Anthrax is a disease of animals, particularly sheep and cattle, and to a lesser extent man, caused by infection with Bacillus anthracis.
—C. A. MIMMS, The Pathogenesis of Infectious Disease, 1987
Wednesday, September 26, 2001. Bob Stevens, a fifty-six-year-old senior photo editor for the national supermarket tabloid The Sun, was in his third-floor cubicle, hunched over his computer. The modern glass and concrete building where he worked, set in a landscaped office park in Boca Raton, Florida, was owned by The Sun's parent company, American Media, Inc. (AMI), whose headquarters were in Manhattan and whose business was big-circulation, celebrity journalism. The Sun and the National Enquirer were its weekly flagship moneymakers.
Stevens was rushing to meet his deadlines before taking a long weekend off. He and his wife, Maureen, were driving to North Carolina to visit their daughter Casey, a student at the state university at Charlotte. Bob was a Brit, gregarious and cheerful. Maureen, equally good-humored but more shy, had been born in Ireland. They had arrived in America in the early 1970s, when they were still in their twenties, and started a new life together. They became American citizens and settled in Florida, happily so. Both had been married before and were already parents, with three children between them, and then they had Casey, the last to leave the nest.
Bob had planned a packed agenda. He wanted to set out for Charlotte at the crack of dawn, go hiking with Casey on the Appalachian slopes near Chimney Rock, take a side trip to Durham to meet her boyfriend who was in school there, and then on Monday he and Maureen would drive back to their home in Lantana, about ten miles south of Palm Beach.
While Stevens edited photos on his computer, another AMI employee, Ernesto Blanco, was working in the first-floor mail room. A Cuban émigré, the wiry Blanco was seventy-two but had a thick head of hair and the stamina of a much younger man. Every morning he drove the company van to the local post office to pick up 10,000 to 15,000 pieces of pre-bundled mail, which he brought back, sorted, and, using a wheeled cart, delivered to the building's three floors of offices. Stephanie Dailey, a young woman with a desk near the mail room, often helped him when she wasn't busy opening mail for the National Enquirer. Ernesto never minded doing the work himself. Every morning he took the train from North Miami to Boca, eager to start his work day, sorry when it was done. All his life he'd been like that—full of energy, never missing a day of work. Six years before, thinking it was time for retirement, he'd sold his small upholstery business in Miami—and almost immediately grew bored. "AMI saved my life," he often said. "Hanging around the house, doing nothing, that was driving me crazy."1
The year before, Bob Stevens had also tried retirement. After nearly thirty years of rushing to meet deadlines, he thought he'd like a life of biking, fishing, and gardening. He and Maureen, a retired secretary, could finally travel. But like Blanco, he missed work, and he missed his friends at AMI, a company that prided itself on a family-like atmosphere. In six months, he was back at his desk, editing photos of celebrity newsmakers.
As planned, early on Thursday, September 27, Bob and Maureen Stevens left for North Carolina. Robert (as his wife preferred to call him) loved driving and was in a great mood. Maureen, who was recovering from a sinus infection and taking the antibiotic Ciprofloxacin (Cipro), counted on his enthusiasm. They both missed having Casey at home. As they traveled north, they talked and laughed and made plans to celebrate their twenty-seventh wedding anniversary, which was coming up on October 18.2
The next day, Friday, after Ernesto Blanco finished sorting the mail at AMI, he felt weak and feverish and was shivering like never before in his life. Concerned, Daniel Rotstein, the personnel director, arranged for a company driver to take the older man home to North Miami. On Saturday Blanco felt better but bewildered and a bit embarrassed. He'd always prided himself on his iron constitution, and now his wife, along with his stepdaughter and her husband, were hovering over him. On Sunday, the feeling of weakness returned, this time with chest pains.
