Anthrax Infection 'Isolated Case,' Say Authorities

Disease:  Florida man is expected to die.  'No evidence of terrorism,' Health secretary says.

MIAMI--A 63-year-old Florida man has been hospitalized with anthrax, a deadly and extremely rare disease that has also been harnessed for use as a germ weapon, state and federal officials said Thursday.  Though the man lives in Palm Beach County, temporary home to many of the Sept. 11 hijack suspects, officials stressed that there is no indication it is a case of bio-terrorism.

"It appears that this is just an isolated case," Health and Human Services Secretary Tommy G. Thompson told a White House news conference.  "There is no evidence of terrorism."

But with the nation on high alert and officials warning that more terrorist attacks are likely, it was none other than National Security Advisor Condoleezza Rice who informed President Bush of the Florida man's unusual illness.  Thompson's own appearance at the daily White House press briefing was also an evident attempt to inform and calm a jittery public.

Still, Dr. Jeffrey P. Koplan, director of the national Centers for Disease Control and Prevention in Atlanta, said the possibility that the anthrax infection resulted from a terrorist act was "on the list" of hypotheses being investigated.

Thompson said the victim was believed to have inhaled an air-borne spore of the bacterium Bacillus anthracis .  Only 18 cases of inhaled anthrax were reported in the United States in the 20th century, and none since 1976.

The rarity of the disease has prompted a large-scale investigation into the Florida case.  The disease, however, is not contagious.

The Lantana, Fla., resident, who recently made a vacation trip to North Carolina, was hospitalized at 2:30 a.m. Tuesday, said Tim O'Connor, spokesman for the Palm Beach County Health Department.  The man was vomiting and delirious and experiencing seizures, he said.

The Sun, a supermarket tabloid, identified the anthrax victim as one of its own employees, Bob Stevens, a photo editor.  Thompson said he was of British descent.  At JFK Medical Center in Atlantis, Fla., the patient was reported to be on a ventilator.

"He's critically ill," Dr. Larry Bush, an infectious disease specialist, told reporters.

O'Connor said the chances of the disease being fatal are "in all likelihood, 100%."

Florida and federal officials, including from the FBI and the CDC, are trying to trace the origin of the disease, O'Connor said.

Up to six days can pass between the time a human comes in contact with the bacterium and the onset of symptoms.  According to O'Connor, the victim, an avid outdoorsman, was on vacation in North Carolina on Sept. 28-30 and returned home Monday.

"We are trying to trace the restaurants he ate in, the people he came in contact with, the fur and skin he may have been in contact with, anything that might give us direction,"  O'Connor said.

The anthrax bacterium can be inhaled as an airborne spore, absorbed through a cut or sore from infected soil or ingested from the tainted and improperly cooked meat of cattle, goats, sheep or bison.

Inhaled anthrax, the rarest kind, is almost always fatal.  At first the symptoms are not unlike those of a common cold, but deteriorate into severe breathing problems, shock and usually death.

At the White House briefing, Thompson said the victim was believed to have inhaled the spore.

"I want to make sure that everybody understands that anthrax is not contagious and is not communicable, which means it is not spread from person to person," Thompson stressed.

At least 10 countries are believed to have experimented with anthrax as a potential weapon.  A 1979 incident in the former Soviet Union, in which at least 68 people died of anthrax inhalation, is generally believed to have resulted from an accident at a bacteriological warfare factory.

An anthrax vaccine is licensed for use in humans and is considered to be more than 90% effective in preventing the disease but is currently only available to the military.  In the event of a mass outbreak, Thompson said there are enough antibiotics on hand to treat 2 million victims for 60 days.

Fears that terrorists might be planning a chemical or biological attack in the U.S. arose when it was learned that Middle Eastern men, including one of the Sept. 11 suspects, had made inquiries about crop-dusting planes in Belle Glade, about 40 miles west of Lantana.

Many of the men believed to have crashed airliners into the World Trade Center and Pentagon also lived temporarily in Palm Beach County towns.

Source of Anthrax in Death Investigated

Disease:  Officials track movements of Florida man before he died.  Tests and antibiotics given to family and co-workers.

From Associated Press

LANTANA, Fla.--Relatives of a Florida man who contracted a fatal case of anthrax are being given antibiotics as a precaution, and his co-workers have been tested and cleared, health authorities said Saturday.

The search to find out how Bob Stevens, 63, contracted the rare and extremely lethal inhaled form of the disease expanded one day after his death.

More than 50 health and law enforcement officials have fanned out across Palm Beach County to track his movements over the last two months and look for other possible cases.  Officials are also going over medical records in four North Carolina counties that he might have visited recently.

"We have a long chronology of common activities we need to pursue,"  Florida epidemiologist Dr. Steven Wiersma said.  "We don't have any really hot leads at this time."

Investigators are awaiting test results from soil and other specimens.  The results could take days.

No other cases of anthrax have been reported in the area.  Wiersma said several of Stevens' co-workers at the supermarket tabloid The Sun have been tested, but results were negative.  Antibiotics are being given to close family members.

Officials have said there is no evidence that Stevens was the victim of terrorism.  Wiersma said tests of Stevens' blood helped confirm that belief because the anthrax in the sample responded to penicillin.  Anthrax developed by some countries as a biological weapon could be resistant to the antibiotic, he said.

The Sept. 11 hijackings have put many people on edge about bioterrorism.

Officials believe Stevens contracted anthrax naturally in Florida.  The disease can be contracted from farm animals or soil, though the bacterium is not normally found among wildlife or livestock in the state.  Stevens was described as an avid outdoorsman who enjoyed fishing and gardening.

Investigators have cast a wide net in their search in Florida.

County medical examiners are looking over any unexplained deaths, but have not found any cases connected to anthrax.  Veterinarians have been told to be on alert for animals who might have the disease, but none have turned up.

Investigators also are visiting restaurants, parks and other locations he frequented or even visited casually, Wiersma said.

Health officials are asking area hospitals to check records going back 30 days for suspicious cases.  They should be finished Monday, said Tim O'Connor, a county health department spokesman.  The disease has an incubation period of up to 60 days.

Meanwhile, the health department is fielding hundreds of calls from worried or curious citizens.  Some want to know what the symptoms are, while others ask where they can get a vaccine to prevent the spread of the disease, O'Connor said.  They are told a vaccine is available only to the military, but they are not at risk because the disease is not contagious, he said.

Only 18 inhalation cases in the United States were documented in the 20th century, the most recent in 1976 in California.  The anthrax case in Florida was in 1974, according to the state health department.

U.S. Still Probing Chem-Bio Warfare

Attacks:  Studies focus on how lethal agents disperse.  Tests are run in subways, at airports.

WASHINGTON--No one challenged them as they moved among Manhattan's busy subway commuters--a group of men, carrying identification from a phony company, who tossed light bulbs that shattered on the underground tracks.  But the men who slipped onto midtown trains 35 years ago were actually U.S. germ warfare scientists, and their light bulbs contained bacteria, considered harmless, that they dispersed among thousands of New Yorkers.

It was one of more than 200 secret tests the Army conducted in populated parts of the country from 1949 to 1969, aimed at producing data on how a biological or chemical attack might unfold.

The studies provoked outrage when they became known in the 1970s.  But today, as some Americans stockpile gas masks and antibiotics in fear of a terrorist attack, they are also a reminder that the government has been probing the science of unconventional warfare for decades, and in substantial detail.

In fact, the government is still conducting studies on the decades-old question of how lethal agents would disperse during an assault.  In nighttime experiments, scientists have monitored air flows in the Washington subway system, which might show how officials could move trains without making an attack worse.  Other tests have been conducted in airports, over Salt Lake City last year and in other settings with complex air flows, using smoke and other materials instead of bacteria.

And that is only one field of science that government biological and chemical defense experts are studying.  The work extends well beyond the most obvious elements of defense, such as developing gas masks and protective gear.

New optical equipment can determine whether a suspicious cloud miles away contains dangerous materials.  The gene revolution has led to hand-held monitors that can detect small amounts of biological or chemical agents.  Because the first signs of biological attack might appear at doctors' offices, new software is helping a small number of public health officials keep moment-by-moment tabs on the illnesses reported by patients.

Some of these products are already available, but it will take years for many others to reach soldiers or civil defense directors.  Moreover, the nation is not always adept at using even the tools it has at hand.

The General Accounting Office, for example, reported last week that poor inventory controls caused the Pentagon to greatly overstate the number of protective suits it had purchased to safeguard troops from biochemical attacks.  And the Virginia-based International Assn. of Fire Chiefs complains that firefighters cannot buy a new type of protective mask already on the market, because a government agency has been slow to certify the equipment as acceptable.

"We are not prepared for a chem-bio attack in this country, and one of the main reasons for it is that the federal government has not yet certified the masks for use by firefighters and other first responders," said Alan Caldwell, government relations director for the fire chiefs' group.  "Having the mask would be a major step forward."

General Sees Some Progress

But at the same time, some people familiar with government efforts believe that their broad scope should bring a measure of comfort to a nation now anxious about the threat of biological or chemical attacks.

"We may not be where we want to be on homeland defense, but we are not starting with a blank sheet of paper," said Brig. Gen. Dean Ertwine, commander of the U.S. Army Developmental Test Command, whose mission includes testing protective equipment.

Many terrorism experts believe that the threat of a biological or chemical attack, at least one that would cause mass casualties, is remote.  Even if a terrorist could obtain a lethal agent, there are technical hurdles to distributing it widely.

The secret tests of the 1950s and 1960s examined how high those hurdles are.  They studied the distance that bacteria, viruses or lethal gases spread in the atmosphere, how fast they degrade and how many casualties they might cause.

In 1950, for example, a Navy vessel sprayed bacteria along two miles of the San Francisco coast.  Thanks to a gentle wind, the bacteria blanketed the city during one test.

Had a similar but lethal bacteria been sprayed, more than 60% of residents would have been infected, according to William Patrick III, a former manager of Army bioweapons programs.

But in a second test, conducted during rougher weather, scientists could find bacteria only as far as two blocks from the shore.  This demonstrated that weather conditions were as important to an attack as the agent used, Patrick wrote in a paper published this year by the National Academy of Sciences.

