Worst of anthrax episode may be over, official says

WASHINGTON -- Eight days after the last anthrax diagnosis, a top federal health official said Tuesday the worst may be over. "For this episode, we're out of the woods," said Dr. Anthony Fauci of the National Institutes of Health.

But another attack, perhaps by some means other than the mail, can't be ruled out. And it's possible, although unlikely, that next month when thousands of people end their preventive antibiotics, a case or two might still pop up.

Could lingering contamination from the anthrax-tainted letters mailed to New York, Florida and Washington cause more infections? Fauci told The Associated Press that's unlikely. "However, another letter could come in addressed to whomever, you or me, who knows?" he added, saying doctors' vigilance cannot wane.

But the most troublesome anthrax victim is Kathy Nguyen, the Manhattan hospital worker whose Oct. 31 death still has federal investigators baffled. No one knows how Nguyen could have been infected. There's no sign she came in contact with anthrax-tainted mail, nor has any bacteria been found at her home or work place.

Police began using Nguyen's subway card to trace her steps around New York City for the two weeks prior to her death. "She somewhere, somehow had an inhalation exposure," said Dr. James Hughes of the Centers for Disease Control and Prevention, and until that mystery is solved, "vigilance is heightened around the country."

New attack?

The big fear is that she was the first victim of a new anthrax attack by some means other than mail.

But "every day that goes by without seeing another unexplained inhalational case makes it less and less likely" that happened, Fauci said.

In Washington, thousands of pounds of mail addressed to government agencies have been piling up since an anthrax-tainted letter arrived at Senate Majority Leader Tom Daschle's office Oct. 15. The Postal Service said Tuesday it had begun sanitizing this mail and would start delivering it within 24 to 48 hours.

The Postal Service hired a second company to cleanse the mail by irradiating it. Facilities in Bridgeport, N.J. and Lima, Ohio, now are tackling that massive effort. Each site is expected to cleanse about 750,000 pieces of mail a day, most coming from Washington, New Jersey and New York, where anthrax contamination was confirmed in some post offices.

More post offices around the country were being tested for possible contamination. Closed post offices in New Jersey reopened Tuesday, as did the Manhattan hospital that was closed when a worker died of inhaled anthrax.

Still facing cleanup is the Hart Senate Office Building where Daschle's office is located. Officials on Tuesday abandoned plans to pump chlorine dioxide gas into the building amid fears it may not work and now say the building will not reopen before Nov. 21.

Four deaths

Four people have died of inhaled anthrax since tainted letters were mailed in mid-September, and 13 others are fighting either the inhaled or milder skin form of the disease.

But it has been eight days since the last confirmed diagnosis -- a good sign that the worst is over, Fauci said.

Indeed, other than the mysterious Nguyen case, the other inhaled anthrax patients came down with symptoms four to six days after being exposed to the bacteria, said CDC's Dr. Bradley Perkins.

Tens of thousands of Americans are taking antibiotics for 60 days to prevent anthrax infection because they may have been exposed to the bacteria, which can incubate for up to two months before causing illness.

There's no guarantee that when all those people finish their drugs, a case or two of anthrax that the antibiotics didn't cure won't appear, Fauci said.

"It is very unlikely, though not impossible, that you will see late cases," he said. "Do I think it will happen in significant numbers? No. But if a case or two cropped up, I wouldn't be surprised."

Thus, all of those people must be alert to possible anthrax symptoms in the days after they quit the antibiotics, he said -- something their doctors should have warned them about, and something the CDC is gearing up to monitor.

Because whoever mailed the anthrax-tainted letters clearly had a large amount of very potent bacteria, "I think they could have done a lot worse," Fauci said. "It's not unreasonable to assume that the people who have this material and have attacked us with letters might try a different modality."

Added Dr. D.A. Henderson, the government's top bioterrorism adviser: "It's critical we remain on alert, and certainly we all are. ... What might happen next is anybody's guess at this point."