Author: Jim

The following is the last in a three-part guest post series by Scott
J. Becker, MS, Executive Director, APHL. This post can also be found
on the APHL blog
here.

Thank you again to everyone at APHL and especially Mr. Scott Becker.

During this period, APHL experienced a surge in media interest, as it
quickly became apparent which labs were doing the anthrax testing. We
went from maybe three media calls per year to up to 60 per day. I
made the decision that APHL should not shy away from media attention,
instead we should let the media tell our story. But I knew that we
couldn’t keep up this pace so I asked the board to approve a one time
deficit spending of up to $30,000 for crisis communications support.
How did I arrive at that figure? It seemed like a number that would
fly – and it least it was a place to start. Following board approval,
I contacted the only director of communications I knew, Jody DeVoll
(then with AMCHP) for advice. She stayed on the phone with me for
over an hour, coaching me on the nuances of media and ended by saying
“you need Jill Merrick, and you need an intern just to handle the
incoming calls.” Jody is Angel #1. Jill Merrick is a communicator
extraordinaire. She was my godsend back then, and now I consider her
a good friend. Jill called me to say, “Jody called me and told me
your situation, how can I help?” Jill was in our office the next day,
and our own media induced chaos became more manageable, and most
importantly it became more strategic. Jill is Angel #2. I gave one
interview on WCBS News radio in New York City about the use of anthrax
home test kids that were being sold on the internet (I said that it
was a bad idea). Nancy Kaufman, an executive at the Robert Wood
Johnson Foundation heard the interview and called to ask if there was
something they could do. “For sure, “I replied, “we need funds to
help pay for crisis communications support.” Nancy is my third angel.
Within days, I had a grant to cover our communications needs, but
with one caveat. We were told that we must produce a communications
plan for the association but the added commentary was “we don’t think
that you can really do much with it, after all it’s only labs you deal
with.” To me, those were fighting words. Not only did we create
that plan, but we proved them wrong, very wrong. About a year after
the anthrax attacks and subsequent media maelstrom, APHL hired its
first director of strategic communications – Jody DeVoll, also known
as Angel #1. Jody now heads up a four person strategic communications
team. The public health lab system rose to the occasion that fall,
testing over 125,000 samples for anthrax contamination.

The fall and winter of 2001 ended for me with a much needed two week
vacation. On December 26, 2001 USA Today ran a multi-page story about
labs and anthrax, complete with a quarter page photo of Kati Kelley,
the Connecticut state laboratory director (and one of my public health
heroes).

Shortly after the new year, my daughter Sophie began to utter her
first few words. They were “dada,” “mama,” and “antrax.” It was at
that moment that I realized what toll these events took on me, having
been absent so much of Sophie’s first year. Someday Sophie and her
younger sister Ali may read these words and realize how important it
is for me to serve the public’s health through APHL, and how my small
role and bearing witness helped shape me as a parent and as a
professional.

Through planning, long days and nights, excellent science (some
admittedly “on the fly”), and the dedication of some of the most
committed public servants in America, we made it through that dark
fall and winter stronger because of the experience. The experiences
of 2001 helped us better serve the public through other health threats
in the past ten years – West Nile Virus, SARS, monkeypox, Hurricane
Katrina, 2009 H1N1 Influenza pandemic, and the Deepwater Horizon (Gulf
Coast Oil Spill) accident.

The unsung heroes of public health, laboratorians, hold my greatest respect.

The following is the second in a three-part guest post series by Scott
J. Becker, MS, Executive Director, APHL. This post can also be found
on the APHL blog
here.

CDC worked up messages that states should be communicating with their
hospitals and physicians to request immediate notification of any
patient who showed symptoms of anthrax and forwarding of any specimens
to the state lab for analysis.

The following week and a half was a blur – anthrax was detected in a
second AMI employee. Swabs were taken from their facility and found to
be contaminated as nasal swabs were taken from many other AMI
employees. Anthrax was then detected in New York City (as if they
haven’t been through enough!) and in Washington, DC at the Hart Senate
Building. We kept a running dialogue with our members, checking on
their needs and with the CDC investigators. That week we also began
to hear of several “white powder events,” as we now call them.

On Friday, October 19th at 5:00 pm I received a call from CDC’s senior
lab advisor, Dr. Jan Nicholson, asking if we could quickly arrange a
50-state call with all state lab directors as CDC wanted to share
information with us. We contacted every state and held the call at
6:30 pm – during which we learned that the CDC linked the four
confirmed cases of anthrax to “intentional delivery of B. anthracis
spores through mailed letters or packages”— the US postal system was
the delivery mechanism for the anthrax.