In all, six tests were conducted in San Francisco, using two types of bacteria.  Other materials were sprayed over Minneapolis and St. Louis, in Washington's National Airport, and elsewhere.  In the 1966 New York subway tests, air flows from the trains were shown to push bacteria widely through the subway cars and underground tunnels.

It was an era with no computer modeling and with less sensitivity than today to the protection of research volunteers.  Military officials did not tell local officials or Congress about the tests, and word did not leak out until the mid-1970s.  There were reports of increased illness in some of the cities involved, but military officials called them coincidental.  A federal judge dismissed one wrongful-death case in San Francisco, ruling that the bacteria release had been harmless.

Today, scientists are still working on some of the same questions as in the secret experiments, but with a major difference.  In 1969, President Nixon halted all work on offensive biological weapons, and the nation began destroying its stockpiles.  By law, all current efforts must be aimed only at improving defenses against an attack.

For example, scientists are still studying air flows.  The information could help them learn how to evacuate people from a subway, airport or city without spreading bacteria further, said Richard Wheeler, who manages chemical, biological and national security programs at the Department of Energy.

One particularly complex problem involves air flows through the "urban canyons" created by tall buildings.  But understanding air movements in cities could be crucial, said Alan Zelicoff, a physician at the government's Sandia National Laboratories in Albuquerque.

With millions of people living and working in Manhattan, N.Y., officials could not rush antibiotics to everyone if they detected a biological attack.  "You'd like to know if maybe people on the left hand of the island have no concerns, because the cloud passed over them, but that those beyond Lexington and 83rd need help," he said.

Last fall, the Department of Energy conducted tests over Salt Lake City using a gas meant to mimic a toxic cloud, Wheeler said.  He said the city was chosen because of unique air flows in the region, and not because it will host the 2002 Winter Olympics.

Often, new information on air flows is fed into a modeling system at the Lawrence Livermore National Laboratory near Oakland, which uses current weather conditions and a vast database to predict how an atmospheric release of materials is likely to travel.

The 20-year-old system was designed to track accidental releases of radioactive material from nuclear power plants, Wheeler said.  But it is being upgraded to include a variety of data, such as how quickly various biological agents degrade in the atmosphere.

At Dugway Proving Ground, an Army testing range in Utah, scientists have built expertise in the arcane science of aerobiology, the study of airborne organic materials.

Studying Various Spraying Devices

Dugway scientists test protective clothing, decontamination systems and equipment that detects lethal agents.  Because different spraying systems create different types of toxic clouds -- from a fine mist to a heavy rain -- the scientists have to know how different spray nozzles affect the way lethal agents disperse.

But that expertise has been important for other reasons.  In the months leading up to Operation Desert Storm a decade ago, U.S. officials became aware that the Iraqi government had purchased several dozen sophisticated spraying devices from Italy.  The devices were meant for agricultural purposes, but military officials feared they could also be used to spread biological or chemical materials in the battlefield.

It fell to scientists at Dugway and other Army programs to determine the threat from these sprayers.  According to an unclassified summary of their report, the scientists tested the equipment and developed estimates of the threat it posed to people who might be downwind.

Some of the government work is aimed at detecting weapon programs by hostile groups.

In early September, the Defense Department confirmed that it had built a germ fermenter in the Nevada desert using commercially available parts.  The goal, the agency said, was to study whether terrorists or other groups that tried similar projects would produce any "signatures" of their work that could be detected by U.S. intelligence-gathering.

The Pentagon has also discussed producing a genetically altered form of anthrax to see if it would be resistant to the anthrax vaccine.  The project, which was first disclosed by the New York Times last month, came about after Russian scientists reported in 1997 that they had implanted foreign genes in anthrax, the Pentagon said.  It has been on hold amid debate on whether it violates an international treaty and U.S. laws that bar work on offensive biological weapons.

Zelicoff, the Sandia scientist, is working on a different aspect of biowarfare defense.  He has designed a touch-screen computer program that allows doctors to record basic symptoms of patients in about 30 seconds.  The information, which includes such data as blood counts and X-ray results, is relayed electronically to public health officials, who look for unusual patterns.

Because biological agents tend to be odorless and colorless, these illness patterns might be the first warning that a biological attack has occurred, Zelicoff said.  The system is at six hospitals now but Zelicoff says he has government funding to put it in 150 hospitals in the next year.

Traditionally, public health officials have had to rely on doctors to phone them with reports of unusual symptoms.  And most doctors cannot tell anthrax, for example, from a more common influenza.  But Zelicoff's Rapid Syndrome Validation Project can detect unusual patterns of symptoms, and it pages public health officials when suspicious clusters of symptoms appear.

1957 New Hampshire Anthrax Deaths Recalled

From Associated Press

CONCORD, N.H.--It has been a long time since Anita Simonds has thought about the inhaled anthrax that killed her father and three co-workers in 1957.

The memories came rushing back when she learned about Friday's death of a Florida man from the rare disease.

"We had never heard of anthrax at that time," Simonds, now 75, said in an interview Sunday.  "In those days, you didn't have the TV and all the news you get now."

Simonds has learned much about the disease since, but said Americans shouldn't worry, even in the wake of last month's terrorist attacks.

"You can't sit there and be afraid," she said, adding that she has no plans to buy a gas mask.  "Whatever God's plans are for us, so be it."

Simonds' father, Antonio Jette, was 49 when he came down with a cough and fever on Sept. 5, 1957.  He died the next day.

His family later learned that he had contracted anthrax while working at the former Arms Textile Co. in Manchester, N.H.  Officials said he inhaled the bacteria from goat hair imported from Pakistan that was to be used in the manufacture of linings for men's suits.

His death and that of three co-workers occurred during a trial of an anthrax vaccine that was conducted by the Centers for Disease Control and Prevention at the textile plant and three other sites where anthrax had occurred.

None of the workers who died was given the vaccine.  They were either given a placebo or started work at the mill after the trial began and didn't participate.

Testing of the vaccine, which was developed by the Army Chemical Corps., was halted soon after the Manchester deaths, and all the workers were given the vaccine, said Dr. Philip Brachman, who led the field evaluation for the CDC.

No one died at the other testing sites, in Philadelphia and Chester, Pa., Brachman said Sunday.  Brachman said he believes the type of goat hair used today in the U.S. is synthetic.

Only 18 inhalation anthrax cases in the United States were documented in the 20th century.  Anthrax usually infects cattle, sheep and goats, but can cause severe illness and death in humans.

A 63-year-old Florida man died of inhalation anthrax Friday.  He was the first human to catch the disease in the United States in 25 years.  No further cases have been reported, and investigators are testing samples of soil, hair and other specimens to find out how he contracted the disease.

An injectable anthrax vaccine has been around since the 1970s, and the U.S. military has required anthrax vaccinations for service personnel since the Persian Gulf War.

3rd Tabloid Worker Found to Have Anthrax Exposure

Health:  The 35-year-old woman has shown no symptoms of the disease.  Officials now consider the cases criminal acts.

BOCA RATON, Fla.--A third employee of a Florida tabloid newspaper company has been exposed to anthrax, U.S. and state officials announced Wednesday, saying there is no doubt that the mysterious outbreak was caused by a criminal act.

At the same time, officials said they have found no evidence yet that the outbreak, which has left one person dead, was connected to the Sept. 11 terrorist attacks in New York and at the Pentagon, or that anthrax bacteria were present beyond a single building in Florida.

Despite a massive investigation, assembling personnel from the FBI, Centers for Disease Control and Prevention and Florida agencies, there is still no answer to how the bacteria got into the headquarters of American Media Inc.

"We are now conducting a criminal investigation into this matter," U.S. Atty. Guy Lewis said at an evening news conference here.  "We understand it's a problem, and we will bring every resource that we have to bear on this problem, and I assure you we will solve it."

Lewis said investigators still needed to find answers to "three basic questions:  how and when the germs were introduced into the building in western Boca Raton, who was responsible, and most important, why.

Wednesday night, officials said a 35-year-old woman, whom they would not identify, is the third American Media employee to show signs of having contact with the anthrax bacteria.  The woman showed no symptoms of the disease, however, and has been put on antibiotics, Florida Health Secretary John Agwunobi said.

Robert Stevens, 63, a photo editor at American Media, died Friday of inhalation anthrax, a rare form of infection that claimed 18 lives in the United States in the 20th century.

A co-worker of Stevens, mail room worker Ernest Blanco, 73, also breathed in anthrax spores but did not develop the illness, which is nearly always fatal.  Family members said Blanco, who was hospitalized for an unrelated case of pneumonia, was recovering and should be released within a week.

With the third exposure case, teams from five FBI field offices, clad in protective garb, redoubled their efforts Wednesday to search the 66,000-square-foot headquarters of American Media, where anthrax had already been detected on the keyboard of Stevens' computer.

Hector Pesquera, special agent in charge of the bureau's Miami office, said Wednesday that there was no indication so far the bacteria had been "produced or caused" by the suicide hijackers responsible for the Sept. 11 attacks.

Lewis, however, left open the possibility that clues yet to be found might connect the mysterious appearance of anthrax with the 19 young suspects, many of whom had lived and studied flying in communities around Boca Raton.

With fear, even paranoia, mounting in this upscale city on Florida's southeast coast, officials stressed that the bacillus had not been detected anywhere outside the headquarters of AMI, which prints the National Enquirer, the Sun, the Weekly News of the World and other popular weeklies.

"All of the evidence to date indicates the anthrax issue we face is limited to the AMI building," Agwunobi said.  He also reminded Florida residents that anthrax is "not a contagious condition:-- a sick person cannot infect others.

Because anthrax is not communicable, all three American Media workers must have caught it from the same source, rather than from each other, officials said.

"If this was a massive exposure, there should be lots of people sick.  We are not finding that," Dr. Scott Lillibridge, bioterrorism advisor to Health and Human Services Secretary Tommy G. Thompson, told a congressional panel in Washington.

