The Anthrax Letters: The Attacks That Shocked America (14 page)

“George,” the caller said, “this is Polly Thomas.” Dr. Thomas, a physician with New York City’s Health Department, had known DiFerdinando when he was at the New York State Health Department. Her call came on October 12 at 12:30 p.m., about 9 hours after CDC Director Koplan’s middle-of-the-night briefing to Marci Layton. Thomas was on the line to alert him that New York City’s health commissioner, Neal Cohen, and Mayor Rudy Giuliani were about to hold a press conference. “They’re talking about a cutaneous anthrax case, an NBC employee. The health department is recommending antibiotics for certain people there,” she said.

“Do you know the source of the bacteria?” DiFerdinando asked.

“There’s confusion. It may be a September 25 letter. It might be one from September 18,” she responded.

DiFerdinando thought to himself: “Okay, George, think clearly. Between one-fourth and one-third of the people at NBC are probably New Jerseyans. Some of them would go to Valley Hospital in Ridgewood, Holy Name in Teaneck, Hackensack Hospital, and others in the area. We’ve got to alert them all.”

DiFerdinando and Thomas reminded each other that New York City’s Health Department protocols for responding to bioterrorism were identical to New Jersey’s. Area hospitals and health care providers needed to prepare for the worst. New Jersey’s Office of Emergency Management is under the authority of the state police. “We immediately got them to activate the Emergency Operations Center phone bank,” DiFerdinando says.

The next morning, Saturday, October 13, he met with six top health department officials. “Dr. Eddy Bresnitz, the state epidemiologist was there, James Blumenstock, an assistant commissioner, others.” Even though the anthrax letter sent to Senator Daschle would not be discovered for another 2 days, the New York case had already shocked everyone—it was the first outside Florida. They hooked into a conference call for an update from Health and Human Services Secretary Tommy Thompson and the CDC’s Jeffrey Koplan. “I think every department of health in the United States was on the call,” DiFerdinando says.

But an even more significant item of news had begun to circulate. Headlined “Anthrax Found in NBC News Aide,” a
New York Times
article reported that the aide, Erin O’Connor, may have been infected by an anthrax-filled letter some weeks earlier. After developing a rash on her chest, the article said, the sore “turned almost black, and she developed a low-grade fever.” DiFerdinando says: “The report got the attention of two physicians in New Jersey who were taking care of postal workers from the same post office who had unusual cutaneous illnesses. Each doctor called in about their patient. Both patients had become ill within a few days of each other in late September.”

The FBI interviewed the physicians and found that one of them had sent a patient to a plastic surgeon who had removed the infected tissue and preserved it. When the FBI learned about this, the bureau had the specimen sent over to the state laboratories.

Dr. Faruk Presswalla has been New Jersey’s chief medical examiner since 1997. After immigrating to the United States from India in the 1960s, he worked in the health departments of New York City and Virginia. “I was reading about the first cutaneous case, Tom Brokaw’s assistant,” he recalled, “when my phone rang.” It was Dr. Eddy Bresnitz, New Jersey’s epidemiologist. In some states the office of the medical examiner is under the state’s health department but not in New Jersey. There it is under the Department of Justice. Bresnitz was calling from the Department of Health:

“Faruk, we have a biopsy from a postal worker who had a skin lesion. Her doctor remembered it was black and didn’t resolve—had to be removed by a plastic surgeon. We’d like you to look at it for anthrax.”

“Why don’t you send it to CDC?” Presswalla asked.

“The CDC said they couldn’t do it quickly. They’re being bombarded with requests for tests. The FBI is anxious.”

Presswalla hesitated. He told Bresnitz that his laboratory was not equipped to provide a confirmation of anthrax. “But I can do the histology and rule out a spider or arthropod bite.” If the lesion was caused by a bite, Presswalla said, a microscopic examination should show evidence of a blister or redness along with leukocytes—white blood cells—that the body dispatches to destroy disease-causing organisms.

