response community. In the wake of the events, criticism was lodged that the blue collar, mostly minority, postal workers had been treated more cavalierly than the Capitol Hill staffers who had been widely screened.  The CDC message that the disparate treatment was based on the best science at the time – the assumption that those susceptible to inhalation anthrax were only those potentially exposed to the opened letter - was not effectively communicated to the public, leaving actions open to criticism.

Confusion about the nature of anthrax screening also contributed to the double-standard perception.  There was a misperception that the mass nasal swabbing conducted on Capitol Hill was a test for anthrax exposure.  In fact, nasal swabs are only used to test for the presence of anthrax in certain areas, and are intended to identify the parameters of risk, not to test whether an individual has the disease.  Again, this was not effectively communicated to the public and fueled perceptions that special medical attention was given to Hill staffers.

The lack of a single, coordinating response agency hindered communications with the public, and mixed messages were delivered.  The anthrax was termed both  “weaponized” and “garden variety.”  It was said to be both identical to the Florida and New York anthrax, and more lethal.  The lack of a good information stream magnified public fears of bio-terrorism, and a fairly minor disease outbreak became a crisis of increased proportions.

Within the health and medical community, communication of environmental results, patient cases, and changes in protocol were unsure and less than efficient.  The local medical community was not accustomed to dealing directly with the Dept. of Health, and the latest information was sometimes obtained via the press.  When Dept. of Health advisories were issued there was uncertainty about the currency of the information.  As a result, medical personnel had a difficult time keeping their response protocols in line with the new risk information.

The DC anthrax crisis highlights the need for effective information management systems.  The need is especially critical in consideration of the multiple jurisdictions and agencies involved.  Although, issues of authority may not be completely resolvable, an incident management system needs to be established, and a consensus reached on the best methods for gathering, sharing, and distributing information. 

Another important lesson from the crisis is that messages set expectations, so a diligence to accuracy is essential, and a desire to reassure the public must be balanced with a healthy dose of skepticism. The rules for crisis communication are to tell the truth, tell it fast, but don’t be afraid to say I don’t know.  Bio-terrorism needs to be combated with a coordinated, steady flow of accurate information. 

One positive result of the experience may be that it provided a valuable learning opportunity for potentially more deadly outbreaks of disease or bio-terrorism in the future.

Source: Washington Post