To date, more than 1,000 employees and visitors to the AMI building have been tested for possible exposure, officials said.  So far, results from 700 of the tests are known, and only one -- the 35-year-old woman -- has been positive for the presence of anthrax.  Results from the remaining tests should be available within two days, officials said.

Along with answering questions abut how and when the bacteria got into the building, investigators were also trying to determine which of the many strains of anthrax was involved.

Information about the strain might give clues to where the bacteria originated.  Anthrax bacteria, which occur naturally, could have been dug from the ground or taken from a sick animal and cultivated by a knowledgeable person, or else taken from a research laboratory or vaccine company.  Most remote is the prospect that the bacteria  came from one of the handful of foreign nations that have attempted to turn anthrax into a weapon.

Florida officials confirmed that medical detectives were trying to determine whether the Florida anthrax was the "Ames strain," which was first isolated in an Iowa laboratory a half-century ago.

That was only one possibility among many, and the CDC said it was premature to draw a conclusion.

Anthrax could be held by thousands of laboratories around the world, some of which conduct research.  A much larger number of labs store it to help diagnose the disease in animals or people.  At least 400 entities worldwide sell tissues and cells to labs, and many of them are thought to supply various strains of anthrax.

The federal government claims to have the world's largest database of anthrax strains, which includes samples from weapon programs run by Iraq and the former Soviet Union.  But until recently, anthrax samples were traded relatively freely around the world, so tracking the Florida strain could be difficult. 

Even in the United States, transfers of anthrax and other pathogens among researchers and commercial entities were largely unregulated until 1996, and the government is unlikely to have records of shipments before that year, several experts said.  Federal rules that took effect in 1996 require laboratories and other entities to register all transfers with the CDC, "and it became immensely more difficult and expensive for anyone who wanted to have pathogens shipped to them," said Raymond Zilinskas, a bioterrorism expert at California's Moneterey Institute of International Studies.

Dahlburg reported from Florida; Ziner reported from Washington.  Times staff writers Marlene Cimons and Eric Lichtblau also contributed to this report.

Fear Boosts Antibiotics Sales

Prevention:  Doctors try to calm patients who are besieging them with requests for Cipro, a drug to treat anthrax.

Fear of being infected with anthrax bacteria has triggered a run on the powerful antibiotic Cipro at some pharmacies and doctors' offices nationwide.

One Southern California family demanded 60-day supplies of Cipro for its six children, at an estimated cost of more than $3,500.  Several local doctors also have requested the drug to keep not just in their offices but also in their homes.

"They're really panicking," Dr. Paul Geller, a Beverly Hills internist, said of some patients.  "No matter how we try to be logical with them, they still go back to their own insanity."

Officials at Bayer AG, which makes Cipro, acknowledge the tremendous attention their drug has received in recent days as Florida officials investigate three cases of anthrax exposure, one of them fatal.

"Given all of the information and all of the play that's been out in the media, I would not be surprised to see an increase in demand," said Karen Dawes, senior vice president for sales and marketing.

Fears have also been fueled by false alarms, including a suspicious package received Wednesday by a soldier at Ft. Irwin near Barstow.  A California National Guard bioterrorism unit flew to the scene, and the package turned out to be a chain letter filled with corn starch.

The public demand for protection is so high that Bayer is opening a shuttered plant in Germany to increase production of Cipro raw materials by 25%.  Cipro is the only drug approved by the U.S. Food and Drug Administration to treat inhalational anthrax after exposure.  Studies have shown that other drugs, such as doxycycline and penicillin, also work, but they are not FDA-approved for anthrax.

Antibiotics have been shown to improve a patient's prognosis if taken after exposure to anthrax--but before symptoms appear.  A delay of several hours may substantially lesson chances of survival.

Consumers who are stockpiling the drug are paying hefty sums (more than $5 per pill) and ignoring warnings from public health officials about the danger of indiscriminate use of antibiotics.  The pill costs so much because it has no generic alternative.

"They're going crazy," said Dr. Laurene Mascola, chief of acute communicable disease control for the Los Angeles County Department of Health Services.

Mascola said her own pharmacy in La Cañada was out of the doxycycline used to treat her son's acne.

Geller said patients have told him that it is cheaper to keep a supply of Cipro in their medicine cabinets than to see a psychiatrist to deal with fears of contracting anthrax.

If pushed, Geller said he prescribes small amounts of Cipro to patients to give them peace of mind.  And for two patients who demanded 60-day supplies each, he prescribed a total of 360 pills.

"That's a lot of pills and a lot of money," he said.  "I would discourage it completely."

One drug wholesaler in California told Los Angeles County health officials of rapidly increasing sales.  In August, the company sold 445 bottles of Cipro, each containing 100 of the 500-milligram pills.  That jumped to 835 bottles in September and 600 in the first 10 days of October, Mascola said.

AdvancePCS, the largest U.S. manager of pharmacy benefits, said the number of weekly prescriptions for Cipro climbed to 30,000 last week from an average of 28,000.  But sales in New York City have doubled since Sept. 11.  And in Boca Raton, where a man died of anthrax last week, sales are up by a third, AdvancePCS spokesman Blair Jackson said.

Demand has peaked in the last three days, pharmacies said, as the Florida cases became known.

Locally, pharmacies have seen different levels of demand, with increases more common in affluent areas.

At the Horton and Converse Pharmacy on Wilshire Boulevard in Los Angeles, daily sales of Cipro have doubled.  Pharmacist Calvin Lai said he warns patients about the side effects of Cipro and that improper use of the drug can cause resistance in the future.  The drugs being dispensed now expire in May 2004.

"They take it with a grain of salt," Lai said.  "For most people, they're not taking the drug.  They're just keeping it on hand."

This attitude leads to a misplaced sense of security, Mascola said.

"What if it's not anthrax?  What if it's something else?" she asked.  "Are we going to get every prescription known to man in our back pocket?  We need to save what we have for the real incidents."

Times staff writer Phil Willon contributed to this report.

Third Anthrax Victim Is Back at Work

One of the three supermarket tabloid employees who were exposed to anthrax returned to work in Boca Raton as investigators waited for test results that might help them find the source of the bacteria that killed one of her co-workers.

"I just want to say I'm fine," a smiling Stephanie Dailey told a crowd of reporters from her front yard in nearby Boynton Beach.  "I'm taking medicine like everybody else."

Dailey, 36, said health officials used a swab to test her nasal passages Monday and she was told Wednesday afternoon that it had come back positive for anthrax.

Federal authorities have begun a criminal investigation but say there is no evidence of terrorism.

Anthrax Found at NBC Office in N.Y.

Terrorism:  An aide who handled letter addressed to news anchor Tom Brokaw contracts rare form of disease.  FBI is checking links to three recent Florida cases.

NEW YORK--An aide to NBC anchor Tom Brokaw has contracted a rare skin form of anthrax, marking the first appearance of the disease outside of Florida since the World Trade Center attacks, federal officials said Friday.

Although the incident has not been linked to the terrorist assaults, it is being investigated as a crime, Atty. Gen. John Ashcroft said.

Barry Mawn, head of the New York FBI office, said agents are checking potential links to three exposures to anthrax that recently were reported in Boca Raton, Fla.  But he noted that "preliminarily, I do not see that.  This is a criminal matter and we will go from there."

Anthrax scares rippled across the nation Friday.  In Nevada, state officials revealed that a letter returned from Malaysia to a Microsoft office in Reno initially had tested positive for anthrax, but a second, more comprehensive test came back negative.  Results of more testing are expected today.

Elsewhere, reports of possible contamination shut down a Denver post office, a Burbank TV station and a busy street in Oregon -- to name just a few examples -- eliciting swarms of emergency workers, but turning up no additional cases.

As public concerns mounted in New York, the New York Times and other local media organizations reported their own anthrax scares, and hazardous-materials teams checked out a suspicious substance at the State Department in Washington.  And in the first sign that the danger may have spread to U.S. interests overseas, the State Department said Friday that it was investigating the white powdery contents of a piece of mail received at the U.S. Embassy in The Hague.

President Bush urged people to remain calm, but Vice President Dick Cheney, in a television interview, said he suspected the anthrax incidents around the country could be linked to the Sept. 11 terrorist attacks on the World Trade Center and the Pentagon, though he offered no proof.

"There's a lot of fear and anxiety out there," said Dr. Neal Cohen, New York's health commissioner, voicing concern that too many city residents have been flocking to emergency rooms, worried that they may be developing the symptoms of anthrax.  "It's only making the situation worse, because we have no evidence there is an uptick in exposure here to these agents."

People Cautioned Not to Panic

Other officials cautioned Americans against panicking and trying to buy up limited supplies of antibiotics such as Cipro, which is used to treat anthrax.  "People should not hoard antibiotics," Health and Human Services Secretary Tommy G. Thompson said at a news conference in Washington.  "We have enough antibiotics to get to the people who need it."

Dr. Scott Lillibridge, Thompson's bioterrorism director, said the nation has enough antibiotics stockpiled to treat 2 million people for two months.

The TV network employee in New York, who is an assistant on the "NBC Nightly News" broadcast, has been treated with antibiotics and is expected to make a full recovery.  She reported receiving a letter Sept. 25 filled with a suspicious powder, according to NBC News President Andrew Lack.

FBI officials said the letter, from an anonymous writer, had a postmark from St. Petersburg, Fla.  There are "some similarities" between the handwriting in the NBC letter and a suspicious letter received at the New York Times, which also was mailed from St. Petersburg, according to Mawn.  Tests on the powder in the NBC letter proved negative, Lack said, but on Friday a skin biopsy came back positive.  That prompted NBC to immediately cordon off its third-floor offices in Rockefeller Center so federal investigators could examine the newsroom site for contamination.

Employees were quickly cleared from the area, and Lack said all those who may have come in contact with the substance would be given medical tests for anthrax.  Later in the day, as anxious crowds milled around, police removed barriers they had put up near the 70-story building.

"She [the NBC employee] is doing well," Bush said, speaking at a celebration of Hispanic Heritage Month in the East Room of the White House.  "But we've got teams on the ground, [including] the Centers for Disease Control [and Prevention in Atlanta], the FBI, who are working closely with local agencies to respond quickly."

