The Killer Strain

Marilyn W. Thompson

• Publisher: HarperCollins e-books
• Year: 2010
• ISBN:
  9780062013477
• Topic: Historia
• Subtopic: Historia de Norteamérica

A lethal germ is unleashed in the U.S. mail. A chain of letters spreads terror from Florida to Washington, D.C., from New York to Connecticut, from the halls of Congress to the assembly lines of the U.S. Postal Service. Five people die, and ten thousand more line up for antibiotics to protect against exposure. The government, already outsmarted by the terrorist hijackers of 9/11, leaves its workers vulnerable and a diabolical killer on the loose.

Based on hundreds of hours of interviews and a review of thousands of pages of government documents, The Killer Strain is the definitive account of the year in which bioterrorism became a reality in the United States. Revealing the little-known victims and unsung heroes in the anthrax debacle, investigative reporter Marilyn Thompson also examines the FBI's slow-paced investigation of the crimes and the unprecedented scientific challenges posed by the case.

The Killer Strain, more than just a thrilling read, is also a clarion wake-up call. It shows how billions of dollars and a decade of elaborate bioterror dress rehearsals meant nothing in the face of a real attack -- and how we may still be at risk.

The Attacks

CHAPTER 6

The Index Case

October 4, 2001
PALM BEACH COUNTY, FLORIDA

Bradley Perkins’s team joined Malecki’s county health department squad at a new emergency center originally built for hurricane relief. The center’s phone banks and computers had been used only twice, once to coordinate response to the devastating Hurricane Andrew and a second time to re-count dimpled ballots in the whisker-close presidential elections of 2000. Along with doctors, lab technicians, and pathologists, the group assembled to investigate Stevens’s case included John Bellamy, a Miami agent assigned to the FBI’s weapons-of-mass-destruction unit, and, oddly enough, a U.S. postal inspector, although no one at the time had any inkling that the anthrax infecting Stevens had come through the mail. Because most recent anthrax hoaxes had involved mailed letters, the FBI had begun to bring postal inspectors along in emergency responses to lend their expertise in identifying and tracking suspicious mail.

The response group hurriedly set up overnight camp, the Palm Beach squad on one side of the room, the federal newcomers on the other. By morning, they would embark on a common mission: to examine each piece of Stevens’s recent life, track his movements, interview his friends and coworkers. For guidance through the details of his daily life, they had to rely on Stevens’s family, because he was unconscious after his grand mal seizure.

Perkins decided it would not be necessary to examine Stevens extensively. He trusted Larry Bush’s findings and approved of the drug regimen put into place for Stevens’s treatment. Still, he badly wanted to see the patient himself. The prospect of examining a living patient felled by inhalation anthrax intrigued the young physician. Perkins, whose specialty was infectious diseases, knew he might never again get the chance to see this disease in action. Even Dr. Friedlander, USAMRIID’s veteran anthrax expert, had never examined a human inhalation anthrax patient.

When Perkins arrived at the 370-bed JFK Medical Center in Atlantis, Florida, he found Stevens’s wife, Maureen, and his immediate family holding vigil in a hallway. They were distressed that yet another doctor had arrived to examine their ailing loved one. Maureen had driven Stevens to the emergency room, perturbed that he had not heeded her advice to stop for medical treatment when he began feeling ill in North Carolina.

Terrified by Stevens’s sudden, inexplicable decline, the family confronted Perkins, desperate for reassurance.

In a Midwestern monotone that suggested his Kansas roots, Perkins told the family that Stevens seemed to be responding to the battery of powerful antibiotics. The doctors were doing all that they could. But he knew that Stevens’s chances of recovery were slim to none.

Perkins ducked into the patient’s room and stood for a few minutes by the bedside, calling Stevens’s name. There was no response. He examined the medical chart hanging by the bed. The patient had a history of mild hypertension and had a stent in his heart to repair damage from a mild attack, but otherwise he was a healthy non-smoker. When he arrived at the hospital, he had a fever, normal blood pressure, and high white blood-cell count.⁴²

Perkins heard the patient’s labored breathing through the ventilator. A screen displayed weakening vital signs. The culture of Stevens’s spinal fluid left no doubt that anthrax bacteria were permeating his system. The index patient was dying. Now the challenge would be figuring out whether his exposure was a fatal mishap or an act of cold-blooded murder.

Still in pain from recent gallbladder surgery, Jean Malecki had barely slept since Dr. Bush phoned her from JFK to report the unusual bacteria growing in Stevens’s spinal fluid. He had called while she was conducting a biological and chemical training seminar for about eighty medical professionals from fourteen hospitals. Bush, an old friend from her days practicing at JFK, left a message at her office for her to call him back immediately.

