Anthrax Threat

GWEN IFILL: Hundreds of people lined up at the Palm Beach County Health Department today to be tested for exposure to the dangerous bacteria, anthrax. Nasal swabs and blood tests were offered to anyone who has worked at or visited the offices of American Media since August 1.

American Media, publisher of the Globe, the National Enquirer, and the Sun newspapers, is located in Boca Raton, not far from Palm Beach County Park Airport, where at least one of the September 11 hijackers took flight lessons. Federal officials confirmed the first case of anthrax last week. By Friday, that victim, Robert Stevens, a Sun editor, had become the first person in 25 years to die from inhaled anthrax in the U.S. Yesterday state health officials said they found inhaled anthrax spores in the nasal cavity of a second employee. That man has not contracted the illness.

DR. STEVE WIERSMA, State Epidemiologist, Florida: This is not a second case. We have evidence of someone being exposed to this bacteria. That is very different than a case. We don't believe this person is suffering from the disease caused by anthrax.

DR. JEAN MALECKI, Palm Beach County Health Department: We do know that there has to be a certain dosage, a dose of the number of spores to be inhaled to be able to come down with this disease. So yes, it is very likely you can have one or two spores and not come down with this disease.

GWEN IFILL: The flu-like symptoms of anthrax can show up within twelve hours to five days after exposure. Timely antibiotic treatment can stop the disease, but, untreated, it infects the lungs and is often fatal within days. No one knows how anthrax got into the Florida building, but yesterday, anthrax spores also were found on a computer keyboard. FBI officials sealed the building, and began treating the case as a criminal investigation. Attorney General John Ashcroft would not rule out terrorism.

JOHN ASHCROFT: We are unable to make a conclusive statement about the nature of this as either an attack or an occurrence, absent more definitive laboratory and other investigative returns. We regard this as an investigation, which could become a clear criminal investigation.

GWEN IFILL: The reports out of Florida, and scares elsewhere, have made for a jittery public.

WOMAN ON STREET: I don't know -- it is hard to avoid things, because you don't know what. Do you not eat food? Do you not open your mail? You not open your bills and send them back? What do you do?

GWEN IFILL: But President Bush, speaking at the White House today, said the government has the situation well in hand.

PRESIDENT GEORGE W. BUSH: There is a system in place to notify our government, and governments, in the case of some kind of a potential biological incident or chemical incident.

And the system worked. And now the system is even working better, because we have, in essence, gone into the building, cleaned the building out, taken all the samples as possible, and are following any trail, any possible trail.

Thus far, it looks like it's a very isolated incident. But any type of incident, any type of information that comes into our government we take very seriously.

GWEN IFILL: Since Sunday, federal officials have taken more than 100 cases of antibiotics from the national pharmaceutical stockpile and shipped them to Florida.

GWEN IFILL: For more on anthrax threat, we turn to three public health experts. Dr. Margaret Hamburg, Vice President for Biological Programs at the Nuclear Threat Initiative, a Washington-based foundation. She was also an assistant secretary for Health and Human Services during the Clinton Administration, and New York City's Health Commissioner in the early 1990s. Dr. Mohammed Akhter, executive director of the American Public Health Association, an organization representing over 50,000 public health professionals. And Lawrence Halloran, staff director and counsel for the House Government Reform Subcommittee on National Security.

Welcome, everyone. Dr. Hamburg, how serious are these cases that we're hearing about in Florida and how unusual are they?

DR. MARGARET HAMBURG: Well, as reported, this is an isolated case of anthrax but it's a very unusual form of anthrax, inhalational anthrax. There hasn't been a case of inhalational anthrax reported in this country since the late 1970s and only about 18 since the turn of the century, so it obviously is something that is of great interest and concern to both the public health community and more broadly.

GWEN IFILL: Is this the kind of a disease that can be naturally occurring, whatever that means?

DR. MARGARET HAMBURG: Well, anthrax does occur naturally. It's mainly a disease in livestock but humans can get it. Often they get what's called coetaneous form or skin-related form through handling of an infected animal or animal materials.

