Wednesday, September 06, 2006

9/11 Anniversary: Don't Forget The Workers

Next week will be filled with media reports about the fifth anniversary of the 9/11 attacks and report cards on "homeland security." President Bush will be seeking to win back the mantle of great protector of the American people that has served him so well in past elections.

But there is another story that should accompany each and every 9/11 commemoration report:

The official death toll from the 9/11 attacks is placed at 2,819. But as the fifth anniversary of the attack approaches, a study released today confirms that the real toll of 9/11 is actually much higher and still growing.

Exposure to a toxic burning brew of caustic concrete dust, asbestos, PCBs, jet fuel, and plastics, lead, chromium, mercury, vinyl chloride, benzene, human bodies and thousands of other substances has seriously damaged the health of thousands of workers who worked to clean up the remains of the World Trade Center. In fact, it may be decades before we know the true toll of the World Trade Center in illness and early death.

But the true tragedy is that much of this additional pain, illness and death could have been prevented, if it hadn't been for the lies and inaction -- lasting half a decade -- of the federal government, and to a lesser extent, the government of New York city.

Yesterday, the Mount Sinai Medical Center in New York released the largest study yet of thousands of Ground Zero workers that confirms that "the impact of the rescue and recovery effort on their health has been more widespread and persistent than previously thought, and is likely to linger far into the future." Only one worker is confirmed to have died from the effects of the smoke, although several others should probably be added to the list as well.

The study covered 9,442 workers and focused only on respiratory problems, although workers also suffered from severe gastrointestinal and psychological effects such as depression and post traumatic stress disorder as well. Later studies will focus on psychological effects.

According to the head of the study,

“There should no longer be any doubt about the health effects of the World Trade Center disaster,” said Dr. Robin Herbert, co-director of Mount Sinai’s World Trade Center Worker and Volunteer Medical Screening Program. “Our patients are sick, and they will need ongoing care for the rest of their lives.”
The results, in brief:

  • Roughly 70 percent of nearly 10,000 workers tested at Mount Sinai from 2002 to 2004 reported that they had new or substantially worsened respiratory problems while or after working at ground zero.

  • One-third of the patients in the new study showed diminished lung capacity in tests designed to measure the amount of air a person can exhale.

  • Of those studied, 46.5 percent reported symptoms like chest tightness, shortness of breath and dry cough that generally affect the lower airways of the lungs.

  • 62.5 percent reported upper-respiratory symptoms like sinusitis and nose and throat irritations.

  • Among nonsmokers, 28 percent were found to have some breathing impairment, more than double the rate for nonsmokers in the general population.

  • Firefighters and others who arrived at the sight earlier, had the worst problems

The full text of the study can be downloaded here

Long Term Effects

Most workers interviewed about the health effects of working on the pile tell of their symptoms getting worse, and the doctors agree.

The doctors said that the persistent nature of the respiratory symptoms raised troubling questions about the workers’ long-term health. Dr. Philip J. Landrigan, a founder of the screening program at Mount Sinai and an author of the new study, said that the toxic nature of the trade center dust had led doctors to conclude that there would be serious health issues for years to come, especially for workers who were exposed to the heaviest concentrations in the early days after the terrorist attack.

“This was extremely toxic dust,” Dr. Landrigan said, noting that some samples showed the dust to be as caustic as drain cleaner. The dust also contained innumerable tiny shards of glass, which could get lodged in the lungs, and a stew of toxic and carcinogenic substances, like asbestos and dioxin, that could potentially lead to cancer decades from now.
Other serious problems plague the victims as well. For example, 40 percent of those who went to Mount Sinai for medical screening did not have health insurance, and will thus not get proper medical care. And as they become sicker and unable to work, more will lose their health insurance.

In addition, many workers received incorrect treatments because their physicians weren't aware of the protocols for treating patients. Although Mt. Sinai established a protocol, or guidelines for treating the responders who were already showing characteristic signs of illness in 2002, the city of New York Health Department didn't issue diagnostic guidelines until last week, almost five years after the buildings' collapse.

