By Scott J. Becker, MS, Executive Director, APHL

Part 3 of a three part series.  

Angels to the Rescue

During this period, APHL experienced a surge in media interest, as it quickly became apparent which labs were doing the anthrax testing.  We went from maybe three media calls per year to up to 60 per day.  I made the decision that APHL should not shy away from media attention, instead we should let the media tell our story.  But I knew that we couldn’t keep up this pace so I asked the board to approve a one time deficit spending of up to $30,000 for crisis communications support.  How did I arrive at that figure?  It seemed like a number that would fly – and it least it was a place to start.  Following board approval, I contacted the only director of communications I knew, Jody DeVoll (then with AMCHP) for advice.  She stayed on the phone with me for over an hour, coaching me on the nuances of media and ended by saying “you need Jill Merrick, and you need an intern just to handle the incoming calls.”  Jody is Angel #1.  Jill Merrick is a communicator extraordinaire.  She was my godsend back then, and now I consider her a good friend.  Jill called me to say, “Jody called me and told me your situation, how can I help?”  Jill was in our office the next day, and our own media induced chaos became more manageable, and most importantly it became more strategic.  Jill is Angel #2.    I gave one interview on WCBS News radio in New York City about the use of anthrax home test kits that were being sold on the internet (I said that it was a bad idea).  Nancy Kaufman, an executive at the Robert Wood Johnson Foundation heard the interview and called to ask if there was something they could do.  “For sure, “I replied, “we need funds to help pay for crisis communications support.”  Nancy is my third angel.  Within days, I had a grant to cover our communications needs, but with one caveat.  We were told that we must produce a communications plan for the association but the added commentary was “we don’t think that you can really do much with it, after all it’s only labs you deal with.”  To me, those were fighting words.    Not only did we create that plan, but we proved them wrong, very wrong.  About a year after the anthrax attacks and subsequent media maelstrom, APHL hired its first director of strategic communications – Jody DeVoll, also known as Angel #1.  Jody now heads up a four person strategic communications team.  The public health lab system rose to the occasion that fall, testing over 125,000 samples for anthrax contamination.

The fall and winter of 2001 ended for me with a much needed two week vacation.  On December 26, 2001 USA Today ran a multi-page story about labs and anthrax, complete with a quarter page photo of Kati Kelley, the Connecticut state laboratory director (and one of my public health heroes).

Shortly after the new year, my daughter Sophie began to utter her first few words.  They were “dada,” “mama,” and “antrax.”  It was at that moment that I realized what toll these events took on me, having been absent so much of Sophie’s first year.  Someday Sophie and her younger sister Ali may read these words and realize how important it is for me to serve the public’s health through APHL, and how my small role and bearing witness helped shape me as a parent and as a professional.

Through planning, long days and nights, excellent science (some admittedly “on the fly”), and the dedication of some of the most committed public servants in America, we made it through that dark fall and winter stronger because of the experience.  The experiences of 2001 helped us better serve the public through other health threats in the past ten years – West Nile Virus, SARS, monkeypox, Hurricane Katrina, 2009 H1N1 Influenza pandemic, and the Deepwater Horizon (Gulf Coast Oil Spill) accident.

The unsung heroes of public health, laboratorians, hold my greatest respect.

Part 1 and Part 2

By Scott J. Becker, MS, Executive Director, APHL

Part 2 of a three part series.  See Part 1 here. 

CDC worked up messages that states should be communicating with their hospitals and physicians to request immediate notification of any patient who showed symptoms of anthrax and forwarding of any specimens to the state lab for analysis.

The following week and a half was a blur – anthrax was detected in a second AMI employee. Swabs were taken from their facility and found to be contaminated as nasal swabs were taken from many other AMI employees.  Anthrax was then detected in New York City (as if they haven’t been through enough!) and in Washington, DC at the Hart Senate Building.  We kept a running dialogue with our members, checking on their needs and with the CDC investigators.  That week we also began to hear of several “white powder events,” as we now call them.

On Friday, October 19^th at 5:00 pm I received a call from CDC’s senior lab advisor, Dr. Jan Nicholson, asking if we could quickly arrange a 50-state call with all state lab directors as CDC wanted to share information with us.  We contacted every state and held the call at 6:30 pm – during which we learned that the CDC linked the four confirmed cases of anthrax to “intentional delivery of B. anthracis spores through mailed letters or packages”– the US postal system was the delivery mechanism for the anthrax.