People across the country need to get on with their daily lives, he said, urging public calm, because "We cannot let the terrorists lock our country down."

Despite reassurances, a key question remained unanswered:  How could the NBC employee have tested positive for anthrax, when the powder she came in contact with tested negative?  Ashcroft, trying to explain the contradiction, said, "The powder may be the source of the anthrax, but it may not be."

Dr. Steve Ostroff, with the CDC, added that there was very little of the powdery substance on the NBC letter when it was tested, which may have enabled anthrax to escape detection.

While the anthrax scare reverberated across the United States, it was felt most intensely in New York.  The news sent shock waves through a host of media organizations; there were other incidents throughout the city, ranging from reports of a suspicious substance at Nasdaq to a suspicious package at the Empire State Building.

On Friday morning, New York Times reporter Judith Miller opened a letter at her desk that contained a hate-filled message and white powder, which smelled like talcum or baby powder.  Miller--who co-wrote "Germs," a book about the threat of biological warfare--told her co-workers and the incident was reported to police.  Authorities retrieved the powder and the air in the newsroom was tested for radioactive and chemical substances.  The tests were negative.

Employees in the third-floor newsroom where Miller works were evacuated.  By midday the building reopened and most employees, except those near Miller's desk, returned to work.  A spokeswoman said 30 people were tested and were started on preventive antibiotics.  Preliminary tests indicated the substance was not anthrax but additional tests were underway.

Meanwhile, CBS and ABC shut down their New York mail rooms after the NBC announcement, although executives at both networks said they had not received any suspicious envelopes.  NBC's sister network MSNBC, which is based in Secaucus, N.J., also closed its mail room.  Officials at news organizations across the country, including the Los Angeles Times, issued cautionary warnings to employees about opening suspicious pieces of mail.  Later Friday, The Times building was briefly quarantined by the Los Angeles Fire Department after a small quantity of a powdery substance was found in the newsroom.  Preliminary tests found no threat.

Alarms false, but anxiety real in OC

by Peter Larsen, Joel Zlotnik and Aldrin Brown

The anthrax jitters spread through California on Saturday as sightings of suspicious powdery substances prompted people to sound alarms out of fear of the deadly disease.

Investigators found no proof of anthrax in any of the cases by late Saturday, and nearly all seemed to be harmless materials--vitamins and cosmetics among them.

Throughout the day, calls came in and emergency crews went out:  to post offices in Huntington Beach and Tustin, to a restaurant at Disney's California Adventure theme park and to the Macy's at the Laguna Hills Mall.

One seemed to be an intentional threat:  A Huntington Beach clothing store was called Saturday night and told it had been exposed to anthrax.

A United Airlines flight was delayed for three hours in San Jose after passengers reported a man spilling a white substance from an envelope while the jet was en route from Chicago.  Other reports surfaced Saturday in Santa Rosa and Riverside County.

Though preliminary tests found nothing harmful in the powders in question, there was damage done as fear spread in the places people live, work and play....

U.S. Now Calls Anthrax Incidents Bioterrorism

Health:  Bush team says it is unclear who is to blame.  Three more exposure cases reported.

WASHINGTON--Three more cases of exposure to anthrax were reported in New York on Sunday, as the Bush administration took to the airwaves to calm Americans in what it is now calling a clear case of bioterrorism.

"There's no question that it's bioterrorism," Health and Human Services Secretary Tommy G. Thompson said.  "But whether or not it's connected to Al Qaeda, we can't say that conclusively."

The latest reports bring to 12 the number of people known to have been exposed to anthrax in two states, New York and Florida.  Pornographic material mailed from Malaysia to a Microsoft office in Nevada was confirmed Saturday to contain anthrax, but none of the six people tested there has yet tested positive for exposure.

Two people have been infected with anthrax, a rare disease that is usually fatal if it gets into a person's respiratory system....

With the number of anthrax exposures increasing, Thompson and other officials Sunday answered questions at length on several television news shows, trying to reassure nervous Americans.

Thompson said there is no proof that there will be an "extensive bioterrorism attack" on America, and even if there is one, the government has enough medicine to treat the exposure of up to 2 million people for six months.  He said he planned to appeal to Congress this week for funding for enough medicine to treat 10 million additional cases.

"I know people are afraid....  But I want to reassure them that the federal government, working with the state and local governments, [is] able to respond."....

The circumstances of the anthrax incidents suggest that those behind them do not have a very effective method of dispersing the bacterium, experts say.

"People have to calm down," said Jeanne Guillemin, author of a book on a deadly outbreak of anthrax in Sverdlovsk, Russia.  "If you inhale spores, it doesn't mean you're going to get the disease.  It isn't sarin gas," she added, referring to the highly toxic nerve gas that a Japanese cult used in the Tokyo subways, killing 12 people and injuring thousands.

Between 5,000 and 10,000 spores must be inhaled into the lungs for spores to initiate the disease process.

There are six possible sources of the anthrax used in the last weeks' incidents, according to [Raymond] Zilinskas [senior scientist at the Monterey Institute of International Studies who specializes in biological weapons].  The bacteria could have been harvested from infected animals and manufactured; stolen from a U.S. lab; taken from a cell culture collection, 46 of which are outside the U.S.; supplied by a country with a biological warfare program; bought or taken from facilities in the former Soviet Union, which used to operate biological weapon programs, or acquired in the U.S. before 1996, when strict security requirements for such substances were enacted.

The recent episodes do not trouble Zilinskas deeply.  But he does have one concern.

"There's only one difficult step between inefficient dispersal and efficient dispersal.  That's what I worry about," he said.  "If whoever has this source figures out how to do a more efficient dispersal and actually does it, then the whole calculation changes as far as what kind of threat we're facing."....

Anthrax Scare Hits Capitol; More Fall Ill

Health:  Senate Majority Leader Daschle is targeted, and evidence suggests a link to the NBC News incident.  Also, the infant son of an ABC producer in New York develops the disease.

WASHINGTON--An unnerving wave of bioterrorist threats swept across the nation Monday as new anthrax scares hit victims ranging from the young to the old to the upper ranks of the nation's power elite.

A 7-month-old child of a television network news producer in New York has developed anthrax; a 73 year-old employee of a tabloid publisher in Florida has been found to have inhaled deadly bacteria and contracted the disease.  Both are being treated and are expected to recover.

And an envelope that tested positive for anthrax was opened at the Capitol Hill office of Senate Majority Leader Tom Daschle (D-S.D.).

The Washington episode was especially nerve-jangling because it suggested the first strong link in the recent outbreak of anthrax:  The letter to Daschle's office bore the same New Jersey postmark and date as the anthrax-bearing letter that was sent last week to NBC News.

Also, President Bush said "there may be some possible link" between the recent spate of anthrax mailings and the terrorist organization of Osama bin Laden, whom the U.S. has accused of masterminding the Sept. 11 attacks on the World Trade Center and the Pentagon.

"It's clear that Mr. Bin Laden is a man who is an evil man," Bush said.  "I wouldn't put it past him, but we don't have any hard evidence."....

Doctors Are Caught Playing Catch-Up

Medicine:  U.S. health system is unprepared to deal with a tricky disease few know much about.

Most doctors have never treated patients infected with anthrax or other agents bioterrorists might use, and do not know how to diagnose the early stages, Los Angeles County's top public health official said Monday.

Moreover, many hospital laboratories do not have the equipment or expertise to detect such agents when analyzing X-rays or blood samples.  And few hospitals, many of them strapped for funds, have been able to set up comprehensive bioterrorism response plans....

Efforts to teach doctors what to look for are in their infancy.  County officials have developed an information sheet but so far have only sent it to emergency room doctors.  Two statewide educational campaigns are being organized....

Cure May Be Health Hazard

Many doctors bend to pressure from patients who want antibiotics after anthrax scares.  Misuse could raise the dangers of resistance.

Anthrax anxiety has spawned a massive public health experiment--one that is unplanned, uncontrolled and perhaps unstoppable.

Never before have so many healthy people been given private stashes of antibiotics to use at their whim.

The trouble, say medical experts, is that indiscriminate prescription of Cipro and other powerful antibiotics could prove horribly counterproductive.  It could ultimately render these last-defense drugs helpless against serious bacterial infections, allowing them to flourish and spread to others.

Even those who don't take Cipro could develop infections resistant to it.

But in a nation with a powerful faith in the ability of drugs to treat any ill, patients are besieging doctors with requests for Cipro and other powerful just-in-case antibiotics.  Unsolicited e-mails from on-line pharmacies fan their fears....

Many Americas use antibiotics inappropriately, taking them for shorter periods than prescribed or for viral infections instead of bacterial infections.  They don't kill viruses.

Over time, this misuse leads to development of hardier bacteria and more virulent infections.

With antibiotics in their personal medical cabinets, patients will be tempted to use the pills, unsupervised, when they are scared or they develop flu-like symptoms that mirror the initial signs of anthrax....

Anthrax Fear Excessive, Region's Doctors Say

Health:  With flu season coming, officials worry people will mistake their symptoms for something worse.  O.C. concerned about lack of vaccine.

The phones haven't stopped ringing at Dr. Giselle Namazie's medical office in Sherman Oaks.

Callers wonder whether their run-of-the-mill sniffles and coughs could be anthrax even though the bacteria hasn't been detected anywhere in Southern California....

The problem is that the initial symptoms of anthrax mirror those of the flu:  exhaustion, chills, sore throat, cough and aches.  The flu is a contagious viral infection.  Anthrax, by contrast, cannot be passed from person to person.  It is acquired by inhaling spores, eating contaminated food or absorbing the bacteria through cuts in the skin....

Expertise Cited in Use of Bacteria as a Weapon

Science:  Anthrax form sent to Capitol Hill called 'professionally done.'  Officials hope tests will give clues to its origin.

WASHINGTON--With growing alarm but limited facts, lawmakers and scientists Wednesday said that whoever mailed anthrax to a congressional office had overcome significant technical hurdles in turning the bacteria into a weapon, something that even experienced microbiologists could not accomplish.

