From Jeanne Guillemin, one of the world's leading experts on anthrax and bioterrorism, the definitive account of the anthrax investigation
It was the most complex case in FBI history. In what became a seven-year investigation that began shortly after 9/11—with America reeling from the terror attacks of al Qaeda—virulent anthrax spores sent through the mail killed Bob Stevens, a Florida tabloid photo editor. His death and, days later, the discovery in New York and Washington, D.C. of letters filled with anthrax sent shock waves through the nation. Federal agencies were blindsided by the attacks, which eventually killed five people. Taken off guard, the FBI struggled to combine on-the-ground criminal investigation with progress in advanced bioforensic analyses of the letters' contents.
While the criminal eluded justice, disinformation swirled around the letters, erroneously linking them to Iraq's WMD threat and foreign bioterrorism. Without oversight, billions were lavished on biomedical defenses against anthrax and other exotic diseases. Worst of all, faith in federal justice faltered.
American Anthrax is a gripping tale of terror, intrigue, madness, and cover-up.
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Jeanne Guillemin is a senior fellow in the Security Studies Program at Massachusetts Institute of Technology, in the Center for International Studies. She is the author of Anthrax: The Investigation of a Deadly Outbreak and Biological Weapons: From the Invention of State-Sponsored Programs to Contemporary Bioterrorism.Excerpt. © Reprinted by permission. All rights reserved.:
Anthrax is a disease of animals, particularly sheep and cattle, and to a lesser extent man, caused by infection with Bacillus anthracis.
—C. A. MIMMS, The Pathogenesis of Infectious Disease, 1987
Wednesday, September 26, 2001. Bob Stevens, a fifty-six-year-old senior photo editor for the national supermarket tabloid The Sun, was in his third-floor cubicle, hunched over his computer. The modern glass and concrete building where he worked, set in a landscaped office park in Boca Raton, Florida, was owned by The Sun's parent company, American Media, Inc. (AMI), whose headquarters were in Manhattan and whose business was big-circulation, celebrity journalism. The Sun and the National Enquirer were its weekly flagship moneymakers.
Stevens was rushing to meet his deadlines before taking a long weekend off. He and his wife, Maureen, were driving to North Carolina to visit their daughter Casey, a student at the state university at Charlotte. Bob was a Brit, gregarious and cheerful. Maureen, equally good-humored but more shy, had been born in Ireland. They had arrived in America in the early 1970s, when they were still in their twenties, and started a new life together. They became American citizens and settled in Florida, happily so. Both had been married before and were already parents, with three children between them, and then they had Casey, the last to leave the nest.
Bob had planned a packed agenda. He wanted to set out for Charlotte at the crack of dawn, go hiking with Casey on the Appalachian slopes near Chimney Rock, take a side trip to Durham to meet her boyfriend who was in school there, and then on Monday he and Maureen would drive back to their home in Lantana, about ten miles south of Palm Beach.
While Stevens edited photos on his computer, another AMI employee, Ernesto Blanco, was working in the first-floor mail room. A Cuban émigré, the wiry Blanco was seventy-two but had a thick head of hair and the stamina of a much younger man. Every morning he drove the company van to the local post office to pick up 10,000 to 15,000 pieces of pre-bundled mail, which he brought back, sorted, and, using a wheeled cart, delivered to the building's three floors of offices. Stephanie Dailey, a young woman with a desk near the mail room, often helped him when she wasn't busy opening mail for the National Enquirer. Ernesto never minded doing the work himself. Every morning he took the train from North Miami to Boca, eager to start his work day, sorry when it was done. All his life he'd been like that—full of energy, never missing a day of work. Six years before, thinking it was time for retirement, he'd sold his small upholstery business in Miami—and almost immediately grew bored. "AMI saved my life," he often said. "Hanging around the house, doing nothing, that was driving me crazy."1
The year before, Bob Stevens had also tried retirement. After nearly thirty years of rushing to meet deadlines, he thought he'd like a life of biking, fishing, and gardening. He and Maureen, a retired secretary, could finally travel. But like Blanco, he missed work, and he missed his friends at AMI, a company that prided itself on a family-like atmosphere. In six months, he was back at his desk, editing photos of celebrity newsmakers.
As planned, early on Thursday, September 27, Bob and Maureen Stevens left for North Carolina. Robert (as his wife preferred to call him) loved driving and was in a great mood. Maureen, who was recovering from a sinus infection and taking the antibiotic Ciprofloxacin (Cipro), counted on his enthusiasm. They both missed having Casey at home. As they traveled north, they talked and laughed and made plans to celebrate their twenty-seventh wedding anniversary, which was coming up on October 18.2
The next day, Friday, after Ernesto Blanco finished sorting the mail at AMI, he felt weak and feverish and was shivering like never before in his life. Concerned, Daniel Rotstein, the personnel director, arranged for a company driver to take the older man home to North Miami. On Saturday Blanco felt better but bewildered and a bit embarrassed. He'd always prided himself on his iron constitution, and now his wife, along with his stepdaughter and her husband, were hovering over him. On Sunday, the feeling of weakness returned, this time with chest pains.
