Health problems plague Ground Zero workers
By Stephanie Armour, USA Today, March 4, 2003

Nearly 18 months after the World Trade Center collapsed in a rain of dust, Frank Noviello still feels the aftereffects. The construction foreman toiled for months in a choking haze of smoldering debris to help clear the wreckage. Today, he worries about the toll that cleanup has taken on his emotional and physical health. "Where's that crushed concrete? It's in our lungs now," says Noviello, 39, of East Islip, N.Y. "Do I feel depressed? How would you feel if you smelled death for two weeks? You saw body parts and body bags go by. I'm a Long Island boy. I've never witnessed anything like that before."

There may be thousands more like him. An estimated 30,000 to 50,000 workers — including carpenters, construction crews, firefighters, day laborers and volunteers from around the country — joined in Ground Zero recovery efforts. Only now are medical researchers beginning to understand the health problems those Ground Zero workers still face:

Nearly 80% of emergency responders reported at least one pulmonary symptom that developed or worsened as a result of their World Trade Center-related efforts. Fifty percent of all responders examined were still experiencing pulmonary, mental health, or ear, nose and throat symptoms a year after the attacks. That's according to preliminary data released Jan. 27 by the Mount Sinai Medical Center in New York. Data were analyzed from a random sample of 250 Ground Zero workers, the first of at least 9,000 workers who will be tested under the federally funded screening program. To date, more than 3,500 responders have been screened. The study is scheduled to conclude in July.

Evidence of lung problems such as asthma and chronic sinusitis were found in about 60% of the workers 10 months to one year after Sept. 11, and one in five reported symptoms consistent with post-traumatic stress disorder.

In December, the Environmental Protection Agency reported that workers and others exposed to debris immediately after the collapse are at risk for acute and possibly chronic lung and heart problems. Elevated airborne contaminants were detected up to three months after the attacks, and tests didn't show a return to normal air levels at the site until January or February 2002.

Up to 500 firefighters could be placed on disability in coming years, according to estimates from union members and medical officers. From 11,000 to 15,000 worked at the site. Many are showing a reduction in breathing capacity, and long-term effects could include asthma, heart disease, cancer and emphysema. The results of these and other new health studies are alarming medical researchers, who say health woes linked to Sept. 11 should lead to policy changes that could prevent and better treat such illnesses if another disaster strikes.

"I am surprised. People are still ill a year after the attack, and they are people in the peak of their earning years. Patients have become disabled," says Robin Herbert, co-director of the Mount Sinai study. "For some, this has been devastating. We don't want to see these heroes become unemployed and economically destitute. We're very concerned that these workers receive long-term monitoring."

Exposure to a toxic brew

After the attack, workers sifted through more than 1 million tons of debris at the World Trade Center site and the Fresh Kills landfill on Staten Island. They were exposed to a toxic brew of contaminants that may have included lead, silica, PCBs, dioxins and asbestos, as well as pulverized glass fibers from shattered windows. Some workers inhaled so much dust that they would cough it up for days afterward. Toxins can be absorbed through the skin, lungs and eye membranes, with possible long-term damage to liver, kidneys, lungs and other organs.

Hazards also have existed for those who live or work near the site. Health officials say that although many buildings have not been tested at all for asbestos dust or other toxins from Ground Zero, studies by federal and university researchers show risks are low for the general population. Millions of dollars are being spent to study the health of residents and employees in Lower Manhattan. According to the EPA, "Except for exposures on Sept. 11 and possibly during the next few days, persons in the surrounding community were unlikely to suffer short-term or long-term adverse health effects."

In many cases, respiratory masks were provided for those who worked at the site. But some rescue workers say they lacked training in how to properly wear them. Others say the working conditions were so severe that they had to occasionally remove the masks to see. Some at the site, such as some immigrant day laborers who hauled away debris or rescuers on the scene immediately after the collapse, had no respiratory protection.

Today, the health effects vary. Upper and lower respiratory illness — commonly known as the "World Trade Center cough" — are the most common. But acid reflux disease, post-traumatic stress disorder, stomach ailments and back or shoulder problems caused by lifting also plague workers. Most of the afflicted are men, although more women with problems are beginning to come forward. The median age of workers hovers around 40.

Joseph Firth of Glen Rock, N.J., worked at the site six days a week right after the attack, sifting through the rubble. Today, he suffers from breathing problems. He used to be able to run a brisk six or seven miles. Today, he's lucky to finish three before getting winded. He is still working at Ground Zero, overseeing carpenters involved in the rebuilding efforts. "I just take it day to day," says Firth, 38, adding that the emotional fallout is also hard to leave behind. He tried seeing a therapist but says his best support system is talking to others who saw what he did. "My best therapy was talking with the other guys who removed the body parts. That's what was best for me."

For John Nimmo, 42, it's meant surgeries and skin grafts. The ironworker from Danbury, Conn., was injured at Ground Zero on Oct. 6, 2001, when an electrical pipe pinned and crushed his right leg. He has had three surgeries to remove dead skin and muscles and was out of work for five months. "I also had the hack for quite some time, and I didn't even have that much exposure," says Nimmo, who is now back working on light duty.

More help needed

While research and support services do exist, union members representing firefighters, ironworkers, carpenters and other trades say the system is a poorly set up patchwork that has failed to reach most workers. Many with health problems are getting no treatment at all. Hundreds of day laborers — primarily Hispanic immigrants — may never be tested. "We need more money for treatment and monitoring," says Richard Weiss of New York, with the Mason Tenders District Council. Their members include construction workers, hazardous-material handlers and others. "We don't even know what's out there yet."

The federal government is spending at least $12 million to fund the Mount Sinai screening, which is reaching beyond New York to include out-of-state rescue workers who worked at Ground Zero. In Ohio, for example, workers who were part of search and rescue teams sent to the World Trade Center site will be screened at the University of Cincinnati Medical Center. Sen. Hillary Rodham Clinton, D-N.Y., and other members of Congress successfully pushed for $90 million to fund a long-term study of workers exposed to toxins at Ground Zero. But many say more attention and outreach are needed.

"We've done a good job of taking care of the dead but such a terrible job of taking care of the living," says Phil McArdle of the Uniformed Firefighters Association in New York. "It's despicable that more isn't being done. Everyone's concerned about the long-term health effects. We don't want this to be the same as with Vietnam soldiers and Agent Orange."

Researchers studying the health effects say the occupational hazards posed by Sept. 11 should spur changes that could reduce exposure-related illnesses in the future. Doctors are calling for a review of respiratory equipment to determine what workers should wear and what sort of training should be provided before disaster strikes. They say procedures should be established so that individual doctors can report illnesses, allowing for systematic data collection such as those used in the surveillance of infectious diseases. If such a referral system had been in place after Sept. 11, doctors say, more workers would have gotten proper treatment by now.

Finally, doctors say, the tragedy has shown the need to set up a way to disseminate information rapidly about how best to treat workers. Without such communication, workers are likely to get treatments that may not help. "In these tumultuous political times and concerns about future terrorist attacks, I'm very concerned about identifying strategies to prevent these situations in the first place," Mount Sinai's Herbert says.

Some workers agree that such study is needed. John Greaney of the United Brotherhood of Carpenters and Joiners Local 608, says long-term follow-up and care are needed not just now, but in the years to come. "Mentally, it affected me. Many still suffer today. Guys are having nightmares," Greaney says. "If there are other long-term effects, I don't know if they will be followed. What we're seeing is just the tip of the iceberg."

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