The making of a health disaster
Officials failed to act on Ground Zero perils
July 25, 2006—Ground Zero workers were sent into
'the largest acute environmental disaster that ever has befallen
New York City' without proper respiratory protection - and thousands
are paying the price.
For Christopher Hynes, life as a forgotten victim of 9/11 is a
battle for breath.
Five years ago, Hynes was a 30-year-old, healthy, nonsmoking New
York City police officer. Then, in September and October 2001, he
was assigned to Ground Zero duty, spending more than 100 hours patrolling
the perimeter of the smoldering rubble of the twin towers. The air
was thick with dust and smoky particles.
Today, Hynes, married and the father of a 4-year-old son, has sarcoidosis,
a disease that scars lung tissues, and asthma, a disease that inflames
and obstructs the airways of the lungs. He coughs constantly and
cannot exert himself without losing breath. He survives with the
help of steroids and performs restricted duties for the Police Department.
"I will probably have this for the rest of my life,"
he says.
For Winston Lodge, life as a forgotten victim of 9/11 is the torment
of chronically inflamed and bleeding sinuses.
Five years ago, Lodge was a 44-year-old ironworker who helped build
things. Then, called on to help dismantle The Pile, he pitched in
at Ground Zero for 12 hours a day, seven days a week, for a month.
Today, Lodge's nose runs constantly and often bleeds. He suffers
headaches from sinus pressure, has shortness of breath from chronic
bronchitis and is bedeviled by acid reflux, a painful heartburn.
He has undergone surgery to relieve sinus difficulties and is awaiting
a second operation. Since 2004, Lodge, a divorced father of four,
has been unable to work.
"I am sick to my bones and I need help," he says.
For Jeffrey Endean, life as a forgotten victim of 9/11 is a struggle
with scarred lungs and ruined sinuses.
Five years ago, Endean was a 51-year-old division commander for
the Morris County, N.J., sheriff's office. He was healthy, able
to run several miles. Then, he was pressed into Ground Zero service
because he had experience helping first responders cope at horrific
scenes. He worked 12-hour shifts from Sept. 11 to Nov. 22, 2001.
Today, Endean has reactive airways dysfunction syndrome, or RADS,
a rare, irritant-induced form of asthma, his sinuses often bleed
and he is prone to headaches and upper-respiratory infections. Married,
the father of three and grandfather of three, Endean retired in
2002.
"I start the day with four to five inhalers and a pill,"
he says. "Will I have cancer at 66? Will I live my life as
long as I should?" The forgotten victims of 9/11 are legion
among the 40,000 people who massed at Ground Zero in New York's
hour of greatest need. Well over 12,000 are afflicted with conditions
similar to those that plague Christopher Hynes, Winston Lodge and
Jeffrey Endean.
They gasp for air with asthma or illnesses that scar deep in the
lungs. They lose their breath from exertion. They endure pain from
persistently swollen sinuses and constant burning from acid reflux.
At a minimum, they cough and cough, hacking with a syndrome known
fittingly as World Trade Center cough.
And, beyond all doubt, at least four responders — Firefighter
Stephen Johnson, Police Officer James Godbee, Detective James Zadroga
and Emergency Medical Service paramedic Debbie Reeve — died
as a direct consequence of their service.
The magnitude of the epidemic has worsened for five years as every
level of government has failed to face the reality of what happens
when large numbers of people without proper respiratory protection
are exposed for long periods to air thick with toxic substances.
Responsibility runs from the federal government, where then-Environmental
Protection Administrator Christie Whitman falsely assured 9/11 responders
that the air was safe, to the New York State Health Department,
which abandoned a program designed to monitor the health of 9,800
state and National Guard personnel, to the New York City Health
Department, which has yet to issue treatment guidelines for physicians.
The failure to create the comprehensive public health campaign
that was so obviously called for is especially outrageous because
public health officials have long had access to evidence of a public
health disaster in the making. Medical researchers have published
at least 27 studies detailing how the toxic cloud that erupted with
the collapse of the World Trade Center ate at the lungs of the workers
who labored to find survivors and cart away the massive rubble.
To read the studies is to confront both governmental inaction and
a question: Why? Why were recovery workers put in harm's way, falsely
assured they were safe and lacking respiratory protection? And why
has so little been done to aid them? The answers, it seems certain,
were, first, ignorance; second, a determination to get New York
moving at all costs; third, bureaucracies that let everyone dodge
responsibility, and fourth, a desire to minimize liability.
