The nation's healthcare industry found itself in the national spotlight again last week as it served on the front lines in the growing bioterrorism threat that shut down the U.S. House of Representatives and further worried an already jittery nation.
It was just a little more than a month ago that the industry mobilized to care for a nation traumatized by the Sept. 11 terrorist attacks.
The anthrax scare-which at deadline included seven confirmed infections and more than 30 exposures, most in Washington-had some hospitals treating patients who feared they had been exposed and others responding to suspected bioterror attacks in their own facilities.
Federal and state health officials issued alerts urging people not to take suspicious packages to hospital emergency rooms, at least one of which had to close down last week when a patient dropped a piece of mail that sprayed an unidentified white powder.
Hospital emergency rooms in New York were inundated with worried people, beginning Oct. 12, when NBC first reported that an employee at Rockefeller Center in midtown Manhattan had contracted cutaneous anthrax, apparently from a letter sent to her boss, network anchor Tom Brokaw.
As the level of public panic grew with each scattered report of anthrax exposure, New York health officials expressed confidence that they were prepared and in control of the situation. By midweek experts at the city's Department of Health already had distributed to healthcare providers and the general public nine long fact sheets and alerts, each tailored to the issue of a particular day.
Just plain scared
At 978-bed St. Vincent's Hospital Manhattan, concern ran so high among visitors that emergency-room doctors offered impromptu and continuous educational sessions about anthrax to some 250 people in a single day, said Bernadette Kingham, a spokeswoman.
New York-Presbyterian Hospital reported that by midweek about 150 people had visited its two Manhattan emergency rooms with anthrax concerns. Doctors' offices were likewise flooded with requests for information about anthrax, said Jonathan Jacobs, M.D., an infectious-disease specialist at the 2,112-bed medical center.
Although only a handful of hospitals treated patients who were exposed to anthrax, many experienced increased ER volume and calls to physicians requesting diagnostic tests or prescriptions for the antibiotic Cipro.
"In the last week we've had six or seven extra visits a day just related to the worry about anthrax," said George Miceli, M.D., chief of emergency medicine at Boca Raton (Fla.) Community Hospital. That hospital tested five of the employees at American Media, where the first reported anthrax spores were found in a mailroom and on the keyboard of photo editor Robert Stevens, who later died from the inhaled form of anthrax.
Amid the increasing fear, HHS recommended that the federal government spend another $1.5 billion to fight bioterrorism as part of the second half of a $40 billion emergency spending law enacted last month. Congress has authorized spending $20 billion of that total.
Included in the White House proposal for the second $20 billion installment is $50 million to hospitals to expand emergency departments' capacity to prepare for mass-casualty events and another $50 million to local networks in 122 cities that prepare emergency workers for disasters.
HHS wants to spend the lion's share of the proposed funds, $1.2 billion, on vaccine stockpiles, including enough vaccine to protect 12 million people from anthrax and enough smallpox vaccine to protect every American.
Jokes that aren't funny
As hospitals tried last week to calm their communities and prevent unnecessary ER visits, several medical facilities confronted possible anthrax exposures within their own walls. With real threats often difficult to distinguish from hoaxes, a nurse in Tennessee was arrested for using talcum powder to play a joke.
In all cases the severity and credibility of the threats were not immediately clear.
In one of several such incidents, Memorial Hermann The Woodlands (Texas) Hospital, about 30 miles north of Houston, was forced to close and quarantine its ER, as well as 20 hospital staffers and 15 patients, for five hours.
A woman had entered the ER holding a package from which a "white substance had spilled out," said Dan Wolterman, senior vice president of hospital operations at 12-hospital Memorial Hermann Healthcare System in Houston, which owns 103-bed The Woodlands.
The powder, which was dumped on the reception counter, "sprayed all over the area, including on a number of our employees," he said. Hospital staffers quickly turned off all air ventilation systems and contacted authorities to initiate quarantine procedures.
"We sealed off all exits out of the ER, and everyone in the ER had to stay there," Wolterman said.
The substance tested negative for anthrax, but in the meantime Woodlands' ER had to be decontaminated three times by the local hazardous materials team.
Close to home
At the Massachusetts Firefighting Academy in Stow, firefighters and National Guard troops staged a mock attack in which a building became engulfed in smoke following the release of a chemical agent.
Rescue workers then searched the building's perimeter before going in to retrieve "victims." They emerged with the victims moments later, according to reports, and then decontaminated them with help from medical personnel.
Public officials who attended the demonstration said that Massachusetts is well prepared for a chemical or biological incident, with 258 technicians from 105 fire departments ready to assist.
