Air Date: Week of September 12, 2003

Although residents and workers in lower Manhattan have had two years to deal with the aftermath of September 11th, many are still not fully recovered from that day. Host Steve Curwood talks with Dr. Stephen Levin, of the Mt. Sinai School of Medicine, about the patients he continues to treat for 9/11-related conditions.

Transcript

[THEME MUSIC]

CURWOOD: Welcome to Living on Earth. I’m Steve Curwood.

Much of the huge dust cloud that settled on lower Manhattan on the days following September 11th has been hosed and filtered away. The remaining particles have settled into the cracks and crevices of the city. Yet, at the two-year anniversary of 9/11, the effects of the World Trade Center dust remain. The Inspector General of the U.S. Environmental Protection Agency recently charged that the agency misled the public about air quality in the days following the attacks. And, it did so at the request of the White House.

That revelation is now political fodder. New York Senator Hillary Clinton says she’ll hold up Senate confirmation for a new head of the EPA until the Bush Administration answers questions about the matter. Meanwhile, in New York, doctors still go about treating residents and workers for September 11th related conditions.

Dr. Stephen Levin directs Occupational and Environmental Medicine at the Mount Sinai School of Medicine. He joins me now from New York City. Welcome.

LEVIN: Thank you. It’s a pleasure to be here.

CURWOOD: Dr. Levin, what do we now know about what was released into the air on September 11th?

LEVIN: Well, we know that initially, when the planes hit the towers and the fires were initiated, there was a tremendous amount of combustion products released, just from the burning of the jet fuel and the burning of the buildings. But the major releases occurred after the collapse of those towers and that resulted in the release of a tremendous amount of dust and soot and smoke. And the dust contained a number of highly irritating materials, including pulverized concrete dust, pulverized glass, fibrous glass, asbestos. And among the gases that were present in that mix was hydrochloric acid as a mist, because when plastic, the kind of PVC plastic that insulates virtually every inch of wire in a building like that, when that burns it releases hydrochloric acid. So that was part of what was released as well.

We also know from measurements that there were these compounds that are the cancer causing agents in cigarette smoke - polycyclic aromatic hydrocarbons - they were released, as well. Because when any wood product or carbon based material burns, and there’s a lot of that in a tower, it releases these particular chemical compounds. And they are cancer-causing agents. There was also a lot of gypsum board, which is a part of the construction materials, and some heavy metals like lead and chrome and cadmium and mercury, although much of that was volatilized or evaporated and probably drifted as a cloud over Brooklyn and out to sea.

CURWOOD: Boy, none of those sound particularly appetizing. Together as a stew, as a mixture, it’s quite daunting.

LEVIN: It was a terrible witch’s brew, and much of the health effects we’re seeing among patients that have been examined, either in our screening program or our clinical center, have suffered the consequences of inhaling that terrible mix.

CURWOOD: Now, some of those were gases which presumably by now aren’t present. But the suspended particles, the dust, if you will, might still be around. I understand some of it migrated into things like floorboards and couches and air ducts. But how much is still around today?

LEVIN: Well, unfortunately, there’s been very poor characterization of how much contamination remains, and how far out from the ground zero site the contamination spread. But I know for certain that there are still many apartments and many office spaces that have never been cleaned except for the minimal amount of dusting to remove what was visible dust. So, a truly adequate assessment and a truly adequate cleanup simply hasn’t been done.

And you’re right, these materials can get into porous surfaces like floorboards, into curtains, into sofas, and into carpets. And it’s not easy to remove these materials even under the best of circumstances, and if you’re asking office workers and home re-occupants to try to deal with this kind of problem on their own, they’re unlikely to be able to remove it all.

CURWOOD: Tell me about the health of these people today, the residents and the workers.

LEVIN: Well, we now have seen over 6,000 workers and volunteers who were part of the rescue and recovery efforts and the people who cleaned up the surrounding buildings. And still, in the last couple of months we still continue to screen new people in our program, and we’re still seeing nearly half are coming in with persistent respiratory problems. And these are often people who have had no successful evaluation or treatment for their problems, and are coming to us with persistent respiratory symptoms now almost two years after the event. The patients of ours who are under treatment, who have been given the appropriate testing, and where we’ve made a diagnosis and provide them with the right kind of respiratory treatment – which usually involves inhalers of the sort that asthmatics use – most of them are improving. Although I can tell you this--out of the hundreds of patients that I’ve seen myself and that I take care of, I think I have only one patient who says he’s as good as he was before September 11th.