Up in North Carolina, on the Sunday drive from Chapel Hill to Durham, flulike symptoms of weakness, fever, and chills hit Bob Stevens like a blow. He crawled into the backseat, letting Maureen take the wheel. On the highway, they kept passing exit signs for local hospitals; Bob adamantly refused to stop for help. After a few hours of rest at Casey's boyfriend's apartment, he felt much better. On Monday morning, he and his wife set off on the return trip to Florida. Bob, although quieter than usual, drove the whole way. They made it home at around 5 p.m., and tired, went to bed at eight.
That same Monday, Ernesto Blanco was admitted to Cedars Hospital in North Miami. His physician there, Carlos Omenaca, was baffled by his condition, which at first seemed like a heart attack. Blanco had some sort of infection, but what was it? Omenaca tried different combinations of intravenous antibiotics, but the weakness and chest pains persisted. Prostrate, Blanco listened to the bedside discussion of his mystery illness. "My father thinks it's from an animal," Dr. Omenaca remarked. "He used to be a farmer." Those were the last words that Blanco remembered hearing before he slipped into a coma.
At 1 a.m. on Tuesday, Maureen Stevens woke to the sound of her husband retching in the bathroom. He was fully dressed and this time, dizzy and weak, he made no objection when Maureen insisted on driving him to the John F. Kennedy Medical Center (JFK) in nearby Atlantis, just five minutes away. Bob had been a patient there before for minor heart problems, and his daughter Heidi had a job in the hospital's administration. Once checked in, Stevens was given a bed to lie down on and, to calm his nausea, a sedative. Then he fell unconscious and, with his vital signs failing, was transferred to intensive care.
A physical examination and routine tests shed no light on Stevens' sudden collapse—it wasn't a heart attack or stroke or pneumonia or trauma from a fall. Maureen took the attitude that no news was good news. Around 5 a.m. she went home to sleep and returned promptly at eight for Robert's scheduled spinal tap. She and Heidi watched in anguish as, still unconscious, he struggled against the painful procedure.
Larry Bush, the hospital's chief of infectious diseases, knew that otherwise healthy adults don't suddenly collapse without cause. A transplant from the urban Northeast, he focused on the clouds, letting others search for silver linings. In his field, his pessimism had yet to let him down. Attuned to the bioterrorism threat, he had in his office a well-read copy of a 1999 article on anthrax as a biological weapon, co-authored by USAMRIID's Art Friedlander and a group put together by the Johns Hopkins Center for Civilian Biodefense Studies. When Bush examined Stevens' spinal fluid under a microscope, he found in it a proliferation of rod-shaped bacteria, like jumbled chains of bamboo, certainly a type of bacillus. Bush ran a simple test and discovered that the bacteria were "gram positive," one of the characteristics of Bacillus anthracis. To be sure, Bush needed more sophisticated tests, the kind that, according to protocol, should be done at the Florida Department of Health laboratory in Jacksonville, which was part of the Laboratory Response Network created under the Clinton administration. For this he needed an assist from a public health official.
Bush telephoned someone he knew on a first-name basis: Dr. Jean Malecki, head of the Palm Beach County Public Health Department. Nearly twenty years before, Malecki had been his colleague at JFK, when both were newly minted infectious disease specialists, he from the University of Pennsylvania, she from New York University.
The dynamic Malecki, six feet tall with long red hair, was already a local legend. In the public eye for nearly twenty years, starting with the early 1980s AIDS fatalities linked to a Florida dentist, and through dozens of high-profile incidents since then, she was in charge of the health of two million county residents and she counted them all as her people. With Florida on alert after 9/11, she had convened a meeting of 200 first responders to assess the potential bioterrorism threat.3 At 2:15 p.m., when Bush's call was forwarded to her, a panel of experts had just finished discussing whether terrorists could effectively use a crop duster to spray anthrax spores. In Florida, the front-page news, based on FBI reports, was that before 9/11 al Qaeda operatives had circulated under cover in Palm Beach, Delray, Venice, Hollywood, and Jacksonville and that, while taking flying lessons, they had inquired about crop dusters.
Advising Malecki to sit down, Bush explained that he had a patient who might have inhalation anthrax and asked her how soon she could come to the hospital to give her evaluation. The patient had presented as a meningitis case, with signs of general acute infection, but Malecki trusted Bush's judgment. Tied up with her meeting on domestic preparedness, she told him that the best she could do was seven that evening. The patient's history of possible exposure would be vital, but with Stevens in a coma Malecki would have to get the details from his wife. "I'll have my staff bring an anthrax questionnaire," she told Bush.
