Playing Down Anthrax Risk Has Cost Us
In the early 1980s, when a mysterious immune deficiency illness first appeared in gay men and hemophiliacs, public health officials downplayed the significance of the reports and the risk. In the absence of clear information, the instinct of the public health crowd was to reassure people in the face of potentially crippling uncertainty.
The disease turned out to be AIDS and went on to devastate many nations. The early reassurance probably helped it spread. Anthrax certainly is not AIDS, but the recent reactions of the Centers for Disease Control and health officials elsewhere illustrate a familiar pattern in incidents that combine serious disease, serious concerns and serious uncertainties: Reassure the public first and gather the facts later.
First the facts: Anthrax is a one-time agent. It doesn’t spread from person to person. The only way to contract the disease is to come into direct contact with the microscopic spores. To get the deadly inhalation form, you need to inhale at least 2,500 of them. The way the disease has been spread--by mail--limits how many people can be exposed.
But for people in targeted professions, fears are hardly hokey. The skin form manifests itself about 12 days after the spores are exposed to a cut or abrasion. But the inhalation form can be a surreptitious killer. Inhalation disease is known to occur up to 60 days after breathing in the spores. The inhaled spores can remain dormant for months and then germinate, meaning some exposed people could still be harboring the deadly infection.
Once the spores germinate in the lungs, they replicate quickly, releasing toxins that cause swelling and bleeding. If the bacteria are knocked out early with antibiotics, patients can do well. When toxin production has reached a critical threshold, usually in several days, the disease can be deadly.
In the case of the postal workers, the first response from public health officials, including the CDC, was to downplay the risk to mail handlers, even after a potent strain of spores had been discovered on Capitol Hill. To press the case for calm, the CDC reportedly gave the Postal Service the green light to invite reporters to a news conference at the mail-sorting center on Brentwood Road in Washington, D.C. This was three days after an envelope laced with anthrax turned up in the office of Sen. Tom Daschle, after passing through the Brentwood facility.
For weeks, we’ve been told by health and government officials that anthrax is not a contagious disease. That dying from anthrax is less likely than being struck by lightning. In other words, concerns over contracting the deadly disease are greatly exaggerated.
True, unless you work for the post office, a media company or on Capitol Hill.
Only after the death of the two postal workers and news of more infections did the CDC recommend that employees of 36 mail centers that service Washington be tested.
The truth is that nobody knows what the true risk is. And those early reassurances are ringing hollow. It is now apparent that some people might have been more preoccupied with preventing undue alarm than ensuring safety.
All along, the CDC, the surgeon general and others have been telling the worried well not to take antibiotics. Clearly, many people with no likelihood of exposure are misusing and abusing Cipro. But some others may not be. The postal workers who died reportedly followed the official advice. If they had been taking Cipro, they might still be alive.
Now we’re supposed to take the government’s word that a bioterrorist attack with contagious and deadly diseases such as smallpox is unlikely, at the same time health authorities go into the market to purchase 300 million doses of smallpox vaccine. Health officials had good intentions, but it is always easier--and politically more rewarding--to exude an air of reassurance and downplay the concerns. But a lack of candor will poison trust as surely as any infection. And once official reassurance is exposed as false, it is difficult for people to regain trust.
