Inhalation Anthrax in NYC-Fall 2001 (Part 5 of 5)

Relieved, as we were, that no anthrax spores had been found in the NYC subways and that in the several weeks that had passed no new anthrax cases arose, it wasn’t the end to the spore story. The fifth and final death, the last of the 2001 mail murders, was perhaps the most perplexing. It occurred in a most unlikely setting: Oxford, a small rural town in southwestern Connecticut. With a population of just under 10,000 Oxford is far from major highways and cities. It boasts two banks, a beautiful public golf course and an annual crime rate of zero.

Retired legal secretary Ms. Ottilie Lundgren was a homebody. At 94-years old her mind was still sharp but she preferred the comforts and familiarity of her routine.  She didn’t drive or prepare her own meals and other than her family and a few trick or treaters her only visitor in the preceding months was her local pastor. On November 14^th she began to feel ill with fever and fatigue. When shortness of breath began two days later she was taken to a local area hospital and admitted. She had been a smoker and was known to have lung disease as a result. Pneumonia in nonagenarians is not uncommon. The next day four samples of her blood were growing bacteria, the gram-positive rod variety, and after only 14 hours. Bacillus anthracis was confirmed and a match to the other 21 cases. She died on November 21^st.

State and local health department staff along with CDC, EPA and law enforcement descended on the small town. They interviewed family, neighbors, postal workers and too samples. As we had done for Kathy Nguyen, they reconstructed her movements in the last two months. They turned out to be few. She went to church weekly, occasionally to a local favorite restaurant, a hair salon and doctor visits. Tests for anthrax spores at her home were negative, just like Kathy Nguyen. We met with Jim Hadler and his team to compare notes: both women lived alone and wore hats, other than this we could find no similarity other than their choice of perfume. The bottle tested negative.

We had checked USPS records to see if any letters that had passed though the contaminated postal sorting were routed to Kathy Nguyen. None were and her local Bronx post office tested negative for spores. Public health officials in Connecticut did the same, and likewise found nothing. They tested 29 pieces of mail found in her home, again nothing. They again tried testing the postal distribution center in Wallingford, again negative.

Four miles away, in the neighboring town of Seymour, Connecticut, a family was following the story with much trepidation. Then came a knock at their door. The visitors were from the State Health Department, CDC and the FBI.  A letter, sorted in Trenton on October 9^th just fifteen seconds after the contaminated letter to Senator Leahy and on the same machine had been sent to their address. The epidemiologist asked if by chance did they still had the letter and envelope? They did. The outside surface turned out to be positive for anthrax spores while the inside was not. With this information epidemiologists returned twice more to the Wallingford Postal Center and swabbed and vacuumed again.  This time four of the sorting machines returned hot with spores.

Mrs. Lundgren opened her own mail. Junk mail she tore in half before tossing into the trash.  CDC postulated that letters that had passed through the contaminated postal sorting machines in Trenton after the Leahy and Daschle letters had subsequently contaminated other sorting machines in other towns, including Wallingford. A letter, perhaps a bill or greeting card, passing though a secondarily contaminated sorting machine had picked up enough spores to infect Mrs. Lundgren. So, what did this mean about the minimal dose of spores necessary to cause infection previously believed to be in the thousands? The range of incubation period for inhalation anthrax was believed to be as long as sixty days, but if only a few spores were necessary could this be even longer? Were there still others incubating a deadly disease? How could we identify people at risk? Anyone over sixty-one? Was the mail safe? Only time would tell.