The New York City (NYC) Health Department’s Public Health Laboratory (PHL)first began to participate in the city’s bioterrorism response planning in the late1990’s. This process established links between it and members of NYC’s Office of Emergency Management (OEM), Fire Department (FDNY), Police Department (NYPD) and the FBI. NYC’s Health Department was represented at citywide planning meetings, trainings and drills. PHL staff conducted biological trainings focused on helping the FDNY HazMat team identify anthrax, at the time using rapid field tests, becoming key members of their response teams which were activated whenever a suspicious package or letter was discovered. It wasn’t unusual to receive a cell phone alert at the lab, be picked up by a first responder within minutes, and go to the potential bio-threat site (often a women’s health facility that received hoax letters). All of this was in place years before September 11, 2001.
The laboratory, located in midtown Manhattan, was close enough to witness the attacks on the World Trade Center Towers, yet far enough north to avoid personal evacuation. The role of the lab became one of support. The avenue in front of the laboratory was a main route for tens of thousands of people evacuating lower Manhattan on foot. We set up a “decon” site on the front steps of the building to assist individuals covered in fine powdered dust returning from Ground Zero. The laboratory opened its doors to assist other government agencies; we set up a makeshift dormitory for children being housed by the NYC Administration for Children’s Services, brought in computers and phone lines and provided space for NYPD Missing Persons detectives, and became the early site for people looking for missing loved ones. The wide, one-way avenue in front of the building became a two-way main route for emergency vehicles transporting the victims to the medical examiners offices for months to come; an escort with sirens announced the transport of each of the hundreds of uniformed fatality that passed the building. Days after, PHL staff assisted in collecting environmental samples at Ground Zero.
Our building also became the back-up emergency operations center for the Health Department, whose headquarters were just blocks from ground zero and forced to shut down until deemed safe to reoccupy. The Department’s Incident Command Structure was in full activation with many of the agency’s staff involved in response to the aftermath of the attacks.
One of the newest units at the PHL was our Bio-Threat (BT) Response lab, which occupied spaces shared within our molecular microbiology laboratory. Two technologists were funded through an Emergency Preparedness Cooperative agreement with the Centers for Disease Control and Prevention(CDC). Some lab equipment, testing reagents and protocols were also supplied by CDC. The technologists and space were assigned to other public health responsibilities when they were not working on BT specimens. Prior to October 2001,an Anthrax hoax letter was received every couple of months. On October 12, 2001, we received our first Anthrax laden letter which was mailed to the office of NBC News here in NYC. The ensuing investigation and media coverage resulted in our PHL receiving thousands of clinical specimens and environmental samples for anthrax testing.
The PHL’s anthrax response took on a life of its own. Space needs expanded from one lab to 10labs, including moving from BSL Level 2 into a BSL Level 3 lab belonging to a research institute located in our building. We established a separate law enforcement entrance and specimen intake area with a decontamination station, locked evidence rooms and we developed an interagency Chain of Custody protocol enforced by Health Department police officers. The Department of Defense (DOD) set-up three labs within our building and sent their scientists to do on-site rapid testing. These laboratories were fully operational in hours of arrival. Our virology staff went home on Friday when it was business as “usual” and came in on Monday to massive security checks because two of the three DOD labs were using classified assays.CDC also sent us scientists who were trained in Biosafety Level 3 (BSL-3) protocols and airlifted in six tons of supplies to the PHL. We went from two people working part time on anthrax to 75 people working on various components of accessioning, testing, reporting and monitoring biosafety protocols. Our 7-hour/5-day work week extended to a24/7 schedule. We worked in unison as a single team. It was an excellent example of selfless dedication, commitment and caring.
As a group, we continued to receive many samples— coffee tables from a department store, suitcases from the airport, dollar bills that had been rolled up, you name it. A sampling protocol was developed to standardize and simplify the collection and transport process to ensure the safety of staff at all links in this incredible chain from the field to the laboratory. The entire response was a lesson on how to reshape our public health laboratory. Originally, our lab had subject matter experts who were responsible for their unit, staff and specific testing mission, i.e., the tuberculosis (TB) lab only did TB testing and the Retrovirology lab only tested for HIV; that is until the week after the NBC letter, then we set up a more unified response. The PHL became one cohesive unit: the chemists did the molecular testing; the HIV folks — who were doing enzyme immunoassay tests and Polymerase Chain Reaction (PCR) tests — became BTPCR responders; and our microbiologists, who were classic bacteriologists, did the BT micro work; all were now identifying a weapon of mass destruction — Anthrax.
The response certainly showed what kind of people work in public health because everyone willingly put in very long hours doing tasks that had often little to do with their regular jobs. Unknown to the public outside of the PHL, their personal lives were put on hold for months.
In the years since 9/11 and Anthrax 2001, much has happened to strengthen the NYC Public Health Laboratory. We set up a more robust laboratory that included a BSL-3 component for bio-threat response, ultimately, expanding this capability to an entire floor. We also created across training program that prepared staff on how to undertake various surge responsibilities. Working under the unified Laboratory Response Network (LRN) of CDC, protocols, state of the art equipment and funding for staff became available. Initially ample funding was available, which has eroded over time.
In 2006, we put all of this into action responding to an interstate case of human anthrax. Trained responders were deployed who could triage the collection of potential bioagents and decide which samples needed to come to the lab and which did not. Sampling and testing were focused and the PHL didn’t get overrun with submissions.
Now, if there are outbreaks or emerging pathogens, the network is in place to send out blast communications to link the local medical and laboratory community to the Health Department; like we did for the 2009 Influenza pandemic which erupted in the schools of NYC and spread through the nation within weeks. We ramped up in a few days to cross-train staff, validated testing systems and successfully set up our incident command system. It was a remarkable difference from 2001.
I cannot state enough how willing and able the public health world is to handle potential biothreats. However, that doesn’t mean we aren’t vulnerable.
The biggest threat is a sustainability of funding— it’s just not there. So much of the response was driven and made possible through federal resources. Unfortunately, these federal grants have consistently been cut so that even service contracts for equipment purchased under the grants can’t be maintained.
Funding is also tied to the workforce. Federal grant support for staffing is decreasing annually for initiatives relating to PHL emergency preparedness, as well as existing and emerging diseases. In addition, challenges to hiring staff compromise our ability to cross-train staff for surge responses and, ultimately, our readiness. The laboratory community is an aging population and fewer people are going into this field. Budget cuts and non-competitive salaries with the private sector are some of the biggest challenges we face, not just for emergency preparedness but for maintaining high quality laboratory systems. Commercial, university and hospital laboratories will not “risk” their mission and operations to perform the services of your local, state and federal public health laboratories. With bare resources, the public health community can respond to whatever comes its way for a short period of time. We need to ensure the resources and people continue to make it into these vital jobs. As first or last responders in a health related emergency, your public health laboratory is your only laboratory whose mission and staff are dedicated and trained to handle these responsibilities.
By Sara T. Beatrice, Ph.D., Assistant Commissioner, New York City Public Health Laboratory