Ebola: Lessons from the 2001 Anthrax Crisis

In following the stories about the Ebola virus, I am reminded that 13 years ago this month, I was in the middle of helping manage the mailing industry’s response to the anthrax bio-terrorism crisis. For people whose memories of 2001 anthrax crisis have faded, these were a few of the critical facts:

Five people died from having received letters from unknown sources laced with anthrax, a bacteria that, if “weaponized,” as these letters were, can be fatal if inhaled. Anthrax bacteria have been around for centuries, but humans are not usually exposed to them in the ways that the five people were exposed, one of whom was a 94-year-old woman in Oxford, Connecticut.
There were thousands of other people exposed to the anthrax virus, including several dozen Pitney Bowes employees working in the U.S. House of Representatives mailroom, but who did not experience any medical consequences from the exposure, since they did not inhale the anthrax particles.
The U.S. government had divided responsibility for managing the crisis, with the FBI (because of the terrorism angle), the Centers for Disease Control and Prevention, and the Occupational Safety and Health Administration all claiming final responsibility for guiding government responses. These organizations did not communicate with one another particularly well, with the result that companies like Pitney Bowes, who were truly on the front lines, had to reconcile inconsistent directives from these three organizations. To the credit of our team, they took the initiative to get representatives from the three federal government agencies to come together and figure out what made sense and align their directives to the public.
The communication outward from the media was of mixed quality and reliability. Some media reporters were completely irresponsible in spreading panic; others genuinely sought to get the truth. I was designated as a mailing industry spokesperson, in addition to Jack Potter, the Postmaster General, and I personally handled 80 TV, radio, and print interviews in a space of three weeks.
The preventive work done after the crisis was uneven. There were obvious precautions that could have been taken and that would have been much more cost-effective than what was done. For example, it was very clear that the only mail that carried anthrax spores was stamped mail (because there is no way to trace the origin of a postage stamp, despite the apparent ability of law enforcement officers on Law and Order and CSI to identify everyone and everything through DNA samples).
Metered mail and permit mail generally originate in pre-identified businesses and other organizations like government and non-profit mailers and, as a result, are extremely unlikely to be the source of a terrorist act, since they are too easy to trace. The notion of providing incentives for “sender-identified mail,” to move the public away from using postage stamps and toward online postage was rejected, because of the power of the various constituencies that promoted the use of stamps, particularly commemorative stamps.
The screening done for government mail bordered on the ludicrous. Government agencies decided to fund what eventually became a multi-billion dollar program to require agencies to zap mail with radiation to insure that the mail would not contain anthrax spores. The fact that Pitney Bowes partnered with agencies to quarantine mail and detect the presence of infectious disease vectors at a fraction of the cost was not taken into consideration, other than to add that to the mail-zapping process that destroyed film sent through the mail (this was in the days before digital photography became the mainstream way of recording images) and damaged credit cards, greeting cards, CDs and DVDs.
There were a number of false alarms because anthrax spores tended to resemble baby powder, with the result that HazMat units were dispatched unnecessarily to many places, including the Pitney Bowes Danbury CT facility. It took a few months for governments at all levels to have sensible responses that did not result in immediate dispatch to sites suspected of containing anthrax.

What lessons from the anthrax crisis mean can help us understand how to address Ebola?

It will take a few weeks, or even a few months, for the world to get the response to the Ebola crisis right. Right now, there is a certain amount of trial-and-error in the process.
We have to guard against an expensive, politically correct response, and look for practical, less expensive ways to address the crisis. If Ebola is concentrated in certain countries, then there should be special precautions taken in the traffic between those countries and other countries, not a wholesale process of checking everyone coming into the United States or other countries.
Unlike anthrax, which spread through the air and multiplied rapidly when a small amount of it was inhaled, Ebola is a virus that requires more intimate contact with an infected patient, more like HIV/AIDS, and we should insure that the public understands this. Because of the significantly greater share of our news that comes from less reliable Internet sources, we have to work harder to reduce panic and to get the right information to the public.
Governments at all levels and around the world need to speak with one voice. Thus far, because the Dallas patient was not infected as a result of a terrorist act, there is less risk of multiple federal agencies giving inconsistent guidance, but there are multiple levels of government in the United States providing announcements to the media, and multiple governments issuing releases.
At the beginning of the crisis, it took four days to determine whether a particular white powder sample contained anthrax spores. Innovations reduced that detection period to minutes over the next few years. Similarly, it currently takes five days to determine whether someone has the Ebola virus. Innovators are finding ways to reduce that testing period to less than an hour, as noted in the attached article. Rapid testing is critical.

college.usatoday.com/2014/10/15/emory-university-students-create-fast-acting-ebola-detection-strips/

There are some unique issues with this crisis not present with anthrax:

The incubation period for Ebola can be far longer than it was with anthrax and the symptoms resemble those of the flu. The rapid testing process needs to be applied selectively, but to encompass people who do not have symptoms.
This is a global crisis, not just a U.S. one, and we need to work closely with public health officials and governments around the world on a coordinated strategy. The worst pandemic in history, the 1917-1918 flu outbreak, which was estimated to have killed 50 million people, was made worse by the fact that it came into being during World War I. Several factors associated with that war accelerated its spread:
President Wilson suppressed information about the disease because he feared that enemies would use it against us during the war.
Wilson also believed that business and commerce should not suffer, and even overrode decisions by public health officials, who had convinced local officials to cancel war bond rallies.

Correct and current information has to flow freely, and we cannot afford to let concerns about maintaining “business as usual” around the world override sensible public health recommendations.

The Ebola crisis demonstrates that we live in a highly interconnected world. When weak national governments disintegrate, because of terrorist insurgency, weak infrastructure, or low popular support anywhere in the world, their ability to perform basic government services, like public health management, also disintegrates. Whether we like it or not, we cannot turn away from what happens in remote parts of the world, because it will come to our shores in one way or another.

Many Americans were legitimately weary of President Bush’s forays into Iraq and Afghanistan and what it cost us in money and goodwill. However, the answer to over-commitment is not complete withdrawal, but a more sensible level of commitment that enables us to monitor and influence what happens on the ground.

We may not have the resources or the will to be the world’s policeman, but we must take a leadership in preventing the destruction of vital government service infrastructure where that destruction is likely to bring a problem to our shores.