New anthrax case raises disturbing questions

WASHINGTON -- The surprise appearance of a life-threatening case of inhalation anthrax in a State Department mail room worker who had never visited the contaminated Brentwood Road postal facility adds multiple new levels of complication to a dangerously spiraling medical mystery.

One possible explanation for the perplexing case is that there are multiple letters filled with tiny but potentially deadly doses of spores now traveling through the mailstream, covertly causing disease.

Alternatively, health officials may for the first time have to grapple with the unnerving possibility that the mere act of receiving an ordinary piece of mail that has at some point come in contact with a tainted letter may be sufficient to bring a person close to death.

That raises the immediate question of whether entire neighborhoods served by even slightly contaminated mail facilities may have to be considered at risk of fatal infection and treated immediately with powerful antibiotics.

In the longer run, both possibilities raise the question of whether the U.S. mail stream as a whole may at some point have to be deemed potentially deadly.

The new case "shows how potent this anthrax really is," said Health and Human Services Secretary Tommy Thompson, "how pure it is and how easily it can be disseminated."

Complex as the unfolding anthrax puzzle has been until now, each new development has pointed to a manageable solution -- if sometimes belatedly as health officials gradually came to understand the ways that purified spores behave when shipped through the mail.

There were surprises, to be sure. Most notably, perhaps, mail handling machinery can apparently force medically significant quantities of spores through tiny gaps in otherwise well-sealed envelopes, potentially causing not only the skin form of anthrax but even the deadly inhaled form of the disease in people who breath the air in those facilities.

That reality alone posed a daunting, though not insurmountable, need to treat all people who had worked in or visited any mail handling facility through which even a single contaminated piece of mail was known to have passed.

But experts expressed surprise Thursday at the possibility that a person could get inhalation anthrax merely by coming in contact with a letter that had passed through contaminated postal equipment in another building. Studies on monkeys, as well as on wool sorters and hide handlers years ago, had suggested that inhalation anthrax occurs only when thousands of spores make their way deep into the lungs. Like so many aspects of the recent outbreak, however, even that truism may have to come under new scrutiny.

"People are somewhat surprised we're learning this on a day-to-day basis," said Jeffrey Koplan, director of the Centers for Disease Control and Prevention in Atlanta. "That's really no different than any other investigation we've done. You always wish you knew on Day 1 what you know on Day 20."

Officials Thursday were still considering the possibility that the State Department worker, whose identity was not released, may have opened a spore-filled letter without knowing it -- or been in a room where such a letter had been opened. The chance that such a serious exposure could occur covertly would still present an enormous public health challenge. But at least that would suggest that new mail scanning or decontaminating technologies might eventually allow such letters to be detected and screened out before they got very far into the system.

If, however, the spores being used by terrorists today are so virulent and easily aerosolized as to be able to cause serious disease even when relatively few are present on the outside of an envelope -- as might happen when a piece of "clean" mail bumps against a slightly contaminated letter in the mailstream -- then the potential for maintaining a healthy mail system grows infinitely more complicated.

To track the flow of potential infections one would essentially have to predict the interactions of at least three supremely complicated and intertwining dynamics: the flow of people into and out of the mail system, including visits to post offices and mail boxes; the flow of the mail itself through the network of tiered handling systems; and the flow of spores as they seep through flaws in envelopes and are carried away on other pieces of mail.

In Washington, one of the biggest unanswered questions is whether anthrax bacteria have reached any of the city's 36 neighborhood post offices through cross-contamination with an anthrax-laden envelope.

Deborah Willhite, senior vice president of the Postal Service, said all U.S. government mailrooms, numbering in the hundreds, will be tested.