I City Struggles to Contend with Widespread WTC Cough
By Laurie Garrett, Newsday Staff Writer, September 30, 2002

First of two stories

Physicians in the city have made it clear: The malady now officially called World Trade Center cough is like nothing they've ever seen, and hundreds - perhaps thousands - of people are experiencing it. The extent of this lung disease is not known, and for a combination of bureaucratic reasons, the extent of the human health impact may be understated. Moreover, cleanup efforts may be inappropriately focused on a single element of the debris: asbestos.

The ailment, as described recently by Dr. Kerry Kelly, the New York Fire Department's chief medical officer, is characterized by a reduced lung capacity and a hyper-reactivity of the airways to inhaled particles, bacteria and viruses. The cough is dry and nonproductive and can leave the sufferer gasping for air.

As physicians sought to pin down the ailment's causes, the U.S. Environmental Protection Agency was monitoring Ground Zero and lower Manhattan for chemicals and substances that violate the Clean Air Act. It has become clear, though, that the cough's causes have little if anything to do with those substances. Rather, the culprit appears to be microscopic bits of glass. Satellite images shot by NASA throughout Sept. 11, 2001, depict the plume of dust, toxins and debris drifting directly from Ground Zero southeastward, blanketing a portion of Brooklyn. Hospitals there have reported increases in respiratory complaints.

In Brooklyn Heights, Dr. Tucker Woods was running the emergency room of Long Island College Hospital on Sept. 11 when, he recalls, the staff handled a "huge influx" of respiratory cases. "And I personally this year have seen a real increase in asthma complaints and chronic bronchitis," Woods said. "It's World Trade Center cough; absolutely new cases. And it's also a worsening of old, chronic respiratory cases."

Even mild forms of the cough can severely aggravate existing conditions. Anne, 33, a Broadway actress who asked that her last name not be used for fear of endangering her roles in musical theater, was home in Park Slope on Sept. 11. Three years ago, she was diagnosed with a mild case of asthma, which, she said, had been controlled with the aerosol medication albuterol.

On the morning after the terrorist attack, she awoke "feeling my chest was tight, sort of heavy. So I stood up to cross the room and get my albuterol, and I passed out." She hobbled to her neighborhood emergency room for treatment to clear her air passages. In November, she found herself gasping for air when she contracted the flu. At New York Methodist Hospital, the otherwise healthy actress required several hours' treatment to restore normal breathing.

In its more extreme form, WTC cough has debilitated otherwise healthy men and women, according to physicians who have treated them. Like sea anemones that ball up when touched, the airways of these patients recoil from microscopic foreign objects and constrict. It is possible, Kelly and other physicians said, that these people are permanently injured and will suffer more respiratory problems.

At the Sept. 9 New York Academy of Medicine conference, where authorities confirmed the cough's existence, Mount Sinai School of Medicine occupational health specialist Dr. Steven Levin said he has treated more than 1,000 people who worked in the Ground Zero area last fall. "It is our impression that many have developed inflammatory responses, and that not so many are really fully well," Levin said. "I have very few patients who in fact have returned to pre-9/11 levels of lung function."

Levin's clinic has identified sinusitis, laryngitis and new-onset asthma in the workers, in addition to the extreme World Trade Center cough. "What you have downwind [in southeastern Manhattan and Brooklyn] are people with variable susceptibility. And we can't predict who the susceptibles will be," Levin said in an interview. It is predictable, he argued, that vulnerable people - workers, residents and commuters - who inhaled Ground Zero air last fall will suffer health problems.

The New York City Department of Health has found little in its air and home sampling to explain the syndrome, Assistant Commissioner of Health Dr. Jessica Leighton said. Only 1 percent of sample sites in lower Manhattan were "above EPA standards" for asbestos or other legally controlled air pollutants.

Indeed, EPA spokeswoman Bonnie Bellow said even in the hours after the Twin Towers collapsed, New York City air "did not exceed national air-quality standards." On only one late September day did the city's air appear unhealthy, according to the EPA's legal criteria. "That's not at all to suggest there wasn't a huge amount of dust," added Mary Mears, another EPA spokeswoman.