Late in the evening of October 15, the FBI brought the specimen to Presswalla’s laboratory in Newark. The next morning, he prepared it for examination. Meanwhile he remembered that some 40 years earlier in India he had seen a case of cutaneous anthrax. Presswalla is short and his dark hair has thinned out. In a melodious East Asian accent, he explained: “My mind went back to that time. Now, when I looked through the microscope, it seemed familiar—a paucity of leukocytes, local necrosis, Gram-positive rods.
Bacillus subtilis
and
Bacillus cereus
look like rods, but in that context—in tissue—I was 95 percent certain that it was anthrax.”

He called Dr. Bresnitz and the FBI and provided them with the specimen and slides for delivery to the CDC. He contemplated what all this could mean and began to worry about his own mail: “I told people in the office, when the mail comes in, we wear gloves and wipe everything with a wet paper towel. And I told my wife not to open mail. I’ll do it. I wore gloves and I wiped envelopes and opened them on the hardwood floor at home.”

Presswalla’s worries during the week of October 15 mirrored much of the nation’s. Another doctor who had treated an anthrax patient told me that he and other infectious disease specialists feared they would be targeted by bioterrorists. Reports of anthrax in Washington, New York, and now New Jersey seemed to be rolling out in an indecipherable jumble. Realizing that the mail was involved only added to the anxiety. How many anthrax letters had been sent? How dangerous was other mail that the contaminated letters may have touched? How dangerous was the post office? These uncertainties played on people’s minds everywhere. Senators, doctors, teachers, laborers, police, firemen, FBI agents—all get mail.

O
n Friday night, October 19, 2001, Joseph Curseen went to work for the last time. Three days later he was dead. For 15 years Joe had been pulling into the parking lot of the mammoth postal distribution center on Brentwood Road in northeast Washington, D.C. He was there when the facility opened in 1986 and a year later when rows of rectangular holes mysteriously began to appear in the parking lot. “Brentwood,” as the center was called, had been built over a graveyard and the asphalt was sinking into empty graves.

The 632,000-square-foot structure is large enough to accommodate 10 football fields. Until it closed because of anthrax contamination in 2001, its machines whirred and hummed through three shifts, 24 hours a day. With the help of these machines, 2,100 employees toiled in its cavernous space to separate, sort, and deliver nearly 2 million pieces of mail every day.

Joe Curseen was part of that routine. Upon arriving at work shortly before the 10:30 p.m. to 7 a.m. shift, he would hang his coat in the locker next to the cafeteria on the second floor. An escalator ride to the vast ground floor area would bring him near the time clock. That Friday, as always, he met his work partner, Jim Harper, next to the clock. And as always, Joe shook his hand and asked, “How you doing, Harper?” It was a ritual of friendship that Harper much appreciated.

After punching the clock, they turned right and walked past an array of cubicles and machines. In every direction stood racks, white plastic tubs, carts of assorted sizes, some containing mail to be processed, some empty and awaiting incoming shipments. Broad conveyor belts, angled at 30 degrees, were moving unprocessed mail up into chutes for initial separation. Yellow lights blinked in synchrony with loud beeps to signal that a sorting machine was being turned on. The feeling was that of an amusement park in which the mail was being treated to dizzying rides and bright lights.

Toward the far end of the building, Curseen and Harper arrived at machine number 17, the “delivery-bar-code sorter” that they had been operating together for 2 years. The machine contained four rows of bins, one above the other, extending more than 60 feet. Altogether there were 250 bins.

“Joe, you want to start loading and I’ll sweep?” Harper asked. That was the way they usually began their shift. Sweeping, in this case, meant pulling the sorted mail out of the bins. “Sure,” Curseen answered, knowing that in an hour he and Harper would switch positions as a matter of course.

Curseen felt as if he was coming down with a cold; nothing serious. He reached into the cart next to him, wedged about 200 letters between his palms, and placed them on the waist-high conveyor belt that feeds into the machine. Bill Lewis, a veteran postal mechanic, knows the sorting machines inside out:

How long does it take for a letter to go through a sorting machine? “It goes so fast you can hardly follow it with your eyes,” Lewis said. Three or four seconds from beginning to end, including a process that sucks the letter under an electric eye that reads the bar code and directs it to a bin.

