Before 9/11 and anthrax, the Arlington County communicable disease bureau’s primary concerns were HIV, sexually transmitted diseases and Tuberculosis control. In fact, screening and other communicable diseases were much smaller efforts and managed by part time staff.

Then, in October 2001, the Arlington community— still reeling from the attack on the Pentagon— was in the middle of one of the biggest public health emergencies the country had ever faced. We wondered if this new threat was part of a general assault on the United States and we didn’t know what else could be coming.

Our immediate priorities were heightened monitoring and surveillance, external and internal communications and establishing partnerships with local emergency responders and medical care providers. We were charged with protecting the community and preventing the spread of disease. The public expected us to keep them safe and we had never before experienced this kind of public health emergency.

Staff already had demanding workloads and now were being asked to work extra hours and maybe even place themselves at unknown risk. In addition, resources were limited and we had to find additional staff from other programs and quickly train them. Everyone assigned to the anthrax emergency worked long hours including week-ends. Staff was “on call” 24 hours a day.

Monitoring and surveillance for individuals who had possible exposure was critical. All calls, reports and stories had to be evaluated and investigated. We also provided 24 hour a day disease surveillance at local hospitals by reading selected patient records to find anything related to the signs and symptoms of anthrax exposure. This information had to be analyzed, reported and recorded.

Communications both external and internal were a top priority. We maintained direct and frequent communications with the State Health Department and the regional staff. County officials, especially emergency response departments, needed regular updates from our health director. Hospitals and community physicians were important partners and all had to receive timely CDC information which had been sent to us through the state health department. We soon learned about “blast fax” —as it was important to give regular briefings to all public health department staff. We also had to create or find anthrax informational materials for public distribution and then produce them on a massive scale.

Questions and concerns came from everywhere. Physicians, first responders, hospitals, businesses and offices, mailrooms, schools and individuals all needed information all at once. We received as many as 200 calls each day at the height of the event. One memorable phone call came from someone who had found a powdery substance in a napkin dispenser at a shopping mall — this wasn’t the only “mysterious white powder” call. Another came from a large mail sorting center fearful that their mail sorters, who were disabled workers, were at increased risk. Local physicians were seeing increased patients concerned about possible exposures and their questions had to be resolved. All calls required evaluation, information, entry into a tracking system and sometimes additional follow-up.

At the same time, we weren’t sure that appropriate post exposure medication would be available to medicate large numbers of people if we needed it. Identifying resources for these medications and then considering options for distribution was another issue.

When the anthrax event was over, it was time to review what we had learned and to identify more and better ways to meet these new kinds of public health emergencies. Our department soon hired a public health emergency planner and much progress has been made over the past 10years. While strategic plans are in place and critical partnerships have been established, we must not be complacent as new and different kinds of public health emergencies occur.

By Jan Tenerowicz, Arlington County Public Health, Virginia Communicable Disease Bureau Chief (ret.)

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