New York City hospital worker dies of inhaled anthrax

Associated Press WriterNEW YORK (AP) -- A hospital worker with a mysterious case of inhalation anthrax died early Wednesday, the nation's fourth fatality in a month of bioterrorism.

Kathy T. Nguyen, 61, died three days after checking herself into Lenox Hill Hospital and being diagnosed as the city's first case of the inhaled anthrax.

Hospital spokeswoman Ann Silverman said Nguyen died early Wednesday. She would not provide any other details.

Nguyen had been sedated and put on a ventilator and was too sick to help the health and criminal investigators trying to find the source of her infection by reconstructing her social life, commute and routines at the Manhattan Eye, Ear and Throat Hospital on the East Side.

Nguyen's illness, and that of a New Jersey woman who contracted the less serious skin anthrax, complicated the investigation by raising the possibility that tainted letters are contaminating other mail or that the spores are sickening people by means other than the mail.

The latest victims raised the number of confirmed anthrax cases to 17 nationwide since the outbreak began in early October. Ten have the inhaled form, including the four who died. The others have less-severe skin infections.

Four of those skin-anthrax cases -- and two more suspected cases -- are linked to city media outlets.

Nguyen, who lived alone and commuted to the hospital by subway from the Bronx, worked in a basement supply room. Until recently, the space had included a mailroom, but there was no evidence of any suspicious letter, and the first environmental samples from the hospital were negative.

"Almost everyone in the hospital came in contact with her," because she delivered supplies to various departments and offices, said Thomas Rich, a co-worker.

Up to 2,000 hospital workers, patients and visitors who have been to the hospital since Oct. 11 are being offered antibiotics, officials said Tuesday. The hospital was closed and other hospitals in the city were alerted to take precautions and report any suspicions.

Dr. Anthony Fauci of the National Institutes of Health said worries about "cross-contamination" -- anthrax spores sticking to pieces of mail at postal facilities -- have grown with the new cases.

On Wednesday, Fauci said preliminary tests show no anthrax at the hospital where Nguyen worked and "that's part of the mystery."

"So all bets are off and we really need to do -- the public health officials, the forensic group -- has to do a real full court press on trying to track this down. This is critical," he said on NBC's "Today" show.

Word of the New York infection came with the nation already on highest alert after warnings of more potential terrorist attacks. Just a few miles away from where Nguyen worked, President Bush threw out the opening pitch in Game 3 of the World Series at Yankee Stadium, where fans encountered especially tight security.

On Wednesday, the outbreak came up at a White House meeting between Bush and congressional leaders of both parties. Senate Majority Leader Tom Daschle said afterward that Congress is committed to improving the nation's ability to respond to bioterrorism attacks.

"There's a lot there that has to be addressed," he said, pointing to the need to boost the availability of vaccines, improve health care responses and protect the nation's food supply.

The spread of the disease -- from mail carriers in New Jersey and Washington to media employees in New York and Florida and now apparently unrelated people -- is giving investigators and researchers alike a painful real-world case study.

Contamination of postal facilities in Washington, New Jersey and Florida has altered investigators' assumptions about how easily the spores can be spread. Postal Service equipment and procedures, too, are under re-examination.

Officials at the federal Centers for Disease Control and Prevention are now keeping an "open mind" about cross-contamination, a spokesman said -- a stark change from a week earlier.

Last week, Dr. Jeffrey Koplan, the CDC director, said cross-contamination was "highly unlikely to virtually impossible." On Tuesday, he said it was a "possibility."

FBI Agent James Jarboe acknowledged Tuesday that the agency had not yet tested quarantined mail on Capitol Hill for possible cross-contamination with anthrax from the Daschle letter. Lawmakers from both parties criticized the bureau after hearing Jarboe's testimony.

But Daschle praised health care and law enforcement officials for their response to the discovery of anthrax in a letter sent to his office.

"We all recognize that given what we've seen in the last several days that left unattended this situation in the Senate could have been a lot worse," Daschle said Wednesday.

Health officials have offered assurances that relatively large numbers of spores are needed for an inhalation infection, citing one report that estimated 8,000 to 10,000 must be inhaled. Another study estimated as few as 2,500. But exactly where the dividing line is remains unclear.

"It's what's in-between," said Dr. Bradley Perkins, a CDC anthrax expert. "We're learning as each day goes by something about this, but unfortunately we just don't have an experience that can offer a clear-cut line."

Rep. Mike Pence, R-Ind., said he was told by investigators that the letter sent to Daschle's office carried about 2 grams of anthrax, or just less than a teaspoon. If the 2 grams were pure anthrax, it would contain enough spores to sicken about 2 million people, said Dr. David Sullivan, an anthrax expert at Johns Hopkins University.

For years, anthrax has been studied as a biological weapon with the potential to sicken tens of thousands. But those scenarios involved widespread distribution through the air, not a few letters sent through the mail.

In Washington, the postmaster general said several billion dollars are needed to safeguard the nation's mail. Anthrax has killed two postal workers there, and officials closed two more post offices while planning a two-week decontamination of a Senate office building where the bacteria were found.

One of the centers of the investigation is a mail sorting center near Trenton, N.J., that processed at least three anthrax-tainted letters sent to Daschle's office in Washington, NBC anchorman Tom Brokaw and the New York Post.

Officials investigating the most recent New Jersey infection were searching for a link to earlier cases. The 51-year-old accountant identified with skin anthrax on Monday does not remember opening any suspicious mail. She has been successfully treated and released from the hospital.

------Associated Press Medical Editor Daniel Q. Haney contributed to this report.

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