The Anthrax Letters: A Medical Detective Story

280 Pages·2003·7.76 MB·English

by  Leonard A. Cole

Leonard A. Cole
Joseph Henry Press
Washington, D.C.
Joseph Henry Press • 500 Fifth Street, NW • Washington, DC 20001
The Joseph Henry Press, an imprint of the National Academies Press, was
created with the goal of making books on science, technology, and health
more widely available to professionals and the public. Joseph Henry was one
of the founders of the National Academy of Sciences and a leader in early
American science.
Any opinions, findings, conclusions, or recommendations expressed in
this volume are those of the author and do not necessarily reflect the views of
the National Academy of Sciences or its affiliated institutions.
Library of Congress Cataloging-in-Publication Data
Cole, Leonard A., 1933-
The anthrax letters : a medical detective story / Leonard A. Cole.
p. cm.
Includes bibliographical references and index.
ISBN 0-309-08881-X — ISBN 0-309-52584-5 (PDF)
1. Bioterrorism—United States. 2. Anthrax—United States. 3. Postal
service—United States. 4. Victims of terrorism—United States. I.
Title.
HV6432.C63 2003
364.152′3—dc22
2003015149
Copyright 2003 by Leonard A. Cole. All rights reserved.
Printed in the United States of America.
Contents
Prologue vii
1 Deadly Diagnosis 1
2 American Media 22
3 The Nation at Risk 47
4 Ultimate Delivery: The U.S. Mail 72
5 The Outliers 95
6 D.A. Henderson, the CDC, and the New Mind-Set 115
7 A Scientist’s Race to Protection 138
8 Terror by Hoax 160
9 Who Did It? 185
10 Loose Ends 212
Epilogue 238
Bibliography 241
Acknowledgments 255
Index 259
v

