Yesterday, for about an hour, many in New York thought there had been another terrorist attack when news of a Brooklyn man infected with inhalation anthrax spread like gossipy spores in the street. When it was later discovered the man was likely self-infected by his working with untanned goat skins to make handmade drums, the City actually paused for a public moment to catch its breath before we all returned to our inner lives.
Anthrax is ancient and organic — some scholars believe the plague in Thebes that destroyed the land and animals and King Oedipus was anthrax — and while not always deadly in small organic quantities, anthrax has an historic relationship with ordinary life on farms with animals. Other than the militarized anthrax scare during the 9/11 crises, the last time an anthrax infection was reported in America happened in 1976.
The key word in that last sentence is “reported” because if you spend any time at all on a farm, anthrax is always a threat lingering in the air and on the skin even if your entire herd is immunized because your animals are exposed to other animals in the wild open and while your animals may not get infected they can, in turn, infect you through their hides or hoofs. Most farm families understand the anthrax threat and they deal with it as the expected price of farming and see no need to make an official “report” to government agencies for investigation and absolution.
If you get a cut on your arm while farming and it turns nasty and won’t heal, you don’t call the Centers for Disease Control and Prevention to report an anthrax poisoning, you suspect your infection is probably anthrax and you just take the salve you made from your great-grandmother’s recipe and lather it on the hurt spot and in a few days your skin clears up. You’ll have a scar where your skin puckered with anthrax but it won’t kill you.
If you still feel sick, you head into town to see the doctor to get on a pill regimen to clean you out from the inside. Inhalation anthrax doesn’t happen as much as skin tainting on farms because the anthrax spores are generally embedded in dirt or in feces and the spores are not small enough or light enough to find purchase in the wind and into your lungs.
The key to wiping the anthrax out of your skin is speed in suspicion, identification and remedy. It is the very lack of speed and suspicion and identification and remedy in the New York case that gives cause for great common good concern. New York City mayor Bloomberg held a press conference yesterday at 3:30pm to calm all lingering fears about another terrorist anthrax strike.
The press conference was informative and knowing and, from a Public Health/Public Relations perspective it was a smashing success. However, the murky undertone of the anthrax event lurking just below the unspoken surface is unnerving when you take a moment to consider the timeline for the discovery of the anthrax infection as reported in today’s New York Times:
The man is believed to be infected by the goat hides in his workspace in Brooklyn.
The man collapses after a performance in Pennsylvania and is hospitalized in that state.
The man’s blood is tested for infection.
The man is transferred to a more sophisticated Pennsylvania hospital 60 miles away.
The man’s blood continues to be tested.
The man’s blood “begins” to show signs of anthrax infection. Blood samples are sent to the Pennsylvania Department of Health for more tests.
February 21 The presence of anthrax in his blood is confirmed by the Pennsylvania Department of Health. A Public Health investigation is initiated and the New York City Department of Health are notified as well as the CDC and the FBI. The CDC are given blood samples for their own analysis.
February 22 The CDC confirms the anthrax infection and the man’s workplace and apartment are quarantined. Four people who interacted with the infected man are provided antibiotics. Do you see the terror in the non-terrorist timeline of anthrax infection and detection? It took seven days from suspected infection to diagnosis confirmation to public notification. That kind of delay is deadly. The infected man is currently in “Fair” condition in the hospital and he is cooperating with the investigation but what if he had been unable to speak?
What if he had been unable to tell his goat hide story? What if he had been a terrorist stricken with his own anthrax and refused to cooperate at all? How fast would the quarantine process been initiated in that case?
If this had been a dedicated terrorist dispersal of militarized anthrax the toxic end result would have happened faster and been far deadlier for many more people. There needs to be a faster process for testing blood for anthrax — as well as other bio-terror hazards — and an immediate response from city, state and federal officials must be forthcoming from the first moment of suspicion.
The public’s right to know — even if the news is bad or malformed — must trump the government’s desire to be cautious and needlenosed. The infected man’s workplace and apartment should have been sealed upon the first suspicion of anthrax on February 20 and not two days later.
That incredible delay allowed the possibility of anthrax exposure to thousands of people in Brooklyn where the man worked and in the West Village where the infected man lived. Today we must assume by default that any slight indication of anthrax poisoning is terrorism first and incidental exposure second and those pledged to protect our public welfare must take quick action to isolate areas and quarantine individuals — we can always ramp down from that point of high concern when it is discovered the inhalation anthrax poisoning was accidental and not purposeful.
To parlay the reverse is to play a deadly waiting game where a test result, instead of common sense, sets Public Health policy for millions of vulnerable and unsuspecting people.