Far From Safe

Sometimes it takes a freak event to underscore just how far the U.S. has yet to go before it is safer from a natural disaster or terrorist attack than it was during the fall terror attacks of 2001.

Case in point: On Feb. 16, Vado Diomande, 44, an African dancer and drum maker, collapsed after a performance at a university in rural Pennsylvania. He was rushed to a hospital, complaining of shortness of breath, general malaise, and a dry cough.

Several days later, laboratory tests performed by the Pennsylvania Department of Health and the Centers for Disease Control & Prevention (CDC) confirmed that he was infected with Bacillus anthracis, the bacterium that causes anthrax. His was the first confirmed U.S. case of inhalation anthrax not related to terrorism since 1976.

Early last December, Diomande, a resident of New York City's Greenwich Village, left for West Africa, eventually reaching his home village of Tousingha, in Ivory Coast. Somewhere in Ivory Coast, Diomande purchased four untanned goat skins, which CDC says he brought back to the U.S. wrapped in a plastic bag that traveled in the plane's cargo hold.

Untreated animal skins from Africa are not supposed to enter the U.S. Diomande didn't declare his purchases to customs agents when he returned to the U.S. on Dec. 20, and agents didn't confiscate them.

Diomande transported the imported hides to a Brooklyn warehouse, where he stored and worked them. He used the skins to make traditional African djembe drums by first soaking the unprocessed hides, scraping hair from them with a razor, and then stretching the denuded hides over drum bases. His workspace was poorly ventilated, and he never wore protective clothing or masks.

Health authorities believe the vigorous treatment of the hides let loose buried anthrax spores. Diomande inhaled the aerosolized spores deeply and in sufficient quantity to make him sick with inhalation anthrax, the rarest and most lethal form.

He was released from the Pennsylvania hospital on March 22, weakened, much thinner, and still taking strong antibiotics.

This tragic and unusual case of natural anthrax shows that federal, state, and local authorities have internalized lessons from the anthrax-laced letter attacks that sickened 17 people and killed five in October 2001. For example, New York City health department officials worked closely with the city's police department and with the Pennsylvania health department, as well as CDC. City officials also coordinated with the Federal Bureau of Investigation and many other state and federal health and law enforcement agencies.

Back in October 2001, it took some time for health and law enforcement officials to think of anthrax as the culprit agent. But, as Stephen S. Morse, director of Columbia University's Center for Public Health Preparedness, has said, the "suspicion index" among physicians, even those practicing in rural hospitals, has increased. Local Pennsylvania health officials ordered appropriate tests and then, as quickly as possible, alerted their counterparts in New York City and at CDC to a likely anthrax case.

Still, definitive tests took days to confirm inhalation anthrax. What's needed, health experts say, are rapid tests that can flag potentially lethal organisms so response—including isolation if necessary—and treatment can begin immediately.

The chain of command established after the 2001 terror attacks worked well this time. But health experts wonder how well things will work if many individuals in many states are exposed to an intentional release of an organism such as anthrax or to a natural outbreak such as pandemic flu.

Health and emergency response experts say the U.S. has fallen dangerously behind in efforts to develop mobile field hospitals that can be erected in the event of a natural disaster or terror attack to treat people of all ages and health conditions. Additionally, the Department of Homeland Security (DHS), which is responsible for developing a prototype hospital, has failed to do so.

The Diomande episode also makes evident just how difficult it is to halt the importation of hitchhiking lethal germs. To keep commerce and travel moving, not everything is thoroughly inspected. And despite the presence of customs agents, a lot depends of the honor system. Imagine the havoc that could have been created if Diomande had been trying to bring in a dirty bomb instead of anthrax-tainted hides.

More systemically, when DHS was created, inspectors from the Customs Service merged with those from the Immigration & Naturalization Service and the Agriculture Department's Animal Plant Health Inspection Service to form the Customs & Border Protection agency within DHS. These various services, some experts say, are still working to define and refine their roles, and coordination among them remains disjointed.

As the Diomande case illustrates, U.S. borders and ports remain porous. Congress is struggling to develop legislation to better secure these entry points. Currently, only 6% of all cargo destined for the U.S. is inspected. Hong Kong inspects 100% of incoming cargo and should serve as a model for U.S. legislation.