Up in North Carolina, on the Sunday drive from Chapel Hill to Durham, flulike symptoms of weakness, fever, and chills hit Bob Stevens like a blow. He crawled into the backseat, letting Maureen take the wheel. On the highway, they kept passing exit signs for local hospitals; Bob adamantly refused to stop for help. After a few hours of rest at Casey's boyfriend's apartment, he felt much better. On Monday morning, he and his wife set off on the return trip to Florida. Bob, although quieter than usual, drove the whole way. They made it home at around 5 p.m., and tired, went to bed at eight.
That same Monday, Ernesto Blanco was admitted to Cedars Hospital in North Miami. His physician there, Carlos Omenaca, was baffled by his condition, which at first seemed like a heart attack. Blanco had some sort of infection, but what was it? Omenaca tried different combinations of intravenous antibiotics, but the weakness and chest pains persisted. Prostrate, Blanco listened to the bedside discussion of his mystery illness. "My father thinks it's from an animal," Dr. Omenaca remarked. "He used to be a farmer." Those were the last words that Blanco remembered hearing before he slipped into a coma.
At 1 a.m. on Tuesday, Maureen Stevens woke to the sound of her husband retching in the bathroom. He was fully dressed and this time, dizzy and weak, he made no objection when Maureen insisted on driving him to the John F. Kennedy Medical Center (JFK) in nearby Atlantis, just five minutes away. Bob had been a patient there before for minor heart problems, and his daughter Heidi had a job in the hospital's administration. Once checked in, Stevens was given a bed to lie down on and, to calm his nausea, a sedative. Then he fell unconscious and, with his vital signs failing, was transferred to intensive care.
A physical examination and routine tests shed no light on Stevens' sudden collapse—it wasn't a heart attack or stroke or pneumonia or trauma from a fall. Maureen took the attitude that no news was good news. Around 5 a.m. she went home to sleep and returned promptly at eight for Robert's scheduled spinal tap. She and Heidi watched in anguish as, still unconscious, he struggled against the painful procedure.
Larry Bush, the hospital's chief of infectious diseases, knew that otherwise healthy adults don't suddenly collapse without cause. A transplant from the urban Northeast, he focused on the clouds, letting others search for silver linings. In his field, his pessimism had yet to let him down. Attuned to the bioterrorism threat, he had in his office a well-read copy of a 1999 article on anthrax as a biological weapon, co-authored by USAMRIID's Art Friedlander and a group put together by the Johns Hopkins Center for Civilian Biodefense Studies. When Bush examined Stevens' spinal fluid under a microscope, he found in it a proliferation of rod-shaped bacteria, like jumbled chains of bamboo, certainly a type of bacillus. Bush ran a simple test and discovered that the bacteria were "gram positive," one of the characteristics of Bacillus anthracis. To be sure, Bush needed more sophisticated tests, the kind that, according to protocol, should be done at the Florida Department of Health laboratory in Jacksonville, which was part of the Laboratory Response Network created under the Clinton administration. For this he needed an assist from a public health official.
Bush telephoned someone he knew on a first-name basis: Dr. Jean Malecki, head of the Palm Beach County Public Health Department. Nearly twenty years before, Malecki had been his colleague at JFK, when both were newly minted infectious disease specialists, he from the University of Pennsylvania, she from New York University.
The dynamic Malecki, six feet tall with long red hair, was already a local legend. In the public eye for nearly twenty years, starting with the early 1980s AIDS fatalities linked to a Florida dentist, and through dozens of high-profile incidents since then, she was in charge of the health of two million county residents and she counted them all as her people. With Florida on alert after 9/11, she had convened a meeting of 200 first responders to assess the potential bioterrorism threat.3 At 2:15 p.m., when Bush's call was forwarded to her, a panel of experts had just finished discussing whether terrorists could effectively use a crop duster to spray anthrax spores. In Florida, the front-page news, based on FBI reports, was that before 9/11 al Qaeda operatives had circulated under cover in Palm Beach, Delray, Venice, Hollywood, and Jacksonville and that, while taking flying lessons, they had inquired about crop dusters.
