First of two parts
It came into the building in a letter. Somewhere along the way, Ernesto
Blanco, an American Media company mail room clerk, handled it. The letter was
opened near a stack of reams of paper for the 68,000-square-foot building's
copy machines. Eventually, photo editor Robert Stevens held the envelope,
unwittingly sprinkling its contents onto his computer keyboard.
It spread all over the three-story Boca Raton, Fla., office building as
those reams of paper were inserted into copy machines that shuffled the pages
about. Or so the Federal Bureau of Investigation would conclude a year later.
It was there, but nobody could have imagined its presence at the time. And
nobody would, until Stevens was taking his final breaths and Blanco was lying
in an intensive care unit, fighting for his life.
On Oct. 4, 2001, the world learned that Stevens was dying of acute
inhalational anthrax disease, and with his death the following day a chain of
events unfolded that would permanently imprint the word "bioterrorism" into the
consciousness of Americans. It would shake up the country's public health
system as nothing ever had. And it would test the resolves of thousands of
health workers, the largest group of whom would be scouring the nation's
capital and New York City in search of clues and answers.
A year later, those dogged disease detectives have scaled many obstacles,
but still face a long list of unsolved mysteries. How two of the five anthrax
victims - including Bronx resident Kathy Nguyen - contracted the disease
remains unknown. The FBI still is searching for the culprit or group
responsible for the deadly mailings.
And officials at the federal and local levels still are struggling to
reshape America's public health system, trying to mend the enormous holes in
the nation's safety net that were revealed last fall. What became clear in the
past year is the extent to which the public health system was overwhelmed by
just seven known anthrax-laced envelopes.
On Oct. 2, 2001, Stevens, 63, was admitted to a West Palm Beach, Fla.,
hospital. He was in a terrible state. The American Media photo editor had been
on a fishing vacation with his wife, traveling about the South, when he came
down with what he thought was the flu, in North Carolina. That was five days
earlier, during which time his condition had worsened considerably. By Oct. 2,
Stevens was nauseated and making little sense. He had no idea where he was,
what year it was, or who was the president of the United States. Blood tests
revealed a war was under way, with millions of white blood cells doing battle
with some unknown invader.
While the nearby Jacksonville, Fla., public health laboratory tried to
identify that mysterious invader in Stevens' blood, the hospital put him on
massive doses of antibiotics. But the anthrax bacteria had long since made
their way into Stevens' spinal cord and brain, triggering meningitis. As he lay
in intensive care, the bacteria released three powerful toxins into his blood.
It would be months before scientists, spurred by the urgency of the anthrax
crisis, would study how these toxins kill. One way, they learned, was by
disabling Stevens' immune system, allowing the other two to wreak havoc inside
cells all over Stevens' body.
Months later, scientists and clinicians would realize that giving
antibiotics to patients as far gone as Stevens only worsens matters, as the
drugs kill some anthrax bacteria, which break open, releasing their deadly
toxins. The sudden toxic surge flooded Stevens' brain, causing a grand mal
epileptic seizure. Were it not for a machine that pumped oxygen into his
airways, Stevens would have died immediately.
By Oct. 3, the toxins began killing cells in Stevens' heart. He suffered a
heart attack and then went into a coma. He never regained consciousness.
Months earlier, the federal Centers for Disease Control and Prevention in
Atlanta had begun a poorly funded effort to upgrade the nation's public health
laboratories in hopes of improving local capacity to diagnose rare infections,
such as anthrax. A tiny cadre within the CDC, the Army and a handful of other
institutions had long feared the potential use of biological weapons and was
appalled to learn that most American health labs couldn't run reliable tests
for a long list of likely germ weapons.
The gold standard for such lab work was set by CDC lab chiefs Richard Meyer
and Tanja Popovic, who had trained several dozen local laboratory staffers
before the Sept. 11 terrorist attacks. Yet nationwide, fewer than 100 health
laboratories - out of thousands - had completed laboratory response network
training and equipment upgrades, Meyer said.