Prologue
W
hen Pat Hallengren arrived at work on August 10, 2002, she
noticed that the middle mailbox was missing. It was the one
she had always used. For as long as she could remember, it
had stood between two other receptacles outside her window in the
American Express travel office in Princeton, New Jersey.
But during the late hours of the previous night, postal authori-
ties had removed the box. Before long, word spread about the rea-
son, and local curiosity turned to horror. The mailbox was found
to have contained anthrax spores. When Pat heard this, her first
thoughts were about her mailman, Mario. “I really wasn’t con-
cerned for myself. I mean, I just put mail in the box, but Mario had
to take it out.” Her worry was understandable.
Anthrax bacteria are as murderous as South American flesh-
eating ants. An army of ants, traveling in the millions, can decimate
an immobilized individual by devouring his flesh layer by layer.
Death is gradual and agonizing. Anthrax bacilli do to the body
from within what the ants do from without. They attack every-
where, shutting down and destroying the body’s functions from
top to bottom. The organisms continue to multiply and swarm un-
til there is nothing left for them to feed on. In 2 or 3 days a few
thousand bacilli may become trillions. At the time of death, as much
as 30 percent of a person’s blood weight may be live bacilli. A
microscopic cross section of a blood vessel looks as though it is
teeming with worms.
vii
viii THE ANTHRAX LETTERS
The anthrax bioterrorism attacks the previous fall, in 2001,
had been conducted by mail. On October 4, three weeks after the
terror of September 11, a Florida man was diagnosed with inhala-
tion anthrax. His death the next day became the first known fatal-
ity ever caused by bioterrorism in the United States. During the
following weeks, more people were diagnosed with inhalation an-
thrax as well as with the less dangerous cutaneous, or skin, form of
the disease.
Almost all the cases were traced to spores of Bacillus anthracis
that had been placed in letters. Perhaps a half dozen letters contain-
ing a quantity of powder equivalent in volume to a handful of aspi-
rin tablets paralyzed much of America. During the fall 2001 scare,
congressional sessions were suspended and the U.S. Supreme Court
was evacuated. Infected mail disrupted television studios and news-
paper offices. People everywhere were afraid to open mail.
Four of the anthrax letters were later found, and all were post-
marked “Trenton, NJ.” That was the imprint made at the large
postal sorting and distribution center on Route 130 in Hamilton
Township, 10 miles from Princeton. Ten months after the attacks,
when Pat Hallengren’s favorite mailbox had been removed, mail-
boxes that served the Hamilton facility were belatedly being tested
for anthrax. In the first week of August, investigators swabbed 561
drop boxes and delivered the cotton tips to state laboratories. Only
that one mailbox, on Nassau Street near the corner of Bank Street
in Princeton, tested positive for anthrax. Could that box, not 30
feet from Pat Hallengren’s desk, have been where the poison letters
were deposited?
The mailer of the anthrax letters had not yet been found. But 6
weeks before the discovery of anthrax spores in the Princeton mail-
box, the Federal Bureau of Investigation had identified a microbi-
ologist named Steven Hatfill as a “person of interest.”
Days after the middle mailbox was removed, federal agents
fanned out through the neighborhood. They showed a picture of a
steely, thick-necked man to merchants and patrons up and down
Nassau Street. It was Hatfill. “Do you remember seeing this per-
son?” they asked. “I don’t recognize him,” Pat Hallengren an-
swered, “but I see so many people on this corner.” Four doors up
from the corner, Shalom Levin, the bearded owner of the Red On-
ion delicatessen, was ambivalent. “I might have seen him walking
around here,” he told an FBI official. But perhaps Hatfill’s face
seemed familiar, he acknowledged, because he had seen it on TV. In
2003, long after the discovery of anthrax in the Princeton mailbox,
PROLOGUE ix
the FBI was still searching for the mailer and still considered Hatfill
a person of interest.
Between October 4 and November 21, 2001, 22 people were
diagnosed with anthrax. Eleven contracted the cutaneous form and
all survived. But among the 11 who became ill from inhaling spores,
five died. In subsequent months, with no new cases, national anxi-
ety eased. But the discovery of the contaminated mailbox almost a
year later in Princeton drew a torrent of television and newspaper
coverage from around the world. Fear had been rekindled.
Concern about anthrax is as old as the Bible. Primarily a dis-
ease of animals, it is thought to have been the fifth of the 10 bibli-
cal plagues visited by God on the ancient Egyptians for refusing
freedom to the Jews. As recounted in Exodus, horses, donkeys,
camels, cattle, and sheep were struck “with a very severe pesti-
lence.” After their carcasses were burned, the virulence of the an-
thrax germs persisted, for the soot caused “boils on man and beast
throughout the land of Egypt.”
In recent years, anthrax spores have been deemed among the
most likely of biological weapons because they are hardy, long
lived, and, if inhaled, utterly destructive. A victim is unlikely to
know he is under attack. As with other biological agents, anthrax
germs are odorless and tasteless, and lethal quantities can be so
tiny as to go unseen.
Every 3 seconds or so, a human being inhales and exhales about
a pint of air. Each cycle draws in oxygen to fuel the body and
releases carbon dioxide, the gaseous waste product. The inhaled air
commonly carries with it floating incidentals such as dust, bacteria,
and other microscopic particles. If a particle is larger than 5 mi-
crons, it is likely to be blocked from reaching deep into the lungs by
the respiratory tract’s mucus and filtration hairs. If smaller than 1
micron, a particle is too small to be retained and is blown out
during exhalation. An anthrax spore may be 1 micron wide and 2
or 3 microns long, just the right size to reach deep into the respira-
tory pathway.
A spore is so tiny that a cluster of thousands, which would be
enough to kill someone, is scarcely visible to the naked eye. A
thousand spores side by side would barely reach across the thin
edge of a dime. Once inhaled, the spores are drawn into the bron-
chial tree where they travel through numerous branches deep in
the lungs. Near the tips of the branches are microscopic sacs called
alveoli. It is in these sacs that inhaled oxygen is exchanged with
carbon dioxide.