Advising Malecki to sit down, Bush explained that he had a patient who might have inhalation anthrax and asked her how soon she could come to the hospital to give her evaluation. The patient had presented as a meningitis case, with signs of general acute infection, but Malecki trusted Bush's judgment. Tied up with her meeting on domestic preparedness, she told him that the best she could do was seven that evening. The patient's history of possible exposure would be vital, but with Stevens in a coma Malecki would have to get the details from his wife. "I'll have my staff bring an anthrax questionnaire," she told Bush.
Public health professionals work in essentially two modalities. One is routine preventive management—making sure schoolchildren have their vaccinations, pregnant women their vitamins, and old people their flu shots, and that chronic and infectious disease incidents are monitored. The other is emergency mode, the team mobilization to contain disasters that is the equivalent of marshaling troops for war. A seasoned administrator, Malecki handled the former every day, but she was no stranger to real-life emergencies or mass attack models. In the late 1990s Malecki had participated in two exercises for responding to mass anthrax attacks that pushed the emergency response model beyond the envelope—which was exactly where Bush's patient, if this were the index case of a larger outbreak, might be heading. The exercises were designed to teach local authorities—herself, hospital officials, police, firefighters, and the WMD experts from FBI field offices—in fact, the very people at her meeting—to make rational decisions that would, if the threat were real, trigger state and federal government rescue responses. The effect should be like a computer game in which communication channels light up, the troops arrive with medical supplies, and hundreds if not thousands of lives are saved from deadly anthrax.
Throughout the response, public health officials had to stay calm and keep the affected community informed, cooperative, and free from panic, or the rescue effort could fall apart. Since 9/11, though, the public was primed for panic, and anthrax and other disease attacks were being touted widely in the media as the next worst terrorism.
Bush's phone call left Malecki with some troubling uncertainties. The minute she asked Jacksonville to test for anthrax, alarms would ring in government offices from Florida to Washington. If the results were positive, louder alarms would ring and the media would be all over the story, no matter how the man at JFK had been exposed. Malecki had spent years cultivating good relations with the press. Did she have enough capital with them to keep communication focused on education and not scare-mongering headlines?
Unfortunately, fear of anthrax was hardly irrational. Its ferocious natural cycle uses the host mammal as a live incubator that must die for B. anthracis to multiply and survive. Within the host's body, the proliferating bacteria rapidly cause massive internal hemorrhage so that, bursting from every orifice in waves of blood and fluid, this new generation of microbes can assume their sturdy spore form and await a new host to infect. As the disease evolved over many centuries, a grazing animal feeding in a spore-contaminated field was usually the next victim. By learning to live successfully off livestock, human beings became potential hosts. When twentieth-century armies developed B. anthracis as a weapon, the potential for the human host population expanded to mass targets, not what nature intended.
Another uncertainty was how federal agencies would react, even to a single confirmed anthrax case. State health officials in Tallahassee would have to invite the CDC (Centers for Disease Control and Prevention in Atlanta) to investigate: anthrax was not endemic in Florida and the last U.S. case of inhalational anthrax dated back thirty years. If evidence pointed to an intentional cause—an act of malice against a single individual, or worse, a mass attack—the FBI would step in as the lead agency to conduct a criminal investigation. If more cases of illness emerged, beyond what Malecki's department, the state, and the CDC could handle, Washington would send the Federal Emergency Management Agency to coordinate a disaster response. Malecki hoped that Bush was sounding a false alarm. Whatever had happened or would happen, she had to stay calm.
When Malecki arrived at the hospital that evening, Bush led her to his patient's room. "I've put him in isolation," he explained, "and he's on broad-spectrum antibiotics." They put on masks and gloves before they entered.
Stevens lay on the narrow bed in a coma, attached to a respirator and an array of drip bags and monitors. He was a big man, husky but muscular. His wife, Maureen, also masked and gloved, sat next to him holding his hand. When Maureen Stevens stood, the look she gave Dr. Malecki was more inquisitive than worried. No one had mentioned the possibility of anthrax in order not to upset her unnecessarily. Instead, Dr. Bush had told her that her husband had a general infection, meningitis, that was affecting his brain and that more tests had to be done. While Maureen waited, she wanted to stay at her husband's side in case he should wake, but she understood that the county health department had some questions for her and that its director, Dr. Malecki, was here to help.