Fortunately, one such trainee was Phillip Lee of Jacksonville, the man who
grew anthrax from Robert Stevens' blood samples. Lee used the special stains
and fluids Popovic had taught him would reveal the presence of anthrax in a
Peering through a microscope at a thousand-fold magnification, he saw
Stevens' cerebrospinal fluid swarming with long thin rods, stained a deep
purple, and lined up end to end to form chains - classic attributes of anthrax
bacilli. When he called Popovic on Oct. 3 to tell her what he found, the CDC
scientist knew the result was solid - America had anthrax on its hands.
The world's top DNA-PCR (DNA fingerprinting) lab and anthrax diagnostics
facility is a two-tiered facility at the CDC. Meyer ran the first tier - a
section that conducted the primary screenings of samples, processing them both
for anthrax DNA and as legally certified criminal evidence.
In a higher-security building, Popovic directed the lab that confirmed
infection by growing living anthrax bacilli from a sample. Fortunately,
Popovic's lab was housed in a brand-new building, completed just weeks before
Sept. 11. A few months before, the dangerous work would have been performed in
a World War II-era facility in which contamination could not have been easily
prevented. By the time she received the fateful call from Jacksonville, Popovic
and her tiny staff were working in a state-of-the-art facility, housed under
security so strict that its innermost core could be entered only by a handful
Meyer's DNA analysis could give a tentative answer within an hour or two,
but Popovic's confirmation couldn't come any faster than the rate at which
anthrax grows - at least seven hours.
Back in Florida on Oct. 3, Lee's anthrax diagnosis was more a matter of
puzzlement than anything else. Nobody then could anticipate the national chain
of events that would unfold shortly. Lee didn't know that another patient -
mail clerk Blanco - also was suffering from anthrax, or that the Florida cases
were part of a bioterrorism event that had already led to skin infections in
New York newsrooms - infections that wouldn't be properly diagnosed for several
On Thursday night, Oct. 4, the CDC's chief of meningitis and special
pathogens, Dr. Brad Perkins, had just nestled in for his daughter's piano
recital when his cell phone rang. The CDC caller told Perkins that a Florida
man was hospitalized with inhalational anthrax. Fourteen hours later, Perkins
was in Florida leading a CDC investigation to determine how Stevens got
infected with a remarkably rare microbe. His first stop was the hospital where
Stevens remained unconscious and was running a fever of 104 degrees.
"He was intubated, critically ill, unable to speak," Perkins recalled. "But
I did not expect him to die that day. And actually the family was very hopeful
that he was going to survive."
In Washington, Health and Human Services Secretary Tommy Thompson
officially had announced the ailing Stevens' anthrax case to a nation whose
nerves were still very much on edge from the Sept. 11 attacks. He said of
Stevens' infection that it "appears that this is just an isolated case" and
"there's no evidence of terrorism."
Proceeding on a scientific mission, Perkins took his team to the American
Media building, where Stevens had worked for The Sun supermarket tabloid. As
they met with editors who knew Stevens, the phone rang. It was the hospital,
informing American Media that the photo editor had just died of anthrax
"That was a fairly dramatic moment because we were sitting in a room with
people who had known him," Perkins said. "This was a universally loved guy.
Everyone was just in utter disbelief."
Stevens' Oct. 5 death brought grim urgency to a CDC investigation that
spanned four states through which he had recently traveled. And it brought the
world's media, numerous state and federal agencies and the White House into the
Thompson once again faced the media, saying the anthrax case was probably
of natural origin, based on something Stevens picked up from drinking from a
South Carolina stream. Anthrax is not a water-borne organism, however, and the
secretary's comment would haunt his department, undermining its credibility for
Thompson, a former governor with no scientific or medical training, issued
orders that all information to the public and media come from his office,
barring government scientists and health experts from providing expert advice
In Florida, meanwhile, Perkins' job was to stay focused on leading a solid,
scientific investigation. He and his small staff meticulously scoured Stevens'
home and office, as well as the American Media mail room, swabbing for anthrax
In Atlanta, the CDC was eager to have autopsy results on Stevens, but
nobody in Florida wanted to perform the procedure. Pathologist Sherif Zaki, the
CDC's top medical examiner, flew to West Palm Beach on Saturday, Oct. 6, and
headed straight for the morgue. He found the staff of the medical examiner's
office understandably frightened, Zaki said, but willing to assist once he had
explained safety procedures.