That may be the point, according to scientists: The chemicals or asbestos for which air is tested may not be to blame. Environmental health expert Lung Chi Chen of the New York University School of Medicine is a member of a team analyzing dust, debris and air samples collected last fall. Chen agrees with the EPA that there was very little asbestos in the debris; indeed, the city Department of Health stopped asbestos installation in the very earliest stages of trade center construction. However, the clouds contained microscopic shards of glass, much of it coated with contaminants such as soot, bacteria, mold and human cells. Additionally, pulverized concrete was highly alkaline or rife with metallic elements.

Normally, the human lung tends to be an acidic environment, with a pH of around 5 to 7. The debris on Sept. 11 had a pH ranging from 9.2 to 11.5. Even a hyperventilating individual suffering from severe anxiety, the normal cause of alkalosis of the lung, rarely runs a pH of higher than 7.7.

The human lung has a mechanism called the "mucous escalator," in which irritating particles trigger a response called complement, which releases large amounts of mucous. The mucous surrounds the troubling particles, which are then coughed up. In response to extreme pH, coupled with glass and other irritants, airways constrict and the mucous that usually encases toxins and allows them to be expelled isn't effective. A dry, nonproductive cough is the result.

Dr. Sonia Buist of Oregon Health Sciences University in Portland, Ore., has studied the impact of the 1981 eruption of Mount St. Helens on the lungs of Oregon loggers who worked seasonally in the area in the next five years. The ash they inhaled, like the World Trade Center debris, was high in ground glass. They experienced lung irritation, and symptoms varied according to the content of the ash breathed, Buist said. Most were restored to full health because the particles were cleared from their lungs.

The Mount St. Helens analogy has its limitations, however. Volcanos produce very acidic, not alkaline, material. Further, Buist found that glass fibers coated with contaminants, as in World Trade Center debris, were harder to clear from the lungs. Dr. Marc Wilkenfeld of the Columbia University Health Sciences Division said he believes the WTC debris was "frankly corrosive" and may have damaged human lung cells in a more direct fashion. He noted that a U.S. Centers for Disease Control and Prevention study of city firefighters found that most WTC cough victims also suffered gastrointestinal tract irritation, the result of swallowing airborne debris. That finding, he argued, is a sign of corrosive damage to the gastrointestinal tract.

All of this puts health officials in a tough position. Within days of Sept. 11, EPA Director Christie Whitman said the city's air was safe - a position a spokesman later clarified to mean that the air did not contain dangerous levels of asbestos or other normally tested toxins. The EPA has maintained that position, and all testing and cleanup operations have focused on a small part of Manhattan, below Canal Street, and a short list of substances, chiefly asbestos.

If testing this fall in lower Manhattan shows "there is anything to indicate we should go outside that area," Bellow said, then residents from other parts of the city who place their names on an EPA list before Oct. 3 may be notified. Residents outside that zone can call 877-796-5471.

So far, no residents above Canal Street or in Brooklyn have been ruled eligible for such federal services as apartment cleaning as a result of residential or occupational exposure, Columbia's Wilkenfeld said. Rep. Jerrold Nadler (D-Manhattan), who has criticized the EPA's response to air-quality concerns, said the agency's focus on lower Manhattan is "entirely, completely arbitrary. There's no scientific basis to it."

Nadler said starting last fall, he asked the EPA to expand its testing so the area of focus could be based on scientific criteria. "In January, I said, 'Get a satellite photo. See where the plume went.' And the EPA said, 'There are no satellite photos,'" Nadler said in an interview. "And when I saw the NASA photos in Newsday [Aug. 23], I was livid, because I was lied to." "That is not true," the EPA's Bellow said. "He was not told that. We would have no reason to tell the congressman that they didn't exist when they did."

http://www.nyc.gov/html/doh/html/wtc/index.html

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