The fact that 31 congressional staff members and security officers were exposed to the anthrax, which is believed to have arrived in a single letter to Senate Majority Leader Tom Daschle (D. S.D.), suggested to many experts that the bacteria were created by people who understood at least the basics of how to design a biological weapon that could harm a large number of people.

But the dimensions of the threat remained unclear.  Even as the notion receded that an amateur had produced the anthrax bacteria, no one could say whether the people who made it had the expertise, the will or materials lethal enough to launch a broader attack that might cause greater harm....

Army scientists at Ft. Detrick, Md., conducted tests Wednesday that might give clues to the origin of the bacteria and the level of know-how of whoever turned it into the powder that was sent to Daschle's office.  The greatest fear, some scientists and officials said, is that the anthrax would trace back to one of the 13 or so nations suspected of developing biological weapons, suggesting a lack of security in a foreign weapon program, if not state complicity in the attack.

Iraq is known to have produced a weaponized form of anthrax, and the former Soviet Union produced huge quantities, in violation of an international treaty it had signed.  Egypt, North Korea and Libya are also suspected of experimenting with it.  Now that President Bush has declared a broad war on terrorism, complicity by any of those nations in the attack might prompt U.S. officials to recalibrate their campaign.

Bacterium Is Not Difficult to Grow

Anthrax now has turned up in three states and on Capitol Hill.  While traces of the bacteria have been found in at least three dozen people, only four have actually developed the disease....

The disease is caused by a naturally occurring bacterium found around the world.  It is not difficult to grow, and some experts say it is not difficult to turn it into a crude weapon.

But making a refined weapon from the bacteria, one that could find its way to a number of people in the same building, requires significant expertise, scientists and lawmakers said.  It also presumes that someone has access to a virulent strain of anthrax, one that can actually harm people.

Scientists and weapon experts said a novice might be able to grow anthrax germs in a broth or culture dish.  But the bacteria would be fragile if released, subject to damage even by sunlight.  To make them hardy, a person would have to starve them or otherwise shock them, which prompts the bacteria to form spores that can last for decades.

The hard part, experts say, is turning this slurry of bacteria into a fine and concentrated powder.  If the clumps were too large, they would fall to the ground and harm no one.  If they were too fine, some specialists said, a person would inhale them and then exhale them before they could lodge in the mucus membranes of the lungs.

But particles that are fine yet not too small will hang in the air in a dangerous cloud.

A similar problem faces industrial technicians who make powdered milk or other powders, said Eric Croddy, a weapons specialist at California's Monterey Institute of International Studies.  In past decades, he said, ball bearings were used to crush spores, a process that also killed many of them.  Weapon scientists in the former U.S. and Soviet offensive biological weapon programs worked for years to solve that problem.

"A layman could not do all this," Croddy said....

6 anthrax cases now confirmed

Terrorism:  An aide to CBS News anchor Dan Rather has skin form of the disease.  Number of exposure cases is 41.

WASHINGTON--A CBS employee who opens Dan Rather's mail and a postal worker in New Jersey were added Thursday to the roster of American infected with anthrax.  As many as three more people reported skin lesions that may signify additional cases....

The disclosure brought the number of confirmed cases of anthrax nationwide to six since Oct. 4.  An additional 41 people in Washington, New York, Florida and New Jersey have tested positive for exposure to anthrax, but there has been no confirmation that any of them have the disease....

Reward Set as Anthrax Cases Increase to 6

Threat:  New Jersey postal worker and CBS News employee contract disease.  The offer of $1 million is prompted by inability to identify senders of bacteria.

WASHINGTON--The tally of confirmed anthrax victims grew to six Thursday, including a postal worker who may have handled contaminated letters, as authorities offered a $1-million reward for information about the bioterrorists who have sent bacteria-laden envelopes to three cities.

The two new infections were confirmed in an assistant to CBS news anchor Dan Rather in New York and an unidentified postal worker near Trenton, N.J.  The reported number of people exposed to the bacteria increased slightly, from 40 to 43.  Health officials also said they were investigating at least three additional anthrax cases they declined to identify.

In Atlanta, the Centers for Disease Control and Prevention issued a rare warning:  Doctors nationwide should watch for cases of smallpox, food poisoning and deadly viruses like Ebola.  Federal health officials also confirmed that they are considering calling for a mass vaccination for smallpox, a highly contagious virus that can spread rapidly from person to person.

In the Trenton area, where at least two of the anthrax letters were mailed, health officials were trying to determine whether the infection of a postal worker indicated that others who handle the mail may have been exposed to the bacteria.  Another postal employee may also be infected and is under a doctor's care, officials said.

FBI investigators in the region were questioning pharmacists about any unusual requests for the antibiotic Cipro before Sept. 18, the postmark date on the anthrax letter sent to NBC TV news anchor Tom Brokaw.

Dr. Julie Gerberding said that the CDC had sent three dozen epidemiologists to Washington, New York and Florida to investigate and manage the response to the anthrax attacks and that more than 50 scientists in Atlanta were working around the clock to process specimens.

She said it was too early to tell if the strain of anthrax found on Capitol Hill was the same as that found in Florida and New York, or if it was a different or more virulent kind.

"There are degrees of similarity, and the more time we have to ... characterize the strains, the more we can work to refine our understanding of how similar two strains really are," she said.

Law enforcement authorities conceded that they were not close to arresting anyone who may have sent anthrax-contaminated letters to Senate Majority Leader Tom Daschle (D-S.D.) and journalists in Florida and New York....

Scientists Hunt Genetic Print of Anthrax Spores

Probe:  A select group nationwide works to unravel the origins of the bacterium used in the recent attacks.

Scientists seeking the genetic origins of the anthrax unleashed in recent attacks are exploring a scientific shadowland familiar to only a handful of molecular biologists, veterinary medical specialists and military biotechnicians, where the state of the art is itself a state secret.

In laboratories from New Mexico to Maryland, government and university researchers for the last week have employed the remarkable power -- and confronted the limitations -- of forensic molecular biology as they seek to determine where the anthrax came from.

With techniques unheard of even a few years ago in public health circles, researchers are attempting to read the cryptic bio-chemical signature of anthrax spores, in the hope they can find a clue that could lead to the bioterrorists who mailed the microbes to unsuspecting victims.

The scientists also can test the powder that has been mixed with the anthrax spores to see if it has any characteristics of known anthrax weapon programs.  By examining the particles, they also can try to determine the degree of sophistication of the operation that produced the spores.

Investigators believe that the same strain of anthrax was used in three attacks in New York, Washington, and Florida.  That suggests the spores came from the same source.  So far they are reluctant to say how they reached that conclusion or what it may mean for linking the spores to suspects.

No one directly involved in the scientific effort will discuss this criminal investigation of a microbe in any but the broadest terms.  The leading academic experts in the field will not even acknowledge officially that they are working on the investigation.

But expertise about anthrax is concentrated in only a few facilities in the United States, so it is not difficult to know the outline of the work being done and where it is taking place.

Initial Screening Is State-Level Work

Initial screening of the anthrax spores is the work of state public health experts in areas where the outbreaks were detected.  They subject the bacteria to a variety of conventional antibody tests that can determine whether anthrax is involved in an attack.

"This laboratory has been completely commandeered by anthrax in the past two weeks," said Florida state public health biologist Paul Fiorella.  "We put our emphasis on detection and identification of anthrax, but not on identifying strains."

That work of identification requires sophisticated genetic analysis of the spores, which is believed to be underway at the Los Alamos National Laboratory in New Mexico and at the national Centers for Disease Control and Prevention in Atlanta.  Several university laboratories also are deeply involved in trying to classify the anthrax strains more precisely.

At Northern Arizona University, Paul Keim, whose anthrax-typing program is widely considered the world's best, declined to comment on whether his laboratory is involved in the current criminal investigation.  But he acknowledged a major increase in research activity....

All this detective work is handicapped by the character of the anthrax spores themselves and the incomplete catalog of known laboratory strains.

Anthrax occurs naturally around the world, and disease-causing strains differ.  Some infect more readily than others; some carry a stronger load of toxin.

But the variations are subtle, making efforts to distinguish among them extremely difficult.  In fact, strains of anthrax collected from even distantly separated locations are strikingly alike.  "They are amazingly similar -- it's really surprising how few real, genetic differences there are in hundreds of isolates," said anthrax researcher Theresa Koehler, associate professor of microbiology at the University of Texas, Houston.

No one knows why that is:  perhaps B. anthracis evolved fairly recently and hasn't had time to change much.  Or maybe it's because the microbe, as part of its life cycle, spends years as a dormant spore waiting to encounter a new animal to infect -- and thus has fewer opportunities to change.

Finding Genetic Fingerprints

But differences do exist.  A handful of anthrax scientists -- most notably Keim and Paul Jackson at Los Alamos National Laboratory -- have found nearly 1,000 places in the anthrax genome where the microbes vary from one another.

Even before the recent attacks, researchers were trying to use these differences to create a genetic fingerprint of each strain....

So far, more than 1,000 strains have been distinguished on the basis of DNA differences, said Jill Trewhella, bioscience division leader at Los Alamos.  That number is growing all the time, as more and more anthrax samples are collected and typed.

Unfortunately, Keim cautioned, "DNA typing is not the answer to everything."....

"I'm just hoping beyond hope that they find the anthrax is something that's been typed before--that it gives them some place to start looking and help build a picture and go after whoever did it," said Eric Croddy, senior research associate at the Monterey Institute of International Studies.

Otherwise, Croddy said, the challenge will be immense:  "Anthrax infects everything from elephants in India to yaks in Nepal."

Anthrax Inquiry Widens as New Inhalation Case Found

Health:  Postal worker in D.C. contracts the more serious type.  Capitol to reopen on limited scale.

WASHINGTON--A postal worker in the nation's capital was in "serious but stable" condition Sunday after being diagnosed with inhalation anthrax, the latest victim of a bioterrorist attack that will keep much of Capitol Hill shuttered today.

The unidentified man is the third American in recent weeks to test positive for the inhaled version of the disease, which often is fatal and has killed a tabloid newspaper employee in Boca Raton, Fla.

The diagnosis came as congressional leaders announced they would reopen the Capitol today but keep surrounding office buildings closed while they await the findings of biochemical experts scouring the structures for signs of deadly anthrax spores....

