What do you remember most about the initial response to the anthrax attacks, both nationally and from your office?

It all happened on October 12, 2001, one of the most remarkable days in the long history of this health department. I remember working at NBC at Rockefeller Center that first day. There were many leaders of NBC, NBC news, and later on General Electric (parent company of NBC) present. The first meeting was with Mayor Giuliani, and CDC (on the phone). This meeting focused on the anthrax biopsy result from an NBC employee and what it meant. After that came meeting with NBC nightly news staff, where Tom Brokaw spoke eloquently to his staff, informing them of the diagnosis in one of their coworkers. Thereafter there was a meeting with staff from one of their investigative reporting shows that was tense. I was on the firing line for questions on anthrax and many were difficult if not impossible to answer. It didn’t help that the HVAC system was shut off, and it was hot in the room. Later that day we held probably the first point of distribution for antibiotics, and that too became chaotic, with NBC staff who worked an early morning shift still waiting to get antibiotics that night. We didn’t finish at Rockefeller Center until the early hours of October13, 2001. Having done outbreak investigations in some dire settings (such as refugee camps) I will say that the physical space and amenities at NBC headquarters were far beyond what I had ever experienced in any other outbreak investigation! The surroundings were luxurious with an in house TV station and other technological capabilities. By the next day, I was assigned a personal ‘shadow’ by NBC who followed me everywhere to better understand what our issues were, and I suppose to brief higher ups about what was going on in their building. I had several heated arguments with NBC usually on the turnaround time for lab specimens, or on the speed of our investigation but all in all they were thankful for the health department’s contributions.

What was your and your agency’s role in responding to the anthrax attacks?

We were responsible for the epidemiologic workup of cases, oversaw environmental sampling, environmental clean up, and provided prophylaxis to those at risk. Once letters were confirmed to have had anthrax in them, we had to map out the flow of the letters starting in the mailroom and throughout the building. We even had to map out the flow of garbage at Rockefeller Center.

How did you work with CDC and other state and local health departments during the response efforts to the anthrax attacks?

CDC EIS officers were already in NYC working on World Trade Center issues. We had great support from CDC laboratories in making diagnoses, as well as expert support in the epidemiologic investigations.

How would you characterize the response to the attack(s)?what were the hardest parts of the response to the attack(s)?

First we started out exhausted by our response to the World Trade Center disaster. We had communication problems because of damage to NYC’s phone system downtown. The nasal swabs we took of potentially exposed people were particularly troublesome. In all the chaos the swab results were frequently delayed, tough to track down, but yet always wanted immediately for press announcements. Lab staff worked extraordinarily hard under difficult circumstances: their lab was contaminated on October 12, and some staff were exposed to anthrax and put on prophylaxis. All of the initial cases were high profile, in part because of anthrax, in part because they occurred in staff from some of the most influential corporations in the United States. Coming after the WTC, there was also a sense of not knowing what was going to happen next.

What were the biggest challenges or gaps at the time? How have those changed or been addressed during the past decade?

Many issues have been addressed; lab facilities have been expanded, and staff cross trained. Surveillance for bioterrorism is certainly more robust today than it was in 2001. We’ve better instituted an incident command system to streamline our response, as well as developed communication back up plans.

What did the country/you learn most from the successive attacks? What was the biggest take away?

First the obvious is that we are vulnerable to bioterrorism, which I don’t think people took that seriously prior to 2001. It also pointed out that public health is a vital part of an emergency response. We also need to do a better job in communicating with the public and give them information on what individuals, families and communities can do to keep themselves safe.

If there were another anthrax attack today, how do you think the response would be different?

Better communication: we have developed and stockpiled information sheets and frequently asked questions on a variety of types of emergencies. More efficient laboratory response: we built a level three bio safety laboratory, cross trained our staff, and have better computer systems at our public health lab. Better plans for providing countermeasures: we now have a system of pre-selected sites for points of distributions(PODs), pre-staged equipment for these PODs, and have done extensive staff training.

What are the most crucial factors to ensure that our country is prepared for a biological emergency?

Assuring an adequate workforce, support of the strategic national stockpile, development of better mechanisms for rapid distribution and administration of antibiotics and vaccines, creation of environmental clean up standards.

Isaac Weisfuse, M.D., MPH is Deputy Commissioner of the Division of Disease Control of the New York City Department of Health and Mental Hygiene

You can download a PDF of the Q & A here.