Podcast episode written and narrated by Anoushka Nambiar
Featuring interview with Dr. Stephen Ostroff, who was a medical epidemiologist with the Centers for Disease Control and Prevention from 1986-2005.
Transcript (full transcript of interview with Dr. Ostroff linked below):
You just heard some news clips from October 4th, 2001.
Over 20 years ago, the United States was faced with one of the most frightening bioterrorism attacks in history, just one week after the September 11th attacks.
Opening mail with gloves for government officials may have been unheard of before anthrax.
There are lasting impacts this had on the nation that we may not consider today, so before we dive into how the disease has and will affect all of us in some way, let’s find out what exactly anthrax is.
So anthrax is caused by a spore-forming bacteria called bacillus anthracis.
Spores are reproductive cells that bacteria can use to spread and defend themselves.
What makes anthrax so dangerous is the bacteria’s mono amino acid shell.
This is like a protein coat that disguises the bacteria. Think of it like a costume.
It blocks our t cells which are important to our immune responses from recognizing it as a pathogen, or something that can cause disease.
So by camouflaging itself, the pathogen is able to invade the body without triggering an immune response.
Both people and animals can get infected with anthrax.
It is not contagious so it’s not spread like a cold or flu.
It can be spread by breathing the spores in, eating food or drinking water with spores, or spores coming in contact with an open wound or cut in the skin.
This means there are generally three different types of anthrax: inhalation, gastrointestinal, and cutaneous.
Symptoms vary with each, but can range from blisters to coughs to nausea and vomiting.
Without treatment, 90% of inhalation anthrax cases are fatal. Luckily, there are antibiotics and antitoxins that fight the toxins the spores release in the body.
I want to emphasize that it is extremely uncommon to get infected with anthrax, which is why it is frequently thought of as a biological weapon.
The 2001 anthrax attacks occurred between september 18th through october 9th 2001, but it’s important to note that there was no connection to the 9/11 attacks.
There were 22 cases of anthrax and 5 people died.
Bob Stevens was the first person to die from the disease in over 25 years.
There were seven letters containing spores mailed to news agencies and senate offices across the country.
The country was left in a panic.
Postal workers were on the front lines and Cipro, the drug used to fight anthrax was running thin.
The spores were studied and were found to be highly purified with essentially no debris.
With the collaboration of scientists, doctors, public health and government officials, Dr. Bruce E. Ivins was found responsible.
There are still uncertainties about why he did it.
There are theories that he released it to test a vaccine he was working on.
This could be in combination with some sort of mental illness.
I had the privilege of talking to Dr. Steve Ostroff about these attacks.
Dr. Ostoff is a physician who has over 20 years of experience at the Centers for Disease Control and Prevention.
He worked for the Epidemic Intelligence Service as an EIS officer and then moved to the Food and Drug Administration.
He was chief scientist for the FDA, the deputy commissioner for the food side of the FDA, and the acting commissioner for a couple of occasions before he retired.
I was super interested in getting to know what these experiences were like for a public health official during that time, so lets see what Dr. Ostroff had to say about the anthrax attacks of 2001.
Could you talk a bit about the steps public health officials took since this was the first time an attack ever occurred?
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So Dr. Ostroff mentioned that the bio watch program looks at these pathogens in different categories and I was wondering what qualifies a pathogen to be organized as category A and the CDC states that a category A pathogen is one that can be easily transmitted from person to person, result in high mortality rates and have the potential for major public health impact, might cause public panic and social disruption and require special action for public health preparedness.
And so based on what we discussed earlier, anthrax definitely checks off these boxes and makes anthrax an ideal biological weapon. Back to the interview
What would you say were the biggest things public health officials/scientists/doctors learned and what other strategies would be enacted if something like this were to happen again?
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I’d like to pause there to let you just think about that for a second.
People regardless if you have a background in biology or medicine or not were equally terrified and unsure about what substances would or would not be connected to these attacks and it affected everyone from an average citizen to US senators.
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It was an honor to speak to Dr. Ostroff about his work and I am grateful for everything he has done not only during the anthrax attacks but for the field of public health in general.
So, what is the relevance of anthrax today?
As Dr. Ostroff mentioned, we are better equipped to handle emergency situations thanks to better technology and more effective communication.
Now that we know how it affects humans, we can example the close relationship between anthrax and the environment.
When you look at the anthrax cycle among animals it has to start with an infected host.
If you look at zebras which are a really common host, they become infected by grazing.
When they die, they immediately attract scavengers.
When their carcass (or dead body) is opened, the spores are deposited in the ground.
When vegetation returns, herbivores eat it and become infected.
Studies have found that spore concentrations do decline exponentially over time once deposited in the soil.
However, any grazing at carcass sites is likely to infect hosts within the first two to four years of deposition.
But grass at carcass sites is more abundant and nutritious in the first 1-2 years so that’s most likely when transmission will occur for herbivores.
Another study by Dr. Choate et al focused on the expression of the ANTXR2 gene which encodes a protein necessary for anthrax toxins to cause disease.
I learned about the fixation index (FST) from one of the figures they included.
FST essentially shows how different populations are different from each other genomically, and in this case they looked at ANTXR2.
The graph showed that Asian populations had a peak in FST when compared to european populations when focused on the ANTXR2 gene.
This emphasized how europeans showed more expression of the gene because again, FST shows how much different populations differ from each other.
So these populations are very different.
This is due to ancestral history with the disease and where it has spread to.
Additionally, the evolution of the diease mirrors human evolution because there was more interactions between humans and the pathogen during hunting and scavenging back in the day.
Another study by Stella et. al in 2020 created an epidemiological model for anthrax transmission that focused on Arctic environmental conditions.
Seasonal grazing and the role of the permafrost as spore storage was taken into consideration.
Permafrost is ground that is completely frozen for at least two years.
The results showed that the active thawing of the permafrost layer may favor sustained anthrax transmission.
This is because warm temperatures may thaw these layers allowing re circulation of spores.
So while this study was focused on the arctic environment, we can assume that things like climate change and soil disruption may reinforce spore circulation, causing reemergence of disease.
So to reflect on all of this, anthrax still exists as a disease.
It is caused by a powerful and dangerous pathogen that has wreaked havoc on the nation.
We looked at why it is used for bioterrorism and how affected people in ways we may never observe today.
Global warming could impact how the environment experiences spore storage and transmission, but advances in medicine allow for better treatment and detection.
We recognize that past events have taught us invaluable lessons and equipped us with strategies to better our communities for public health emergencies in the future.