“You have to keep this very quiet,” she heard him whisper into the telephone. Bush had described his patient and the disturbing results of a gram stain of the spinal fluid. As unlikely as it seemed, the germ looked distinctly like B. anthracis.⁴³

Malecki urged caution as she sank wearily into her office chair. Her stomach hurt, and she could feel this new wave of stress tangling it in knots. How unlucky could she be to end up with a case of anthrax in her jurisdiction?

Unlike Jeffrey Koplan, with his well-appointed executive space at the CDC, Malecki ran her public health empire out of a spartan office with institutional furniture and thin wall-to-wall carpeting. Malecki served a population of more than a million, her job included duties ranging from running school immunization and maternity services to administering seven public health clinics and a wide range of environmental programs. Despite the job’s demands, Malecki valued her role on the front lines of the public health system and had concentrated on the new threats of the bioterror age more than most local health officials across the country. The first step, she told Bush calmly, would be more testing on Stevens to try to eliminate anthrax as the agent. Maybe the gram stain was wrong. If further tests still suggested anthrax, she said, then the doctors could “start going through the textbooks to see what we need to do.”

Bush soon called again to report that Stevens’s chest X ray showed unusual widening of the mediastinem. “The organism is growing out profusely in his blood,” the doctor told her. “He was comatose, and we never got a history from him.”

After alerting the Florida State epidemiologist, Steve Wiersma, Malecki headed for the hospital. The state would have to go through the protocol of inviting CDC specialists to come to Florida for consultation, and she didn’t want to lose any time. With the patient unable to speak, doctors needed his family to provide information about Stevens as quickly as possible during the weeks leading to his illness. Malecki had to know if her agency was facing a time bomb that could soon bring hundreds, perhaps thousands of additional patients into local hospitals.

She went to JFK’s intensive care unit and found a private room where she could interview Maureen Stevens.

First, Malecki sketched the patient’s basic biography in her notebook.

63-year-old white male; native of London.

Retired as commercial artist. Now working as photo editor at Globe Communications, which owns the National Enquirer among other publications. He is based at their complex on Broken Sound Blvd., Boca Raton.

At work, he mainly makes phone calls and gets photos faxed to them from all over the world. It was unknown to his wife if he receives and opens mail there (? Photos). Drives to and from work via A1A with open sunroof and music…. Leaves home at 8 A.M. and it takes 35–45 minutes for the drive to work.

At home she has feral cats, which she feeds. Buffo toads go after the cat food. He has relocated buffo toads by catching them in nets—taking them to lakes. Maybe as many as 50.

He is a cyclist.

Mr. S. history of heart attack 5 years ago with stent insertion; meds, 1 adult aspirin per day; Lopressor, ½ tab with breakfast and lunch. He carries nitroglycerin with him.

Malecki began taking down the details of Stevens’s days, beginning on September 22:

Saturday:

1. Possibly went fishing (place unknown). His usual fishing spots include the pier at Boynton Beach Inlet (salt water, ocean fishing); Loxahatchee Wildlife Preserve (fresh water); and also Lake Osborne in Lake Worth. He does not use a boat; he fishes from the banks. He does not hunt.

2. Out to dinner with friends at Roadhouse Grill in Boynton Beach. He had steak, a small sirloin.

Sunday:

6:20 to 8:20 A.M.. Bicycling with friend at John Prince Park, Lake Worth. Later to Lake Worth Beach with 11-year-old granddaughter to possibly the public pool or arcade there.

Monday: He worked.

Tuesday: He worked.

Wednesday: He worked late.

Maureen Stevens gave Malecki more facts about her husband’s late workday. He had stayed later than usual the night before they left for North Carolina. He had been in the office alone during some of this time.

Malecki coaxed the wife to remember minute details of their trip: their gas stops along I-95, the sandwiches they ate for lunch, a description of their daughter’s Charlotte apartment and her pet dog.

Malecki wrote:

She has a little puppy.

It nipped both pt. [patient] and wife.

Stevens’s daughter had been ill with a sore throat for two weeks, and Maureen Stevens had been on Cipro for two weeks to treat a cough.

On Friday, September 28, the family had left for Lake Lure, near Chimney Rock, North Carolina. They toured a musty cave, then took an elevator up to a snack bar. While hiking up the mountain to an observation point, Stevens stopped and drank two handfuls of water from a waterfall.

For dinner, he had a steak, salad, and potatoes. Nothing seemed wrong.

On Saturday, they toured Charlotte and had a pub lunch—smoked salmon on brown bread. They visited the building where their daughter worked but did not go inside.