Three of Malecki's assistants then met with Maureen in a small conference room. They had written the questionnaire themselves, on the fly, after finding nothing available from the CDC. In her soft, precise Irish accent, Maureen gave them a detailed account of the trip to North Carolina and described her husband's everyday routine and his hobbies. She answered every question, even the odd ones. Yes, she kept a clean house and frequently laundered their clothes, sometimes daily. No, they had not been at any country fairs or crowded events. Yes, he liked genuine leather shoes. No, as far as she knew, he didn't handle mail at work.
She had no idea how these questions could help her husband's diagnosis, but realizing these officials were nearly as puzzled as she was, Maureen summoned new energy and told them everything she could remember, including how on their hike Robert had stopped to drink from a mountain stream, which he (unlike Maureen and Casey) trusted was unpolluted.
After going over Stevens' case records and viewing the bacilli from his spinal fluid, Malecki reached the same startling conclusion as Bush: the patient was likely infected with anthrax. By 10 p.m., a sample of the bacteria from the spinal tap was on its way by express mail to the Jacksonville laboratory. Phil Lee, one of the lab's microbiologists and its biological defense coordinator, had recently returned from a course on anthrax analysis at the CDC, given by Tanja Popovic, head of the CDC's Anthrax Laboratory, with an unrivaled reputation for B. anthracis identification. In 1989, Popovic had come to the CDC as a Fulbright scholar from Croatia and found her niche in the lab science of domestic preparedness. By October 2001, she had trained sixty public health employees like Lee to recognize anthrax in their own laboratories, all part of the nation's Laboratory Response Network.
As Malecki expected, her Tuesday night request to Jacksonville rang alarm bells. When her office opened the next morning, two FBI agents were waiting for a transcript of Maureen Stevens' interview, which Malecki's staff, having worked through the night, had ready by 10 a.m. The interview, with Malecki joining in, had lasted until nearly eleven the night before. Maureen Stevens would have stayed even later, if asked. As one interviewer reflected, her narrative, with all its careful detail, was "a love story" told by a wife who wanted her husband brought back to health, to her.4 In addition, Malecki alerted Steve Wiersma, the state epidemiologist, and John Ogwunobi, the young pediatrician who had just assumed the post of Florida's secretary of health.
At the Jacksonville lab, Phil Lee proceeded with the first and then the second of the tests he'd learned at the CDC. Both involved growing and staining the bacteria to elicit an important identifying trait: dangerous anthrax bacilli are distinguished by a capsule, a casing essential for virulence. The third and most conclusive test, which had been developed at USAMRIID, involved exposing the bacilli to a virus called gamma phage that would invade and destroy them if they were truly B. anthracis. By late afternoon, the first two tests had registered positive—the distinguishing capsule was present. Larry Bush called for the results, but Lee was reluctant to draw a definitive conclusion. The third test had just been started and could take twelve hours or more. Lee, to make sure he was doing everything right, contacted Tanja Popovic at the CDC, who calmed his apprehensions. As far as she could tell, Lee was being meticulous and should reach a valid diagnosis.5
In Palm Beach, awaiting Lee's results, Malecki began planning a three-team public health investigation to determine the source of Stevens' infection—strictly by the book. One team would search the Stevens house and garden, another would track possible exposure sources outside the home, and a third would investigate his workplace, the AMI building. Stevens' recent trip to North Carolina meant that public health officials there might have to check with hospitals for any suspicious meningitis cases and with veterinarians for any unusual livestock or other animal deaths. A visit to Casey Stevens' apartment and that of her boyfriend—where Bob had taken a nap—would also be necessary. As a precaution, Malecki telephoned AMI in Boca Raton with the message that if any other employees had an unusual illness or skin infection, they should call her department right away.
