Seeing Anthrax Saved Us, and other lessons from the 2001 biological

attack on the U.S. CapitolKelly Fado

Administrative DirectorOffice of U.S. Senate Majority Leader,

Tom Daschle on October 15, 2001

Setting the Scene

• September 11, 2001

• Emergency and contingency planning sees renewed interest

• Press stories about smallpox and bioweapons

Mr. Stevens• Robert Stevens was admitted to the ER at 2am on 10/2/01 with fever, nausea and

“was disoriented to person, place or time.” He worked at AMI as a photo editor.• Gram stain +, spinal fluid cloudy – diagnosis meningitis• Bacillus in spinal fluid• Testing revealed bacteria that were large, nonmotile (not capable of spontaneous

movement) and nonhemolytic (didn’t destroy red blood cells)• Bacteria had a capsule (a thick outer coating)• Bacteria had a particular polysaccharide in the spore wall• Gamma phage test was positive (type of virus that rapidly reproduce and cause

bacterial cell to open). • 8:15am on Thursday October 4, test conclude infection is bacillus anthracis• Huge press conference at hospital (CDC, FBI, Florida health officials)• Friday, October 5, 2001 – late afternoon -- Robert Stevens dies in Florida• Cause of death is inhalation anthrax – first such death in US in 25 years.

• First known bioterrorism fatality in the USA

Mr. Blanco• October 1, 2001 (day before Mr. Stevens), Ernesto

Blanco was admitted to the hospital with flu-like symptoms and diagnosed with pneumonia.

• He worked in the AMI mailroom.• When Robert Stevens died, AMI was notified of the

anthrax diagnosis and called the hospital treating Mr. Blanco.

• His doctor began treating him with massive IV Cipro• He went home 22 days later

AMI Building• Sunday, October 7, lab tests confirmed anthrax in

several locations in the AMI building.

• The building was closed.

• Anyone who had been in the building since August 1 was instructed to report to the health department for a nasal swab and 10 days of cipro.

• One additional person had exposure confirmed via nasal swab but was already on cipro.

Week of October 7-12

• Anthrax, bioterror stories running 24/7• Operation Enduring Freedom began on Sunday,

October 7.• Guidance on mail opening in Senators offices

developed, with meeting on Friday, October 12 to present it and the new security procedures to all 100 Senate offices.

• Capitol Police begin responding to a suspicious mail or suspicious package calls – more than once a day.

NBC Employee

• She’d visited her doctor on October 1 with an ulcerative lesion on her chest, and she was feeling weak and tired.

• The health department tested her biopsy and it was negative for anthrax.

• When the news broke about the AMI exposures through the mailroom, she remembered a letter with white powder.

• She visited a dermatologist who sent a skin sample and the letter to CDC.

October 12, 2001• CDC confirmed that a skin biopsy on an NBC

employee was positive for anthrax.

• It was all over the news that Tom Brokaw’s assistant had opened a letter addressed to him containing white powder.

• The letter postmarked September 18 mailed from Trenton NJ tested positive for anthrax

Friday, October 12

• We’d stopped opening mail in Senator Daschle’s office

• Managers attended the briefing including one for “cleared employees only”

• Daschle managers met with staff who opened mail and explained new procedures.

• Mail opening was to resume Monday.

The letter

• On top of the pile of unopened mail was a letter from the 4th Grade, Greendale School, Franklin Park, New Jersey.

• Postmarked Trenton NJ on October 9• An identical letter with an identical postmark

would be found weeks later addressed to Senator Leahy.

• It sat in the office all weekend

What it said

Monday, October 15, 2001

• The letter was opened about 9:45am• Intern who opened it sat motionless and held

the letter shut• Capitol Police responded swiftly, ours was the

third call about “white powder” that morning.• Capitol Police conducted the a rapid “field

test”. The initial test was positive for anthrax• Incredulous, they performed a second test.

The Initial Response

• 13 people present when the letter was opened on 6th Floor of the Hart Building.