Only the mayor of New York didn't seem too impressed with yesterday's study:

Mayor Michael R. Bloomberg, speaking at a news conference at City Hall yesterday, questioned the conclusiveness of the study, saying that statistics could suggest a connection between events, but not prove a direct link.

“I don’t believe that you can say specifically a particular problem came from this particular event,” he said. Nonetheless, Mr. Bloomberg announced that the city would create a screening and treatment program for anyone exposed to the trade center dust or fumes.

The mayor did, however announce the establishment of a $37.5 million city monitoring and treatment program that will offer its services at no charge to residents of Manhattan or Brooklyn, office workers, city employees and volunteers, and people involved in debris removal and cleanup.

In order to understand the full magnitude of this study, it's important to understand some recent history.

EPA's False Assurances That The Air Was OK

Three days after the buildings collapsed, then-U.S. Environmental Protection Administrator Christie Whitman issued a press release: "Monitoring and sampling conducted on Tuesday and Wednesday have been very reassuring about potential exposure of rescue workers and the public to environmental contamination." Two weeks later, Mayor Rudy Giuliani said rescue workers faced minimal risk because the air quality was "safe and acceptable."

But in August, 2003 and internal EPA Inspector General's report found that White House officials had instructed the agency to be less alarming and more reassuring to the public in the first few days after the attack, even though they didn't have the information to support that assurance.

Earlier this year, federal judge found that former Environmental Protection Agency administrator Christie Todd Whitman deliberately mislead the public when she reassured the public after the collapse of the World Trade Centers that the air was safe to breathe in lower Manhattan and Brooklyn.

And last month documents and memos obtained by Newsday revealed that New York city officials, pressured by building and business owners to open up downtown New York in the vicinity of the collapsed World Trade Center buildings following 9/11, ignored advice from experts, possibly dooming thousands to illness, shorter lives and death. The documents show that city officials may have opened up hazardous areas prematurely, even though they were warned by other officials at the New York Department of Environmental Protection that the air may have still been hazardous.

The false assurances of EPA and the city of New York served as a preamble to one of the biggest scandals of this tragedy:

OSHA's Failure To Enforce The Use of Respirators

Although New York Times writer Anthony DePalma didn't go into the whole respirator issue in today's article about the study, last June he wrote a long piece in the Times about the "botched opportunities, confused policies and contradictions that failed to ensure [workers'] safety."

As bad as EPA was, I wrote then in reviewing DePalma's article, the real culprit was the Occupational Safety and Health Administration, the agency tasked by Congress to ensure the health and safety of American workers. And there's no exception for federally declared disasters:

As the magnitude of the recovery operation grew clearer, attempts were made to bring order to the operation. On Sept. 20 the city issued its first safety plan, and it asked the Occupational Safety and Health Administration to take charge of distributing respirators. In what would become a controversial move, OSHA used its discretionary powers to decide not to enforce workplace safety regulations but to act in a supportive role that would not slow down operations. "Given that the site was operating under emergency conditions, it was normal that we should suspend our enforcement action and assume the roles of consultation and technical assistance," Patricia Clark, OSHA regional administrator for New York, said in a 2003 OSHA publication.
What we're dealing with here is a traditional conflict between production (in this case, cleaning up the site as quickly as possible) and worker safety, along with the additional political push by the can-do Bush administration to get things cleaned up quickly.

It has been argued that the World Trade Center site (as well as the post-Katrina Gulf) were emergencies and, at least in the immediate, chaotic aftermath, there may have been nothing OSHA could have done to enforce respirator use. But the cleanup of the site went on for nine months beyond the initial emergency. In addition, similar "emergency conditions" didn't stop the Pentagon from escorting workers off the site if they weren't wearing proper respiratory gear and more than 90 percent of the workers at the Fresh Kills landfill on Staten Island, which was overseen by the Army Corps of Engineers, wore respirators, according to the Times.