Lee left his laboratory at 10 p.m., with no result yet from the gamma phage test. When Bush called the next morning around eight, the result was in, but Lee, knowing the fallout was going to be calamitous, hesitated to tell Bush about it. Irate, Bush reminded him that it was his patient whose life was at stake. Lee then revealed that the gamma phage had destroyed the bacilli: Bob Stevens had anthrax.
The news went immediately to Tallahassee and John Ogwunobi, who brought the news to Governor Jeb Bush. Once he was updated, the governor had one question: "Is the disease contagious?"6 His foremost interest was in keeping the public panic level down. Since 9/11, he had been focused on protecting potential terrorist targets in Florida—Cape Canaveral and Disney World were two of them—while at the same time worrying about the precipitous drop in tourism to the state. People were afraid to fly, which could spell disaster for Florida's winter economy. Tourists would be even more likely to stay away if Florida were hit by a contagious disease outbreak, especially if it were intentionally spread. To the governor's relief, there was no cause to worry about contagion—and the single case in Lantana might have been naturally caused.
At the JFK Medical Center, Larry Bush consulted with hospital administrators and his staff about what steps to take next. Not only the governor's office, but the White House, cabinet secretaries, the National Security Council, and a network of federal counter-terrorism officials were being alerted to the diagnosis, which could signal the start of a mass attack—or nothing more than an isolated infection. In reaction to rumors, media inquiries had already started. The decision was to hold a press conference that afternoon, at the hospital, to make an official announcement.
* * *
In all the excitement, no one had told Maureen Stevens about her husband's diagnosis. At noon, she left his bedside to pick up photographs from their North Carolina trip, as reminders to talk about with Robert. She and Heidi acted on the presumption that, although unconscious, he could still hear their voices and that they needed to stay connected with him. After picking up the photos Maureen made a brief stop at home. As the news of Bob's hospitalization spread, the answering machine became full of get-well messages from friends and co-workers and, despite the heat, a kind neighbor had volunteered to mow the lawn. Maureen was in the kitchen when Dr. Malecki telephoned.
"I have some difficult news for you," she said. Malecki then explained that Bob had contracted a disease called inhalational anthrax. She cautioned that his chances of survival were not good. The infection had been treated late, after it had spread.
"Is there no hope?" Maureen asked. She remembered the hospital exit signs between Charlotte and Durham—and Robert's refusal to stop.
"There's always hope," Malecki assured her, sparing Maureen the facts about the ferocity of the disease. Then she added that word of the diagnosis had necessarily spread and would soon become public. "There's a press conference scheduled for two o'clock at the hospital."
As soon as she hung up the phone, Maureen began contacting the children. She called Casey in North Carolina, who immediately made arrangements to take the next plane home. Maureen reached Heidi at JFK, just minutes before a senior administrator took her aside to tell her about her father's diagnosis. Bob's son Neil was already driving down from Tallahassee, where he lived, and Maureen's daughter Tania was arriving the next evening from Scotland. Still in her kitchen, Maureen telephoned the news to Daniel Rotstein, the AMI personnel director who had been in close touch with her since Bob had fallen ill. He was shocked and then he suddenly apologized. "Maureen, I'll call you back. There's something important I have to do right away."
That something important was to find out what had happened to Ernesto Blanco, who had yet to return to work. When Rotstein learned he was at Cedars Hospital, he tried to reach his physician there but couldn't get through. Might Blanco have the same disease as Bob Stevens? The implications for the company and other employees in Boca could be terrible.
Just before the press conference at JFK, Larry Bush met with Maureen Stevens to explain the anthrax diagnosis and that this particular disease was not contagious. Maureen didn't recognize most of the other people gathered around them, except for some hospital staff. Events were moving faster than she could comprehend. She had just one question for Dr. Bush: "Is my husband going to die?"
Bush repeated what Malecki had said, that when treated late in its course inhalation anthrax is nearly always fatal. But, like Malecki, he told her there was always hope. Just the idea of hope gave her strength and calmed her.