2 D.C. Postal Workers Die; Anthrax Likely

Inquiry:  Health officials reevaluate danger posed by tainted envelopes before they are opened.  Postal Service takes safety steps.

WASHINGTON--Two postal workers in the nation's capital have died of suspected inhalation anthrax, prompting health officials to acknowledge Monday that some of their key assumptions about how the deadly bacterium is spread may prove to be wrong....

If anthrax is confirmed as the cause of death, the men, ages 47 and 52, would be the second and third victims killed by the infection since the biological warfare agent first surfaced at a Florida tabloid office less than three weeks ago....  Their deaths raised particular concerns because they may have succumbed to inhalation anthrax--the most lethal form of the disease--simply by working in a facility that handled contaminated mail.

Postal officials had been advised that a sealed envelope "would not transmit anthrax," Postmaster General John Potter said Monday.

But several severe incidents have forced health and law enforcement officials to reevaluate their understanding of the disease.

"This is really a new phenomenon," said Dr. Mitch Cohen of the Centers for Disease Control and Prevention.  "At first, we had no evidence that any of the mail handlers were at risk."

In addition to the cases of the two who have died, officials are concerned about two confirmed cases of inhalation anthrax among Washington postal workers and about two New Jersey postal workers who have the more treatable skin form.

The inhalation cases involve a dock supervisor and a courier at Washington's Brentwood central processing facility.  The two were in serious condition Monday.  Nine additional Washington postal employees appear to have been exposed to anthrax.

A key focus of the FBI's anthrax inquiry, officials said, is determining whether a single anthrax-laced letter sent to Senate Majority Leader Tom Daschle on Oct. 8 from New Jersey could have exposed 13 postal employees at the Brentwood center -- plus 28 in and near Daschle's Office.  Traces of anthrax also were found over the weekend in the mail room of a House office building, but no cases of exposure have been reported there.

Authorities also are investigating whether the postal workers could have been infected by anthrax spores from contaminated letters or packages that have not been detected....

U.S. Warns Mail May Not Be Safe

Health:  There's no guarantee that items are free of anthrax, the postmaster general says.

WASHINGTON--The nation's top postal official acknowledge Wednesday that he could not guarantee that the U.S. mail is safe and advised all Americans to wash their hands after handling it.

The extraordinary public warning came as another New York Post employee was feared to have contracted skin anthrax and the U.S. Postal Service unveiled new safeguards, including gloves, masks and irradiation machines, to protect employees from anthrax-laden letters.

Meanwhile, a biological weapon expert said Wednesday that the anthrax sent in a letter to Senate Majority Leader Tom Daschle (D-S.D.) was a higher grade than that sent to NBC News anchor Tom Brokaw.

Richard Spertzel, who headed the United Nation's effort to rid Iraq of biological weapons, said the contents of the letter mailed to Daschle appeared to be weapon-grade anthrax, which would have required highly sophisticated processing techniques to reduce the spores to a very small size to keep them from sticking together, so they would spread quickly through the air....

State Dept. Worker Develops Anthrax

Bioterrorism:  The mail handler had no known link to tainted areas.  15,000 in U.S, are advised to take antibiotics

WASHINGTON--The circle of anthrax exposure widened significantly Thursday as health officials announced that one State Department mail worker has the inhaled form of the disease and a second employee has suspicious symptoms, even though neither man is known to have visited a contaminated postal facility or handled an anthrax-laced letter.

The discoveries alarmed health officials, who each day are learning new details that force them to reassess who is vulnerable to the disease and how the bacteria are spread.

And as the number of Americans advised to take anti-anthrax drugs climbed to more than 15,000, the new cases raise more disturbing questions about who is at risk.

"It is in fact the first case in our region that does not have a direct link, an 'I was in the back room' kind of link to the Brentwood facility," Dr. Ivan Walks, the District of Columbia's chief health officer, said of the confirmed State Department case.

Though the State Department receives its mail from Brentwood, the central mail processing facility in Washington that handled the anthrax-laden letter to Senate Majority Leader Tom Daschle (D-S.D.), officials said they don't know how the workers who have been hospitalized, would have come in contact with dangerous anthrax spores.  They could have handled mail contaminated by the Daschle letter or another contaminated letter.

Meanwhile, officials discovered the first evidence of anthrax contamination in a New York postal facility and announced that another NBC employee has a suspected case of skin anthrax.

And on Capitol Hill, two new anthrax hot spots, including an air-conditioning filter, were discovered in the Senate office building where the letter to Daschle was opened Oct. 15.

Combined, the developments suggest that the nation's anthrax scare is far from over.  Government leaders continued to warn that additional contaminated letters could be circulating.  They concede they are no closer to identifying the sender of the letters or the source of the anthrax spores....

Evidence Reveals Few Clues to Powder's Source

Probe:  Government official says finding any details that might help identify how the mailed anthrax was concocted is a 'chemist's nightmare.'

WASHINGTON--It is an intimidating task:  Take a tiny organism, sent anonymously through the mail, and figure out how it was grown, dried and turned into a powder.  Identify any chemical that might be mixed in.  In fact, there might be more than one additive.

"It's the chemist's nightmare," said Alan Zelicoff, a government physician, physicist and weapon specialist.

But it is those details that might give investigators clues to who made or mailed the anthrax that has already killed three people.  On Thursday, government officials acknowledged that teasing the evidence from the bacteria is proving tough.

Many scientists outside the government say there is little doubt that the bacteria were mixed with some kind of chemical to help them float easily through the air and into their victims' lungs.  But federal officials said they had not identified the chemical and were not even sure it existed.

"Although we may see some things on the microscopic field that may look like foreign elements, we don't know that they're additives; we don't know what they are," said Maj. Gen. John Parker, commander of the U.S. Army Medical Research and Materiel Command at Ft. Detrick, Md.  "We're continuing to do research to find out what they possibly could be.  They're unknown to us at this present time."

Nor is it clear who made the anthrax.  The United States, Russia and Iraq turned anthrax into weapons, using different methods to dry and process the material that would leave different telltale marks on the germs.  But officials said that so far they have found no match to any foreign weapon program and are not even certain that the material came from another nation.

"I don't think I've seen any preliminary tests that drew any conclusions as to where it could or could not have been produced," said Thomas J. Ridge, director of the White House Office of Homeland Security.

Quality of Spores Alarms Some Experts

Even with only incomplete data available, weapon experts outside the government say they are increasingly alarmed by the high quality of the anthrax preparation mailed to one location, the office of Senate Majority Leader Tom Daschle (D-S.D.).

Ridge describe the anthrax spores sent to Daschle as "pure" and smaller than those sent in other letters.  With enough of that bacteria, experts say, a person who distributed it covertly in a subway, shopping mall or other enclosed area would probably cause a large number of deaths....

Scientists have studied the bacteria under microscopes, including an electron microscope, which offers extraordinarily fine detail.  They are also running chemical analyses....

Scientists have also studied the behavior of the bacteria when faced with different drugs, as well as its genetic makeup.  They have determined that the bacteria have not been genetically engineered to be immune to antibiotics.  They have also determined that the bacteria came from the same strain, or family -- a fact that is turning out to have little investigative value, Ridge said.  Known as the Ames strain, it is found in laboratories around the world and cannot be linked to one source.

However, there are important differences in the bacteria found in different locations.  The anthrax spores--the hardy casing containing the bacteria--found in Daschle's office were uniformly small, Ridge said, "therefore, they're more dangerous because they can be more easily absorbed in a person's respiratory system."

By contrast, the spores found at the New York Post were "more coarse and less concentrated," Ridge said....

Success of Probe Still in Question

There is no guarantee that science can point investigators to whoever sent the anthrax or even narrow the field in a meaningful way.  Even if scientists can determine what machinery was used to dry and process the bacteria and what chemicals were added, those materials may be widely available to laboratory workers in any number of industries.

Investigators are sure to try to match characteristics of the anthrax bacteria with what is known about anthrax used in the U.S., Iraq and former Soviet Union weapon programs.  Those three nations are thought to have made the most progress in turning anthrax into a weapon....

Feel Sick?  Diagnosis Hysteria

Anthrax cases have become a catalyst for what scientists call mass psychogenic illness, in which fear alone can trigger real symptoms in groups of people.

In Maryland, a deranged man sprays a substance inside a subway, and several dozen frightened passengers suddenly experience headaches, nausea and sore throats.

In Tennessee, an office worker opens a foul-smelling envelope.  She complains of dizziness, and soon 16 co-workers are reporting similar symptoms.

And in Washougal, Wash., more than a dozen middle-school students and a teacher say they smell fumes and complain of feeling faint.

After investigating each of the three cases -- which occurred within the last month -- public health officials found no evidence of exposure to a dangerous substance, chemical or germ.  The liquid sprayed in the subway, in fact, turned out to be a cleaning solution.

The incidents are what scientists call mass psychogenic illness, a well-documented phenomenon in which real symptoms are triggered by false information or fear.  With anxiety over anthrax thick in the air, experts on the subject say that conditions are ripe for additional mass hysteria outbreaks.

"In this type of situation, where there is concern over physical illness from bioterrorism, I think mass hysteria is a real risk," said Dr. Gary Small, a UCLA psychiatrist who has studied the condition.  "People under psychological stress tend to over-interpret everyday experiences, such as talcum powder spilling on your shoe or having symptoms of the flu.  When we become hyper-vigilant, we start looking everywhere for a germ."

If Americans begin "looking everywhere," outbreaks of mass hysteria could burden public services at a time when the nation can least afford it.  More than 2,000 false anthrax scares have been reported since the first confirmed case killed a Florida man.

Investigating false reports is time-consuming and costly because mass hysteria can be hard to distinguish from real illness.  Investigators typically would not cite mass hysteria as the likely explanation for an incident until they could eliminate other causes by conducting environmental and medical tests.

"Anthrax is a poor weapon to kill millions of people, but it's a good choice for terrorizing millions of people.  It sends shivers up and down our spines," said Robert E. Bartholomew, a Vermont sociologist and author of a new book on mass hysteria....

