Anthrax Kills 4th Person; Crisis Response Criticized

Anthrax claimed a fourth life Wednesday as government leaders stepped up their investigation amid mounting criticism that they were slow to appreciate the magnitude of the attacks and sent conflicting signals about how Americans should protect themselves.

The death of Kathy T. Nguyen, a 61-year-old New York hospital worker, remained the focus of the investigation, largely because the source of her infection is unknown. Unlike other victims, Nguyen, a Vietnamese immigrant, is not known to have handled mail or a contaminated letter.

“This is a very puzzling mystery,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “So all bets are off. Public health officials [have] to do a real full-court press on trying to track this down. This is critical.”

Nguyen died early Wednesday at Lenox Hill Hospital in Manhattan after coming to the facility’s emergency room Sunday night.

She became the fourth anthrax fatality in a month, after the deaths of a Florida newspaper editor and two Washington postal workers. There are 12 other confirmed cases, according to the Centers for Disease Control and Prevention.

A second person at the Manhattan Eye, Ear and Throat Hospital--where Nguyen worked in a medical supply room--was being tested for the skin form of the disease, said New York Mayor Rudolph W. Giuliani. The woman, who has a suspicious lesion, was taking antibiotics as a precaution, but results were not expected until today.

“The death has caused us to rededicate our efforts and ourselves,” said Tommy G. Thompson, secretary of Health and Human Services, which, he said, now has 450 employees working on the crisis, including more than 150 at the CDC.

Asked if the government believes it has contained the threat posed by the current anthrax outbreak, U.S. Atty. Gen. John Ashcroft said Wednesday that there had been no progress to report in the investigation and that no arrests were imminent.

“I can’t say that people have any right to think that the risks have abated as it relates either to the anthrax or other terrorist risks,” Ashcroft said.

Tests at Workplace, Home Negative So Far

Dr. Neil Cohen, New York City’s Health Commissioner, said Nguyen and the other hospital worker being tested for skin anthrax worked in different areas of the outpatient hospital.

So far, tests for anthrax at the hospital and at Nguyen’s third-floor apartment have been negative, Giuliani said at a City Hall news conference.

Detectives and experts in tracing disease patterns were trying to reconstruct how Nguyen spent her last seven days--a task complicated by the fact that investigators were unable to speak with her once she was placed on a respirator.

At Nguyen’s brick tenement-style apartment building in a heavily Latino neighborhood in the Bronx, investigators tripped over trick-or-treaters in Halloween costumes as they continued to question neighbors about Nguyen’s activities.

Which subway did she take to work? Did she go to church? Where was her favorite restaurant? Such everyday activities are now the focus of a massive criminal investigation.

“They asked so many questions. They kept each of us here for at least half an hour to an hour,” said neighbor Carol Soto, who spoke with investigators Tuesday. “They wanted to know if anyone had been visiting her lately, if anyone would want to hurt her and if we had ever seen any strangers in the hallways.”

A swab of the clothing Nguyen wore when she checked into Lenox Hill Hospital showed possible signs of anthrax, though tests have not been completed.

Health officials plan to conduct an autopsy to analyze the type of bacteria that killed Nguyen and determine whether it matches anthrax recovered in contaminated letters or from other places, said White House Press Secretary Ari Fleischer.

Fleischer disputed the notion that absent some progress in the anthrax probe public confidence may fade in the government’s ability to deal with the problem.

Public health officials concede they are learning new things about the disease every day, largely because they have never confronted a deliberate release of anthrax spores. That has left many Americans confused about whether they should take antibiotics and has spurred a national debate about the risk posed by opening the mail.

But Fleischer cited a recent ABC poll that showed more than three-quarters of those surveyed said the government has responded effectively to the anthrax crisis.

“I think what you’re seeing is a country that is going through something for the first time,” Fleischer said. “Somebody is trying to kill the American people by mailing anthrax through the mail. And the president believes the actions of the government have saved lives.”

Meanwhile in New Jersey, officials said a fifth postal worker appeared to have skin anthrax, though the case has not been confirmed by the CDC. A mail processing plant in the southern part of the Garden State that serves 159 local post offices was closed while investigators searched for traces of spores.

The 54-year-old man developed a skin lesion on Oct. 13 and blood tests were positive for antibodies to anthrax. Results from a biopsy of the lesion were not yet available.

Acting New Jersey Health Commissioner George T. DiFerdinando said the man was responding well to antibiotics and was expected to return to work by the end of the week.

New Jersey officials were still trying to find out how an accountant who was diagnosed with skin anthrax earlier this week contracted the disease. They think she might have opened mail at home or at work that had been contaminated at a Hamilton, N.J., postal facility that processed the three anthrax-tainted letters to Senate Majority Leader Tom Daschle (D-S.D.), NBC anchor Tom Brokaw and the New York Post.

In Indianapolis, another postal facility tested positive for trace amounts of anthrax. The contamination is thought to have been brought on equipment that was moved from the Brentwood facility in Washington to Indianapolis for routine cleaning, before the bacteria was discovered at Brentwood.

In the capital Wednesday, Daschle proposed sanitizing all 200 billion pieces of mail delivered annually to kill anthrax and other harmful bacteria.

“In my view, all mail should be irradiated from here on out,” Daschle said. “The sooner the better. The quicker we can acquire the equipment to do that, the better.”

He said he did not know how much such treatment would cost.

Anthrax Reported in Mailbags Overseas

On Tuesday, postal officials said they would need $2.5 billion to pay for a plan to irradiate all government mail and all mail dropped off in public places, such as collection boxes.

On Wednesday, the State Department said it found anthrax in several more mailbags at an overseas U.S. embassy, this time in Lithuania. Earlier this week, traces were detected in a pouch to Lima, Peru.

But health officials in Washington said Wednesday they were encouraged by the fact that there have been no new suspected anthrax cases in the capital and that three mail workers with inhalation anthrax continue to improve.

Three neighborhood post offices that had tested positive for anthrax reopened Wednesday after being decontaminated.

Ivan Walks, the city’s chief health officer, who earlier this week said he saw “no light at the end of the tunnel,” said Wednesday that the anthrax crisis in the capital appears to have peaked.

“We’re at a point where we are settled in,” Walks said.

Health officials in the capital are considering revising their recommendations about how many mail workers should be taking antibiotics as a precaution.

On Wednesday, the CDC narrowed its own guidelines, suggesting fewer people need to take antibiotics. Washington health officials may adopt similar guidelines today, officials said.

Until now, Washington health officials recommended antibiotics for all Brentwood mail workers, people who had visited the back room of Brentwood, workers at other post offices that have tested positive for anthrax, and mail sorters at 4,000 businesses that receive mail in bulk from Brentwood.

*

Goldman reported from New York and Sanders from Washington. Contributing to this report were Times staff writers Edwin Chen, Megan Garvey and Charles Ornstein in Washington, and Josh Getlin and P.J. Huffstutter in New York.