When they opened Stevens' chest, Zaki recalled, the team found "evidence of
anthrax in literally every organ we touched," especially the man's
disease-fighting lymph nodes. Those were so saturated with the toxins that they
actually disintegrated as Zaki's probes touched them.
The next day, Perkins got word from the CDC's anthrax laboratory that swabs
collected from Stevens' computer keyboard and the mail room tested positive
for Bacillus anthracis. That finding triggered the FBI's criminal
investigation. He also got CDC laboratory confirmation that there was a second
case of the disease - in someone who worked in the same building as Stevens -
and learned about Ernesto Blanco, fighting for his life in another hospital.
At that point, Perkins said, he decided to place thousands of American
Media employees and recent visitors on ciprofloxacin antibiotics as a
precaution. In coming days television footage of long lines of anxious
Floridians queued up to get nasal swabs and pills would spark public anxiety
and a demand for antibiotics. Within two weeks the nation's entire supply of
ciprofloxacin would be sold out, with none available for treatment of genuine,
and often serious, ailments for which it is normally used, such as children's
In Atlanta, the CDC was deluged with calls asking who should be given
antibiotics. In what doses? What are the symptoms of anthrax? Is the powder in
my Alaska office a hoax or the real thing? The agency was in danger of being
overwhelmed. And because of the directives from Thompson, most of the queries
had to go unanswered.
"We needed information," John Auerbach, executive director of the Boston
Board of Health, said recently. "Every kind of government report that we needed
was delayed. We were getting information from journalists, for God's sake, not
the CDC. There simply wasn't a good, accurate, timely internal communication
"We made a decision at CDC that the people who needed information in order
to effectively respond should be our priority," Dr. Julie Gerberding recalled.
Last fall she was the deputy director of the CDC's National Center for
Infectious Diseases. Ten months later, her boss, Dr. Jeffrey Koplan, would be
forced to resign and Gerberding would be named CDC director. Few could get
information from the CDC for days, Gerberding would later concede, not even
America's physicians, most municipal health directors or even members of
With the exception of New York City, where then-Mayor Rudolph Giuliani
personally handled all public announcements related to terrorism, the nation's
public health messengers were late in communicating. Public health officials
learned that their communications systems - computers, phones, faxes, video
systems - were woefully out of date. Their ranks of skilled speakers and
information officers were thin, and their ability to control panic minimal. A
year later, the CDC has built the Health Alert Network, reaching every public
health department, no matter how small or remote, in America. But that was a
mere skeleton last October.
"As events wore on, it became clear the CDC needed to be the primary source
of scientific information," Gerberding said in an interview months later. "But
once it was obvious to all that we needed to take the lead, we were in a
reactive mode. And we are still catching up."
Within hours of the collapse of the World Trade Center, Dr. Kevin Yeskey,
director of the CDC's Bioterrorism Response Program, had issued an alert to
health departments nationwide "calling for enhanced surveillance, meaning,
'Please be vigilant for anything that might be suggestive of a bioterrorism
event,'" Yeskey said. As word of the Florida case spread, health providers and
public health officials all over America started remembering that alert, and
anxiously sought information from Atlanta.
"I said, 'Let's set up an Ops [Operations] Center here,'" Yeskey recalled.
He sat down with a sheet of paper and drew a pyramid, with CDC director Koplan
at the top and Infectious Diseases Director Dr. James Hughes and Gerberding
just below. He drew a military-style chain-of-command map that connected Koplan
to the field investigators then dispersed over the states tracing Stevens'
movements and suspected additional anthrax cases.
Yeskey, a former military officer, marched into Gerberding's office, his
chart in hand, and said, "We need a Special Ops Center. This is what it would
look like. Field A responds to command leader A here in Atlanta, and Field B
Gerberding stared at the piece of paper and thought it was a crazy idea.