Massachusetts health officials handling real threats last week said some people were bringing suspicious packages with them to the hospital. "We would obviously prefer not to have anything that's a potential contaminant entered into a hospital environment," said Nancy Ridley, assistant commissioner at the Massachusetts Department of Public Health in Boston.
Patients bearing potentially dangerous packages do not represent the only bioterror hazard hospitals faced last week. Medical centers also found potential contaminants in their laundry facilities, research laboratories and employee locker rooms.
On Oct. 13, a laundry worker found a plastic bag containing a white substance in the off-site laundry facility of 109-bed Charlotte Hungerford Hospital in Torrington, Conn. Another worker subsequently disposed of the bag but didn't report the incident until the following day when a strange letter surfaced in the laundry area mentioning U.S. Sen. Christopher Dodd (D-Conn.). At that point the laundry workers alerted hospital officials.
Two dozen laundry workers took a nasal swab test to determine if they had been exposed to anthrax; none tested positive. The two workers who came into contact with the plastic bag were treated with the anthrax-busting antibiotic Cipro until they were found to be uncontaminated.
"Fortunately it was in a separate building so it didn't impact hospital operations at all," said John Capobianco, Charlotte Hungerford's vice president of administration. Many patients who were treated in the hospital during the incident, however, called to find out if they could have been infected, Capobianco said.
Some anthrax scares quickly turned out to be pranks. Police arrested a nurse in Bristol, Tenn., last week after he planted a white powder and threatening note in the physicians' locker room at 348-bed Wellmont Bristol Regional Medical Center. Thomas Arnold Jr., 47, said he had played a joke. He now faces felony charges of false reporting, which carry a maximum sentence of six years in prison and a $3,000 fine.
In Chicago, 703-bed Rush-Presbyterian-St. Luke's Medical Center sealed off the 13th floor of a research building after an engineer found a white powder in an open employee locker. Three employees were tested for anthrax and held in the ER until they were found to be infection-free several hours later. The unidentified substance tested negative for anthrax, and patient care was unaffected, said Chris Martin, a Rush spokesman.
The Chicago police and fire departments, as well as the FBI, responded at Rush to assess the situation, Martin said.
"Like many other institutions, conscientious and cautious employees at Rush have reported finding white powdery substances several times," according to a hospital statement. "Each incident has been taken seriously by Rush authorities, who have notified city officials."
At the state level, physicians and health officials coordinated with local agencies to educate citizens, some of whom may have unnecessarily visited the hospital with run-of-the-mill cold or flu symptoms.
"Maybe (two weeks ago) they wouldn't have come in, but now they're coming in with a cold worried it could be anthrax," said Christopher Richards, M.D., a professor in the department of emergency medicine at Oregon Health Sciences University in Portland. "But there's not vast numbers of people coming in the door."
Richards' perspective on patients has changed, however. "Tonight when I go to work and someone who works in the governor's office shows up with flulike symptoms and a rash, I'm going to look at them a little differently," he said.
"We're going to have more patients coming in with flulike symptoms (who may have the flu but are worried about anthrax), but I think we can deal with that," said California Medical Association President Frank Staggers, M.D.
The 22,000-member American College of Emergency Physicians met in Chicago last week with an agenda modified to address the rapidly emerging bioterrorism threat. "The nation's healthcare system must be strengthened to respond to chemical and biological events," Michael Carius, M.D., the group's new president, said in a written statement.
The Centers for Disease Control and Prevention in Atlanta, meanwhile, warned doctors in its weekly bulletin to watch for possible cases of smallpox, food poisoning and deadly viruses such as Ebola following the anthrax mailings and scares. State health officials should remain on 24-hour alert for reports of the intentional release of biological agents, the agency said.
In a list of biological agents "of highest concern," the CDC also included plague, more cases of anthrax and tularemia, a rare bacterium that humans can contract from the carcasses of dead animals.
Julie Gerberding, M.D., acting deputy director of the CDC's National Center for Infectious Disease, cautioned that the warnings in the report are general and, except for anthrax, are not tied to specific incidents.
During a news-conference call, Gerberding sought to douse some of the anthrax hysteria.
"In general, the message is: We are not experiencing a national outbreak of anthrax. The cases are limited to some very specific exposure incidents, and it is not contagious," Gerberding said.
"We're working around the clock, but we've been able to continue our normal public health activities," Gerberding said. "The CDC is in great shape."
-With Cinda Becker, Vince Galloro and Jonathan Gardner