Anthrax

& the Post Office

Update 11/7/01

Update 4/16/02

Anthrax:

It appears that our medical knowledge about anthrax has not been as complete as we thought. Our information was based on biowar studies conducted by the United States and other countries during the Cold War. The present situation was not "gamed" or investigated to any degree, probably because it isn't an efficient way to engage in biowar.

Anthrax remains confined to four locations in the country, Florida, Washington D.C., New Jersey, and New York City. As I write this, about a dozen cases have been confirmed, with all the newest cases being in the Washington D.C. area. It does not appear at this point that there are any new cases in Florida or New York City. The reported exposures in Reno, Nevada were false, as was the Kenyan report. Gov. Pataki's office in New York City is apparently clean. (I expected that. Why would anthrax show up in the highest security area in the office and no where else?) The general rule of thumb should be with all these reports, if it seems out of left field, it probably is.

The newest cases, among postal workers, are presumed to have occurred through the handling of several letters containing anthrax spores. To this point, only one letter in Washington has been recovered. There is an active search on for a letter sent to the House of Representatives, and one to the White House, based on contamination found in mail areas in both spots.

The first thing to remember in all this is that some of the initial contamination cases will prove false. Testing must be repeated, with more and more definite tests, and sometimes the first tests will have been incorrect. Better to err on the side of caution, however.

The CDC and the medical community is no longer certain of the quanity of spores necessary for an exposure to turn in to an infection. This uncertainty is based on the assumption that all these cases came via exposure to a very small number of mailed letters. That assumption may not be valid and I am sure investigators are ruling out other means of exposure.

The assumption is that automated mail handling equipment caused spores to be dispersed from the letters into the air or machinery, where normal cleaning by compressed air blowing would then disperse them into the air. Despite "anonymous" sources, there is no evidence at this time that spores were released through the envelopes themselves. As we all know, most envelopes are not sealed; that's why letter openers work. There is at least a small opening at either end of the flap.

Cipro:

The drug of choice for treatment of anthrax in adults is Cipro. It is not suitable to treatment of children or pregnant women due to its side effects. Healthy adults may also suffer the side effects. The strain(s) of anthrax currently found respond to treatment by other antibiotics, including plain old penicillin. There are sufficient doses of antibiotics in this country to treat the entire population for anthrax.

Broadly treating populations with antibiotics without testing risks people being exposed to side effects unnecessarily. It also may increase the likelyhood of development of antibiotic resistant strains of bacteria.

Postal Service:

The government has begun to mass treat postal workers with antibiotics in several of the potential exposure areas, before testing them. This is in response to the heavy criticism by the Postal Employees Union, Congress, and many in the media to what is perceived to have been a slow response to the developing situation.

Until the first postal worker was diagnosed with Anthrax, there was no reason to suspect that an exposure had occurred. The side effects of antibiotics, especially Cipro, are such that broadly based treatment represented a higher risk than anthrax did, at that point in time. At this time, there are reportedly over ten thousand postal workers being treated with antibiotics, based upon less than ten confirmed cases, in New Jersey and Washington. You should decide for yourself if the current risks justify the broad based treatment.

The Postal Employees Union has been engaged over the last three decades in very strong advocacy for its members. They have strenuously opposed the introduction of machinery that handles the mail at significantly higher speeds than people do. They have suggested that the volumes and handling changes now asked of the membership create safety issues. The Union has lost members due to cuts made possible by changes in mail handling. Their perspective on this issue does not merely include the threat to members from anthrax.

A Threat?:

Various officials have suggested in the last days that the mail running through the contaminated postal facilities may be itself contaminated. My guess is that it is not. Taking postal employees out of the mix, there has been one fatality (the very first case discovered), and perhaps three other infections, and about forty exposures which have not yet resulted in any infections. These all occurred, apparently, via the opening of contaminated letters. The risk of exposure is slim and the risk of infection is miniscule, based upon this data. We may see a tiny number, less than twenty, of cases of cutaenous anthrax exposures from mail that passed by or though contamination and that sould be appearing before Halloween. Why? To get the skin form of anthrax, the spores have to enter the body through a break in the skin, cut or sore. The skin is your best defense against infection and it does a great job. Few people could have both the exposure and the break in the skin.

The postal employees seem to have been exposed or infected by the airborne spread of anthrax spores. Whether it came as a result of mail handling equipment, or by some other means, the population at risk for this is small. If you weren't in that mail handling area at the time the letters were processed, I believe your risk is very small.

We have not seen any new outbreaks in the last two weeks. All of the current hot spots were generally identified some time ago and nothing new has come up. If you don't work in certain very specific locations, you haven't been exposed.

Questions:

Where did the exposure of the 7 month old child of an ABC employee come from? No anthrax has been detected at that location. Was it, in fact, anthrax?

Was the exposure of Washington D.C. postal workers due to letter handling, or were they infected by some other means?

Were letters mailed to the House of Representatives and the White House? If so, where are they?