Lessons the Anthrax Scare Taught Us

Now you can put the mechanisms in place so that when this happens again, we're a lot more prepared.'

Editor's note: Jolanda Janczewski is President and CEO of Consolidated Safety Services Inc., a Fairfax, Va.-based safety and occupational health consulting firm with about 45 employees. CSS was honored in September 2002 as the U.S. Department of State's Small Business Prime Contractor of the Year for on-site testing and decontamination services provided during the October 2001 anthrax episode in the nation's capital. In the following excerpts from a Sept. 19, 2002, conversation with the editors of First Responder, Janczewski discusses the experience and how the safety and emergency response community can prepare for the next crisis.

First Responder: Tell us about the award, the work you did that brought this about.

Janczewski: We have been the State Department's safety and occupational health contractor for overseas operations for about 10 years now, providing on-site surveys, doing a lot of emergency response, mostly indoor air quality problems. When the gentleman was diagnosed with anthrax at the State Department's mail handling facility in Sterling, Va., we were the ones that were called in to immediately consult on what was going on.

At the time, it was obvious that contamination had gotten into the State Department's mail stream. And there were multiple issues to address. One is, what do we do with all the mail that now spread out throughout the world? Understanding that this facility processes all the mail for every consulate's office, every embassy, and a lot of other agencies which are located within the embassies throughout the world.

We immediately shut the building down, shut the ventilation system down, and took a step back and said, What do we do? The mail then also moves to several downtown buildings within the metropolitan area, so we had several mailrooms within those buildings that we had to worry about. We stopped the mail, thanks to the brilliance of the physician down there, Dr. Dumont, he immediately put the entire staff that worked at that mail processing facility on antibiotics, prophylactic antibiotics, shut everything down, and we started going through and sampling all the mailrooms. I think there were over 170 mailrooms or mail processing areas throughout the D.C. area and all the passport offices throughout the United States.

We went through and disinfected all those rooms, bundled up all the mail that was there because they were instructed to leave everything behind, put everything in containers, and held it until a later date. And that went from October, when it happened, till the beginning of November. (Editor's note: At that point, CSS personnel moved to a second building, Building 32, and devised a method for decontaminating about 50,000 mail pouches.}

The State Department got an EPA exemption crisis permit. And we recommended using paraformaldehyde gas. We built chambers, in the long run it was five gas chambers within the facility to process those 50,000 mail pouches so they could get the mail going.

They couldn't purchase [replacement pouches]. It was more cost effective to treat them and get them out of there. So from January through July, we processed 50,000 mail pouches and close to 30,000 parcels/boxes. All the boxes were HEPA-vacced on each side; the HEPA socks were sent off to the lab, they were bundled in lots of 25 packages, they were held until the clearance came in from the laboratory. And then they were stamped that they had been cleaned, moved onto a truck, and moved to a temporary facility so they could go back to the distribution center at the State Department.

Q: Quite an undertaking.

A: It was a lot of staff. We had to staff up very quickly. I think we had close to 40 employees out there, all doing odd jobs, because--just like asbestos--you had to have containment areas, everybody had to be trained, we had to have a medical officer on staff that came in and out. We followed OSHA recommendations to be under the HAZWOPER standard, and it was pretty well treated as a [hazardous waste] site even though it wasn't required just because that helped us set up procedures. We had to do site plans. All of this was working as fast as possible, of course with no guidance because no one had ever done anything like this before.

Now, I've worked extensively with paraformaldehyde gas and decontaminating biological safety cabinets, laboratories. I was a biological safety officer for the National Cancer Institute up at Fort Dietrich, so I'm used to dealing with paraformaldehyde gas--knowing full well that EPA had chosen to use chlorine dioxide, but to me it's not as controllable and there's not as good a history with it as there is with paraformaldehyde. EPA exemption people were very helpful, I think they got that permit through in days. Got everything up and running, and now the building is shut down and the building has been turned over to the Army Corps of Engineers.

Q: Can you give us a ballpark of what all that effort cost?