We also have patients who went back to their apartments, and they had no other place to live and they had been given reassurance by the EPA that the air quality was safe, so they returned. Some of those individuals also developed sinusitis and laryngitis and asthma and bronchitis as a result of their exposures, at lower rates and generally with less severity than people who were on that pile with their faces really right in the smoke. Many people who were down there on the pile found it very difficult to wear those respirators, largely because it was hard to talk to each other. And communication in a dangerous site is really key. I can tell you that most of my patients who were workers or volunteers on that terrible pile would have done the same thing again if they were called upon to do so, even if they suffered some of the physical and psychological consequences that so many have suffered

CURWOOD: Describe for us, Doctor, the spectrum of the psychological effects of 9/11 there in lower Manhattan today.

LEVIN: Well, it was a combination of people witnessing human horror – I mean, to watch people leap from buildings and land near you, to see so much death, to see people dismembered by falling glass – the scope of human trauma was beyond what anybody had ever been prepared to deal with. So, the classic picture of post-traumatic stress disorder with anxiety, and flashbacks, and intrusive thoughts, and difficulty sleeping, feeling distanced and numb, was so common among people who were down there. Nearly half of the people who have come through our screening program show evidence of persistent psychological distress.

The other thing that we’ve seen among so many patients of ours is depression. People have a persistent sadness and an inability to enjoy life that really resulted as a consequence of their experience down there, and these are people who had never experienced significant depression before. Again, for many of our patients, they’re improving. But I can tell you that I have virtually no patients who suffered these psychological consequences of what they witnessed down there who are fully back to the way they were before September 11th. These are very persistent problems and, in a way, for the post-traumatic stress disorder problems it’s perhaps not so surprising because we saw the same kind of problem after Vietnam among the veterans, and the Oklahoma City bombing also taught us a great deal about how long lasting these problems can be. But the physical problems that we’re seeing are much more persistent than we would have expected. And that’s something of a surprise and I think it has to do with that terrible witch’s brew we were talking about of exposures that caused such significant respiratory burns.

CURWOOD: Now, the New York City Department of Health and the Centers for Disease Control recently set up a survey of people in lower Manhattan who feel they have health effects due to 9/11. And supposedly, people who respond will be followed for twenty years. What’s your take, Dr. Levin, on how it’s going to be carried out?

LEVIN: I have some concern about how thoroughly the registry will be able to capture the populations they want to reach. It’s going to be very difficult to find all the volunteers who were down there. It will be hard enough to find the people who were employed on the rescue and recovery efforts. Then you have all those people who returned to office space in the lower Manhattan area, and all the people who went back to school and went back to their homes.

One of the problems in setting up such a registry is that it’s not clear to people why is it in their interest to be registered. Because while they may be followed by postcard over time, should they become ill, it’s not clear at all that the registry will have a mechanism to guide them into care.

Right now, so far as I know, that registry has not been granted funding for more than the initial establishment of lists. They haven’t been given funding for follow-up tracing of people, and that’s very time and resource intensive. It takes a lot of money and a lot of staff to contact people year after year to find out what their health status is, and whether they’re still alive, and if they’re not alive what did they die from?

CURWOOD: It sounds to me like you think the New York City health department and the CDC are a day late and a dollar short here.

LEVIN: Probably many dollars short. And the registry isn’t really up and running until now two years after the actual terrible event. There will be many people who are lost to follow up, and that’s unfortunate, because one of the things we’ve learned as a public health lesson is that within weeks of that event there should have been a vigorous attempt to capture the information and contact information on everyone who was down there. That was a lost opportunity, and for the first few days, since it was like the Wild West down there, you could understand and forgive the fact that not much systematic registering was done. But you know, within a week’s time we had plenty of opportunity to do that and we failed to do it.

CURWOOD: Dr. Steven Levin is the medical director of the Irving J. Selikoff Center for Occupational and Environmental Medicine at the Mount Sinai School of Medicine. Thanks so much for taking this time with me today.

LEVIN: Thanks very much for having me.

[MUSIC: Sparta “Glasshouse Tarot” WIRETAP SCARS (Dreamworks -2002)]