Now that anthrax was seemingly everywhere on the East coast, we were more than on alert, we were set to action.  A major gap was uncovered during the 50-state call – there was no standardized protocol for testing for B. anthracis from an environmental sample, only a human clinical specimen.  So we created one over the course of the weekend.

From Friday night through mid-day Sunday, APHL members and CDC scientists developed a protocol by working through the days and nights, handing off the still draft protocol to the next team in the next time zone, until the protocol was deemed by CDC anthrax leads to be ready for prime time.  Prime time turned out to be Monday morning.

Sunday morning I was on a call with Dr. Nicholson and was asked if we could meet with Postal Officials that evening at their emergency operations center in DC.  Very fortunately, APHL’s then-president Dr. Mary Gilchrist was already en route to DC for other meetings and was able to join me.  Knowing how the government works, I didn’t want to the two of us to be outnumbered, so I enlisted Carol Clark,APHL’s chief operating officer, to join us.  The APHL band of three entered the USPS headquarters at 8:30 pm and met with a team of five officials all of whom looked like they hadn’t slept for days.  Truth was, they hadn’t.

CDC was beginning to be deluged with specimens from the postal system, so private clinical labs (which had no protocol) were testing specimens for anthrax; state labs were getting inundated with objects, powders and some of the strangest things one could imagine for testing.

The postal officials were questioning Dr. Gilchrist, a world-class microbiologist and architect of the LRN, about spore size and how far spores could float.  She, in turn, was asking them about the mail handling process.  She described how spores may go towards electrostatic charges, charges that would be present as mail went through a machine that essentially “pounded the hell out of the envelope,” as was described to us.

Carol and I worked with Mary to devise a plan to bring some order to the chaos that was ensuing in mail facilities across the country.  We learned about the process of mail flow and incorporated terms like “upstream and downstream” facilities into our lexicon.  We established that by mid-week APHL would deploy a lab system coordinator to the US Postal Service part time and that the person would work from APHL offices in downtown Washington the rest of the time.  We initially figured we would need a coordinator inside USPS for a few days per week for a few weeks.  We enlisted Tony Sambol who serves as the bioterrorism lab coordinator for the Nebraska Public Health Lab to come to DC.  Tony and his boss, Dr. Steve Hinrichs, readily agreed to the arrangement. Tony arrived the following Wednesday, and it was a full month before we saw him at APHL.  He never left the USPS ops center, there was just no time.

The USPS was looking for order out of chaos and we delivered. Tony set up a system of communication and coordination for the high threat samples (as deemed by postal inspectors and/or FBI) to quickly reach the closest LRN lab capable of testing and that wasn’t inundated at that moment.  All of this required knowledge, dedication, nerves of steel and excellent communication – all of which Tony possessed.  APHL was contracted by the USPS for this testing.  LRN support was still fairly thin so this arrangement allowed the LRN labs to conduct the testing without worry that it was draining state coffers or limited grant resources.

Lab directors were fully supportive of this system.  They knew they were under the gun to deliver quality results to the public as quickly as possible.  The labs were on the frontline in the war against terrorism because it was within those labs that answers were housed.  The public health labs were the only ones who could determine if anthrax was present or not.

These were some tense times.  I was told to be on a call (and ensure that Dr. Gilchrist was on it too) with some state epidemiologists who were very concerned and angry that their state lab was being “used” by APHL for fee-for-service postal testing….It seemed that even a few weeks into the events, the public health community was not yet convinced of how real this threat was.  Fortunately, just before the call, cooler heads prevailed, and, as I understand it, some East coast epidemiologists supported this system because they were seeing the chaos first hand.

The next few weeks were some of the craziest of our lives. Anthrax was seemingly everywhere.  Rural towns, big cities, the Hawaiian Islands, State Department outposts around the globe all had anthrax scares.  Nowhere seemed off limits to the ubiquitous white powder.   It wasn’t only white powders and false alarms, the lab system also detected the real deal.  Anthrax was in newsrooms in NYC, the Senate office buildings, and portions of the postal system.  It was discovered that a 61 year old health care worker succumbed to anthrax, as did a 94 year old woman who rarely left her home.  Contaminated mail was the working theory and remains so today.

To be continued… (Part 1 and Part 3)

By Scott J. Becker, MS, Executive Director, APHL

Part 1 of a three part series.

Everyone has a story of when their life changed forever.  It could be before kids or after kids – or a traumatic life event like the death of a spouse, or a happy event like graduating from university.  For an entire generation it was 9/11 and the anthrax events that soon consumed those of us in public health.

