Some Near Ground Zero Have Breathing, Other Health Problems from Dirty Air
By The Philadelphia Inquirer, Knight Ridder Newspapers, October 17, 2003

NEW YORK - There are nights when David Rapp wakes up gasping for air. His days are largely confined to watching television in a small room in his family's Queens, N.Y., apartment. Just walking up a flight of stairs leaves the former construction worker out of breath.

"I don't want to live like this," he said. "I can't stand this."

Rapp, 42, hasn't been able to work since April 2002, when the dizziness, shortness of breath and itchy rashes he had been experiencing for months forced him off the job. He believes the five months he spent working at the site of the World Trade Center, exposed to dust and smoke from the terrorist attacks, damaged his lungs so badly that they only take in half as much air as they used to.

More than two years after the World Trade Center was leveled in a terrorist attack, thousands of New Yorkers have ongoing health problems that they - and their doctors - say are related to exposure to the fire and dust they encountered near Ground Zero.

New York is only beginning to study whether the terrorist attacks damaged the physical health of residents as badly as it did their psyches. The questions are especially acute for rescue and cleanup workers who inhaled caustic smoke from fires that smoldered into early 2002. Residents of Lower Manhattan, however, also worry that dust from the collapse may have left their homes unsafe to inhabit.

A federal government report in late August that said the Environmental Protection Agency falsely reassured New Yorkers that it was safe to return to Lower Manhattan just after the Sept. 11, 2001, attacks has only aggravated those fears. Documents released last week in connection with that report show that the discussions between the EPA and the White House over what to tell the public about air quality in Lower Manhattan were heated.

"I think it was a public health failure in many respects," said Dr. Robin Herbert of the EPA's efforts. Herbert is co-director of the World Trade Center Worker and Volunteer Medical Screening Program at Mount Sinai Medical Center in New York, where Rapp is being treated.

Scientists from both the EPA and universities collected thousands of samples of air and dust in the days and weeks following the attacks, but they disagree on what conclusions can be drawn from that research. They also disagree about whether the EPA had done enough testing when it told city residents during the week after the attacks that it was safe to return to Lower Manhattan.

What they do agree on is that the medical evidence points to significant health problems caused by inhaling smoke and dust. Mount Sinai Medical Center says it has treated thousands of patients for symptoms ranging from coughs, to severe bronchitis and asthma, and lung damage. Doctors there and at other hospitals worry that these symptoms may only be the harbinger of more serious future illnesses, such as cancer.

"People who were down there particularly on September 11, and even more so people who were down there when the towers collapsed, were exposed to a toxic soup of chemicals," Mount Sinai's Herbert said.

Of 3,500 Ground Zero workers seen at Mount Sinai, half still experience health problems, including coughing, asthma attacks when exposed to what had been minor irritants such as smoke, and mental-health problems. The respiratory symptoms signal a disease called Reactive Airways Dysfunction Syndrome, or RADS.

No one knows what the long-term effects will be, including whether exposures will cause emphysema or cancer, Herbert said.

"Our hope is that what we're seeing won't turn into longer latency diseases, that take 15-20 years to appear," she said. "The bottom line is we really just don't know."

Trying to get its arms around the problem, the city has established a registry for people exposed to the dust and smoke of Sept. 11, and intends to track their health over several years.

David Rapp helped shore up the wall that kept river water from flowing into the World Trade Center site. He worked there for two weeks immediately after Sept. 11 as a volunteer and then returned as a paid worker in November. By January, he experienced trouble breathing. Medical personnel at Ground Zero gave him oxygen. He felt better and returned to work because the work he was doing required four men.

"It's not safe for the team with only three, so I went back," he said.

He tells his story matter-of-factly. He's grateful for the help he has received so far, including gifts from charities and help with rent from the Federal Emergency Management Agency. He lives on $400 a week in workers' compensation, plus money from his wife's catering job. He takes about 12 medications, mostly to help him breathe. When he goes out, he carries an oxygen tank, just in case.

"I'm fighting," Rapp said. "I'm not going to let it beat me."

Doctors and scientists believe the towers collapsed so rapidly that they were pulverized into particles small enough to penetrate the lungs. These tiny pieces of concrete and glass were highly acidic, burning people's airways and causing RADS.

"The lung's defenses are compromised at exactly the time when the nose throat and lung are being assaulted with this very fine, caustic dust," said Thomas Cahill, a professor emeritus of physics and atmospheric science at the University of California at Davis.

Cahill tested the air around the World Trade Center after Sept. 11 and found it filled with dangerous particles. But because hot air rises, they cleared the area quickly, he said. As a result, he believes recovery workers were at much greater risk than residents and others in Lower Manhattan.

Even so, residents worry that exposure to dust that landed in their apartments may harm them. Some dust samples contained asbestos, which has been linked to cancer.

The EPA has tested or cleaned more than 4,000 homes, but some people who live near the site fear that their apartments have not been cleaned thoroughly.

EPA spokeswoman Mary Mears said she was confident her agency had responded appropriately to the thousands of requests for testing and cleaning in the area.

"We believe our cleaning was effective," she said. Only a small number of residents whose homes EPA cleaned have complained.

An atmosphere of distrust pervades Lower Manhattan on these issues. The EPA never did widespread testing of indoor dust and air, a step some scientists said was necessary. Testing and cleanup of offices was voluntary, so many workers don't know whether they were exposed or continue to be exposed to dangerous chemicals.

Safety and health issues have been simmering for two years but exploded into national controversy in late August when the EPA Inspector General, an internal agency watchdog, concluded that then EPA administrator Christine Whitman lacked adequate scientific evidence when she reassured the public on Sept. 18, 2001, that the air downtown was "safe to breathe."

The Inspector General also said that the White House Office of Environmental Quality had influenced the EPA to leave out statements that included guidance for cleaning indoor spaces and cautious statements about the potential health effects from trade center debris.

James Connaughton, who heads the White House Office of Environmental Quality, disagreed with the inspector general's characterizations of his office's actions.

"There was no such thing as the White House directing EPA to do things ..." he said. "There was discussion and consensus around what we knew and what we could say about it."

Press releases were only one source of communications, he added. The EPA and the city communicated with Lower Manhattan residents directly in meetings and in cleaning information sent to homes.

But the Inspector General's report continues to stir controversy. New York Sen. Hillary Clinton and U.S. Rep. Jerrold Nadler are holding up the nomination of Michael Leavitt as head of the EPA until Congress investigates the EPA's actions after the attacks.

Clarke and others believe the federal government intentionally misled people.

"From the very beginning they just wanted to tell the world, tell the country, tell New Yorkers, everything is OK," she said.

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