Mysteriously, the attacks ended almost as quickly as they had begun. But they were so frightening to many U.S. citizens that a new term -- bioterror -- was soon burned into the American consciousness.
Those attacks also showed the panic and very real danger posed by the release of such toxins on an unsuspecting public.
While people clearly need to worry about exposures to various chemical and biological agents during these trying times, the mail attacks right after 9/11 quickly put anthrax front-and-center in the minds of many Americans.
In a way, that early emphasis on the perils of anthrax exposure may have actually aided the U.S. in its fight against a bioterrorist attack. Bioterror experts say that the symptoms of an anthrax exposure are the easiest to deal with as long as one is treated soon after exposure. The flu-like symptoms may persist for as long as three days before becoming worse; although once the severe stage sets in, death can occur in as little as two hours or up to two days.
That problem showed governments everywhere the necessity of a rapid response to a bioterror attack, since a large segment of a nation's population may die if those with the infection are not quickly and properly treated.
So while microwaving mail probably won't kill any spores, it won't really hurt anything to continue doing just that if you've been microwaving letters since 9/11. Though be careful; some experts have recorded cases of people starting serious fires in their microwaves as they 'nuked' their mail. If you decide to do this, be cautious of the dangers.
Granted -- but isn't there anything people can do to protect themselves?
"They should learn more about anthrax so they know what it [certainly] is and what it isn't," Coffin advised.
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The cutaneous form of anthrax is contracted through the skin, via a cut or abrasion. Three to five days after infection, a painless blister appears. A day or two later, this becomes a black, open sore. Cutaneous anthrax accounts for 95 percent of anthrax cases in the United States, and is easily treated with antibiotics.
But left untreated, perhaps 5 percent of cases progress to a dangerous bloodstream infection, which is almost always fatal.
The inhaled form of anthrax incorporates the same germ as the cutaneous form; however, inhaled anthrax is both rare and extremely deadly. Studies of previous cases indicate that a dose of just 2,500 to 55,000 anthrax spores is lethal to about half of the people who inhale them.
The first stage of inhaled anthrax infection, lasting from hours to a few days, involves flu-like symptoms, including fever, coughing, weakness and chest pains. Only at this stage can inhaled anthrax be treated with antibiotics.
The second stage usually ends in death within days. Lung damage deprives the body of oxygen. The victim then goes into shock. Brain infection may also occur. Antibiotics only prove helpful at the earliest stages of the disease because they fight bacteria, not the toxins the bacteria produce in abundance during the final stage of infection.
What people should not do, health officials say, is demand antibiotics from their doctors. The reason is simple: "If these drugs are used inappropriately, the organism is going to develop resistance to them. The worst thing you can do is contribute to these organisms becoming resistant," said U.S. Surgeon General David Satcher.
Health and Human Services Secretary Tommy Thompson has asked people not to hoard anthrax antibiotics, saying the government had enough to treat those who might require the drugs. A more reliable form of protection, many say, is to simply keep an eye on unusual letters or packages arriving in the mail.
*misspelled words or wrong titles on the label;
*having been sent from an unknown person in a foreign country;
*having excessive postage or no return address;
*restrictive markings such as "personal";
*oily stains, discolorations or crystallization on the packaging.
If you receive an envelope and there's a powder inside, set it down carefully, don't move it or give it to anyone else, quickly wash your hands with soap and water and call 911.
The flip side to all this is that most Americans probably won't have to worry about such a threat: most of those actually targeted in the anthrax attacks, after all, were public officials and journalists. Experts therefore say there is very little reason to suspect you've been exposed unless there has been a specific incident where you live or work.
"It's just not a big enough threat for most people to be worrying about," said Dr. Henry Rosen, a professor of medicine and expert in infectious diseases at the University of Washington in Seattle. "It's a threat that has been tremendously exaggerated. How often do you worry about things that effect two or three people in 300 million?" he said.
Rosen said he is more concerned about the ill effects of constantly living in fear of bioterrorism. "The health effect from the anxiety of this is probably bigger than the overall threat from [such things as] anthrax," Rosen said.
Experts say smallpox would be a very effective bioweapon, both because it kills 30 percent of its victims and it has a long incubation period. It may take up to two weeks for symptoms to appear; but after that time, the victim may develop high fever, malaise, headache and backache. Two days after symptoms start, a rash of pus-filled boils develops, spreading all over the body. Smallpox is easily spread, and there is no known treatment for one who has contracted the disease.
For centuries smallpox was a worldwide terror, one spread through coughing, sneezing or physical contact -- even by handling the bed linens of the afflicted.
But thanks to a global vaccination effort begun by the old Soviet Union, by the late 1970s the virus' domain had been contained to a few tightly controlled laboratories in Russia and the United States.
That's indeed something for the Reds to be proud of; yet we shouldn't pat the old Soviets on the back just yet. There are rumors in U.S. intelligence circles that the Russians, along with Iraqis and North Koreans, have held onto undisclosed stores of smallpox for weapons purposes.
And that, dear friends, is what makes smallpox so very dangerous.
But don't head for the hills just yet, folks. There are arguments against smallpox being used as an instrument of bioterror.
