was still early when Larry Bush arrived at the emergency room of the John F. Kennedy Medical Center in Atlantis, Florida, part of a strip of towns that stretches from Miami to West Palm Beach. Bush was a hospital chief of staff and an infectious disease physician, on his way to a regular morning meeting, but some emergency physicians asked him to come. A 63-year-old man named Bob Stevens was brought in around 2:30 a.m. with a high fever. Now he was in a coma and connected to a ventilator, his frightened wife by his side.
The wife told Bush their story. As he remembers it later, she said they live a few miles away, near the ocean. Her husband worked in Boca Raton for a company that published newspapers in the supermarket, but they were out of state for a week to visit their daughter. He had started feeling ill the day before on the long drive home, and had gone to bed as soon as they arrived. He had woken her up in the middle of the night, wandering around the house confused.
Fever, confusion, and rapid collapse: This looked to Bush like meningitis, an infection of the membranes around the spinal cord and brain that can be caused by several organisms. Heading to the hospital lab to check test results, he found himself staring at a microscope he hadn’t expected to see: strings of bright purple rod-shaped bacilli, threaded from end to end like train cars on a track.
Bosch recognized the arrangement, but could not understand it. Infections with the object being seen were so rare that they occurred in the United States less than 20 times in a century, and only among people in a narrow range of occupations – ranchers and drummers, not picture editors in suburban Florida.
He said to himself, “If this is anthrax, then this is bioterrorism until proven otherwise.”
It was October 2, 2001. It took two days to confirm Bush’s suspicions. When his diagnosis was announced at a press conference on October 4 – 20 years ago today – he launched the most complex and focused public health response in US history to that point, rivaled today only by efforts to respond to Covid.
You couldn’t open a laptop or turn on the news three weeks ago without being reminded of the 20th anniversary of the World Trade Center attacks on September 11, 2001. Compared to that respectable memory, the anthrax attacks – the first lethal bioterrorist attack on US soil – are barely remembered. , though in the days after Bush’s announcement, they killed five people, sickened 17 more, sent 30,000 people to doctors, put 10,000 of them on preventive antibiotics, and perturbed Capitol Hill and the New York media world.
But people involved in the response at the time, including Bush — who continues to work as an infectious disease specialist at the medical center where Stevens later died — say the anthrax attacks provided harsh lessons that, if remembered, could have helped the Covid response. “What has gone really well is our ability to instantly recognize it, and report it,” says Bush, who is now an associate professor at the Colleges of Medicine at Florida Atlantic University and the University of Miami. “But we are no better prepared now than we were then.”
Brief recap, though with something as complex as anthrax attacks, it’s hard to be brief: Stevens wasn’t the first case; He was only the first to be diagnosed. Anthrax was sent by mail in September and October. All of the victims had some contact with messages garbled with spores that were sent to offices in Congress and the media, or were revealed after the messages spread the spores into mail processing equipment and contaminate mail, workplaces and other homes.