Curseen’s sorter was the last machine through which a letter would pass. By that time other machines had already imprinted cancellation lines and bar codes on the envelope. But the ride through the sorting machine was also quick and turbulent. Letters poured into the bins at a rate of 13,500 per hour. Harper’s job, alternating with Curseen’s, was to pluck them from the bins and place them in plastic tubs. The sorted mail would be loaded on trucks headed for post offices, perhaps to an airport, or directly for local delivery.

Appreciation of the mail as an essential means of communication in America predates the birth of the republic. In 1775 the Continental Congress named Benjamin Franklin, perhaps the most venerated citizen of the time, as the first postmaster general. (Historian Alan Taylor deemed Franklin “the leading figure in colonial politics, literature, science, and social reform.”) His mandate included the establishment and regulation of post offices “from one State to another.” After the Constitution was adopted in 1789, one of the first acts of the new Congress was to establish the Office of the Postmaster General. The office was given authority over the country’s 75 post offices and its 2,000 miles of post roads and was seen as instrumental in fostering both commerce and national unity.

During the next two centuries, the operations of the postal service were linked to the advance of technology. Transportation of the mail, which started by horse, later included conveyance by rail, sea, and air. To this day, mail is delivered by train, truck, boat, and airplane, and in the Grand Canyon by mule. Despite the emergence of other methods of communication—notably the telephone and the Internet—postal communication remains a vital part of American life.

In 38,000 post offices, the U.S. Postal Service handles more than 200 billion pieces of mail a year. Every person in the United States receives, on average, two to three mail items a day. In every part of the country the mail is channeled through large distribution centers like the one on Brentwood Road in Washington, D.C.

Thursday, October 18, 2001, was a pivotal day in the anthrax crisis. Although feeling out of sorts, Joe Curseen was still working at his post with his friend Harper. Until that day, four people were known to have been infected with anthrax: Bob Stevens (who had died) and Ernie Blanco from American Media, Inc.; Erin O’Connor from NBC; and the baby of an ABC employee in New York City. In addition, the day before, on October 17, twenty-eight people were found to have been exposed to anthrax by the letter sent to Senator Daschle. In all these cases the risk seemed limited to people in the vicinity of an opened letter. On October 18, another such case, that of Claire Fletcher, who opened mail at CBS in New York, was reported.

But additional findings that day raised new and larger worries. A lesion on mail carrier Teresa Heller’s arm was confirmed by the CDC as the first anthrax infection in New Jersey and one on mechanic Richard Morgano’s was a suspected second. (His blood specimen contained antibodies to anthrax.) Moreover, they were the first postal workers identified as having anthrax. Heller was based in the West Trenton office in Ewing Township and Morgano at the nearby Hamilton distribution center, where letters were postmarked “Trenton, NJ.”

October 18 was also a day of paradox. Although postal employees had not previously been considered at risk, many were worried, especially at the Brentwood and Hamilton facilities. To dispel anxiety, U.S. Postmaster General John Potter decided to make an appearance at Brentwood. On Thursday afternoon, October 18, he visited the center and mingled with employees. At a press conference in the large working area, he announced a $1 million reward for information leading to the culprits responsible for the anthrax letters. Potter assured the assembled workers that they were not in danger. The Daschle letter, he said, “was extremely well sealed, and there is only a minute chance that anthrax spores escaped from it into the facility.” Neither Potter nor anyone else realized that, as he was speaking, postal workers there and elsewhere had already been infected.

Officials did not order the Brentwood facility closed until Sunday, October 21. But in New Jersey the decision to close Hamilton came earlier. It was prompted by the news about Teresa Heller and Richard Morgano. Heller had first noticed a red sore an inch above her wrist, on the palm side, on Friday, September 28. “It itched a lot,” she said “and in a couple of days it blistered and turned into a brown scab.”

Heller, 45, had been a mail carrier for 8 years at the West Trenton post office. Soft spoken and reticent, she has routinely refused requests for media interviews. One year after the incident, she was willing to tell me about her experience. On October 1 she had decided to see her physician, Dr. Elsie Jones. (The name is a pseudonym at the doctor’s request.) She said, “By the time I went to the doctor, the scab had gotten bigger and turned black, and my wrist had started to swell up. I told her that someone at work said it looked like it could be a spider bite.”

