Anthrax: Lessons learned from the U.S. capitol experience

Military Medicine, Sep 2003 by Martin, Gregory

It is a great pleasure to be able to talk about this, which has been kind of close to my heart for the last 6 or 8 months since the events occurred. And what I wanted to talk about is actually what happened [on and in the days after] October 15, 2001. I think we've all read in the Washington Post and in all of the news magazines what went on and have heard it on the radio and television for a long time. This is more of a behind-the-scenes, military medicine perspective. I think that there are a lot of really important lessons learned. I broke this up into an early phase and a late phase of lesson learned during the first week and then things that we learned as things evolved over the subsequent month.

[The] anthrax [incident] was a great example of cooperation among the different services and shows the great utility of Department of Defense (DoD) medicine to be able to rise to these kinds of occasions. I do have to say, though, this weekend I found that poison ivy is probably the most effective bioterrorism agent that there is out there, although I've never heard of it being weaponized at this point.

I am sure you have all seen the infamous envelope, which was opened in Senator Daschle's sixth floor office on October 15, 2001, around 10:00 a.m. in the morning. The intern who opened this letter had just had training the week before [on] what to look for [pertaining to] a suspicious envelope. This [envelope] didn't really meet much of them, because they get letters like this all the time in the Capitol. It looked fairly innocuous, like a fourth grader may have actually written it. She opened it up, saw a little puff, put it down on the floor, closed the area she was in, and called the Capitol police, just the way she had been told. And, you know [what happened], tens of millions of dollars later, from that little bit.

The Capitol police came in. The Hazardous Materials team removed the letter. They had already been talking about how they would try to secure ventilation in the buildings. It was 45 minutes later before they were able to do this. I [spoke with] our facilities personnel at the [Bethesda] Naval Hospital to find out how long it would take them to shut down the ventilation in one area of the hospital. I think we would be very lucky if we came close to 45 minutes. It is very difficult to get this shut down. You would like to just shut this down in 3 minutes, but it is a fairly difficult thing to do. What we've done at Bethesda now is to essentially shut down the ventilation in the entire hospital until they can figure out where it is that they have to isolate. And that's what they'll do at the Capitol if this happens again.

Then the Capitol Police [have] been using [an] initial handheld rapid enzyme-linked immunosorbent assay, [because] there have been numerous hoaxes at the Capitol with different biological warfare agents. They've never had one positive. They were shocked to see this one was positive. The enzyme-linked immunosorbent assay kits are widely available now; NMRC [Navy Medical Research Center] has been heavily engaged in their production.

Admiral Eisold's office was notified. Admiral [John] Eisold is the attending physician to the Capitol and is in charge of all of the Capitol medical facilities, [including] the Supreme Court. I consult for him as the Chief of Infectious Diseases at Bethesda. He usually calls me about a congressman with cellulitis or somebody who has diarrhea or for pre-travel assessments, so this represented a bit of a jump up in the level of acuity. We had him do nasal swabs of all of those in the immediate area, [including] the people in Senator Daschle's office [and] the adjoining suites-about 60 people. The swabs came to our laboratory at Bethesda, and I had them plate them not just on the initial agar, but [on] some other [culture media], concerned [that] we could have a mixed exposure. Just because we know it is anthrax does [not necessarily] mean that there isn't some plague in there, too, so we started culturing to rule out these other pathogens.

As everybody knows, prophylactic ciprofloxacin was [recommended for potentially exposed individuals]. The suspect areas were closed off, [as] was the whole southeast corridor of the building, and potentially exposed [individuals] were reassured and sent home. Now unfortunately, the Capitol Police essentially just told people to go home. And they were in their same clothes. They were not told to go home and walk in the door, drop [their] clothes into the washing machine and get into the shower, so some of them played with their kids, or were roaming around, and some didn't change their clothes until the next day. As a result, there were concerns about cross-contamination in the home.

Over that following night, much to everybody's surprise, the media reported already that the sample was weapons-grade anthrax. Nobody knew how this was already known, but apparently when the Centers for Disease and Prevention (CDC) opened up the same envelope, [they] saw a big poof, and said, "Wow, this stuff really aerosolized well. This has really been finely milled, like 'weapons grade'."