And then, of course, it probably didn't help much that our Commander In Chief didn't feel the need to worry about the air. (Of course, he left quickly)

The Current Situation

The federal Government has finally started to take the situation seriously. Following the first confirmed death of a rescue worker, President Bush appointed John Howard, Director of The National Institute for Occupational Safety and Health to coordinate the federal government's 9/11 health efforts. But even Howard admits "that costly delays and missed opportunities may have shattered responders' trust in government." Although many are relieved that someone is in charge, the problems continue:

Dr. Howard, who was trained as a pulmonary specialist and is the director of the National Institute for Occupational Safety and Health, has not assigned a single one of his 1,300 employees to work full time on ground zero medical issues, though about 20 work on such issues part time. And though the institute has a budget of about $285 million, he has not received any additional money to address the complex medical issues involved.

“I’m a czar without a budget,” he said.

Money continues to be a serious problem. Although money has been available for screening and monitoring programs run by Mt. Sinai, until last year, almost no money was available for treatment. Last year, New York's Congressional delegation convinced the Bush administration to restore $125 million in unused workers comp funds that it had threatened to take back, but that still doesn't come close to what will be needed.

Finally, a new law was passed in New York making most people who performed rescue, recovery or cleanup work after the collapse of the World Trade Center eligible to register with the Workers’ Compensation Board. Anyone who is registered who develops a 9/11-related illness at any time in the future will be eligible to file a workers’ compensation claim. Failure to register by August 14, 2007 will make it impossible to file a claim, even if the worker develops a 9/11-related illness.

What does it all mean?

Finally, take a look at this article by public health historians David Rosner and Gerald Markowitz, authors of the just published Are We Ready?: Public Health Since 9/11. Rosner and Markowitz note that the New York public health system worked when 9/11 happened. Emergency health services were ready to go, measures were taken to prevent food from rotting, vermin infestations and mosquito outbreaks. But that was soon to end:

It took no time at all for the administration to start systematically undercutting the efforts of experienced health administrators in New York and at the national Centers for Disease Control. By pressing them to return the city to "normal" and feeding them doctored information about dust levels -- ignoring scientific uncertainties about the dangers that lingered in the air -- the administration lied to support a national policy of denial.

Putting in place a dysfunctional bureaucracy would soon undermine the public's trust in the whole health system in downtown Manhattan. In the process, it also effectively crippled systems already in existence to protect workers, local residents, and children attending school in the area. As a result, what promised to be an extraordinary example of a government bureaucracy actually working turned into a disaster and later became the de facto model for the Federal response to Hurricane Katrina.
The next step was the starvation of the national public health system while money was wasted on wild goose chases like smallpox immunizations and the war in Iraq instead of "laboratories, well-baby clinic care, and inoculation campaigns. " And here we are today:

In the wake of September 11th, the public health community saw its sanest initiatives stifled and its priorities distorted. While money is now less available for the inoculation of babies from the real threats of rubella, mumps, and measles, as hoped-for funds to prevent as many as 350,000 children from getting lead poisoning are no longer on anyone's agenda, as federal funds to support health education have been rescinded, and as (unbelievably enough) money needed to protect U.S. ports from dirty bombs or bioterrorism have all-but-vanished, Katrina victims still wander the nation wondering whether they will be able to see a physician.

For the next 9/11, when it comes to public health, don't think New York, Ground Zero, 2001; think New Orleans, August 29, 2005. Think: "Brownie, you're doing a heck of a job..." Then sit back amid the disaster and wait for the private charities to appear, wait for FEMA to send in the mobile homes.

Finally, let's return to the numbers. The main result of the Mt. Sinai study was that 70% of the Ground Zero workers studied had serious respiratory problems. An estimated 40000 persons worked at Ground Zero during those months. Given the fact that these symptoms are getting worse for many, that many symptoms have not yet been studie, and that we've already seen some deaths, and that we have not begun to see the long term effects of the smoke, what kind of numbers will we be looking at in 30 years and how will they compare to those lost on 9/11 itself? I shudder to think.

NOTE: "9-11 Toxic Legacy" airing on DiscoveryTimes Sept. 9 at 5 p.m. and Sept. 12 at 10 p.m. (Produced by Susan Teskey, Canadian Broadcasting Corporation) Excerpts can be seen here.

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