Now that anthrax was seemingly everywhere on the East coast, we were
more than on alert, we were set to action. A major gap was uncovered
during the 50-state call – there was no standardized protocol for
testing for B. anthracis from an environmental sample, only a human
clinical specimen. So we created one over the course of the weekend.

From Friday night through mid-day Sunday, APHL members and CDC
scientists developed a protocol by working through the days and
nights, handing off the still draft protocol to the next team in the
next time zone, until the protocol was deemed by CDC anthrax leads to
be ready for prime time. Prime time turned out to be Monday morning.

Sunday morning I was on a call with Dr. Nicholson and was asked if we
could meet with Postal Officials that evening at their emergency
operations center in DC. Very fortunately, APHL’s then-president Dr.
Mary Gilchrist was already en route to DC for other meetings and was
able to join me. Knowing how the government works, I didn’t want to
the two of us to be outnumbered, so I enlisted Carol Clark,APHL’s
chief operating officer, to join us. The APHL band of three entered
the USPS headquarters at 8:30 pm and met with a team of five officials
all of whom looked like they hadn’t slept for days. Truth was, they
hadn’t.

CDC was beginning to be deluged with specimens from the postal system,
so private clinical labs (which had no protocol) were testing
specimens for anthrax; state labs were getting inundated with objects,
powders and some of the strangest things one could imagine for
testing.

The postal officials were questioning Dr. Gilchrist, a world-class
microbiologist and architect of the LRN, about spore size and how far
spores could float. She, in turn, was asking them about the mail
handling process. She described how spores may go towards
electrostatic charges, charges that would be present as mail went
through a machine that essentially “pounded the hell out of the
envelope,” as was described to us.

Carol and I worked with Mary to devise a plan to bring some order to
the chaos that was ensuing in mail facilities across the country. We
learned about the process of mail flow and incorporated terms like
“upstream and downstream” facilities into our lexicon. We established
that by mid-week APHL would deploy a lab system coordinator to the US
Postal Service part time and that the person would work from APHL
offices in downtown Washington the rest of the time. We initially
figured we would need a coordinator inside USPS for a few days per
week for a few weeks. We enlisted Tony Sambol who serves as the
bioterrorism lab coordinator for the Nebraska Public Health Lab to
come to DC. Tony and his boss, Dr. Steve Hinrichs, readily agreed to
the arrangement. Tony arrived the following Wednesday, and it was a
full month before we saw him at APHL. He never left the USPS ops
center, there was just no time.

The USPS was looking for order out of chaos and we delivered. Tony set
up a system of communication and coordination for the high threat
samples (as deemed by postal inspectors and/or FBI) to quickly reach
the closest LRN lab capable of testing and that wasn’t inundated at
that moment. All of this required knowledge, dedication, nerves of
steel and excellent communication – all of which Tony possessed. APHL
was contracted by the USPS for this testing. LRN support was still
fairly thin so this arrangement allowed the LRN labs to conduct the
testing without worry that it was draining state coffers or limited
grant resources.

Lab directors were fully supportive of this system. They knew they
were under the gun to deliver quality results to the public as quickly
as possible. The labs were on the frontline in the war against
terrorism because it was within those labs that answers were housed.
The public health labs were the only ones who could determine if
anthrax was present or not.

These were some tense times. I was told to be on a call (and ensure
that Dr. Gilchrist was on it too) with some state epidemiologists who
were very concerned and angry that their state lab was being “used” by
APHL for fee-for-service postal testing….It seemed that even a few
weeks into the events, the public health community was not yet
convinced of how real this threat was. Fortunately, just before the
call, cooler heads prevailed, and, as I understand it, some East coast
epidemiologists supported this system because they were seeing the
chaos first hand.

The next few weeks were some of the craziest of our lives. Anthrax was
seemingly everywhere. Rural towns, big cities, the Hawaiian Islands,
State Department outposts around the globe all had anthrax scares.
Nowhere seemed off limits to the ubiquitous white powder. It wasn’t
only white powders and false alarms, the lab system also detected the
real deal. Anthrax was in newsrooms in NYC, the Senate office
buildings, and portions of the postal system. It was discovered that
a 61 year old health care worker succumbed to anthrax, as did a 94
year old woman who rarely left her home. Contaminated mail was the
working theory and remains so today.