A: Oh my gosh. I can't separate everything, but I think the whole bill was like a couple of million dollars. It was relatively inexpensive. With equipment, chemicals, and labor of course being the major cost, and they were up and running in a matter of months.

Q: A lot of the businesses our readers work for are small businesses, and of course a lot of businesses across the country are. And to have one or even a handful of diagnosed cases of inhalation anthrax, they may have no concept of what kind of an effort it would take to clear or declare safe your facility. We're talking months and months, and maybe, as you say, it's still shut down a year later, at huge cost.

A: I look at the price tag for the [U.S. Senate's] Hart building, which was just astronomical. And when I look at the effort that we put into the State Department, and that includes all the outlying facilities, the passport offices, and everything that needed to be done, to me, it was relatively inexpensive.

A lot of people don't understand. Why does it take so long, why is the building still not done? You have to be very careful. You're using highly toxic gas and you're using large quantities, as you well know. Nobody usually blasts paraformaldehyde or chlorine dioxide at those kinds of levels in those kinds of quantities. These structures are huge, they've got a lot of penetrations running through them, they do breathe, everything has to be sealed before you can pump it up with any kind of gas to be able to hold it long enough. So it's going to take a while.

Army Corps now has been brought in to take a look at the buildings and decide what do they want to do. Do they want to do some demolition? Do they want to do some reconstruction inside? Do they want to decon? It's their oversight now, we were just in charge of taking care of the immediate problem and getting the mail up and moving and making sure it was done safely.

It's a very laborious process. When we did the packages, we had to set up a hot zone, a warm zone, and a cold zone. The packages would move in--and keep in mind, my guys were gowned up, they're in full protective gear, so they can only go in for a certain number of hours and then we've got to pull them out of the building because you can't put that kind of stress on them. You're working everybody in shifts, and at times we were working 24 hours a day, three shifts a day. You take the packages, break them into lots of 25s, you HEPA-vacuum each side of them, move them into the warm zone, bag them up, hold them, wait for the lab results, move them into a cold zone, and then out the building they go.

The diplomatic pouches, you set up the gas chamber. It took a long time to figure out exactly the right quantity of bags to put in there so you didn't have too many exposed surfaces that would then affect what the concentration of the gas should be. So you move bags in there, they'd all be hung on racks so they were wide open. You'd gas them, you'd hold them for so many hours, then you'd have to neutralize and you'd have to vent, and you'd have to get clearance samples so the guys could go in there and take the bags down.

And then we took quality control samples, which then you had to wait for the spore strip analysis to come back to be sure that we had a complete kill before we released the pouches. You're talking hundreds and hundreds of chamber runs, so yes, it takes a long time if you want to do it right and you want to do it safely.

Nobody knew what to do. It was such a crisis, we were just trying to recover from 9/11, all of us were here in the Washington metropolitan area. Now, in the meantime, the State Department was not our only client. We were one of the few approved GSA contractors as well to go out and test the government buildings, so we were getting work funneled from GSA to go get the rest of the government buildings along with a host of other contractors in town.

We were just scattered everywhere. Supplies were tough to get. Try to get calcium alginate swabs. I think we bought up everything we could possibly get our hands on, and then our competitors were having to buy them from us because we just had wiped out the market of swabs. It was getting quite comical actually, pleading and begging with vendors to get you what you needed quickly. You couldn't buy enough respirator cartridges.

Q: This caught everyone by surprise, and it would be very hard to be adequately prepared in any case.

A: Yes, it would be. Especially in small businesses, which an industrial hygiene business typically is. You don't have these large firms doing this, and even if you are one of the huge, huge companies out there, you just have a small group that does occupational safety and health. It is not cost effective for us to stockpile this stuff, waiting for it to happen one day. Even if you have the expertise, like we did on staff, this still was a challenge--to try to be sure that we were doing the right thing. We had no guidance, we had no agencies coming in, and even though we had several sitting at the table, none of them would look at us and say, 'OK, this is what you do.' I'm calling every biosafety expert I know in the business to come up with the best way to handle this problem.

