Amerithrax (5 page)

taminated wool, hides, leather, and hair products of tainted animals have been those most infected. Spores can enter the human body through the lungs when people inhale spores flecked off an animal hide. Perhaps Stevens’s spores had come from imported wool.

Inhalational anthrax was first identified in the nineteenth century when a handful of laborers in a textile mill fell ill. They had been exposed to spores released into the air by the new industrial processes developed to make wool. Mill workers were so frequently exposed to imported animal fi- bers contaminated with
B. anthracis
spores that anthrax be- came known as “wool-sorters’ disease” in England and “ragpickers’ disease” in Austria and Germany. In the early 1900s, human cases of inhalational anthrax began showing up in the U.S. in conjunction with the flourishing domestic textile and tanning industries.

In the last part of the twentieth century, with improved industrial hygiene practices and restrictions on imported an- imal products, the number of cases dropped dramatically. In goat hair mills, goat hair was treated at 170 degrees Fah- renheit for fifteen minutes. Moist heat works better than dry heat on the spores. However, even after this treatment, many spores retained their viability. In 1942, a Pennsylvania tex- tile worker and a rug salesman died of inhalational anthrax. In both those cases their lymph nodes, not their lungs, had been the most notably infected.

In 1957, the country’s only epidemic of inhalation an- thrax occurred. Four woolen-mill workers at the Arms Tex- tile Mill in Manchester, New Hampshire, were killed by inhalational anthrax. Almost all textile mills use air condi- tioning to control moisture so they can produce uniformly strong fibers and threads. But air conditioning also spreads spores. In the same year, a man and woman living near a Philadelphia tannery died of inhalational anthrax. Shortly afterward, a football player contracted the disease from playing-field soil. In San Francisco, a woman who beat bongo drums made of infected skin, a construction worker who handled contaminated felt, and several gardeners using contaminated bone meal fertilizer also caught the disease.

In rare cases people contract intestinal anthrax from eat-

ing undercooked meat, but the GI type of anthrax amounts to less than 1 percent of all cases. The most common anthrax infections are cutaneous, contracted through abrasions and breaks in the skin. Livestock workers are exposed to anthrax every day. Skin anthrax occurs naturally in rural areas around the world, especially around large herds of sheep, goats, and domestic cattle. Cutaneous anthrax accounted for 234 human cases in the nation between 1955 and 1991. A few recent cases in North Dakota, Nevada, and Texas had been cutaneous, contracted while handling animals.

Everything in the autopsy room that had come in contact with Stevens’s blackened blood had to be decontaminated or destroyed. The cleanup took nearly three hours.

All day Saturday, October 6, journalists arrived in Flor- ida, attracted by the tragedy of Bob Stevens. Among them- selves the reporters speculated that he had been a victim of a deliberate attack. If so, it would be the first documented use of anthrax as a murder weapon in the nation’s history. The following day, the CDC visited AMI again to ques- tion employees still on the job five days after Bob Stevens had been diagnosed. By being allowed to remain in the building, employees had received further exposure to an- thrax spores. Health workers, protected only by gloves, had done the early environmental sampling with sterile swabs.

All were now at risk.

Testers, during this stage of the search, restricted their tests to air vents on the first floor where Blanco and Stevens worked. The air conditioning system controlled moisture so that AMI’s workers and mountains of paper and back issues would remain unaffected by the Florida humidity. When the air in a room becomes filled with moisture and odors, it must be removed as conditioned air is blown in. If there were spores the vents might have blown them around. Since they found no spores there, this led environmental officials to report it was unlikely that anthrax had been widely dis- persed. Later findings would present a completely different picture of contamination inside the building.

Dr. Malecki painstakingly compiled a dairy of Stevens’s travels over the last sixty days so environmental assessments could be made. Perkins dispatched three teams to uncover

the source of the anthrax. One group journeyed to Chimney Rock, the second to Stevens’s many fishing spots, and the third to his home. All the tests proved negative. After an- other meticulous sampling of Stevens’s home and backyard, the medical detectives were more puzzled than ever. Perkins and his staff decided to make another sweep through AMI. They took away Stevens’s office mail slot, mail cubicle, and computer keyboard for examination. They didn’t have long to wait for an answer.

Dr. Perkins got word from the CDC’s anthrax lab that swabs collected from Stevens’s keyboard and the mailroom had tested positive for
Bacillus anthracis.
The entire first- floor workstation was blazing with anthrax. Discovery of anthrax spores inside AMI proved Stevens had not acquired his infection naturally from the soil in the North Carolina wild. And the spores on his keyboard ruled out earlier spec- ulation that he might have inhaled them from imported wool.

The CDC learned that another AMI employee, Ernie Blanco, had developed pneumonia symptoms and was at a local Miami hospital, Cedars Medical Center. They went there immediately. A man in Virginia, who had recently visited the
Star
, had developed pneumonic symptoms like Blanco’s. Blanco’s nasal swab, obtained on Friday, October 5, had yielded a positive culture for
B. anthracis
on a petri dish.
1
Perkins studied Blanco’s results from the CDC:

A left thoracentesis yielded serosanguinous fluid positive for
B. anthracis
DNA by PCR. Bronchoscopy showed bloody secretions in the right lower lobe and left lung, with severe mucosal hyperemia, mottling, and inflam- mation. Bacterial cultures of bronchial washings and pleural fluid did not grow. A transbronchial biopsy showed
B. anthracis
capsule and cell-wall antigens by immunohistochemical staining. The pleural fluid from

1
Subsequent testing revealed a positive PCR test for
B. anthracis
in hemorrhagic pleural fluid and reactive serologic tests. A diagnosis of inhalational anthrax would not be officially confirmed until October 15.

the second thoracentesis was positive for
B. anthracis
DNA by PCR. A pleural fluid cytology preparation and pleural biopsy showed
B. anthracis
capsule and cell-wall antigens by immunohistochemical staining.

