DAY EIGHTY-SEVEN:Dec. 6:
This morning I had to dig my summer clothing out of the back closets, as temperatures once again broke all historic records for the month of December, topping 72 degrees. Across the river in New Jersey it got up to 75 – high enough to make everybody wonder whether global warming was going to destroy our Christmas. To put this in perspective, typical high temperatures for this time in December are 45 to 50 degrees.
For a while New Yorkers were loving the balmy temperatures, but now the climate seems to be depressing everyone. It simply isn’t right. And it’s hard to be in the Christmas spirit when it’s so damned hot. Outside Columbia Medical School this afternoon I spotted a group of Peruvian immigrants selling heavy handmade woolen sweaters into which they had patterned American flags. That was smart post-September 11 marketing, except for one thing: nobody wants to buy heavy sweaters – no matter how patriotic the design -- when they are sweating in cotton T-shirts.
This morning macroeconomist Jeffrey Sachs was in town from Harvard to speak at Cornell Medical School about the economics of global health. He drew a large crowd, most of who were dressed in the starched white physician’s coats that are worn by senior medical staff. Sachs told the crowd that seriously addressing the roots of terrorism meant investing billions of dollars in global public health infrastructures. The crowd of usually conservative physicians was very receptive to Sach’s proposals. Fear of bioterrorism has turned even the most right wing doctors into sudden advocates for public health – at least, for the moment.
Today anthrax turned up in the mail-handling facility of the Federal Reserve Board in Washington. A contaminated letter was found in a bin of about 150 letters. The Fed said that since the first anthrax cases surfaced in October the board has processed all mail through the secure mail-handling facility, and it is not distributed inside the Federal Reserve buildings until it has been cleared. That should mean that nobody outside the storage room has been exposed to contaminated mail.
Meanwhile, the Centers for Disease Control told people who are concerned they may contract anthrax from contaminated mail that the risk is “very low.” Some members of Congress are demanding that the CDC perform the seemingly impossible exercise of tracking down every single piece of mail that may have passed through the postal distribution centers in Washington and New Jersey at the same time as the anthrax-laced letters to Senators were sorted. The CDC disclosed today that 85 million pieces of mail went through those facilities before the centers were closed. Tracking 85 million pieces of mail, more than two months after they were posted, would clearly be an exercise in supreme futility.
“Would an old envelope that might have been contaminated or cross-contaminated have a spore or two on it? Could it still? Yes,” CDC director Dr. Jeffrey Koplan said in a press briefing today. “But there really isn’t a basis for undue alarm and fear around this.”
Koplan said that people who are concerned about contamination should keep their mail away from their faces when they open it, avoid blowing or sniffing the contents, avoid tearing or shredding the mail before throwing it away, and frequently wash their hands. That made some sense. But then he went on to suggest that people not open letters, “if there are spores on the outside of the envelope”. This was an amazing remark, as individual spores are microscopic in size. Did Koplan mean to suggest that Americans should purchase microscopes, and use them to scrutinize mail before opening it?
