2 new anthrax cases baffling

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From the Chicago Tribune

2 new anthrax cases baffling: N.Y., N.J. victims have no ties to Postal Service

By Naftali Bendavid and Mickey Ciokajlo, Washington Bureau. Tribune staff reporter Marla Donato in Chicago contributed to this report

October 31, 2001

WASHINGTON -- The confirmation of two surprising new anthrax cases in people who are not postal workers and did not work in institutions previously targeted with anthrax-tainted letters dismayed public health officials, baffled investigators and opened a new phase in the crisis.

A 61-year-old New York hospital worker was confirmed with anthrax Tuesday and a New Jersey bookkeeper the day before, bringing the total of confirmed cases to 16. The two new cases suggest two possibilities: More anthrax-bearing letters are circulating, or the bacteria have a far greater ability to spread than previously thought.

The cases are prompting officials to ask for the first time whether people can get sick from their mail at home or work, even without direct contact with an anthrax-tainted letter. At a minimum, the new occurrences appear to expand the circle of those at risk for the disease.

"People have been going back and forth about what it might mean," said Dr. Greg Evans, director of the Center for the Study of Bio-Terrorism and Emerging Infections at St. Louis University. "My feeling is there are probably letters out there that we have not recognized." He added: "They might have had smaller amounts of anthrax spores in them that were not easily detectable. Or there might be letters that were never opened but were destroyed or thrown away because they were suspicious."

Few additional developments emerged Tuesday. Trace amounts of anthrax were found in a U.S. Agriculture Department mailroom, making it the latest government agency to yield such results. All the agencies get their mail from the Brentwood postal facility, which handled a letter sent to Senate Majority Leader Tom Daschle (D-S.D.).

More spores in Washington

Traces of anthrax also were found at two Washington-area post offices, Friendship Heights and Dulles, which also are in the mail-processing stream from Brentwood. Deputy Postmaster General John Nolan described these findings as "extremely localized." In each location, only one of many sites tested positive.

Nearly four weeks after anthrax was discovered in a Florida man--with officials declaring there was no evidence of terrorism and promising "a very intense investigation" --neither health officials nor the FBI have had much success getting to the bottom of the crisis.

John Flaherty, an infectious disease expert at the University of Chicago, said it is too early to rule out "cross-contamination," the possibility that anthrax is spreading from one letter to another at the post office. "We're still on that steep portion of that learning curve, trying to sort out all of what's happened," he said. "Nobody feels very confident at all that they know what is going on here."

Surgeon General David Satcher, speaking at a Catholic Charities event in Chicago late Tuesday, echoed that sentiment. "Ten days ago none of us would have thought that a closed envelope passing through a post office could have resulted in people in that post office being infected," Satcher said. "And we still don't know what happened . . . Let's remember that we don't know what happened in terms of the sorting machines and things like that."

Until the discovery of the new cases this week, the outbreak seemed to be settling into a comprehensible, if troubling, pattern. In Florida, no new cases had been discovered in almost a month, and the state is no longer an anthrax "hot spot." In New York and New Jersey, a confined group of postal workers and media employees had contracted anthrax from a seemingly finite group of suspect letters. In Washington, the only people to contract anthrax were postal workers at the Brentwood center, which processed the letter to Daschle.

But the new cases have raised serious questions, because the two people infected did not work for the Postal Service or at places considered likely to have received anthrax-tainted letters. A Bronx woman was confirmed late Monday with inhalation anthrax, the most severe form of the disease. She works at Manhattan Eye, Ear and Throat Hospital, in a stockroom that until a week ago shared space with a mailroom.

The woman is in critical condition and on a ventilator, so investigators cannot communicate with her. They are interviewing co-workers, relatives and friends while examining her patterns of activity and testing her home for anthrax. "We are not making an immediate assumption that she was exposed at work," said Dr. Jeffrey Koplan, director of the federal Centers for Disease Control and Prevention.

The New Jersey woman, whose skin anthrax was confirmed Monday, works at an accounting firm that receives mail from the Hamilton Township mail processing center, which is known to have handled three anthrax-tainted letters.

Investigators baffled

Investigators are examining all links between the patient and the Hamilton facility, but are baffled in her case as well. The two cases follow an announcement last week that a State Department mailroom employee has inhalation anthrax. The State Department is a more likely target for an anthrax-bearing letter than a hospital or accounting firm, and the mailroom worker might have handled one. So far, no such letter has been found at the State Department.

The cases are prompting health officials to rethink such basic questions as how many anthrax spores are required to get sick. Experts previously assumed it would take 8,000 to 10,000 spores, but now they are wondering if fewer would do it. Of equal importance, some are beginning to doubt what had been considered a near-certainty: that a person cannot get anthrax simply from handling an ordinary letter that brushed by an anthrax-tainted letter at the post office.

"Up to yesterday, there was no evidence at all that there could be, or is, an individual in which there might be the reasonable question: `Did they get infected from a piece of mail that went to their home?' " said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "That is being intensively investigated right now."

Jason Pate, senior research associate at the Monterey Institute of International Studies in California, said that is troubling. "Is the mail safe? That is what everyone is wondering," Pate said. "And the short answer . . . is, we don't know."

Despite the significant new questions posed by the three cases, they suggest more of a widening or a rippling outward of the anthrax crisis than a completely new eruption. All three patients worked in municipal areas already hit by anthrax, and all may have had proximity to the mail at work. "There is circumstantial evidence linking the cases still," Pate said. "If this was happening in Nebraska or on the West Coast, it would be different."

Still, experts in and out of government admit being at a loss. "I lie awake at night trying to think through these things," said Evans, of St. Louis University. "We just haven't gotten enough information yet."

Copyright 2001, Chicago Tribune

-- Swissrose (cellier3@mindspring.com), October 31, 2001

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