You can also ingest infected meat and occasionally breathe it in and get the kind of disease we're talking about today, inhalational anthrax.

GWEN IFILL: Dr. Akhter, from what you have read about this particular case, how does it strike you that this kind of anthrax could have come to find its way into an office building?

DR. MOHAMMED AKHTER: It's quite unusual. There's no question in my mind that there were no cows or sheep or wool being processed in the building.

This is a new building. And to find two cases where one is actually, a person has died from the disease and the other one has the anthrax spores in his nasal cavity, that these were brought in by a human.

This is clearly a criminal case where further investigation by the intelligence agencies is warranted to really make sure where this came from so that we can get to the source of it and make sure that this kind of stuff will not happen in the future.

GWEN IFILL: Mr. Halloran, this is not a contagious disease. How can there be two people with the same-

LAWRENCE HALLORAN: The most likely scenario at this point is the situation that the FBI deals with all the time. They get, before were hoax calls to say someone has mailed an envelope containing a suspicious powder to a building; we had one here in D.C. a year or so ago.

In this case it looks like someone got ahold of some anthrax, put it into an envelope and sent it through in the mail to a building addressed to the reporter, who appears to have opened it at his keyboard, spilled some, inhaled some, and gotten quite ill.

GWEN IFILL: So this had to be deliberate?

LAWRENCE HALLORAN: I think there's very little alternative. It's like watching the World Trade Center. One plane might be a pilot who had an accident. Two planes you connect the dots and somebody had to be behind it I think.

DR. MARGARET HAMBURG: I mean, it could be potentially a more benign story that maybe he received a goat skin in the mail and opened it up and it spread some spores - but -- an infected shawl, who knows what.

But it's very hard to imagine and clearly there was a common source that dispersed the spores through the air. He breathed it in, got terribly sick and someone else was exposed.

LAWRENCE HALLORAN: Particularly inasmuch as this turned out to be a lethal strain. There are many strains of anthrax, many which are lethal to animals, not all lethal to people. And to narrow it down to lethal strains to human again has to raise suspicions that this was perniciously planned.

GWEN IFILL: Dr. Akhter, is our public health system prepared to cope with this kind of whatever it is, infection, spread?

DR. MOHAMMED AKHTER: Let me say that the way the florid people acted is commendable. Truly the system worked. We were about to identify the case very quickly. We were able to deal with the people there.

But the system isn't as ready as we would like to see it. We are under prepared. You saw these people just a moment ago, lines around the health department waiting to get their drugs. Just imagine if there were 5,000 or 10,000 people in the building. That's when really the trouble starts. So we don't have the surge capacity to deal with this additional number of people that would be around, that will stretch our resources. So what we need to do is really expand our resources, to make sure that we are able to deal with the larger incidents.

GWEN IFILL: When you say we, do you mean government, state, local, private institutions?

DR. MOHAMMED AKHTER: I think we're all in this together. Certainly the governments take the lead. It is the people who are first contacted. These are the folks, the medical community. They then call the health departments. The health department calls the CDC, we then call the FBI, so we are all in this together as the private sector, as the government. Everybody needs to work together to make sure....

GWEN IFILL: But none of us ready for it?

DR. MOHAMMED AKHTER: I think we're quite ready in Florida. But for the rest of the country, that may not be true.

LAWRENCE HALLORAN: We're ready for a smaller or isolated outbreak in one, maybe two occasions that we can identify quickly enough and deal with.

We're not ready for a scenario such as unfolding in a dark winter exercise where you have deliberate release of an infectious agent in three locations of this country, which would overwhelm.

The other thing is we're not prepared to deal with the media's role in this. This is very much a public event an outbreak. And we are definitely not prepared in our public health system to deal with a mass of the worried well who hear it on TV or that there's a disease outbreak and will rush to the emergency room and definitely would swamp the system; we don't have - we're not prepared to deal with that.

GWEN IFILL: The worried well. That's a new phrase. Dr. Hamburg how about beyond just anthrax? We are all focused on this particular one disease.

What about something like smallpox? You've dealt with tuberculosis outbreaks.