Slightly amused, she listened as Yeskey spun a web of desks and phones and
chains of command. But under prior bioterrorism preparedness guidelines, she
knew some sort of operational center was necessary, so she gave Yeskey the
green light to implement what, in the back of her mind, remained a whacky
Within 24 hours, Yeskey's team had transformed the CDC's auditorium into a
command center, with portable walls erected according to the chart he had
mapped out. In each space were CDC officers, drawn from their normal duties to
handle emergency coordination. One desk was Florida. One desk soon would be New
York City. As events unfolded, Washington, D.C., and other hot spots around
the country got desks, staffed 24 hours a day by high-ranking CDC scientists
whose job was to coordinate all the information and logistics in a given field
At another desk was a medical team that did nothing but answer questions
from physicians. If doctors called in with suspected anthrax cases, that team
had a list of questions and symptoms to walk the person through, aimed at
winnowing out cases that obviously were not anthrax.
By mid-October, the Ops Center was a noisy beehive, coordinating activities
all over the world - indeed, a global liaison desk was added. Never in the
history of the CDC had such a system been used. Of course, Hughes said, "Never
in the history of the CDC have we dealt on so many fronts at the same time,"
even during serious epidemics.
A year later, the CDC is building a multimillion-dollar Special Ops center
in Atlanta, and encouraging local health departments all across America to
erect mini-versions of such communications and command centers. Looking back on
October 2001, health officials shake their heads in wonder that Yeskey's
primitive pyramid had somehow gotten them through the chaos of the anthrax
TUESDAY, in Discovery:
A New York Diagnosis
Sept. 18, 2001: Two letters, later found to contain anthrax spores, are
postmarked at the main post office outside Trenton in Hamilton Township, N.J.
Postal inspectors later said the letters could have started at any of 46 mail
facilities before reaching the main post office.
Sept. 19 or 20: One of the letters, addressed to Tom Brokaw, arrives at NBC
News in Manhattan. Employee opens it, finds brown granular substance
inside, and dumps much of it into the garbage.
Oct. 2: Bob Stevens, 63, a photo editor at The Sun, a supermarket tabloid owned
by American Media Inc., enters Florida hospital critically ill, vomiting and
Oct. 4: Stevens diagnosed with the inhalation form of anthrax. Lab tests find
bacteria in blood and spinal fluid. CDC lab, using DNA test, confirms bacteria
Oct. 5: Stevens dies.
Oct. 6-7: Anthrax spores found on Stevens' computer keyboard at Sun office.
Ernesto Blanco, 73, mailroom clerk at American Media, enters hospital for
treatment of pneumonia.
Oct. 12: Authorities in New York announce an NBC News employee contracted the
skin form of anthrax. It was believed to be the first confirmed case of anthrax
in the city's history.
Oct. 13: Letter opened by NBC employee Sept. 19 or 20 tests positive for
Oct. 15: Tests confirm Blanco has the inhaled form of anthrax. Second letter
bearing Trenton postmark opened by employee of Senate Majority Leader Tom
Daschle; letter, containing white powdery substance, tests positive for anthrax
in initial field tests and more sophisticated tests at Fort Detrick, Md. FBI
says letter delivered to American Media likely was incinerated with rest of
company's trash before investigation began.
Oct. 21: An employee at the Brentwood postal center in Washington, D.C., dies
Oct. 31: Two days after being diagnosed with inhalation anthrax, Kathy Nguyen,
a Manhattan hospital worker, dies.
Nov. 17: Anthrax-laced letter addressed to Sen. Patrick Leahy (D-Vt.) is
discovered in barrels of quarantined mail from the U.S. Capitol.
Nov. 21: Ottilie Lundgren, of Connecticut, dies of inhalation anthrax.
Dec. 6: Government scientists open the Leahy letter. It appears to have been
sent by the same person who mailed the letter to Daschle.
June 25, 2002: Dr. Steven Hatfill, 48, a former employee of an Army research
institute in Fort Detrick, Md., allows the FBI to search his Maryland
apartment. FBI says Hatfill is on a short list of "persons of interest'' in the
anthrax case, but not a suspect.
July: Hatfill is hired by the National Center for Biomedical Research and
Training at Louisiana State University.
Aug. 11: After more searches of his property, Hatfill and his attorney hold a
news conference in Alexandria, Va., professing Hatfill's innocence and saying
he is a "fall guy'' for the FBI's inability to solve the nearly year-old case.
Sept. 3: Hatfill is fired after the university receives an e-mail message from
the Justice Department directing it to "cease and desist'' from using Hatfill
on "all Department of Justice-funded programs.''