Anthrax Assurances Cited as Threat to Public Trust

Government health officials investigating the anthrax attacks are facing growing criticism for making safety assurances that later were recanted and have ended up eroding the public trust.

The controversy came to a head this week when officials from the Centers for Disease Control and Prevention warned that tens of thousands of pieces of mail might have been cross-contaminated at a New Jersey postal facility that had processed the anthrax-laden letters to Democratic Sens. Patrick J. Leahy of Vermont and Tom Daschle of South Dakota.

That conclusion stemmed from the discovery last week of a letter in Seymour, Conn., that appears to have been contaminated while being processed shortly after the Leahy letter.

After assuring Americans for weeks that their mail was safe, postal and public health officials are exploring whether similar cross-contamination was a factor in the deaths of Ottilie W. Lundgren, 94, of Oxford, Conn., and Kathy T. Nguyen, 61, of New York. Cross-contamination is also believed to have caused a less serious case of skin anthrax in a New Jersey accountant.

“There are rules in public health about dealing with these kinds of things, and they seem to have broken every one of them,” said Helen Schauffler, director of the Center of Health and Public Policy Studies at UC Berkeley. “You don’t speculate about what might be happening. You don’t falsely reassure. It only undermines people’s confidence.”

Meanwhile, Rep. Christopher H. Smith (R-N.J.) called upon government officials to release a list of ZIP codes that received mail processed at the Hamilton, N.J., site at the same time as the contaminated letters.

“It is possible that other letters could have been cross-contaminated and that other postal customers may be exposed to the bacteria,” Smith wrote in a letter Tuesday to FBI Director Robert S. Mueller. “It may be in everyone’s best interest that [ZIP codes be disclosed] so people are cautioned of this possible danger, however small the chances may be.”

CDC officials said they are discussing how or whether they will notify Americans who might have received cross-contaminated mail but have made no final decision.

They stressed they still believe that the risk of infection caused by cross-contamination remains low.

But the agency is sufficiently concerned about the possibility that it plans to release an advisory to public health professionals nationwide, alerting them to the risk of contracting inhalation anthrax through cross-contaminated mail, said CDC spokesman Tom Skinner. Among other recommendations, the CDC suggests that Americans not hold mail near their faces and that those with health problems such as emphysema take extra precautions when opening mail.

The advisory is the latest in the CDC’s evolving guidelines for coping with the anthrax attacks.

Schauffler credits the CDC for its rapid response to the anthrax crisis and aggressive recommendations on prescribing antibiotics, which she said probably saved lives.

But she worries that the repeatedly false assurances may be creating a credibility gap with an anxious public.

“It undermines the public’s confidence,” Schauffler said. “Public health can’t be effective without the public trust. If we have another major crisis, the public may not believe what they are hearing or may not respond appropriately.”

Jeffrey Koplan, the CDC’s director, stresses that health officials are doing the best they can to cope with an unprecedented bioterrorist attack. He notes that the anthrax mailings mark the first time U.S. health officials have had to cope with the deliberate release of the deadly bacteria, which in these cases had been treated to make spores easier to spread.

“During the course of this investigation, we’re learning things on an ongoing basis,” Koplan said.

Government health officials said they do not think their efforts to calm and inform Americans have undermined public confidence or caused long-term damage.

“The public has a firm understanding that this is an entirely new ballgame,” said Tony Jewell, a spokesman for the U.S. Department of Health and Human Services.

But public confusion over the government’s response is understandable, experts say.

Critics say HHS Secretary Tommy G. Thompson got off on the wrong foot in early October by proclaiming that the death of a Florida newspaper photo editor appeared to be an “isolated” incident. He suggested the man might have contracted the disease by drinking from a stream.

As the nation quickly learned, numerous letters were mailed to individuals in at least three states by a terrorist who continues to elude authorities.

Then the CDC assured nervous postal workers that they were safe because anthrax spores were unlikely to escape from sealed envelopes--a theory that could have been easily tested but never was.

It wasn’t until two Washington, D.C., postal workers died that health officials realized their mistake and called for widespread testing of postal facilities and immediate antibiotics for affected mail workers.

Postal unions complained bitterly that their members had been treated like second-class citizens compared to Capitol Hill workers, who were quickly offered testing and antibiotics after the Daschle letter was opened at the Hart Senate Office Building.

The CDC and U.S. Postal Service then insisted that the mail was safe and that Americans were highly unlikely to become infected by mail arriving in their homes.

But soon traces of anthrax began appearing in dozens of mail rooms and postal facilities. On Oct. 22, a New Jersey accountant was hospitalized with skin anthrax. She is believed to have contracted it from handling her company’s mail, which was processed at the same site that handled the contaminated letters.

In response, CDC officials again changed their tone, saying that Americans should wash their hands after handling mail to reduce the risk that cross-contamination might cause skin anthrax.

But they insisted there was only a minute chance that it could cause the more serious form of inhalation anthrax.

This week, Koplan and other public health officials announced that cross-contamination is now one of the leading theories to explain the Lundgren and Nguyen deaths.

“The likelihood is increased in light of the cross-contamination [found on the Seymour letter],” Koplan said.

At a minimum, government officials should notify those Americans who may have received contaminated mail, said Dr. Stephen Morse, director of the Center for Public Health Preparedness at Columbia University.

“If nothing else, you want to warn people,” Morse said.

If a person throws a piece of contaminated mail, such as a birthday card or bank statement, in a desk drawer, it might still contain harmful spores months later, Morse said. Sunlight, he said, typically kills spores within minutes.

But Morse said public health officials are probably grappling with how to warn the public without alarming people, and what sort of recommendations to make.

“It’s a tough one,” Morse said.