Dr. Jones clearly remembers Heller’s visit. “The lesion looked deep and purplish. I had never seen anything like it before,” she said. “Were you doing anything unusual, maybe outdoors?” Dr. Jones asked Teresa. Teresa couldn’t think of anything out of the ordinary. “You know, when I’m walking on my route, sometimes I go by some bushes.” “Any insects bite you?” “Not that I remember.”

They both understood, of course, that Teresa could have been bitten and not realized it. Elsie Jones, a family medicine practitioner, prescribed Avelox, an antibiotic that, like Cipro, is in the quinolone family. Because the infection seemed like it might have reached her bone—“it was the deepest cellulitis I ever saw”—she made an appointment for Teresa to see an orthopedist, thinking he would scrape out the necrotic tissue.

That night Teresa felt worse. “I started getting a fever, and my arm was swelling from my wrist to my elbow.” The next day the orthopedist looked at her arm and said he could not do anything for it. Then he and Dr. Jones decided to send Teresa to a plastic surgeon.

By the time Dr. Parvaiz Malik, the plastic surgeon, saw Teresa on October 3 she had “spiked a fever” and he put her in the hospital. On October 5, Teresa was discharged. That was also the day Bob Stevens died in Florida, though at that point no one dreamt that the two cases were related. Meanwhile, Dr. Malik had scraped out the blackened wound on Heller’s arm. “Most of the time I just throw necrotic tissue away,” he says. “But this was a good size, and I tossed it in a bottle of formalin and left it sitting in my office.” Formalin, a mixture of formaldehyde and water, is a preservative as well as a germ killer.

Dr. Jones’s husband, also a physician, shares an office with his wife. He saw Teresa’s lesion when his wife did, and he was equally puzzled. On Saturday morning, October 13, the day after the CDC’s confirmation of the first skin anthrax case in New York, Dr. Jones was out shopping with her children. Her husband was at home, listening to the news on the radio. The first thing he said to his wife when she returned was: “What if I told you there was a cutaneous anthrax case at NBC in New York?” She understood the implications immediately. “A light flashed on for both of us.”

Dr. Jones had not only been Teresa’s physician for 10 years, she was also a neighbor. Their homes are in Bordentown, and “she lives right around the corner from me,” Teresa said. That Saturday afternoon Dr. Jones “stopped by my house. She told me what she had just heard, and that she had been reading more about the symptoms of anthrax, and that they sounded like mine. She knew I was a mail carrier. She said, ‘It just seems like too much of a coincidence.’ Then she asked if I wouldn’t mind if she contacted the authorities.” Teresa, whose husband is a sheriff’s officer, readily agreed. Even though she was feeling better by then, when she heard she might have anthrax, she was “a little shaky.”

In thinking about that afternoon, Dr. Jones evinced some frustration. She returned home and called the local police, “but they weren’t interested.” Then she tried the state police. “They weren’t interested either, but they suggested we contact the FBI [Federal Bureau of Investigation] or the state’s emergency hotline. I called both.”

She also phoned Dr. Malik. When his pager went off, Malik was at a fundraising dinner for his hospital, the RWJ Hamilton. He left the dining table to return the call. “It looks like Teresa Heller’s lesion might be anthrax,” Dr. Jones said. “I’m shocked,” he replied, and acknowledged later that he felt frightened by the news. When he returned to the table his wife asked, “What’s wrong? You look troubled.” He told her what he had just heard and then thought about the tissue specimen that was still in his office. “I called the CDC and said someone should pick it up and look at it. They suggested that I call the FBI.” When Malik reached the FBI, an agent said he would meet him at his office.

That night at 10 p.m., as Malik handed over the bottle containing Teresa’s black specimen to the FBI agent, he said, “I hope you can help get this checked quickly.” “Yes, we can do that,” the agent said. The specimen was delivered to Eddy Bresnitz, the state epidemiologist, then to Faruk Presswalla, the medical examiner, for initial testing, and ultimately to the CDC.

Malik did not hear from the FBI or any other authorities. Five days later, while watching television, he learned that the skin specimen had tested positive for anthrax. He was eager to see the laboratory report. “I called the FBI twice and then the CDC.” Months later he still had not seen the report. “I took pictures of the lesion, and I wanted to write an article for a medical journal, but I can’t do it until I get the report.”