CDC and Anthrax

WHEN EVERYTHING CHANGED AT THE CDC

The New York Times, Tuesday, November 13, 2001

by Lawrence K. Altman, M.D.

ATLANTA – About 3 AM on Oct. 12, 2001, Dr. Jeffrey P. Koplan, Director of the Center for Disease Control and Prevention, awoke to a call from one of his top epidemiologists, Dr. James M. Hughes, who said, “We’ve got something reported from the lab, and we need to look at it.” A few minutes later, Dr. Koplan, Dr. Hughes and a pathologist, Dr. Sherif R. Zaki, were peering through a microscope at a specimen of skin from an employee of NBC in Manhattan, who was suspected of having cutaneous anthrax. It was just what the centers had been on alert for since an antrax case had been detected in Florida a week earlier. The events that unfolded in these early hours would lead the CDC to embark on the largest epidemiological investigation in its history, covering over 50 years.

As the medical detectives met, they had only the bit of skin to test. The question of whether the NBC employee, Erin O’Connor, had anthrax–and thus, whether terrorists might have spread anthrax spores in New York City–now depended on an immunological and chemical test that Dr. Zaki had developed a few years ago. “We knew we were going to be subject to incredible scrutiny,” Dr. Koplan recalled, especially since they had no powder, no suspicious letter or other evidence. Nor had they tested a culture, the preferred but slower method of determining anthrax. “But,” he said, “we have enough confidence in Dr. Zaki to say, If he says it, we’ll go with it.”

About 3:30 AM, after Dr. Zaki had finished explaining his findings, “we walked away convinced,” Dr. Koplan said. Ms. O’Connor probably had anthrax. The CDC doctors informed the New York City Health Department’s top epidemiologist, Dr. Marcelle Layton. A few hours later, Dr. Koplan was on the phone with Mayor Rudolph W. Giuliani. “Are you sure it’s anthrax?” the mayor asked. “Well, we have a high degree of probability,” Dr. Koplan replied. “No, no, no, don’t give me that stuff,” was the mayor’s rejoinder. Is it anthrax or is it not?” “Yes,” Dr. Koplan said. “Fine, that’s all I needed to hear,” Mr. Guiliani said.

In the following days, Dr. Koplan pulled together the largest epidemiological force the disease centers had ever marshaled. As the investigators learned about cases at other news media companies and among postal workers, they worked to check out suspected and confirmed cases in New York City, Ne Jersey and the District of Columbia. The work went on around the clock; some investigators napped briefly on cots set up in offices; others went home only for quick showers. One epidemiologist postponed her wedding to join the investigation. The effort was huge, but for many doctors, especially in the early stages, it was not enough. “We needed concrete recommendations about how to handle situations,” said Dr. Daniel Ein, a physician in Washington and the former president of the city’s medical society. Instead, he said the early stages of the investigation were plagued by confusion and conflicting information.

When he called the disease centers’ hotline, he said, he “talked to some fellow who might have had a high school education and he was fumbling around,” unable to answer Dr. Ein’s questions. It was days before things were running more smoothly.

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