True Hysteria Needs Element of Plausibility

Mass hysteria occurs more often among women and young people.  About 60% of all US,. outbreaks occur in schools, according to UCLA's Small.

In 1993, for example, 10 Harbor City Elementary School students complained of nausea after smelling a strong odor.  Emergency workers were called in, and the school was evacuated as a precaution.  When students exiting the building saw the array of ambulances and firetrucks, dozens more began suffering headaches, nausea and stomachaches.  In all, 66 students and seven teachers were taken to hospitals, according to a medical journal article about the case.  The cost to evaluate and treat the cases was an estimated $33,050.

Several years earlier, 2,500 people were evacuated from the Santa Monica Civic Auditorium one evening when performers in a student concert began to faint and become nauseated.  While some students and parents complained of a strange odor and "toxic fumes," researchers concluded that the April 1989 incident that felled 200 people was mass hysteria.

For mass psychogenic illness to occur, there must be a strong element of plausibility.  With several cases of anthrax infections now confirmed in the United States, it is easy for people to believe it could happen to them, Bartholomew said.

"You can't see anthrax.  You can't smell it.  It could potentially be anywhere, any time," he said.  "Everyone is a potential victim."

In retrospect, outbreaks of mass hysteria often appear silly.  But, said Jones:  "You can't blame people when, in the background, really scary things are actually happening....

Learning Anthrax, Case by Case

Medicine:  With modern techniques and drugs, the infection can be beaten, doctors discover.

...  [Doctors] have learned much [about anthrax]:  They now know what anthrax looks like.  They know what antibiotics are most effective against it.  Most important, they know that with a bit of luck and considerable effort, it can be beaten....

"We have at least four people who are stable and improved, in fact, one person who's been discharged from the hospital after inhalation anthrax," Dr. Julie Gerberding, senior epidemiologist at the national Centers for Disease Control and Prevention, said at a Thursday news conference.

Doctors "are doing better than we would generally expect," Gerberding said.

Inhalation anthrax is still extremely dangerous.  But the general belief among medical experts before Oct. 1 that it was almost invariably fatal was based on scant data from decades ago.  Today's superior medical care, experts now believe, can make a significant difference to a patient's chances....

The biggest recorded human experience with inhalation anthrax comes from Soviet-era Russia, where a leak of spores from a biological weapons facility in 1979 killed at least 64 people in the industrial city of Sverdlovsk.

The incident was covered up for years; most of the medical papers were destroyed.  To this day, it's unclear how many people died, how sick they were before seeking help and what kind of medical care they received.

Only 11 people are on record as having survived the infection--most died within a day of being hospitalized--but Soviet-era medical care was not great even under the best conditions.

Moreover, survival numbers could be biased toward a more gloomy prognosis because less-seriously ill people may have survived but never made it into available records.

The other human outbreak that is used to calculate mortality occurred in the U.S. in 1957 at a New Hampshire textile mill.  Five workers contracted the disease from goat hair contaminated with anthrax spores.

Four died even though they were treated with intravenous doses of antibiotics, though perhaps in lower doses than those being used today, recalled Dr. Philip Brachman.

Brachman, a professor at the Rollins School of Public Health at Emory University in Atlanta, investigated the outbreak while head of epidemiology at the CDC.

But the difference between medicine in the 1950s and now is like night and day, said Dr. Paul Krogstad, a UCLA infectious disease specialist.

"The 1957 report is quaint -- it even speaks about physicians performing house calls," Krogstad said.  In so many ways, he said, "we're almost talking about a different type of medicine."

These days, intensive-care units are vastly better at managing serious illnesses.  Mechanical ventilators assist breathing, and drugs manage complications such as hemorrhage and plummeting blood pressure that infections like anthrax can cause.

There are also more potent, and varied, antibiotics -- and a wealth of experience in using them to manage other bacterial infections.

New guidelines released Friday by the CDC recommend using several antibiotics to treat confirmed inhalation anthrax cases -- ciprofloxacin or doxycycline and one or two others from a list of seven.

Moreover, it may be that even in years past, anthrax was not as uniformly deadly as people believed.  "Maybe we've not seen enough anthrax to recognize that there's a milder form of inhalational anthrax," Brachman said.

The speed and quality of care a patient receives can make a difference.  Two postal workers from the Washington area died from anthrax this week.  At least one of them initially went to a local hospital, where doctors did not ask him where he worked and diagnosed his illness as the flu.  By the time he returned to the hospital the next day, he was near death.

Inhalation anthrax is hard to diagnose because the early symptoms look so much like flu or other viral infections....

Nation's Doctor May Be In, but He Seems Out of the Loop

Policy:  Politicians have preferred to inform the public themselves on anthrax, ignoring the Clinton-appointed surgeon general.

WASHINGTON--As the anthrax scare unfolds, America's national doctor has been largely out of sight, unable to reassure a jittery public about the health threat.

Even as Surgeon General David Satcher steps up appearances on talk shows and at news conferences, some health experts say it is too little too late.

The Bush administration, in its efforts to contain the escalating crisis, has virtually ignored its lame-duck surgeon general.

In part, that's because Satcher is a Clinton administration holdover.  But more broadly, the White House has been slow to relinquish control over information given to the public to anyone other than Cabinet-level officials, according to knowledgeable sources.

This changed abruptly about two weeks ago when "they realized it was a huge mistake" not to let the doctors talk, said an official at the Centers for Disease Control and Prevention.

"The early communications strategy was not a good one," said Dr. Allan Rosenfield, dean of the Mailman School of Public Health at Columbia University.  "There should have been experts with a medical and public health background speaking out about the health aspects of it.  That's what a surgeon general is for."

Instead, the administration has turned primarily to two former governors, Health and Human Services Secretary Tommy G. Thompson of Wisconsin and Homeland Security Director Thomas J. Ridge of Pennsylvania.

"This administration will learn, like previous administrations, how important the surgeon general's voice is in a time of health crisis.  [But] they haven't learned that lesson yet," said a senior health official who worked for Thompson's predecessor in the Clinton administration, Donna Shalala.

For Cattlemen, Anthrax Just Another Aggravation

UVALDE, Texas--Gnarls of mesquite trees dot the plains of southwest Texas.  There are cattle here, and goats and sheep.  And there is anthrax.

Anthrax is endemic here, an age-old plague like the eagles that snatch newborn lambs or the red ants that bite with a wicked sting.  The spores seed this ragged ranch country southwest of San Antonio, lurking in the soil, burrowed by mesquite.

Every so often, the anthrax spores surface.  Animals ingest them and, unless they have been vaccinated, they die.  The same thing happens now and then across much of the Southwest and Midwest:  the Dakotas, Oklahoma, Kansas.  Anthrax has killed sporadically for decades, if not centuries, and it will kill sporadically for decades more.  This is an aggravation.  But it is not cause for alarm.

"We've had it here forever," rancher Carl Hellums says.  He bends over the bleached bones of a bull that died of anthrax on his land years back.  "I don't know if it's ignorance or what, but we're not overly concerned."

Hellums had just spent his morning castrating lambs amid clouds of dust so thick he could barely see his boots.  That dust could well have contained anthrax spores.  He could well have inhaled them.  Hellums shrugs.  He's not one to worry.  Or rather, he worries about the coyotes that stalk his sheep, about the hard time he's having finding a ranch hand tough enough for the work.  Anthrax?  It's not on his mind.

"It's just a fact of life around here," explains Dr. Herman Rathke, a veterinarian.

Another livestock vet, Dr. Cecil Arnim Jr., says, "Nobody's ever had their nose swabbed."

There is a world of difference between the clumps of dormant spores in the Texas soil and the concentrated, purified, finely ground particles that have been sent through the mail to lethal effect.  Ranchers out here understand the distinction.

Still, they observe the anthrax panic knotting the nation with the been-there, survived-that confidence of cowboys.  "Livestock producers who have lived with this for generations know how to deal with it," explains Dr. Terry Conger, an epidemiologist with the Texas  Animal Health Commission.

To be sure, it is possible for humans to get sick from the soil spores.

This summer, a Texas ranch hand developed a nasty lesion after skinning a buffalo in a pasture where several cattle had died of anthrax.  By the time doctors figured out the lesion wasn't just a bad spider bite, the man was so sick he had to spend nine days in the hospital.  Antibiotics eventually cured him.

Another case of cutaneous anthrax cropped up in North Dakota a year earlier.  The victim contracted the disease while disposing of five anthrax-stricken cows; he apparently had brushed one of his gloves -- teaming with spores -- against a cut on his face.  A month after that case emerged, Minnesota officials announced that two family members who ate hamburgers made from a diseased cow had developed symptoms of gastrointestinal anthrax.  Both recovered before the disease could be confirmed.

Inhalation anthrax, however, is all but unheard of on the ranch, because the spores common to U.S. soil are too lumpy to waft airborne and lodge in human lungs.  They could be kicked up in dust clouds, but even so, experts say, it's doubtful there would be enough of them to infect a person.  Skin anthrax is a more likely threat, but gloves usually are protection enough.  No bio-hazard suits or Cipro are needed.

Hunting guide Jim Roche explains the Texas perspective:  "You have a better chance of getting bit by a rattlesnake or attacked by a rabid coyote out here than you do getting infected by the anthrax."

If anthrax inspires fear here at all, it's fear of financial loss.  A microbe that can fell a $3,000 bull in hours -- without so much as a visible symptom -- is a fearsome enemy indeed.

There is a vaccine to prevent such losses; it is inexpensive and extremely effective, although the protection only lasts a year.  In regions like southwest Texas, where anthrax spores are seeded thick, most livestock are vaccinated each spring.  Yet there's always some rancher who grows complacent, or forgets, or puts off the vaccines just long enough for an outbreak to flare.

Anthrax in livestock, as in humans is not infectious.  But scientists believe horseflies can spread the disease from animal to animal.  And when a stricken animal dies, the billions of bacteria in its blood revert to spores, an exceptionally hardy form.  As the carcass rots, the spores re-enter the soil, where they can lurk for decades -- or infect the next unvaccinated animal to come along.