• They were taken into the hallway and nasal swabbed, then taken to the large conference room on the 9th floor of Hart

• Nasal and clothing swabs were taken• Staff were sent back to the office with a 3 day supply

of Cipro.• Nobody was decontaminated

The 5th Floor Staff

• 25 people were on the 5th Floor when the letter was opened

• We were locked in the office for 5 hours – • Our colleagues from the 6th floor rejoined us

for a pizza lunch (delivery man got 60 days of cipro)

• 5th Floor staff waged a battle to received nasal swabs. We were told to walk to the Capitol to get them.

The Day

• The power was “floaty”, it could be seen in the air when the police opened the letter

• HVAC system was difficult to shut off - took an hour• People kept coming in and out of the back door

(some in bio hazard suits/most were not)• Office was sealed with duct tape and plastic• Southeast quadrant of Hart all floor was sealed off.• Did I mention that we were sent home in our clothes

on metro and by foot and car.

Tuesday, October 16

• Massive lines form for nasal swabs (in Hart)• Southeast quadrant of Hart (all floors) closed• FBI arrives in Trenton NJ Postal facility.• Senate and House in session• Dr. Greg Martin stopped by the Bethesda lab

to check the blood agar culture plates of our nasal swabs. Less than 12 hours after plating, anthrax was covering about a dozen plates.

The day keeps getting worse…

• The bacteria is growing – some of us will likely test positive – but it’s not responding to antibiotics

• Word came back that a woman in Daschle’s Capitol Office had tested positive (raising possibility of secondary exposure)

• In the military protocol was post-exposure anthrax vaccine – but we are not eligible; CDC maintains a civilian stockpile and Secretary of HHS Thompson assures Daschle “whatever you need, Senator, you’ll have.”

Wednesday, October 17 - Results

• Our swabs began showing a response to antibiotics around 8am.

• All 13 people on the 6th floor tested positive.• 7 people on the 5th floor also tested positive. This

result meant that all 38 people in the office were presumed exposed and put on cipro.

• Members of Senator Feingold’s staff tested positive along with first responders.

• False positive on environmental sample of Capitol staff (no secondary exposure)

The Briefings

• Navy – “Just because you tested positive for exposure does not mean you will develop anthrax.”

• USAMRIID– General Parker “Sample is highly concentrated” “Pure Spores”

• CDC – “We have seen hundreds of cases of anthrax”• Psych Team – “Stop watching television and reading

the newspaper”

Our clothes

• The FBI asked us to bring in the clothes we’d been wearing on Monday

• So ever dutiful, we complied resulting in a panic in the Capitol.

• The FBI decided they didn’t want these after all, and our clothing journeyed through multiple government agencies and returned to us, heavily sampled, about six months later.

“Garden Variety Anthrax”• Anthrax spores normally exist in soil and are

durable lasting years in soil• Grazing animals may become infected by

ingesting or breathing the bacteria• Human anthrax infection almost always come

from contact with infected animals or it’s wool or hide. “Woolgathers disease”

• Cutaneous anthrax (spores enter skin through cuts or openings) is treatable with antibiotics.

Gruinard Island• During WWII, allied scientists performed anthrax

experiments on this isle off Scotland• They exploded devices containing anthrax spores and

tethered sheep at various intervals to measure contamination

• The animals died and their remains incinerated. island grasses burned to kill any remaining spores

• From 1943-1990, the island’s soil was tested and the spore count undiminished. No humans allowed.

• It was finally decontaminated in 1990.

Sverdlovsk, USSR

• 1979, a worker in an anthrax lab forgot to replace a filter and approximately 2 grams of “aerosolized” anthrax spores was released.

• According to official reports, hundreds of animals and more than 60 people died

• 2 grams over an entire city

The Poor Little Monkeys

A momento

More Cutaneous Anthrax

• Case #2 - Monday, October 15, NY health department announces a second case of cutaneous anthrax (in an infant who visited his mom at ABC news)

• Case #3 – An assistant to Dan Rather at CBS news. She’d been on antibiotics since early Oct.

Cutaneous Anthrax

• Case #4 – NY Post Employee. Her symptoms began Sept 22. Her diagnosis was made Oct 18.

• Letter to NY Post containing anthrax was not opened. It was in a bin of suspicious mail.

• Postmark was September 18 from Trenton, NJ• At the end of year, 7 people in NYC had been

diagnosed and recovered from cutaneous anthrax infections.