Like many of you, I remember exactly where I was when the towers fell.  I was on my way to deliver a keynote address to the Mississippi Public Health Association and the topic was Branding Public Health.  Upon landing in Atlanta, I called my hosts to let them know when I was due to land in Jackson, and heard that there was some “trouble” but that we should be in touch when I landed.  I then started to pick up snippets of conversation around me, words that sent a chill down my spine.  “Bombing… New York… Washington…” were just a few.  I jumped back on the phone to call my wife to ask her to please go pick up our 5 month old daughter, Sophie, at daycare.  You see, that very day was Sophie’s first full day in daycare, and the daycare center was a few blocks from the White House.  I caught my wife back at home in Bethesda, who immediately turned on the TV, and then headed back downtown.  I wandered the terminal for a minute or two, trying to wrap my head around what I was hearing and then called a colleague at CDC, realizing that I would be stuck in Atlanta.  He offered me his office and I headed up after encountering the longest taxi line I’ve ever seen (I was quick; I got out in 20 minutes.  Folks that waited longer were there most of the day).

Once I got to CDC it was apparent what had transpired.  And then CDC was evacuated, as it was deemed a possible target by the unknown enemies.  We had now moved into our new life, but were too numb to understand it.  Soon thereafter I checked into a hotel, and joined many others glued to a TV.  We were a new “family” of sorts, all of us stuck together in this unfolding national tragedy.  I was finally able to get a call back to my wife and was relieved to learn that she had gotten Sophie out of DC, even before the Pentagon was attacked.  Sitting there, I learned that my flight that morning left Dulles the same time as the one used by the terrorists that flew into the Pentagon.

Hearing that sent me into action; I needed to get home.  Through divine intervention and many phone calls, I secured a one-way car rental the next day.  Virginia’s lab director Jim Pearson, APHL staff Jeff Jacobs (now with ASCP) and I drove straight home.  No planes in the sky; no cars on the road; patriotic signs on many overpasses from Georgia to Maryland.  After 12 hours of travel we came over a small hill on 395 in Arlington and looked down on the smoldering black hole in the Pentagon complete with the American flag… and the quiet almost desolate city of Washington just beyond.

What I couldn’t quite grasp was exactly how our world was now completely different.  There were Humvees on every corner, security officers with guns and policemen… just about everywhere.  Our city, like New York, was transformed overnight.   So were our professional lives, particularly for those of us working in public health.

At APHL, we’d been focused on lab preparedness for terrorism since 1999, when we constructed the Laboratory Response Network (LRN) with CDC and the FBI. But on this day, September 12, 2001, the once obscure threat was palpable; it was real.  We worked with CDC to ensure that all the state labs had the tests, materials and equipment they needed in case a threat was made to human health in some sort of attack.  We made sure that all of the contact lists were accurate and that we knew with whom to consult if needed.   The LRN went onto a high state of alert – we were on the lookout for any suspicious samples or specimens.  Our members were told to report anything out of the ordinary, no matter how small it seemed.  Everyone was on edge, and for good reason.  News reports were issued daily (for weeks) and used terms like “biological or chemical warfare,” “possible use of bioweapons,” “biowarfare,” or “smallpox.” And then the question was being asked first privately and then publicly:  “Are we prepared?”  That question is still with us and always will be – the real question is for what and for how long?

Vice President Cheney was particularly concerned as President Bush had asked him upon his inauguration to take charge of overseeing intelligence matters and to conduct a study of the nation’s vulnerability to biological weapons and terrorism in general.  One vulnerability identified was access to dangerous pathogens such as anthrax, plague and pandemic strains of influenza viruses.  And public health labs had access.

On October 2^nd, all the possibilities of bioterrorism became a reality.  It was on that day that an infectious disease physician recognized a possible case of inhalational anthrax in a man who was hospitalized in Palm Beach, FL.  The local health official immediately began an investigation which included having the patient’s clinical specimen sent to a lab for diagnosis.  The clinical lab couldn’t rule out anthrax, so according to protocol, they contacted Dr. Phil Lee, the Biological Defense Coordinator for the Bureau of Laboratories at the Florida Department of Health Lab in Jacksonville.  Once he received the specimen (On Wednesday October 3^rd at noon) he began the analysis immediately.  The series of tests took less than 24 hours, and early on Thursday October 4^th he confirmed what is now known as the index case of anthrax.  All eyes were on Florida as the index case worked and lived there, and CDC was sending investigators to his work place, AMI Media, to figure out how this could have happened.

Since the Florida anthrax case followed the 9/11 attacks so closely, it was unclear what we were dealing with, but we were at the ready.

To be continued… (Part 2 and Part 3)