All of which should have been swept aside as scientists reported
their findings; all of which must be swept aside today. Too many
people have gone without proper monitoring and treatment, and too
many are threatened by worse illnesses, to allow further denial
and lethargy.
The reports are available in publications such as the New England
Journal of Medicine, the Journal of Occupational and Environmental
Medicine, the American Journal of Respiratory and Critical Care
Medicine, Chest, and the Centers for Disease Control and Prevention's
Morbidity and Mortality Weekly Report. Many were written by the
Fire Department's own doctors, who are among a handful of officials
who have performed in exemplary fashion since 9/11.
The collapse of the twin towers was, in the words of a 2004 report
in the journal Environmental Health Perspectives, "the largest
acute environmental disaster that ever has befallen New York City."
The air became laden with highly alkaline concrete dust, glass fibers
and particles of lead, chlorine, antimony, aluminum, titanium, magnesium,
iron, zinc and calcium. Flaming fuel and plastics released carcinogens
including dioxins, polycyclic aromatic hydrocarbons, polychlorinated
biphenyls and polychlorinated furans.
Three days after the attack, rain helped cleanse the atmosphere,
but particulate levels rose and fell for weeks, dropping at night
when the air was still and rising with flareups in The Pile. Construction
machinery added diesel exhaust to the stew, and caked gray-white
dust was omnipresent. It was not until December 2001 that the fires
were extinguished and dioxin levels returned to normal. The final
pieces of steel were trucked away five months later.
The devastating consequences of laboring amid poisons became immediately
evident.
In the first 24 hours, 240 firefighters and Emergency Medical Service
workers sought treatment, half for dire respiratory symptoms. Three
were hospitalized for life-threatening inhalation injuries, two
of whom went into acute respiratory arrest.
Within 48 hours, more than 9,000 firefighters — 90% of the
FDNY's earliest responders — suffered acute cough, nasal congestion,
chest tightness or burning. Three out of four told researchers that
for the first week, they didn't wear respirators, which cover the
nose and mouth and filter out contaminants. Some used paper masks
that were practically useless.
Two weeks after 9/11, a 38-year-old firefighter was admitted to
Bellevue Hospital with acute eosinophilic pneumonia, a rare disease
caused by exposure to extreme amounts of dust, according to the
description of his case published in the American Journal of Respiratory
and Critical Care Medicine. He had ash, fiberglass, silica, metal
particles and asbestos in his lungs.
The firefighter, whom the FDNY declined to identify, had arrived
at the Trade Center 20 minutes after the collapse and worked 16
hours a day for 13 days, wearing no respiratory protection for at
least the first week. Early on, he coughed up black phlegm, and
for two days before he was hospitalized he complained of fatigue,
muscle pain, fever, dry cough, chest discomfort and breathlessness.
He required three weeks of treatment before recovering.
A team of doctors, including David Prezant, the Fire Department's
deputy chief medical officer, wrote up the case as an example of
a condition known as interstitial lung disease. ILD affects tissues
deep in the lungs that extract oxygen and is far rarer than illnesses
that obstruct breathing passages, such as asthma. It is the type
of illness that led to the deaths of Johnson, Zadroga and Godbee.
In October, doctors diagnosed almost 60 firefighters as suffering
from airway hyperreactivity, a narrowing of breathing passages commonly
found in miners after years of exposure to airborne particles. The
firefighters' conditions worsened over the next six months. In November
and December, researchers for Beth Israel Medical Center and Johns
Hopkins and Columbia universities examined hundreds of cops and
cleanup workers and found that they, too, had coughing, wheezing
and other lung ailments. For example, Beth Israel doctors checked
240 Emergency Service Unit cops and found that 77% had developed
new or worsening respiratory symptoms within days after 9/11, and
that one-quarter of the 240 still had symptoms three months later.
In February 2002, a study of 97 ironworkers who were at Ground
Zero during the first five days found 77% had respiratory symptoms
such as cough, chest tightness and wheezing.
Symptoms emerged among people who had not been on The Pile. Two-thirds
of the residents in 414 randomly selected households in Battery
Park City, Southbridge Towers and Independence Plaza reported eye
or throat irritation six weeks after the attack, and nearly half
had persistent coughs.
A survey of downtown women who were pregnant on 9/11 found shorter
gestation periods and smaller babies than normal. The maternal and
cord blood of women who lived within a mile of Ground Zero had elevated
levels of PAHs in the month after the attack. PAHs are associated
with genetic damage.
