Powdered doughnuts. A coffee table. Rolled-up dollar bills. Dead birds. Disposable underpants.
The suspect samples rolled in and public health officials, some working literally in converted closets, worked day and night to test them. The anthrax attacks that followed Sept. 11 tested the limits of the U.S. public health system and changed for a decade the way Americans looked at the mail carrier.
In the days that followed the Sept. 11 attacks, many bioterrorism experts wondered the same thing - was a biological attack next? For years, these specialists had met, talking about the potential threat of smallpox, nerve gas, plague and Ebola virus. But the No. 1 suspect always was anthrax.
Bioweapons seem like an obvious choice for a terror attack. Powdered anthrax spores released, say, from a small plane could infect hundreds of thousands of people, who wouldn't know until it was almost too late. Anthrax, a type of bacteria found naturally in the soil, is easily treated with antibiotics. But it grows spores that can settle deep in the lungs and by the time they cause symptoms, it is almost always too late to save the victim.
Biological weapons are difficult to trace, and Iraq, Russia, and many other countries were known to have biological weapons programs. The United States had its own program for a while, closed by President Nixon in the late 1960s. The shuttered "anthrax tower" remained standing in 2001 at Fort Detrick, Md., outside Washington.
Powdered anthrax sent through the mail in September and October of 2001 ended up infecting at least 22 Americans and killing five. It was a fitting follow-up to Sept. 11. -- almost too perfect, in fact. As it turned out, the FBI fingered one of the very experts who had been warning of the threat for years. A motive was never discovered, but the suspect, Bruce Ivins, had a history of mental disturbances and ended up committing suicide in 2008 as federal investigators closed in.
In a review of the response to the attacks released on Thursday by the Trust for America's Health and the Robert Wood Johnson Foundation, public health officials recount some of what they had to deal with in the weeks and months following the attacks.
Lab technicians ran more than a million tests on 125,000 samples. "We realized there was no cavalry coming to sort things out. We would have to manage most of this ourselves," emergency physician Dan Hanfling, special adviser on emergency preparedness and disaster response to the Inova Health System, said in the report.
News organizations and congressional offices were targeted by the anthrax letters. Thousands of Hill workers took antibiotics for weeks on end to prevent infection. Anthrax spores can stay dormant in the lungs for months, and the only way to prevent them from becoming quietly but fatally active is to take drugs continuously. Mail rooms around the country were closed as each letter took on an ominous aspect.
"On October 12, 2001, we received our first anthrax laden letter which was mailed to the office of NBC News here in NYC," Sara Beatrice of the New York City Public Health Laboratory said in the report. "The ensuing investigation and media coverage resulted in our Public Health Laboratory receiving thousands of clinical specimens and environmental samples for testing… coffee tables from a department store, suitcases from the airport, dollar bills that had been rolled up, you name it."
"Here was a typical scenario: A jittery and unnerved town resident would discover 'suspicious' white powder in his community," recalled Howard Koh, now the Health and Human Services assistant secretary for health. "Immediate notification of the local police or fire department would trigger both the closing of the local post office and the sudden arrival of HAZMAT teams, bedecked in imposing space-suit paraphernalia.
"A hastily arranged press conference would feature harried state and local officials trying to explain the unfolding developments to an increasingly anxious public. And when testing in the laboratory subsequently yielded negative results for anthrax, that finding would prompt yet another round of news announcements as well. Multiply this situation by several thousand -- and that was the fall of 2001 in our state, and indeed, around the country."
Anything the least suspicious-looking was sent to hapless state and local public health offices for examination.
"The types of environmental samples received were variable to say the least. From the obvious bulk mail from post offices, suspicious mail from homeowners and powder samples (including powdered doughnuts), to the more obscure airline seat covers, dead birds, body bags, teddy bears, disposable underpants, a Marilyn Monroe effigy and residential mail boxes together with post and concrete anchor.... each presented a new challenge," recounted Phil Lee of the Florida Department of Health.
The attacks did mean that public health labs, badly neglected for decades, got a boost in funding. Congress increased biological warfare-related funding at the National Institute of Allergy and Infectious Diseases by $1.5 billion in 2003. The Project Bioshield Act, which provided $5.6 billion over 10 years to buy new vaccines and drugs, was passed in 2004.
States began stockpiling "biological countermeasures" from latex gloves to face masks. "Cipro" -- short for ciprofloxacin, the most effective antibiotic for treating anthrax -- entered the common vernacular. An embarrassed Centers for Disease Control and Prevention was forced to explain why mostly white congressional staffers got weeks of cipro while mostly black D.C. postal workers whose workplace ended up being contaminated got no such protections. Two D.C. postal workers -- Thomas Morris Jr. and Joseph Curseen -- died.
The FBI estimates it cost $1 billion to clean up the mess. The anthrax spores got into the equipment used to sort and process mail. It took more than two years and cost $130 million to clean up the Brentwood center in Washington where Morris and Curseen worked. The Environmental Protection Agency spent $41.7 million to clean up government buildings in Washington, including Senate office buildings.