Remember, unlike anthrax, the human smallpox virus was virtually eradicated in the late 1970s, and the only known stores are in Russia and the U.S. Both countries have sworn to a war against terrorist activity after the events of 9/11. All of this would presumably make it far more difficult for an extremist person or group to obtain smallpox for bioterror purposes.
"If this thing in Florida with the anthrax turns out to be a strain that the Soviets had, or if it turns out to be a strain that the Iraqis had, or Iran or North Korea, or if we had it only in a (Centers for Disease Control and Prevention) lab -- if that turns out to be the case, then I think we need to be worried about smallpox," he said.
According to Dr. Raymond Zilinskas, deputy director of the Chemical and Biological Weapons Nonproliferation Program, the main danger is that a smallpox attack wouldn't require the highly technical dispersal mechanisms that terrorists need to spark a widespread anthrax outbreak.
"With smallpox, you don't need any of that, you just need infected people ... the biological equivalent of a suicide bomber," he said.
In 2000, a year before 9/11, the CDC put in a $343 million order with the company Acambis for the production of 40 million doses of a new smallpox vaccine at its facility in Cambridge, MA; the order however would not be filled until 2004. But in the wake of the anthrax attacks, the timetable was accelerated so that those doses would be available by the end of 2002 -- even though the vaccine would still lack the Food and Drug Administration's full approval.
"It could only be administered with informed consent," Tucker explained. The vaccine still has to go through years of testing before it could be administered routinely, however.
In the meantime, researchers at four medical centers -- Baylor College, the University of Rochester, St. Louis University and the University of Maryland -- are investigating whether the existing vaccine would work even if it were diluted fivefold or tenfold. That would stretch out the nation's supply to serve 75 million people or more, a much more comforting scenario.
Other researchers are trying to develop anti-viral drugs to fight smallpox cases, but it will take years to turn that research into safe medications.
Even in the wake of the suicide attacks on the World Trade Center and Pentagon on 9-11, some experts like Zilinskas find it hard to believe that anyone would seriously attempt to unleash smallpox on the world again.
"Even though (Iraqi leader) Saddam Hussein is ruthless, I don't think he is completely reckless," he said. "You'd have to be reckless, because if you have these things you must know that everyone is vulnerable... . The pandemic would spread to other parts of the world, including Iraq, and they're just as vulnerable as anyone else in the world."
Of course, he's not considering the fanatical beliefs of Iran and Radical Islam. They're likely to believe that "Allah" will protect them from the effects of smallpox, if they could ever get their hands on and to use it as a weapon.
For instance, since early symptoms of deadly inhaled anthrax are similar to the flu, a sudden increase in sales of flu medications could tip off authorities to check for anthrax before victims become ill enough to seek medical attention, the researchers suggest.
The Carnegie Mellon project was started long before the anthrax mail attacks in late 2001, said Stephen E. Feinberg of the university's department of statistics.
He added the group's focus is on larger scale attacks in an urban area, not the relatively limited hazard posed by the mailed germs.
"We're talking about exposures of thousands of people in a concentrated location, and then you've got very large-scale impact to assess and every second counts," Feinberg explained.
Gregory C. Gray, an epidemiologist at the University of Iowa, said there is precedent for using such sales to detect disease. An outbreak of the intestinal parasite cryptosporidium in Milwaukee in the early 1990s was first detected by pharmacists who noticed a run on antidiarrheal medicines, he said.
The Carnegie Mellon work focused on sales of cough medicine and the system had trouble detecting a flu outbreak during a holiday, but the study could point the way to developing a more broad-based method for detecting bioterrorism attacks.
That will have to take into account seasonal sales patterns, local flu outbreaks, cut-price sales, store hours and other factors that affect how much of a product is sold.
According to Carnegie Mellon's Stephen Feinberg, the long-term goal is to develop a system looking at cough syrups as well as pain pills, stomach medicines and other drugs so analysts can create a "footprint" of sales and detect unusual patterns.
"Cough medicine has a lot of variability. You have a set of symptoms working in concert and if you can look at an ensemble of symptoms, you clearly will have a more accurate system for detection," he explained.
If the system signaled an alarm, he said, local public health officials could be alerted. They would determine if an actual bioterror attack were underway before the public is unnecessarily alarmed, Feinberg added.
That, he said, could give officials a head start toward reducing the number of deaths if an attack were occurring.
Such sweeping governmental moves would probably never have occurred without the attention newspapers and other news outlets have brought to the problem. But there is a sad part about the American media's fixation on bioterror. According to a supposed statement released in December 2001 by Aiman al-Zawahiri, Al-Qaeda's real military leader, it apparently never occurred to the group to use something like anthrax against its targets until 1998, after the group's bombing attack on the U.S.S. Cole. Operatives began reading worried reports published by U.S. media outlets on the possibility and inherent danger of bioterror attacks -- and the rest, as they say, is history.
All the same, these efforts by both scientists and government officials to fight bioterror are now necessary. But with the rise of rogue governments like Iran and North Korea, and probably alliances with powerful nations like Russia and China, it seems more likely each year that some kind of bioweapon or other weapon of mass destructions will make it's way into the hands of a terrorist organization willing to use it.