"You always wish you knew on Day 1 what you know on Day 20," says Dr. Jeffrey Koplan, director of the Centers for Disease Control and Prevention (CDC). "Are we going to miss some? I'm afraid that's the nature of these things in general." The probe is "as major as anything we've done," he says.
As of mid-afternoon today, 16 people have contracted anthrax or suspected anthrax, including three who died from the disease, government officials say. Eight cases are the skin form of anthrax, while seven are inhalation anthrax, the most serious form of the disease and the one responsible for the fatalities.This afternoon, the State Department announced that a mailroom employee at a Sterling, Va., handling facility has been diagnosed with anthrax and has been hospitalized. "When and how he was exposed is not known," says Frederick Jones, a State Department spokesman. He says he doesn't know what form of anthrax the worker has.
However, the letters and parcels processed at the building come by way of the Brentwood mail facility in Washington where an anthrax-contaminated letter to U.S. Senate majority Leader Tom Daschle was processed.
All of the State Department's mail handlers were prescribed preventive courses of Cipro Wednesday, including the 135 employees at the Sterling facility, Jones says. The department is no longer accepting mail.
The first death, which occurred in early October, was a photo editor at the Florida tabloid paper The Sun. Two Washington, D.C. postal workers died this week from the illness, presumably after coming into contact with contaminated letters at the Brentwood facility.
Before the State Department announcement this afternoon, the latest case of suspected inhaled anthrax had involved a reporter who was near Sen. Daschle's office the day the letter containing the bacteria arrived. She is being treated at a Maryland hospital. Investigators have since found anthrax spores in several locations in the Hart Senate Office Building, where Daschle works.
CDC officials say their investigation now is focused on finding traces of anthrax in any of the 100 mail facilities fed by the main station in Washington. They also have flown in planeloads of experts, who are working around the clock. Tests from those facilities will take at least 24 hours to prove negative, and perhaps longer to confirm presence of the germ, they say.
The CDC says every state in the nation and many local health departments have received suspicious letters, but for the time being anthrax has been confirmed only in four places: Florida, New York, New Jersey and Washington, D.C.
"We would be naìve to think that this is over yet," warns Dr. Julie Gerberding, acting deputy director of the CDC's National Center for Infectious Diseases.
As of today, thousands of Americans, many of them postal workers, were taking preventive doses of antibiotics in case they came into contact with anthrax. Earlier this week Bayer Corp., which makes Cipro, agreed to sell 100 million tablets of the drug to the government at 95 cents a pill, a steep discount from its usual price. Health officials also are stressing that less expensive antibiotics, especially doxycycline, are effective against anthrax infection.
"We don't want to send the message that the only thing you should take for prevention is Cipro," says Gerberding. Prescribing a variety of antibiotics can help avoid making other germs resistant to Cipro, she says.
Gerberding says the Food and Drug Administration has been "bending over backwards" to kick-start trials with drugs that might help neutralize anthrax toxin.
Koplan and Gerberding spoke to reporters today at a hastily-arranged teleconference a day after Surgeon General David Satcher said the CDC was "wrong" to downplay the threat to Washington-area postal workers. Initially, health officials insisted that infection was all but impossible, and simply concentrated on tracking the path of the contaminated envelope sent to Sen. Daschle.
"The best we can do is to follow the trail of a given letter," Koplan says. "That's what we were doing as these inhalation cases occurred" in Washington, two of which proved fatal. "If we had seen inhalation disease [initially] then we would have behaved very differently."
Koplan says investigators are somewhat puzzled about how the anthrax at the Brentwood handling depot might have escaped from envelopes, which appear to have been carefully sealed. The letter to Sen. Daschle, for example, was taped so securely that it had to be cut open.
But when anthrax spores turned up not only around the mail sorting equipment but in an area well apart from those machines, Koplan says officials were forced to revise their assessment that the germs involved didn't pose a significant threat of airborne infection.
There have been mixed reports about the strength of the anthrax found so far. A number of bioterror experts have said they believe the highly virulent pathogen mailed to the Senate, though not the strain sent to Florida or to the New York news agencies, shows signs of tinkering that could only have been performed at a sophisticated laboratory, such as one with government support. But Gerberding says the agency has "absolutely no evidence to suggest that these isolates have been genetically altered" or engineered.
Only the United States, Russia and Iraq are known to have substantial anthrax weapons programs, terrorism experts say.
What To Do
Health officials continue to stress that people should not take antibiotics unless they've likely been exposed to anthrax. Doing so probably won't hurt you, but it weakens the effectiveness of the drugs over time by promoting bacterial resistance. And the drugs can cause side effects. "We've already seen some significant adverse effects from these antibiotics," Koplan says.
If you are prescribed antibiotics after confirmed exposure, be sure to take them for the full 60 day course, Koplan says. Doctors may cut back the dose once exposure has been ruled out.
Although a mail recipient's risk of contracting anthrax appears to be "very, very low," Koplan says washing one's hands after handling mail is a good idea.
For the latest information about anthrax, check the CDC.
For more on defending against bioterrorism, visit the Center for Civilian Biodefense Studies or the Association for Professionals in Infection Control and Epidemiology.
For more on the various bioterror weapons, try the American Medical Association.