October 11

October 11, 1999

In N.Y. Outbreak, Glimpse of Gaps in
Biological Defenses

NEW YORK TIMES
By JENNIFER STEINHAUER and JUDITH MILLER

NEW YORK -- On Sept. 23, nearly three weeks after Mayor
Rudolph Giuliani announced that New York was being attacked
by a mosquito-borne virus often found in the southern United States,
senior federal health officials convened a conference call to hear some
startling news.

The scientist who initially identified the virus as St. Louis encephalitis said
he had changed his mind, according to an official who was present. It
was probably West Nile virus, a disease never before seen in the
Western hemisphere.

Stunned by the sudden turn, senior
officials at the federal Centers for
Disease Control and Prevention
peppered their colleague with
questions. Was he sure? What
testing was done? Was it repeated?

The officials decided not to inform
New York of the new finding
immediately. They sent the scientist,
Duane Gubler, back to his
laboratory in Fort Collins, Colo., to
do more tests. He reconfirmed the
conclusion, and the next morning,
calls went out to New York City.

Federal public health officials were
chagrined but not overly worried by
the sudden switch in diagnosis. West
Nile virus is slightly less virulent than
St. Louis encephalitis. And the city
was already eradicating the
mosquitoes that transmitted the
disease, whatever it was.

But the announcement caused
concern among many of the
scientists and government officials
who are working to strengthen the
nation's defenses against biological
warfare. They saw the New York
outbreak as a dress rehearsal, a test
of how public health officials could
detect and deal with the sudden
spread of a disease not typically
found in the United States. To them,
the missed diagnosis was unnerving.

"The encephalitis outbreak in New
York is a powerful lesson for public
health authorities," said Alan
Zelicoff, a senior scientist at the
Center for National Security and
Arms Control at Sandia National
Laboratories in New Mexico. "It is
a sobering, not so reassuring,
demonstration of the inadequacies of
the U.S. detection network for
emerging diseases."

Local and federal officials agree that
there is much to be learned from
New York's experience that can be
applied equally to defense against
biological warfare and the emerging
need to deal with the global spread
of virulent disease.

While the public health system
performed well in many regards,
officials point to several key missteps. For instance, in testing samples
from the initial victims, the CDC screened only for six viruses common in
this country. The scientists did not test for several that have been linked
to foreign epidemics or germ warfare.

In addition, the scientist holding a key clue to the true identity of the virus,
a bird specialist who had noticed the unexplained deaths of crows near
the Bronx Zoo, could not get anyone at the CDC to return her calls for a
week. In the end, she turned to several other government laboratories,
including a military research center, to confirm her suspicions that the
CDC had the wrong virus.

Finally, the myriad state, local and federal agencies involved in the
investigation did not always communicate well with one another.

"We've learned about the need for, and benefits of, improvements in
laboratory coordination," said Scott Lillibridge, who leads the CDC's
Bioterrorism Preparedness and Response Program. "We've also learned
how helpful surveillance can be, particularly in beginning to track the
beginning, extent or progress of an infectious disease outbreak."

Over the past several years, the federal government has invested
hundreds of millions of dollars on a national program to defend against
biological terrorism. Several officials said that in light of New York's
experiences, much more money should be invested in the public health
systems that detect epidemics.

On Aug. 23, Dr. Deborah Asnis, an infectious disease specialist at
Flushing Hospital Medical Center in Queens, called the city's Health
Department with some distressing news -- two elderly patients had come
in with symptoms that looked like a neurological illness -- fever, muscle
weakness and confusion.

Dr. Marcelle Layton, who heads the Health Department's Bureau of
Communicable Diseases, told Dr. Asnis to send samples to the state
Department of Health, and then called the CDC to warn them that
something -- maybe botulism -- was happening in New York City. As
the week went on, the number of sick people started to mount.

The case was assigned to Gubler, one of the CDC's experts on diseases
spread by insects. His suspicions focused on St. Louis encephalitis,
which is often found in the southeastern United States.

To confirm his theory, Gubler tested the samples for antibodies against
six viruses transmitted by insects and commonly found in the United
States. The tests came back positive for St. Louis encephalitis, which is a
close relative of West Nile fever.

The CDC announced on Sep. 3 that tests of blood and spinal fluid had
confirmed Gubler's suspicion.

The mayor called a hasty news conference in Queens. His office of
emergency management took the helm and began a $6 million campaign
to wipe out New York's mosquitoes.

Within days, New York City had practically cornered the nation's supply
of insect repellent, and 250,000 brochures about the disease were
printed and distributed, along with free repellent, by 500 city employees.

And New Yorkers quickly began to debate which thing unknown to their
region they feared the most -- St. Louis encephalitis or malathion, the
insecticide that began to rain down from clacking helicopters.

At the Bronx Zoo, officials were worrying about what seemed to be a
serious, but separate biological event. Since July, zoo officials had been
receiving calls from people in the Bronx and Queens about dead birds.
Four days after the city's St. Louis encephalitis announcement, several
exotic birds at the zoo were dead. But not emus. And that made Tracey
McNamara nervous.

Dr. McNamara, the head of the department of pathology at the zoo,
knew that St. Louis encephalitis, which is carried by birds and
transmitted through mosquitoes, does not normally kill the birds.

She considered the possibility that the birds were being killed by another
common form of encephalitis. But that disease is deadly to emus, and the
zoo's emus were thriving. Something much more complicated was afoot,
she reasoned.

