WashPost

N.Y. Hospital Worker Dies of Anthrax

By Michael Powell and Ceci Connolly Washington Post Staff Writers Thursday, November 1, 2001; Page A01

Public health officials scrambled yesterday to investigate the mysterious infection and death of a New York woman from inhalation anthrax, as experts warned Americans that the wave of bioterrorism could expand in coming days.

Kathy Nguyen, 61, a hospital worker from the South Bronx, died yesterday morning at a New York hospital, three days after doctors placed her on a ventilator. A second worker at Manhattan Eye, Ear and Throat Hospital, where Nguyen worked, has been tested for skin anthrax, but no trace of spores has been found at the hospital.

Investigators say they may have pulled some anthrax spores off Nguyen's clothes.

The lack of fresh leads, even as 1,000 detectives, FBI agents and medical investigators combed through offices and homes, frustrated officials. Jeffrey Koplan, director of the Centers for Disease Control and Prevention, spoke of Nguyen as the latest "murder victim in New York."

Top health officials warned that the anthrax attacks are still escalating. And experts who track anthrax caution that the terrorists appear to be sophisticated scientists -- not basement experimenters following a poisonous recipe for the first time.

Among 16 anthrax cases that have resulted in four fatalities nationwide, Nguyen's death is the first to have no link to the news media or the Postal Service -- where the disease is presumed to have spread through letters contaminated with millions of anthrax spores. She was also one of two anthrax cases this week that involved Americans who did not routinely deal with mail on the job.

President Bush warned business leaders yesterday that the United States is "still being attacked." And White House spokesman Ari Fleischer acknowledged the fear that comes with trying to combat an invisible threat from an unknown enemy.

"I think for the American people it's frightening, it's scary," Fleischer said. "We do not know how she contracted the anthrax."

In New York, Mayor Rudolph W. Giuliani emphasized that the anthrax that infected Nguyen, however terrible, appears isolated to a single hospital and one or two victims. He said investigators may have found traces of anthrax bacteria on the clothing Nguyen wore when she was admitted to the hospital Sunday, including -- according to preliminary tests -- her shirt, sweater and jeans.

"No one can assure anyone that we're all perfectly safe," Giuliani said. "All I can do is give you the facts."

Police Commissioner Bernard Kerik said investigators are looking beyond the hospital, to Nguyen's home and, more remotely, the subways: Nguyen rode the No. 6 train down the East Side of Manhattan to work each day.

The U.S. Postal Service, meanwhile, swiftly closed another central mail-processing facility, this one in southern New Jersey, after learning late Tuesday night that a worker there tested positive for skin anthrax. The infected man lives in Delaware.

"He is not hospitalized. He's okay. We are very comfortable the exposure has not occurred in Delaware," said Ulder Tillman, director of the state's Division of Public Health.

Investigators swept through the processing and distribution plant located about 35 miles south of the contaminated Hamilton Township site, where three letters containing anthrax spores were postmarked. No tainted letters have surfaced with the Bellmawr postmark, although health and postal officials have long speculated that more contaminated letters remain to be found.

Meanwhile, public health officials struggled to make sense of the latest cases, with experts offering several theories. The leading theories tend to fall along two lines: One holds that anthrax is likely being spread through new pieces of contaminated mail; the other is that terrorists are experimenting with new avenues of attack.

If tests reveal new cases of anthrax at the small, 28-bed hospital where Nguyen worked, it might suggest fresh, direct exposure to the diseases, as opposed to cross contamination from an existing piece of mail. But the search for new infections is more difficult because Nguyen's co-workers are already taking antibiotics, which could mask the presence of anthrax.

The recent case of the woman in New Jersey, a bookkeeper who came down with skin anthrax, appears to worry officials less. They note that she worked close to a post office contaminated with particularly finely milled spores, and that spores might have passed from envelope to envelope.

"The cutaneous anthrax part of it is compatible with cross contamination," said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. "The case in New York City is clearly much more perplexing, because at this point, there really is no apparent connection.

"And the inhalation component of it makes it even more perplexing."

Indeed, the closer scientists look at the spores that have traveled through the mail, the more impressed and concerned they have become. Alan Zelicoff, senior scientist at the Center for National Security and Arms Control at the Sandia National Laboratories in Albuquerque, said investigators need to begin to focus less on the microbiology than the physics, which is impressive.

"We didn't think that anybody could come up with the appropriate coatings for anthrax spores to make them float through the air with the greatest of ease," Zelicoff said, adding that exposing 28 people with a single opened envelope "is no mean trick."

And C.J. Peters, director of the Center for Biodefense at the University of Texas at Galveston, said that someone who has learned to produce two grams of anthrax spores milled to one to five microns -- as was true of the spores mailed to Senate Majority Leader Thomas A. Daschle (D-S.D.) -- could just as easily produce two kilograms of the stuff.

He sees the potential for a grander terror.

"With two grams of finely milled anthrax," Peters said, "if you can disseminate it in a closed system like a subway or building, you could infect hundreds of thousands of people."

The anthrax crisis has forced scientists and health officials to reconsider other verities as well, including the number of spores it takes to cause inhalation anthrax. Sen. Bill Frist (R-Tenn.), the Senate's only physician, who has steeped himself in bioterrorism, said no case has so alarmed him as the death of Nguyen. And he suggested that scientists discard the existing assumption that it takes 8,000 to 10,000 spores to infect someone.

"I'd throw it out the window," Frist said.

Scientists and public health officials have said in recent days that they believe that age, health and even how deeply a person breathes could affect whether they become infected. A 1993 study by the Office of Technology Assessment concluded that "1,000 spores or less can produce fatal pulmonary anthrax in some" people.

More important than the number of spores may be the bacteria's ability to travel through the air and into the lungs.

"If you're far away or the wind has dispersed it significantly, it gives you a considerable advantage," said Stephen S. Morse, director of the Center for Public Health Preparedness at Columbia University.

For now, officials find themselves less certain about a disease that, although treatable, has the potential to cause many more deaths.

"In hindsight, this has been an escalating event," said Mohammad Akhter, executive director of the American Public Health Association. "We will continue to see new cases of anthrax disease. We do not have a complete handle on who was exposed."

The answers to those questions are as eagerly awaited in the South Bronx, where Nguyen lived, as on Capitol Hill. Anna Rodriguez, the former manager of the West Farm Estates apartments where Nguyen lived for more than two decades, recalled a woman who always smiled, and brought along doughnuts and coffee whenever she came to the office.

"We loved this woman; she would give us hugs and kisses," Rodriguez said. "I hope that someone comes back and gives us some answers."

Staff writers Christine Haughney, Robert O'Harrow Jr. and Dale Russakoff contributed to this report.

-- Anonymous, October 31, 2001