Fear of bioterrorism remains very high on the agenda among medical providers. In my meetings today at both Cornell Medical School and Columbia I found medical students and faculty very concerned about finding appropriate ways to anticipate and respond to such horrors. At Columbia Medical School and the School of Public Health student questions were well informed, intelligent and laced with serious emotional concern. These young doctors realize that they are learning the craft of medicine in a New World – a world for which their teachers are ill equipped. Nobody can provide them with pat answers, simple recipes for how to diagnose and respond to manmade epidemics. And this makes them extremely nervous. Young physicians and medical students would like to believe that government regulators could preempt some terrorist attacks through effective monitoring. New York citizens share that hope. But the Washington Post is reporting tomorrow that, at least in the case of food safety, that is not the case:
“Yet the politically potent food industry, led by the National Food Processors Association, the National Grocers Association and the American Frozen Food Institute, has vigorously — and effectively — argued that government and industry food safety and quality control systems are more than adequate to meet any threat. Rather than expanding government regulations, industry officials say, Congress should simply provide more inspectors and more funding. “I think we’ve already got the system in place to deal with terrorism,” Kelly Johnston, executive vice president and chief lobbyist for the food processors, said last week. “We just need more information from the government to make sure we can address any potential threat.” What security experts fear is not, generally speaking, mass poisoning of wheat fields or food processing plants; because the food supply is so diffuse and diverse, that would be logistically difficult to do on any meaningful scale. What they do fear is the nationwide panic that terrorists could induce by contaminating even a few shipments of imported food or by introducing a virus deadly to U.S. livestock or crops. Food is big business in America — the U.S. meat industry alone reported $100 billion in sales last year, and food processors generated $490 billion in revenue — and it has commensurate political clout. Last year, agribusiness and food processors contributed $13.9 million to Republican and Democratic candidates, according to the Center for Responsive Politics. The industry opposes more government regulation because it adds to its operating costs, forces companies to open their books to investigators and could result in delays in moving perishable goods to market.” For the second year, industry leaders last month blocked a proposal by Sen. Richard J. Durbin, D-Ill., to consolidate the federal food inspection agencies under one roof to coordinate their activities. A few weeks earlier, they helped defeat an amendment by Sen. Tom Harkin, D-Iowa, that would have ensured the continuation of new limits on salmonella in meat and poultry that are being challenged in court. But with time running out on Congress, the Kennedy-Frist bioterrorism bill is looming as the likely vehicle for any final action this year on enhanced food safety measures. Working from a series of proposals offered by HHS Secretary Thompson, Sen. Hillary Rodham Clinton, D-N.Y., Sen. Judd Gregg, R-N.H., Senate Majority Leader Thomas A. Daschle, D-S.D., and others, Kennedy and Frist would give the FDA new tools for tracking and monitoring food shipments.”
Tonight over dinner with friends who are deeply involved in global health issues discussion focused on time: How much time is left to salvage the political situation. They are worried that Congress and the American public are swiftly loosing their sense of concern about the sorry state of public health, and leaders in the field are moving too slowly on efforts to convince Congress to support infrastructural improvements. Time, they insisted, is running out. There is great anxiety that when all is said and done Public Health will be worse off in 2002 than it was on September 10, 2001, having spent itself into financial oblivion dealing with anthrax threats, and receiving no compensation from Washington.
As Ebola reemerges in Africa, concern heightens about the capacity of America’s public health institutions to handle a biological “war”, if you will, on two fronts. In the Clinton administration days the Pentagon used to lobby Congress for money by arguing it needed the ability to fight wars on two fronts at the same time. Well, what about public health, advocates ask? Today it was reported that 17 people have died in an Ebola outbreak in Misangandu, in Congo’s western Kasai province, and a total of 30 cases of hemorrhagic fever have been diagnosed. The Congo outbreak is occurring at the same time as another Ebola situation is unfolding hundreds of miles away in Gabon. Gabon may be better equipped to fight the disease; Congo has been in a state of civil war for more than three years. Even in 1998, during a brief period of peace, I found Congo’ health infrastructure in a complete shambles.
On the other side of the world, late tonight the Taliban were surrendering strongholds all over Afghanistan, including Kandahar, Lashkargah and Tora Bora, where Osama bin Laden was said to be hiding. So far, there is no sign of bin Laden.
On a happier note, we dined tonight in TriBeCa, the beleaguered neighborhood that borders on Ground Zero. We ate in a new restaurant, The Harrison, which opened two weeks after the World Trade Center attacks. Since September 11 some seventy TriBeCa establishments have gone out of business, and most of the once-posh eateries are now dead. Bouley, for example, which was four months ago considered one of the four or five best restaurants in New York, is now boarded up and bankrupt. Remarkably, however, The Harrison, which didn’t even exist prior to September 11, was packed, and turned away customers. We asked the owner how he could account for the success, and he grinned and shrugged. Whatever the reason may be – and certainly good food is at the top of likely explanations – the success of The Harrison is a striking morale booster for the people of downtown Manhattan. As the cab driver that drove me home tonight put it, “anything that’s good for TriBeCa business is good for my business. And anything that’s good for cabby business is good for New York. And I believe in New York – we’re coming back, I know it.”
A Moroccan immigrant, the driver said, “I wouldn’t live anywhere else in the world. This is the greatest city there is, and I’ve lived in Rabat, Paris, London, you name it. New York is my home, it’s the greatest, and I believe.”
So do I.
Be well. Stay safe. Stand defiant.