The pathologist took to her lab, spending 12 hours a day analyzing bird
samples. What she found was so disturbing, she said, that she called the
CDC to alert them. The dead birds were bleeding from the brain and had
badly damaged hearts. Was a similar virus infecting people?

"We had dead people and dead birds, and I thought we needed to
pursue this," she said.

She also contacted the National Veterinary Services Lab in Ames, Iowa,
part of the U.S. Department of Agriculture, to study the samples. Around
the same time, Ward Stone, the chief wildlife pathologist for the state
Department of Environmental Conservation, began noticing large
numbers of dead crows, and alerted his counterparts in New Jersey and
Connecticut that something strange was happening to the local bird
population.

While the CDC agreed to take some of Dr. McNamara's samples,
agency workers then did not return her daily calls for a week. "I got
voice mail," she said. In fairness, she acknowledged, dead people were
taking precedence.

But the agency seemed slow to grasp the possible link to the birds'
illness. Dr. McNamara is circumspect about criticizing her colleagues at
the CDC, but she said, "I would say a lesson to be learned was that there
was some tunnel vision."

In the federal government's dress rehearsals of how a city might detect
and handle a sudden outbreak of disease, officials had foreseen many
different scenarios. But no one had anticipated an outbreak in which
crucial evidence would be uncovered by a wildlife specialist.

"How we respond to introduced diseases in the wildlife perspective is not
very well resolved," said Michael Samuel, a research project leader at
the National Wildlife Health Center, a unit of the Department of Interior,
which is also researching New York's outbreak. "I don't know that we as
a nation have a contingency plan in place."

Dr. Stephen Ostroff, the acting deputy director for science and public
health at the CDC, said that confusion is a normal part of an investigation
of emerging disease.

"Anyone who continues to maintain that there was some mistake here
doesn't understand the way science proceeds in outbreak investigations,"
Ostroff said. "You won't hear any apologies from me." He said he was
not aware of Dr. McNamara's repeated attempts to reach CDC officials.

Back in the Bronx, Dr. McNamara was getting impatient. The veterinary
lab in Ames had already exhausted its capabilities, but could not
specifically identify the strange virus that was killing the birds.

Dr. McNamara sent more samples to the CDC but she also put in a call
to the U.S. Army Medical Research and Material Command, looking for
a favor. Could the laboratory, which does not usually get involved with
civilian requests, take a peek at her samples?

Dr. McNamara, it turned out, had some chits to call in. She had recently
attended the wedding of the pathologist who performs such tests. The lab
agreed to take a look.

The system was working, after a fashion. The military's finest minds on
bioterrorism had turned to New York's outbreak.

On Sept. 21, Dr. McNamara sent the samples to the lab by overnight
mail. Within a day, the Army's unit, which is based in Fort Detrick, Md.,
confirmed that a virus of a very different sort was killing birds.

Meanwhile, the CDC was beginning to make the connections. On the
same day, officials at the agency called Dr. MacNamara and said they
wanted more material, which she sent out that evening.

On Sept. 23, scientists at the Army lab told her that the tests of bird
samples for West Nile virus "really lit up," Dr. McNamara said.

The CDC, with help from each of the labs involved, had come to the
same conclusion that same day. The next day, the agency announced that
birds were dying in New York City, and a West Nile-like virus was the
reason. The scientists strongly suspected that the humans had been killed
by the same virus, but had yet to confirm it.

The answer came, strangely enough, from California. The New York
State Department of Health, without telling CDC, sent some of the brain
tissue from people believed to have died of St. Louis encephalitis to a lab
run by Ian Lipkin, a scientist at the University of California in Irvine who
had bumped into state scientists at a conference in Albany.

On Sept. 24, Lipkin found that a form of West Nile virus -- which
scientists now believe is similar to a strain previously found in Europe --
had sickened the New York patients. Soon after, the CDC reached the
same conclusion.

The words "West Nile virus" had little significance in New York. But in
Washington, they raised red flags among U.S. intelligence officials who
follow bioterrorism, according to a report in this week's New Yorker
magazine.

In April, a supposed associate of Saddam Hussein published a book in
Britain in which he claimed that the Iraqi leader had threatened in 1997 to
unleash a form of West Nile virus against his enemies.

A closer look at the Iraqi biological weapons program found no evidence
that Baghdad had ever experimented with the virus, and intelligence
officials, along with arms inspectors who had visited Iraq's laboratories,
concluded that the report was baseless.

The eerie coincidence underscored what officials said was a new reality.
"Sadly the world has changed. The threat of bioterrorism is real and
growing," said Dr. Margaret Hamburg, an assistant secretary at the
Department of Health and Human Services who was previously head of
the New York City Health Department. "Whenever a new or unexpected
disease emerges in an outbreak such as this, it would be irresponsible not
to at least consider the possibility of bioterrorism."

Congress, the officials said, has been slow to spend money on detecting
outbreaks, even as it invests hundreds of millions in other bio-defense
efforts and vaccines.

This year, lawmakers for the first time approved $120 million to
strengthen the CDC's programs for education and monitoring disease.
However, the $40 million set aside for improving state and local health
detection was only disbursed late last month, as a West Nile-like virus
was spreading through New York.

"We're spending hundreds of millions on questionable stockpiles of
vaccines and antibiotics," said Zelicoff, the scientist at the Sandia
Laboratory. "We should be improving the ability of local public health
officials to recognize and report strange illnesses to a central authority
that can quickly tell them what to do about it."