Right after September 11, 2001, we implemented our response procedures but no one really thought an attack would reach our part of the country. On November 19, 2001, the Monday before Thanksgiving, I was in an emergency management meeting and the talk centered on how our small towns would never face a bioterrorist event. In the back of my mind, I was thinking yes we could.

That very same day, my health district, in Naugatuck Valley, was asked to transfer a specimen from a local hospital to the state lab — a somewhat simple and ordinary request.

Going to work at 7:30 a.m. on November 21, I heard on the radio that local postal workers and citizens were receiving antibiotics in response to a potential anthrax case in the area. I immediately thought of the specimen from two days ago and wondered who was giving the antibiotics to the workers.

When I got to my office, I received a call asking our health district to administer the antibiotics. By 2:00 p.m., we had a clinic up and running and dispensed antibiotics to approximately 80postal workers and family and friends of Ottilie Lundgren, who was the last person to die from the attacks. We also took nasal swabs of everyone who may have come into contact with Ms. Lundgren or letters that contained anthrax.

Right after Thanksgiving dinner, the Connecticut Department of Public Health asked our district to host a meeting for the entire community on Friday — giving us just a few hours to prepare.

At the meeting, it was surreal to look out at the largest community gathering I had ever been a part of and see my family, friends, neighbors and press from all over the world (as far as Japan). It was just five days, one work week, yet it forever changed our district.

From November 24 to December 3, we performed surveillance to see if additional people contracted anthrax. Meanwhile, the Centers for Disease Control and Prevention (CDC), the state of Connecticut, the Federal Bureau of Investigation(FBI) and the United States Postal Inspection Service recovered a letter in another home in our town that tested positive for anthrax. This became the first documented case of cross contamination of anthrax spores.

Now we know that the world is a much smaller place (and growing smaller) and everywhere is connected. If another attack occurred, we’d be less surprised and more prepared.

The importance of communication

Looking back, one of the most taxing aspects of the tragedies was receiving and disseminating information— what we knew, thought we knew, and could and could not communicate. It doesn’t seem like that long ago, but we had to rely on faxes — e-mail wasn’t nearly as prevalent. We received information from CDC or our state health department at 8:30 a.m., and would send those guidelines to physicians. Frequently, just 30 minutes later, we would get a “stand by” for new guidelines and then we’d send out the new guidelines. We didn’t have a mechanism to send a blast fax either, so everything was done manually. It was the 21st century, but communication was light years behind where we are now.

In addition to the sheer quantity and frequency of communications, because it was a criminal issue, the FBI was involved. This was completely new to our world. But we learned quickly how to work with them. A few months after the attacks, I was doing a presentation about our response at the University of Connecticut. One of the FBI agents was in the audience and began waving his hand during my presentation. I immediately stopped because I thought I passed along sensitive information. In actuality, he was swatting a fly away from his ear. So I think the FBI trained us well!

While intra-government communication was important, it was vital to calm the public. Looking back, what stands out in the forefront of my memory is how calm the postal workers remained. In our district we had a lot of respect for them and could meet individually or in small groups to allay their fears. They were an incredibly brave group. The main sentiment was that they hoped people would simply pick up their mail — a return to normalcy.

Better Prepared in 2011

The pace of change in the world is amazing. Since the tragedies, technology — when it comes to communication, testing and scientific analysis — has improved dramatically. In addition, we are much better connected to partners.

When the attacks occurred, we unearthed municipal response plans and found they dated back to World War II and the Cold War. While our current plans can’t always keep up with the times, we have certainly made vast strides.

That said, there are still threats in this world. Perhaps our biggest threat is complacency. We responded swiftly and successfully to H1N1without the public being affected. So it’s been10 years since we’ve had a massive public health emergency. Unfortunately, to be truly prepared requires continual training and staffing. With complacency comes an erosion of the public health infrastructure which could send us all the way back to the Cold War. Quite simply, I don’t have any more staff in 2011 than I did in1972 and the pristine plans we’ve created might start to gather dust. Without consistent funding, we cannot continually drill, so the next generation could be back where we were a decade ago.

By Karen Spargo, M.P.H., MA, RS, Director of Health, Naugatuck Valley Health District, Connecticut

You can download a PDF of the story here.