One woman told researchers at the Johns Hopkins Bloomberg School
of Public Health in Baltimore that she had had an abortion because
she feared birth defects.
Still, the Ground Zero recovery workers suffered the worst illnesses.
Thirteen firefighters contracted pneumonia in the first three months,
and by month six more than 30 firefighters had come down with reactive
airways dysfunction syndrome, the asthma that struck Jeffrey Endean.
An additional 332 firefighters and one EMS worker had a severe enough
cough to require four weeks of sick leave — the first medical
definition of what became know as World Trade Center cough.
All of them had coughed up black or gray phlegm containing pebbles
or particles in the first days after the attack, and one year later,
more than half of those 332 showed only partial improvement. Almost
nine out of 10 also suffered from persistent, severe heartburn or
acid reflux, an ailment common among the forgotten victims of 9/11.
(Doctors believe that breathing concrete dust inflamed lungs and
sinuses, and swallowing it damaged digestive systems, causing the
release of acids. Vapors generated by those acids then worsen the
respiratory inflammation, creating a vicious cycle. One retired
firefighter had a cough so severe that the constant jarring of his
teeth knocked out most of his fillings, said the FDNY's Prezant.)
Most stunningly, FDNY doctors calculated that the average lung capacity
of Ground Zero firefighters and EMS workers had decreased by the
equivalent of 12 years of aging. The doctors also saw sarcoidosis,
the lung-scarring disease that afflicts Christopher Hynes, at more
than five times the usual rate in the first two years.
That's where the scientific measurements of the Ground Zero health
crisis end for the moment, but more is known because Fire Department
physicians and doctors at the Mount Sinai World Trade Center Medical
Monitoring Program have monitored or treated tens of thousands of
patients.
Their conditions are similar to those suffered by Hynes, Lodge
and Endean: asthma, RADS, interstitial lung diseases, bronchitis,
sinusitis, acid reflux and, most commonly, World Trade Center cough.
The doctors say that while aggressive treatment has helped many
to improve, few have been restored to the health they enjoyed before
9/11. Many are severely debilitated.
The Daily News is calling on Mayor Bloomberg to lead a public health
drive on behalf of the forgotten victims of 9/11. His long dedication
to public health, his command of municipal resources and his ability
to get things done ideally suit Bloomberg for the job. Not incidentally,
he also occupies a position from which to mobilize the state and
federal governments into fulfilling their responsibilities to the
Ground Zero responders.
And those responsibilities are, indeed, huge. They belong to, among
others, Gov. Pataki and his successor in Albany come January, state
Health Commissioner Antonia Novello and her successor come January
and U.S. Health and Human Services Secretary Michael Leavitt, who
assigned Dr. John Howard, head of the National Institute for Occupational
Safety and Health, to serve as federal WTC health coordinator. All
must begin to accept their obligations.
Bloomberg responded to our call with a commitment to study "whether
we are doing everything that we can," and a promise to do what
he can "consistent with what our resources are, to make sure
that this city acts responsibly and recognizes the great sacrifice
and the hard work that people made down at the World Trade Center
site."
To which we say, "Good, Mr. Mayor, take a close, hard look."
Action will surely follow, and we look forward to seeing the start
of a comprehensive, aggressive crusade, because the facts demand
it. Even a cursory study will show that Trade Center responders
were falsely assured the air was safe. And that they didn't get
or use proper respiratory protection.
And that the primary medical program for most responders, the one
run by Mount Sinai, has never been adequately funded so that cops
and construction workers must wait four months for an appointment
for treatment.
And that doctors at Mount Sinai and affiliated hospitals are experiencing
a surge of new patients five years after 9/11.
And that many of Mount Sinai's patients arrive after having been
misdiagnosed or ineffectively treated.
And that medical experts, including Dr. Kerry Kelly, FDNY's chief
medical officer, and Prezant; Dr. Robin Herbert and Dr. Stephen
Levin, who run Mount Sinai's program, and Dr. Alvin Teirstein, a
noted Mount Sinai pulmonary specialist, are concerned that the forgotten
o f9/11 may be on the verge of more serious illnesses. Tumors and
lung-scarring diseases have been known to emerge between five and
20 years after a toxic exposure. The responders are about to cross
that five-year milestone.
They served New York and it cost them their health and even their
lives. They deserve nothing less than long-term, gold-standard health
care — now.
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