Public health professionals work in essentially two modalities. One is routine preventive management—making sure schoolchildren have their vaccinations, pregnant women their vitamins, and old people their flu shots, and that chronic and infectious disease incidents are monitored. The other is emergency mode, the team mobilization to contain disasters that is the equivalent of marshaling troops for war. A seasoned administrator, Malecki handled the former every day, but she was no stranger to real-life emergencies or mass attack models. In the late 1990s Malecki had participated in two exercises for responding to mass anthrax attacks that pushed the emergency response model beyond the envelope—which was exactly where Bush's patient, if this were the index case of a larger outbreak, might be heading. The exercises were designed to teach local authorities—herself, hospital officials, police, firefighters, and the WMD experts from FBI field offices—in fact, the very people at her meeting—to make rational decisions that would, if the threat were real, trigger state and federal government rescue responses. The effect should be like a computer game in which communication channels light up, the troops arrive with medical supplies, and hundreds if not thousands of lives are saved from deadly anthrax.
Throughout the response, public health officials had to stay calm and keep the affected community informed, cooperative, and free from panic, or the rescue effort could fall apart. Since 9/11, though, the public was primed for panic, and anthrax and other disease attacks were being touted widely in the media as the next worst terrorism.
Bush's phone call left Malecki with some troubling uncertainties. The minute she asked Jacksonville to test for anthrax, alarms would ring in government offices from Florida to Washington. If the results were positive, louder alarms would ring and the media would be all over the story, no matter how the man at JFK had been exposed. Malecki had spent years cultivating good relations with the press. Did she have enough capital with them to keep communication focused on education and not scare-mongering headlines?
Unfortunately, fear of anthrax was hardly irrational. Its ferocious natural cycle uses the host mammal as a live incubator that must die for B. anthracis to multiply and survive. Within the host's body, the proliferating bacteria rapidly cause massive internal hemorrhage so that, bursting from every orifice in waves of blood and fluid, this new generation of microbes can assume their sturdy spore form and await a new host to infect. As the disease evolved over many centuries, a grazing animal feeding in a spore-contaminated field was usually the next victim. By learning to live successfully off livestock, human beings became potential hosts. When twentieth-century armies developed B. anthracis as a weapon, the potential for the human host population expanded to mass targets, not what nature intended.
Another uncertainty was how federal agencies would react, even to a single confirmed anthrax case. State health officials in Tallahassee would have to invite the CDC (Centers for Disease Control and Prevention in Atlanta) to investigate: anthrax was not endemic in Florida and the last U.S. case of inhalational anthrax dated back thirty years. If evidence pointed to an intentional cause—an act of malice against a single individual, or worse, a mass attack—the FBI would step in as the lead agency to conduct a criminal investigation. If more cases of illness emerged, beyond what Malecki's department, the state, and the CDC could handle, Washington would send the Federal Emergency Management Agency to coordinate a disaster response. Malecki hoped that Bush was sounding a false alarm. Whatever had happened or would happen, she had to stay calm.
When Malecki arrived at the hospital that evening, Bush led her to his patient's room. "I've put him in isolation," he explained, "and he's on broad-spectrum antibiotics." They put on masks and gloves before they entered.
Stevens lay on the narrow bed in a coma, attached to a respirator and an array of drip bags and monitors. He was a big man, husky but muscular. His wife, Maureen, also masked and gloved, sat next to him holding his hand. When Maureen Stevens stood, the look she gave Dr. Malecki was more inquisitive than worried. No one had mentioned the possibility of anthrax in order not to upset her unnecessarily. Instead, Dr. Bush had told her that her husband had a general infection, meningitis, that was affecting his brain and that more tests had to be done. While Maureen waited, she wanted to stay at her husband's side in case he should wake, but she understood that the county health department had some questions for her and that its director, Dr. Malecki, was here to help.
Three of Malecki's assistants then met with Maureen in a small conference room. They had written the questionnaire themselves, on the fly, after finding nothing available from the CDC. In her soft, precise Irish accent, Maureen gave them a detailed account of the trip to North Carolina and described her husband's everyday routine and his hobbies. She answered every question, even the odd ones. Yes, she kept a clean house and frequently laundered their clothes, sometimes daily. No, they had not been at any country fairs or crowded events. Yes, he liked genuine leather shoes. No, as far as she knew, he didn't handle mail at work.
She had no idea how these questions could help her husband's diagnosis, but realizing these officials were nearly as puzzled as she was, Maureen summoned new energy and told them everything she co...
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