But then, abruptly, Maureen was forced to confront the possibility that her husband had been deliberately attacked. She signed one form permitting the FBI to search the Stevens home and property the next day. She signed another form given her by officials from the Atlanta office of the Postal Inspection Service, the plainclothes criminal investigation division of the U.S. Postal Service. That signed form gave the postal inspectors the right to appropriate and examine the family's mail. Perhaps, they explained, someone had personally targeted her husband by sending an envelope or package with anthrax powder in it. Another postal attack might be coming—a frightening thought. A Miami FBI agent was detailed to watch over her. It was dawning on Maureen that the news about her husband's diagnosis had been passed along to strangers—to hospital officials, the FBI, postal investigators, even to the governor of Florida and the president of the United States—without her knowing anything.
Thinking only of her husband, she hurried to the new room where he was sequestered under guard, surrounded by even more medical equipment and nurses. With no threat of contagion, the masks and gloves were no longer necessary. Afraid of losing him, she stroked his forehead, and whispered words of comfort.
The press conference was held on the first floor of the hospital, off the lobby in the conference room usually used for medical lectures, and at least fifty news representatives from local and national print, radio, and television outlets jockeyed to get near the speakers. State epidemiologist Steve Wiersma had arrived from Tallahassee. Jean Malecki was by far most familiar to the Florida press, but the star of the event was Larry Bush, who had flagged a case that other physicians might have misdiagnosed or dismissed as a medical mystery.
Privately, Bush believed the maxim expressed in the 1999 Johns Hopkins article on anthrax, that any new anthrax case should be presumed intentional until proven otherwise. But he, Malecki, and hospital officials agreed beforehand to make no speculations about how Stevens had contracted anthrax and certainly not to promote the idea that the case had anything to do with a bioterror attack. Instead, they announced that an unnamed hospital patient had contracted inhalational anthrax, a diagnosis confirmed by the Florida Department of Health Bureau of Laboratories, and they described how medical tests supported this diagnosis. By way of instruction, they presented a recent x-ray showing unusual mediastinal widening—an enlargement in the midchest area often characteristic of this form of the disease. About his patient, Dr. Bush commented dispassionately, "He is critically ill, but hopefully he'll respond to treatment."7
* * *
The sensational news of the Florida diagnosis went out immediately on the wire services, sparking national attention. In Washington, Tommy Thompson, secretary of Health and Human Services, interrupted a White House press conference to announce the news, but he too insisted, "This incident has nothing to do with terrorism."
Behind the scenes, President Bush was worried that the Florida case was the first sign of a mass attack.8 Since 9/11, the president had been taking Cipro, on the advice of a federal consultant on bioterrorism threats. President Clinton's dread of an apocalyptic outbreak intentionally inflicted on Americans was based on nightmarish conjectures. For Bush, the Stevens diagnosis and its implications crossed the line to the fact of an anthrax infection and a possible "second blow" struck against the nation. As the United States moved closer to attacking the Taliban in Afghanistan—the first missile assault was only days away—there were fears in the administration that al Qaeda would retaliate with bioterrorism. Vice President Cheney, officially in seclusion as tension mounted, was anxious about both germ and chemical terrorism. After 9/11, he kept a gas mask and protective clothing within easy reach and he was nearly always accompanied by a physician.9
From Florida's capital, the call for assistance went to the CDC, which was at some disadvantage. The 9/11 attacks had diverted some one hundred of its field officers to New York City and exhausted them with the extraordinary public health demands of a traumatized city. The CDC's usual mission was the statistical documentation and prevention of the nation's everyday health care problems, which ran to chronic diseases like heart and kidney ailments and cancers common in industrialized nations with older populations. It was only late in the Clinton administration that the centers were put in charge of the nationwide domestic preparedness program and of organizing the national Laboratory Response Network and the stockpile of emergency antibiotics and vaccines. At the CDC's National Center for Infectious Diseases, its director, Jim Hughes, had a global perspective on disease prevention, and its acting deputy director, Julie Gerberding, came from a background in hospital and health care safety. Given the rarity of anthrax cases—only eighteen in the United States in the previous hundred years—there was no expert with field experience who understood dose response and the random risk of even a single inhaled spore. A retired CDC officer, Phil Brachman, had conducted studies of inhalational anthrax cases among American textile and tannery workers in the 1950s and 1960s.10 But Brachman's research, done with U.S. Army cooperation, had been neglected by the younger generation of epidemiologists focused on contemporary plagues: AIDS, malaria, cholera, drug-resistant tuberculosis, and other dangerous diseases. Not even the 1994 publication of the Sverdlovsk investigation results and their implications for dose response were well known among CDC infectious disease experts. By far the person in the strongest position was Tanja Popovic, the head of the Anthrax Laboratory, with a staff of forty-three and expertise to spare. But at the time not even she understood the enormous difference between preparing for bioterrorism and the emergence of an actual case of deliberately caused anthrax.