DR. MARGARET HAMBURG: Well I think whether you're looking at naturally occurring infectious disease or intentionally caused infectious disease, we as a nation can and must do better in terms of preparing.

We need to really support our public health infrastructure because they are the first line of response to an incident, particularly a bio terrorist attack. We would not have a lights-and-sirens kind of reaction where we would know that something had happened and be able to mobilize a response.

Instead days, even weeks later, we only learn about it -- unless there was an announcement that says an attack had occurred -- when cases started to appear in doctor's offices, emergency rooms and hospitals.

GWEN IFILL: Where is the front line in a war like this? How do you begin to cope with it? What should we be doing now to prepare for what may happen?

DR. MARGARET HAMBURG: Well, there's an array of activities that need to be undertaken but with respect to the public health and medical preparedness, first and foremost we need to invest in a critical set of public health needs -- the ability to do disease detection -- outbreak investigation on the ground, the need to educate medical professionals to recognize these kinds of diseases or unusual clusters of symptoms and report them to the public health department.

There needs to be someone on the other end of that line to answer and respond. We need to improve our laboratory capacity to make these diagnoses, and we need as a nation to have a pharmaceutical stockpile as mentioned in the film clip that can rapidly mobilize the drugs or vaccines that are needed in the event that a major attack occurs.

GWEN IFILL: Dr. Akhter, this sounds very expensive getting ready.

DR. MOHAMMED AKHTER: I think it's going to cost money. This is terrorism. To deal with it is not cheap. We as a nation have no other alternative but to prepare ourselves. When unthinkable happened in New York, it just... All bets are off.

We can't simply say it may not happen or it's going to cost too much. I think the only choice we have is to prepare ourselves and do the kinds of things that we have been advocating for many years to do, and having all our front line workers-- the doctors, the nurses, the people who the patients come in-- educated.

We have not seen a case of smallpox in this country. We have not seen many of these tropical diseases. Having them prepared and then having them connected to local health departments and somebody be vigilant watching every day.

By the way, many of these local health departments are 9:00 to 5:00 operations at this time. If something happened on Friday night, there would be nobody there to take your call until Monday morning, so we've got to change that.

GWEN IFILL: Mr. Halloran, what should we do?

LAWRENCE HALLORAN: The good news about public health expenditures is that just as the technology of making weapons is called dual use technology -- you can make a vaccine as well as you can ferment anthrax.

Public health capacity is truly dual use technology. It is good every day, all day against the flu, against a natural outbreak and against a terrorist outbreak. And so it is really a very wise investment of public dollars that serves us well every day even when the terrorists aren't lurking about.

GWEN IFILL: Is the risk truly greater since September 11 or are we just paying attention for the first time?

DR. MARGARET HAMBURG: Well, I don't think the risk has changed or our vulnerability but certainly the perception has changed dramatically and I think has changed forever just as Dr. Akhter was saying.

After having witnessed the devastation that occurred in the World Trade Center and the clear intention to cause as much damage as possible I think nobody feels comfortable saying that certain groups or terrorists wouldn't use these kinds of weapons if they could get their hands on them.

GWEN IFILL: Do those changed perceptions create the potential for an overreaction?

DR. MOHAMMED AKHTER: I don't think that I fully agree that risk has not changed. I think the risk has changed. With us declaring war on terrorism, the risk of a response on us, doing something to us, has increased.

All our intelligence agencies tell us to be prepared. We should be prepared. So it's not only the issue of perception. It's what our intelligence agencies tell us. We should be prepared to deal with those things and deal with those things adequately because consequences of those things are so horrendous that hundreds of thousands of people will die and what-happened in New York will just look like something very small.

GWEN IFILL: Briefly, Mr. Halloran.

LAWRENCE HALLORAN: Our same intelligence agencies tell us that there are still technical barriers that terrorists have yet to overcome to our knowledge to create mass casualties with these weapons.

So we have some time in ranking our public health threats; I don't think is first behind what nature might throw at us everyday. But they're getting better at it.

GWEN IFILL: Lady and gentlemen, thank you all very much.