You know, you never can be ready. But I think it's a wake-up for those of us in this business. We are small, we are a very limited number, and now you can put the mechanisms in place so that when this happens again we're a lot more prepared.

Q: The government will go about that when the Department of Homeland Security is set up. I assume they'll devise some kind of protocols to deal with this problem. Is that what you're thinking?

A: Even if the government steps in to do something, they're turning around and calling us. They are calling the industrial hygiene/safety/occupational health industry. We still have to be ready to respond. Some of the agencies are staffing up now, but they have the same problem we do: 'What are we going to do with these people in the meantime?' They rely on their contractors.

I think it was a great learning experience, I think we were all very successful--even more successful than I would have thought considering the circumstances we were under. I think we need to just get a little more prepared so the next time the agencies call us, we can jump and get our hands on supplies a lot faster.

You can't stockpile respirators; how long are you going to leave them in a warehouse before they're going to get brittle? How long are you going to leave cartridges sitting around? Swabs--anything--you can't just have the stuff hanging around for years. You've got to have good relationships set up with your suppliers.

Q: You mentioned it will be the safety and health community, the IH community, that gets the calls. Should that community now be taking some proactive role here? Trying to write protocols, trying to prepare in some way that they haven't been doing up to now?

A: I think it's time to step up to the plate and say, we're the ones with the expertise. You can't necessarily rely on the government to do everything because in my opinion, the best experts are out there in the industry. The American Biological Safety Association, which I'm one of the founding members of, during the middle of this crisis was having their annual meeting. Every biosafety top expert in the world is at that meeting. And nobody was down there tapping that expertise. I found that absolutely shocking. I know the patriarchs of the business, they're my mentors from when I was growing up and learning the business, and nobody was calling them.

Q: I think the community that I'm familiar with is in the posture of waiting to be called.

A: I think we have to make ourselves more known. No offense against M.D.s, but a lot of the shots are being called by M.D.s who could have been very well assisted by our profession. I just met with some CDC officials yesterday, who we have a contract with to do a database for first responders, a database that's accessible through PDAs and all sorts of other new technology. And he told me that now their task force, their response groups, are putting together a policy that they must be staffed with an industrial hygienist, as well. Which is great because typically they consist of an epidemiologist, an M.D., and a lot of other scientific types, and now they're going to include the safety and occupational health specialists. It's nice to see that this did awaken the government response community to the profession of industrial hygiene and biosafety. M.D.s are great--don't get me wrong.

Q: Their expertise isn't unlimited, either.

A: It's related, but they don't look at things the same way we do. They don't have an eye to exposure as much as we do, they have an eye to curing.

Q: If being prepared doesn't mean stockpiling equipment and respirators and things like that, then what should businesses be doing to prepare?

A: Be sure that you keep a good relationship with your suppliers. Be sure you know what suppliers have available. You've got to keep up with the current technology, as well.

Relationships with the laboratories are very important. The laboratory industry had a big wake-up call. The ones that we send our samples to, there is a huge market for biologics in this industry, and the labs aren't servicing it. We had a lot of problems with local labs that do bacteriology work. They couldn't handle the workload and they weren't set up to handle environmental samples. That was a big problem. I think we need better relationships with labs, I think we need a better understanding of our labs on the biologics side. They're really good at doing our chemicals, they're not real good at doing our biologicals.

So, relationships are important. I think as an industry we need to be better known. We're a sleeper industry. We are always called in after it's a tragedy.

Q: More reactive than proactive.

A: Exactly. We need to be proactive. We need to get out there and let these people, the public health officials, the EPAs, the CDCs, we need to let them know we're here.

Q: Everybody always fights the last war. The next event may not be anthrax; it might be something else. Is there any way to, in a broad sense, prepare?