The Stevens diagnosis also rang alarms at the FBI, which had intensely combed Florida, including Lantana, for the pre-9/11 presence of al Qaeda operatives. At its Quantico, Virginia, campus, the Bureau's WMD division had spent years tracking international and home-grown terrorists. There chemist Benjamin Garrett had long studied biological and chemical weapons history, as well as handled the strange cases—like the 1984 poisoning of salad bars with salmonella by the Rajneesh cult in Oregon—that came with the chem-bio watch. After 9/11, Garrett's division was on high alert for another al Qaeda attack, as was the Bureau's Hazardous Material Response Unit (HMRU), also at Quantico, where microbiologist Doug Beecher, experienced in pathogen detection, worked. These and other experts, a veritable brain trust, would prove key in responding to the Florida and subsequent crises. But on October 4, the Bureau, concentrating fully on its 9/11 investigation and unsure if a crime had actually been committed, delayed coordinating a top-down response.
Still, the FBI had the flexibility of a large, decentralized organization whose field agents could be locally deployed. Two of them quickly drove from Jacksonville to Atlanta to deliver a sample of Stevens' bacteria to Tanja Popovic so that she could verify Lee's results at the CDC's Anthrax Laboratory. Carefully growing the bacilli in culture medium (which could take another day or more) was essential to accurate identification at the CDC's gold standard level.
The missing clue was strain identification: Which of the forty or so known virulent anthrax strains had infected this patient in Florida? The Quantico brain trust turned immediately to Paul Keim, the Northern Arizona University scientist who had developed advanced methods for genetic strain identification and maintained a considerable archive of strains. Doug Beecher telephoned Keim to give him a heads-up. Beecher, experienced in hazardous material response, had previously visited Keim's lab and understood the science of B. anthracis. The message from Beecher to Keim was that a share of the CDC sample was being flown by a chartered plane to Flagstaff, where Keim himself should collect it for analysis.
Until 9/11, when his university put his lab under strict protective security, Keim's work life had been placidly academic, with a mix of intriguing microbial projects, not just ones on anthrax. Lanky and sandy-haired, Keim looked more like a graduate student than a professor. Late in the afternoon on October 4, though, Keim was about to enter the world of crime scene investigation.11 He drove out onto the tarmac at the Flagstaff airport to meet the chartered plane, from which descended an attractive blond woman who handed him the box containing the bacteria from Stevens' spinal fluid. Speeding back to his laboratory, Keim organized his assistants to begin the process of matching its genetic markers against those in his archive of anthrax strains from around the world.
* * *
At the U.S. Army Medical Institute for Infectious Diseases (USAMRIID) at Fort Detrick in Frederick, Maryland, the news of the Florida diagnosis sparked interest but caused no shock waves. The case, after all, was a civilian matter, unlike the analyses of air samples from the Pentagon that USAMRIID's Special Pathogen lab, run by John Ezzell, had just finished.