Veterinarians advise burning anthrax-infected remains to kill off spores.  Still, a few dead animals and scattered patches of hot soil can set off an epidemic.

That's what happened in southwest Texas last summer.

Rancher John Rogers, a burly cowhand from way back, turned into his pasture one June morning to find Old Ben, his favorite rodeo horse, gasping for breath and teeming with hundreds of flies.  "It was the first time in my life I had seen anything like it," he recalls.  Rogers phone his vet, who recommended 30 milliliters of penicillin.  A few minutes later, the vet called back to amend the dose.  Rogers hurried into the house to fill the syringe.  By the time he came back out, Old Ben was dead.

Rogers knew right away it was anthrax, although he never had seen the disease on his land.  Within days, he lost three cows as well.  Vaccinations saved the rest of his herd, but it turned out that his ranch, in the small town of Montell, was smack in the middle of an epidemic unlike any the region had seen in decades.

Dozens of horses and cattle in five Texas counties died of anthrax, along with a few elk, some water buffalo and even a pet llama.  By far the most devastated animals, however, were deer.

Thousands of them died; some ranches reported entire herds wiped out, and they canceled their fall hunts.  Hellums says one of his neighbors hired three men to help him dispose of contaminated carcasses -- "and all they did for a month was find and burn dead deer."

Despite the grim memory of that epidemic and the emergence of anthrax as a terrorist weapon, those who draw their livings from the wide-open land here seem unfazed by the spores in the soil.  There are bacteria that cause cows to miscarry and there are bacteria that infect sheep muscle and anthrax is, in the end, just another nasty bug.

As Rathke the veterinarian puts it:  "It's just one of the things we have around here.  There's no use becoming alarmed."

Hellums, proud of his good health at age 68, is proud too that he has not let anthrax scare him.  But he has started wearing latex gloves when he works with his animals in a way that will draw blood, such as castrating the young lambs.

"I always have cuts and scratches on my hands, and I got to thinking:  if their blood should mingle with mine..."  Then Hellums gives a good natured snort of a laugh.  "It's not panic.  But there's no sense inviting trouble."

Health:  Experts unsure how bookkeeper got infection.  New case is suspected in Manhattan.

WASHINGTON--Health officials announced Monday they have identified the first case of anthrax in a person who is not a mail worker and has no apparent connection to an office targeted with a contaminated letter.

The case -- involving a 51-year-old Hamilton Township, N.J., bookkeeper who contracted skin anthrax on her forehead -- raises the prospect that more Americans, especially on the East Coast, could be at risk from opening their mail and that the deadly bacteria can spread more easily than previously believed.

The Centers for Disease Control and Prevention said late Monday that they have launched an "active and intense" investigation to determine how the woman, the 14th person to contract the disease, was infected.  They are taking environmental samples at both her home and workplace, but there was no indication that she or her company was targeted, authorities said....

Amid speculation of a possible link between the anthrax cases in the U.S. and the alleged perpetrators of the Sept. 11 attacks, federal agents have tested cars owned by two of the suspected hijackers in Florida for spores, but they showed no trace, the FBI said....

Health:  Infections with no known sources raise doubts about how spores are thought to spread and general mail safety.

NEW YORK--Anthrax infections in two East Coast women with no known links to contaminated letters are forcing government officials to rethink basic assumptions about how easily the disease may infect people and how widely it may have spread through the mail.

Government investigators said Tuesday they could not explain how the deadly bacteria infected a New Jersey bookkeeper, who is recovering from skin anthrax, and a 61-year-old New York hospital supply clerk who is critically ill with the more dangerous inhaled form of the disease.

The women are the nation's 15th and 16th confirmed anthrax victims, but neither appears to have received suspicious mail or spent time at a contaminated postal facility....

Until now, health officials have assumed that an inhalation anthrax infection could only be acquired by a person who breathed thousands of anthrax spores.

That, they believed, would be impossible unless a person came into direct contact with a letter containing anthrax.  So-called cross-contamination -- a letter simply picking up spores by moving through the postal system -- would not be enough, officials have thought.

If the [New York] woman received such a letter, that would be a significant new front in the anthrax problem.  To date, the only confirmed anthrax-laced letters have been to media organizations and the office of Senate Majority Leader Tom Daschle (D-S.D.).

If she did not receive a letter, however, then officials must confront the possibility that anthrax is more infectious than they had believed....

WASHINGTON--More than eight years after anthrax-laced letters killed five people and terrorized the country, the F.B.I. on Friday closed its investigation, adding eerie new details to its case that the 2001 attacks were carried out by Bruce E. Ivins, an Army biodefense expert who killed himself in 2008.

A 92-page report, which concludes what by many measures is the largest investigation in F.B.I. history, laid out the evidence against Dr. Ivins, including his equivocal answers when asked by a friend in a recorded conversation about whether he was the anthrax mailer.

"If I found out I was involved in some way..." Dr. Ivins said, not finishing the sentence.  "I do not have any recollection of ever doing anything like that," he said, adding, "I can tell you, I am not a killer at heart."  But in a 2008 e-mail message to a former colleague, one of many that reflected distress, Dr. Ivins wrote, "I can hurt, kill, and terrorize."  He added: "Go down low, low, low as you can go, then dig forever, and you'll find me, my psyche."

The report disclosed for the first time the F.B.I.'s theory that Dr. Ivins embedded in the notes mailed with the anthrax a complex coded message, based on DNA biochemistry, alluding to two female former colleagues with whom he was obsessed.

The report described how an F.B.I. surveillance agent watched in 2007 as Dr. Ivins threw out a article and a book, Douglas Hofstadter's "Godel, Escher, Bach:  An Eternal Golden Braid," that could betray his interest in codes, coming out of his house in Frederick, Md., at 1 a.m. in long underwear to make certain the garbage truck had taken his trash.

Whether the voluminous documentation will convince skeptics about Dr. Ivins's guilt was uncertain on Friday.  Representative Rush D. Holt, a New Jersey Democrat and a physicist who has sharply criticized the bureau's work, said the case should not have been closed.

"Arbitrarily closing the case on a Friday afternoon should not mean the end of this investigation," Mr. Holt said, noting that the National Academy of Sciences was still studying the F.B.I.'s scientific work.  He said the F.B.I. report laid out "barely a circumstantial case" that "would not, I think, stand up in court."

Dropped into a mailbox in downtown Princeton, N.J., the anthrax letters were addressed to news organizations and two United States senators and contained notes with radical Islamist rhetoric that appeared to link them to the Sept. 11 attacks, which occurred a week before the first of the two mailings.

In the jittery wake of 9/11, they set off a nationwide panic over random discoveries of white powder that people feared might be more anthrax.  The real anthrax -- a few teaspoons of very fine powder -- infected at least 22 people, including several postal workers, and killed 5.

Congressional offices and the Supreme Court were evacuated as a result of anthrax contamination, and the Postal Service spent hundreds of millions of dollars to clean up mail-processing centers.  The federal government increased spending on biodefense, with a total of nearly $60 billion since 2001, and rejuvenated the faltering military anthrax vaccine program on which Dr. Ivins had worked for many years.

The investigation included more than 10,000 interviews on six continents, the report said, and F.B.I. investigators conducted preliminary investigations of 1,024 people and "in-depth investigations" of more than 400 people, examining those with possible financial motives, links to the drug and pesticide industries or a history of corresponding with the lawmakers targeted by the mailings.

In response to requests under the Freedom of Information Act, the bureau also posted on the Web more than 2,700 pages of interview notes and investigative documents to bolster its case.

Dr. Ivins, a microbiologist who had worked with anthrax for decades as part of the vaccine program at the Army's biodefense laboratory at Fort Detrick, Md., took a fatal overdose of Tylenol in July 2008 at the age of 62, after months of intense scrutiny by the F.B.I., which had placed a GPS device on his car, examined his trash and questioned his wife and two children.

They discovered his penchant for taking long drives at night, sometimes mailing letters and packages from distant spots under assumed names.  They discovered his obsession with a sorority, Kappa Kappa Gamma, and with images of blindfolded women, hundreds of which were found on his computer, the report says.

Days after his suicide, Justice Department and F.B.I. officials said they believed that Dr. Ivins had carried out the anthrax attacks alone and they released search warrant affidavits that included some of the evidence against him.

The affidavits included e-mail messages in which he confessed to paranoia and delusion; time records showing he had worked alone in the laboratory late at night before the anthrax mailings in September and October 2001; and genetic analysis tracing the mailed anthrax powder to a flask overseen by Dr. Ivins and stored in his lab.

But some of Dr. Ivins's colleagues at the United States Army Medical Research Institute of Infectious Diseases in Frederick, including several supervisors who knew him well, publicly rejected the F.B.I.'s conclusion.  They said he was eccentric but incapable of such a diabolical act, and they questioned whether he could have produced the deadly powder with the equipment in his lab.

Skeptics also pointed to F.B.I. investigators' long focus on another suspect, Dr. Steven J. Hatfill, another former Army scientist whom the F.B.I. pursued in 2002 and 2003, keeping him under constant surveillance.  In 2008, the government exonerated Dr. Hatfill and agreed to a settlement worth $4.6 million to resolve a lawsuit alleging that his privacy rights had been violated.

Long before he became a serious suspect, Dr. Ivins, one of the government's most experienced anthrax researchers, was a valued consultant to the F.B.I. investigators on the letters case.  Only after path-breaking genetic analysis led to his lab did investigators consider that their genial scientific adviser might actually be their quarry.

As they focused on Dr. Ivins and read his e-mail messages, the report said, they began to be increasingly convinced that he was the mailer.  And as he became aware that he was under scrutiny, he directed the F.B.I. repeatedly to other potential suspects.  Once, in 2007, he wrote what the F.B.I. calls "an illogical 12-point memo" suggesting that the two female former colleagues with whom he was obsessed might have mailed the letters.

When one of the women, made aware of the memo, confronted Dr. Ivins about it in 2008, he wrote to her, blaming an alternate personality he called "'Crazy Bruce,' who surfaces periodically as paranoid, severely depressed and ridden with incredible anxiety."  He complained that "it seems as though I have been selected as the blood sacrifice for this whole thing."

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