A: I think we need to keep very knowledgeable on what the top biological, chemical, and radiological warfare agents might be. CDC is doing a wonderful job in getting that word out there. We're such a good industry about sitting down and brainstorming. We're all in the same industry, so when we all sit down at night with each other and go to dinner, that's all we do, is brainstorm the what-ifs. We need to do a lot of that now with some of these hot agents that can be used by terrorists.

Q: John Henshaw of OSHA says they're trying to have some role in this whole thing, encouraging preparedness in businesses. Do you think there's anything they can do there?

A: They put some stuff on the Web site as quickly as possible and said, 'Here are the best recommendations we have.' Unfortunately, they are so chemically oriented and construction safety-oriented; they need some help in the bio expertise. We need better guidance to protect our people because ours are the first ones in there. I think they also have a really good role in helping first responders.

Firefighters are the first to be called in. They're very good; if you give them a recipe they'll follow it, but they need that recipe. What do they do? What protective equipment do they use? When are they actually putting their body in stress because they're overkilling on their protective equipment? When can they back off? Firefighters typically will always use SCBA. They need to, but [biologicals] isn't something they normally come up against.

Q: That's the only kind of respiratory protection they ever use.

A: OSHA's putting together some training programs, or training recommendations for first responders in these areas to let them learn more about protective equipment. All they know about is SCBA.

Q: That's something [Henshaw] spoke out about just a week ago, something they learned at the World Trade Center recovery site: that's all they were used to doing.

A: When I had to hire guys out there at Building 32, half of them were firefighters, and you wouldn't believe what I had to go through to help them understand they don't have to go in that building with SCBA. It's very risky on them anyway. I've got all these medical requirements that I've got to live by, they're putting so much stress on their body and they can't move around and do the things they need to do. We had to retrain them to use full-face respirators, air-purifying respirators, how to put on Tyvek, how to tape themselves up. OSHA has a great role to play in trying to help these people understand level of risk and other types of protection that are out there.

Q: You mentioned there was a lot of activity, maybe almost chaotic activity. Is there any suggestion you have should this happen again, for how an employer or the industry should work in a systematic way? How can you avoid the chaos?

A: The industry, we were all getting pulled in every direction. We're working more with our clients now to be more in a readiness position in the event this happens.

Since the government is our major business, we're setting up open-ended contracts so that they can immediately rely on that contract to get our services. Because the procurement system in the government is very complex, they can't just call you up and have you come in. So we're getting contract mechanisms in place right now that can just be activated immediately in the case of an emergency. We're more clearly defining what we can do and what we can't do for our clients.

I think the government, in the area of occupational safety and health, has a lot to learn. They need to know we're out here, and in the second place, I think they need to get a little more organized. Interagency organization--who's in charge?

Q:. That happened at the World Trade Center and the Pentagon, as well. You really needed to know who was in charge of the safety end of it, and everybody kind of ran up there at once.

A. It's still that way down here. Let's see, EPA and I think the Coast Guard were the lead agencies on the Hart Building. Army Corps of Engineers is now taking over Building 32, and I think EPA is down at [the U.S. Postal facility at] Brentwood as the lead agency. It's very difficult for us as a profession because we're trying to find the go-to group when we need them, and I'm not too sure who they are right now. And let's not forget, you've got HHS. Here's an absolutely shocking thing during this crisis--who are the experts in this country on anthrax? Who's ever had to decontaminate for anthrax? It's the Department of Agriculture. Nobody called them. When we needed some technical advice, we were calling them.

You've got the industrial hygienists saying we're in charge, we're the lead people, then you've got the American Biological Safety Association saying no, we're the ones. We're even fragmented by ourselves here. You need things like this to get yourself organized and get things straightened out. There's a positive experience that came out of this, as well.

Q: That's an excellent point. You do learn how ready you are and how ready you're not. And you prepare better for the next time if there is one.

A: No matter what the crisis is, we will certainly be better prepared than we were last time. We may not know exactly what to do and we may have to do some quick thinking on our feet, but we're certainly going to be better off. I know we are.

This article originally appeared in the January 2003 issue of Occupational Health & Safety.

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