Stevens’s and Blanco’s symptoms, though, were very dif- ferent, a fact which further puzzled the medical detectives. Blanco showed no signs of meningitis, yet Stevens did. Blanco had no enlarged space under his breastbone (a symp- tom unique to the pneumonic form of anthrax), yet Stevens did. And why had the older man survived while Stevens had not? History had shown the elderly were at greater risk from death than the young when exposed to inhalational anthrax and neither was a young man.

Differences in the spore-containing aerosol might have affected the two men differently. Blanco’s survival might lie in his lack of susceptibility. In the goat hair mills, where workers were daily exposed to anthrax spores, some devel- oped antibodies and some did not. Why had no other AMI employees become infected? Some of it was luck, some was natural tolerance.

Popular wisdom said that it took the inhalation of hun- dreds of thousands to millions of anthrax spores to cause the disease. In 1970, the World Health Organization theo- rized that between 130,000 and 3 million deaths could be caused by aerosolized release of one hundred kilograms of anthrax spores upwind of the Washington, D.C., area. A later study showed that while 100,000 people would die if a nuclear bomb hit a major city and that 10,000 would die in a successful attack on a toxic chemical plant, a million people could die if terrorists launched a biological attack that widely dispersed anthrax. The CDC estimated it would cost the United States nearly $27 billion for every 100,000 persons exposed to pulmonary anthrax.

With Stevens’s death scientists determined that only a microscopic quantity, ten to twenty thousand spores, were sufficient to infect a human with pulmonary anthrax. Decades-old Russian tests had determined even fewer might accomplish the same result. In the midst of all the tumult, Ernie Blanco remained hospitalized on heavy antibiotic ther-

apy, a baffling case to doctors who had become detectives. At this point, Dr. Perkins urged his boss, CDC director Dr. Jeffrey P. Koplan, to engage the FBI in what he now considered to be a criminal case. Perkins’s worst fear was that someone had deliberately released anthrax bacteria, a favorite weapon of modern germ warfare engineers, upon the employees of AMI. Stevens might not only be the na- tion’s first anthrax murder victim, but possibly its first victim

of bioterrorism.

“Here you are,” Dr. Perkins told
Newsday
later, “you’re in Florida, you’re down where the terrorists trained, you’ve just had 9-11. It’s easy to conclude it’s bioterrorism, but my responsibility was to rule out that it was a sporadic, natural case. That was very much the local focus [in the begin- ning].”

During the autumn of 1997, the Department of Defense had beat the band to publicize bioterrorism as a national security priority. Drafting a trio of reports, Defense named bioweapons as the new central threat to national security. John Deutch, former director of the CIA, wrote in a 1998 Harvard University study, “If the device that exploded in 1993 under the World Trade Center had [distributed] a deadly pathogen, the chaos and devastation would have gone far beyond our meager ability to describe.” Brookings Institute scholars told the Bush Administration they should concentrate homeland security efforts on doomsday terrorist scenarios that have the potential for causing the greatest number of deaths. Since developing defensive biological strategies presupposes the need for testing material, the United States should quickly gear up to produce an offensive biological capacity. Through congressional hearings they laid the groundwork for a whole new series of defensive programs against the threat of anthrax, but most were never implemented.

“Terrorists will use weapons of mass destruction as soon as they perfect the means of delivering them,” said former FBI deputy director Oliver Revell. “Both nuclear and chem- ical are difficult [to deliver], but biological are much less so. They are readily available and can be delivered through many means. Where you have groups that have state sup-

port, then I think biological pose a serious risk and that genie is already out of the bottle. Would they be able to wipe out the population of the United States? No. But could they cause thousands, perhaps even hundreds of thousands, of casualties? I think the answer is absolutely yes. With the Internet, with Global Positioning Satellites, and with mobile communications, a small terrorist group has more command, control, communications and intelligence capability than nation-states had, except for great powers, years ago.”

The FBI had already established a tiny presence in Dade County, Florida, because the skyjackers of the jets crashed into the WTC and in a Pennsylvania field had spent time in the area. Since Stevens had been stricken, the number of agents in Dade had doubled and would soon triple. News- men in choppers hovering above AMI televised the covered portico and terraced front of the tan and white building be- low. A number of cars were parked in the employees’ lot in back. Along a windbreak of palms, an American flag fluttered in front. The words “American Media,” in black upper- and lowercase, were set off by black-trimmed win- dows. From above, the complex’s extensive air-conditioning system on the roof was visible as two huge rectangles.

After Koplan called FBI Director Robert S. Mueller III, an army of federal investigators inundated the region look- ing for a possible connection to 9-11. But the government agents and Dr. Perkins perceived the outbreak and its after- math differently. The FBI saw the AMI building as a crime scene jam-packed with clues that would lead them to a killer. Perkins visualized the site as a means of identifying the source of a contagion and saving lives.

A few years earlier, Dr. Perkins had been part of a New York City bioterrorism exercise. On Sunday, November 9, 1997, city emergency workers evacuated “victims” of a mock bioweapons attack a few blocks from City Hall. Per- kins’s experience with law enforcement there had been eye- opening. The mock scenario concerned a Manhattan office building deliberately contaminated with “anthrax” by ter- rorists. One NYPD officer was asked what he would do in the event of such a situation. “Bring in the tank,” he said. “The tank?” asked Dr. Perkins. “It’s a show of force,” the

cop replied. “So I had been educated about this,” Perkins said later, “but investigation was easier before the FBI was really involved. Before Public Health was in charge. Now it was a criminal investigation. At that point I decided to chemoprophylax [treat with antibiotics] people who had worked in the building.”