Bruce Ivins, angry and withdrawn after the 9/11 attacks, seemed energized by the October 4 news of the Florida diagnosis. That afternoon and into the next morning, he fired off emails to colleagues to offer his ideas about the source of the exposure, which he theorized was natural, somehow from the environment. Although unaware of Beecher's recruitment of Paul Keim, he knew about the Anthrax Laboratory at the CDC. (His friend Ezzell had actually been there on 9/11, and was evacuated with everyone else from the CDC's main campus.) Ivins posted an email to the centers, to ask a perceptive question: Had its experts identified the strain and did they know if it was native to Florida? In fact, Tanja Popovic at the CDC was trying to identify the strain at the same time as Paul Keim.
But no return message was sent to Ivins. Even if the CDC hadn't been deluged with emails, Ivins' inquiry would have gone unanswered. Popovic understood that the Stevens diagnosis could embroil her and her bosses in a major bioterrorism incident—and that national security necessarily narrowed channels of communication.
* * *
That evening, Bob Stevens' wife, his son, and his two daughters surrounded him with affection, taking turns holding his hands and keeping up a conversation about good times past and good times to come. Heidi went home early to her family. Later, near midnight, the rest of the Stevens family—Maureen, Neil, and Casey—wished Bob good night. As they reached the lobby, what seemed like a SWAT team burst through the main doors, backlit by klieg lights from the camera crews still waiting outside. It was a mixed group of county public health officers and FBI agents with a hurried request for blood samples from Maureen and Casey. The two were tired but consented. When the procedures were done, they dashed past the press lingering in the parking lot.
Arriving home, they found that a media blitz was waiting for them. Vans with satellite dishes were parked on both sides of the narrow street. In the glare of spotlights, reporters crowded the newly mowed front lawn. With microphones in hand, news anchors talked nonstop to cameras about their on-site coverage of the Stevens case. A swarm of reporters and photographers, avid for news about the victim, attempted to interview the family members as they ran for cover. The brightly lit, noisy broadcasts continued for hours. Finally, to block the lights, the Stevens family hung blankets and sheets over the windows.
* * *
While the Stevens family tried to sleep, Paul Keim and his team worked through the night to identify the Florida anthrax bacteria. In the early morning, they finally matched them to the highly virulent Ames strain. The name, as they found out later, was a misnomer. The strain, from a Beefmaster heifer that died in Texas in 1981, had been shipped to USAMRIID with an envelope that bore the return address of Ames, Iowa. Iowa had nothing to do with the strain's origin, but the mistaken attribution stuck.
From his lab, Keim telephoned the news to the FBI and the Department of Energy (his two main funders) and then to the CDC.12 That same day, Friday, October 5, at the CDC, Tanja Popovic corroborated Keim's discovery.
For Doug Beecher and others at the FBI in Quantico, the strain identification was a game changer: the Florida inquiry stopped being a public health inquiry and became a criminal investigation, one with heavy national security implications.13 The Ames strain, found once in nature and never again, was currently used in defense research laboratories for testing vaccines and antibiotics and other protective interventions. The defense laboratories that possessed the Ames strain—whether government labs or private contractors, whether in the United States or in allied countries—would have to be determined. Since the intelligence community was engaged in anthrax research projects, the Bureau might hit what policy analysts called "the wall"—the separation between criminal investigation and intelligence activity that divided the internal organization of the FBI and blocked communication between the Bureau and the CIA.14
There was another, worse problem. According to Keim—and this was well known among anthrax researchers—the Ames strain, like other strains of anthrax, was so genetically conservative that it would be unlikely to vary in successive generations or from one laboratory sample to another. That is, it was fundamentally generic. The anthrax weapon was identified, but it no more had a distinct signature than a bottle of Tylenol pills. When a weapon was that generic, the criminal might never be found.15
By interagency agreement, the news of the Ames strain identification—which practically canceled out a natural source—was withheld from the press. From Florida to Washington, authorities were denying that the diagnosis had any connection to terrorism. To anyone listening to the news—the perpetrator included—no bioterrorist attack had taken place, or at least none had been launched that any terrorist group was claiming.
Copyright © 2011 by Jeanne Guillemin