When they returned to the apartment, Stevens stayed alone while the others shopped. He walked the puppy and rested. They ate leftovers, and he went to bed before 10 P.M.

On Sunday, he stayed behind while his family went to church; then they set out for Duke University, in Durham, to visit his daughter’s boyfriend. On the way, Stevens began to shiver and complained of numbness. He reclined in the car, but insisted that they continue. He rested in a Duke fraternity house while the others dined. On the way home, they passed signs for five hospitals, but he didn’t want to stop.

He got up early Monday to leave for home. Maureen noticed that his pillow was soaked with perspiration. He complained of chills and wore a sweater, but insisted on driving while she navigated. They stopped twice along the way, but he stayed in the car. At home by five P.M., he sipped tea and ate a sandwich, his temperature at 101 degrees. Maureen also felt sick; she had a 102-degree fever.

Tossing fitfully in bed, he pushed his wife away and said, “Stay away from me! You’re hot.” Around 1:30 A.M., Maureen heard him vomiting. He was disoriented when she checked on him.

Maureen insisted on taking him to the emergency room. He walked to the car on his own, but once they arrived, he lost coherence. At 5:30 A.M., once Stevens’s condition stabilized, the emergency room staff sent her home.

Maureen had returned at 8 A.M. and found him in isolation. After having a seizure, he had lost consciousness.

Throughout the reconstruction, Malecki elicited other clues that might suggest contact with anthrax. At lunchtime, he frequented Bud’s Lounge in Delray Beach. He bought packaged noodles at an Oriental food store, which also sold goat meat, and liked to shop for Indian foods on Dixie Highway. He had recently purchased Borelli leather shoes.

His hobbies included collecting fishing poles and growing herbs, and he had recently weeded the garden. Mosquitoes often bit him. During two weeks in England in June, they had taken country walks and had their shoes checked for hoof-and-mouth disease at Heathrow Airport in London.

Malecki furiously took notes. A few of the items intrigued her: the late night of work in an empty office, the drink of water from the mountain waterfall, the visits to stores that might have contained skins or pelts tainted with anthrax. The next day, Maureen called to give more details about a trip the couple had made a few weeks before to feed feral cats. She had noticed a pile of rancid garbage, and Stevens had placed it in a parking lot for removal. Now, his wife wondered, could that have been the source?

On Friday, October 5, Bob Stevens passed away. The next day, Malecki went to the grieving family’s home with an investigator’s detachment to record notes about their final moments together.

Someone at the hospital had seen Stevens’s daughter snip a lock of hair from his head as a remembrance, and this worried Malecki, since spores could have become embedded in the patient’s hair.

After interviewing the daughter, the doctor’s concern abated. She wrote:

i) She did not sniff the hair.

ii) She cut the hair sample from the top of his head with scissors obtained by a social worker.

iii) She placed the hair sample in a zip-lock type baggie, which the hospital social worker had also given her.

She scribbled more notes as she strolled around the Stevens property: the type of car used on the family trip, the name of the deceased’s regular biking partner, the details of a neighborly dispute over trees planted along a fence. In the garage, she noticed a fertilizer spreader and wondered if it could have created an aerosol.

For the epidemiologist trying to solve a puzzle, every fact was relevant, even the family’s tearful good-byes at the victim’s bedside. Malecki jotted down a brief description of the last point of contact between the infected man and family members, who now must be watched as other potential anthrax victims. Before leaving the deathbed, the doctor noted, his wife hugged him, and fearing nothing, leaned over to kiss him good-bye.⁴⁴

As Malecki completed her interviews with the family that Saturday, another team of CDC experts, headed by Sherif Zaki, was making its way from Atlanta to Palm Beach County to bring final authority to the diagnosis of anthrax in Stevens’s case.

The CDC experts believed an autopsy was imperative, and after tense negotiations with the county coroner, Zaki’s pathology team had received permission to autopsy the body. The examination would reveal more about the course of inhalation anthrax, which was crucial information in case more South Florida victims surfaced.

Although the Stevens family had given consent, Palm Beach County coroner Lisa M. Flannagan expressed deep reservations to Zaki about cutting open a victim of inhalation anthrax. The prospect of autopsying Stevens had disturbed her staff, concerned that the morgue would be contaminated.

True, there was a chance that anthrax spores could find their way into the morgue if blood or tissue splattered in the room and was left unattended. If left to dry out, spores might incubate under a table or in a dark, unnoticed corner. Medical advisories had routinely warned doctors that an anthrax-infected corpse was best left undisturbed.

Zaki offered to perform the procedure himself, in consultation with his CDC team, so that the federal experts would bear the greatest risk.

Perkins, then on the ground in Florida, agreed that it was essential to autopsy Stevens since doct...