Kathy Nguyen &
The Manhattan Anthrax Cases
Analyzed by Ed Lake
(Revised June 12, 2003)

Why did Kathy Nguyen's anthrax have to come through the mails?  Yes, mail cross-contamination did spread the anthrax, but there are also other ways to spread anthrax.

Isn't it far more likely that she was killed by the anthrax that was unwittingly disposed of by NBC, ABC, CBS and the New York Post?

There were apparently 4 anthrax-laced letters sent to New York City in the mailing of September 18th - letters to Tom Brokaw at NBC, Dan Rather at CBS, Peter Jennings at ABC and The New York Post.  (There may have been others, but these are the only letters that are actually known to have caused cases of anthrax.)

Kathy Nguyen worked in the supply office of the Manhattan Eye, Ear and Throat Hospital in the same general area of Manhattan - as can be seen by the map below.

Since the only letter that was recovered unopened was the letter to the New York Post, and the rest were all thrown in the trash, it seems evident that a lot of anthrax was thrown into the trash - along with the letters and envelopes sent to ABC and CBS.  And none of this anthrax was any longer enclosed in any sealed envelope!  It was loose anthtrax powder being dumped from trash basket to trash bin to trash truck to .... !

When it was learned that someone was sending anthrax through the mails, people began to search through trash and mailrooms for discarded letters previously thought to be hoaxes.  Trash pickups may have been delayed in order to accomodate such searches.  As a result of one such search, a police officer and two lab technicians were found to be contaminated with anthrax on October 14.  Apparently as a result of another search, two mailroom employees at The New York Post contracted anthrax.  Searches probably continued for some time at all locations.

Kathy Nguyen was hospitalized with anthrax on October 29.  The incubation period for anthrax can vary from 1 day to six weeks or more.  Click HERE for more info on incubation periods.

What happened to that trash?  It was almost certainly transported through the streets of Manhattan.  How?  Where did it go?  What route did it take?

Who came in contact with that trash?  Did any of them get covered with spores?  Did any of them happen to visit the Manhattan Eye, Ear and Throat Hospital nearby?  Did any of the trash collectors go there?  Did any of the garbage trucks go there?  Did any street scavengers rummage through the trash bins?  Was Kathy Nguyen responsible for disposing of trash of any kind?  What time was the trash picked up at the hospital?  Is it on the same route as any trucks that also pick up trash from NBC, ABC, CBS and/or the Post?  Did any garbage collectors go there?  Could Kathy Nguyen have traveled in the subway with someone who had anthrax on their clothes as a result of hunting for anthrax letters?  Did the mail room personnel wear smocks?  Did the supply room personnel wear smocks?  Did janitorial service wear smocks?  When, where and how were the smocks laundered?  Did any janitorial service workers from the TV studios go home on the same subway at the same time as Kathy Nguyen?

I've never seen any of these questions even asked, much less answered.

Instead, the CDC and the New York Health Department seem locked into the idea that Kathy Nguyen's anthrax must have come from the "second wave", i.e., from the letters sent to the Senators.  Do they even look at their own charts?  The chart below was prepared by the CDC and shows clearly that two of the three New York Cases that occurred during "the second wave" were actually cases at The New York Post that resulted from going through the trash to find the letter from the first attack! (The comment in red is my comment.)

The Second Wave

I discussed Kathy Nguyen's case with two people, a scientist who is closely following the anthrax case and a newspaper reporter.  Their responses were very different:

While still convinced that Kathy Nguyen contracted anthrax from the second mailing,  the scientist thought it was a definite possibility that it could have been a result of the actions to find the anthrax-laced letters in New York after it became known that anthrax had been sent through the mails on September 18.  The scientist specifically pointed out one likely scenario:  Kathy Nguyen could have encountered the police officer who transported the NBC letter to the lab. The police officer who found the letter sent to Tom Brokaw at NBC transported that letter to a lab somewhere in New York and the officer became contaminated in the process.  Furthermore, when the officer turned the letter over to the lab technicians, two technicians were also contaminated.  This is according to CDC documents and New York City’s Department of Health.

"If you look at the onset times for NY cases that were exposed to the two mailings," the scientist also told me, "you will see that Kathy Nguyen was in the second wave."  He pointed out that, during that "second wave", two employees at The New York Post also contracted anthrax apparently while hunting to locate that discarded anthrax letter.  And that anthrax was definitely from the Sept. 18 mailing.  But that wasn't enough to convince him that Kathy's anthrax came from the Sept. 18 mailing.  He still favored the Oct. 9 mailing as the source.

The newspaper reporter, had a totally different reaction: He clearly indicated that he didn't believe my idea about the trash.  He said, "She was part of 'the second wave'."

I asked him what he meant by "the second wave", and he wasn't sure, but after I pressed him he said it meant that she was contaminated from the second anthrax mailing (to the Senators).

I told him, "the first wave" merely pertains to the first cluster of cases (late September), and the "second wave" just pertains to the second cluster of cases (mid-October), but that doesn't mean circumstances (such as sorting through trash) couldn't have caused someone to be contaminated from the first anthrax letters during the time of the second wave.

But that didn't seem to be the way this particular reporter was viewing it.

When I pressed him further, he said that Kathy died of inhalation anthrax and the other New York cases were all cutaneous anthrax - which again made him believe she died from the more refined anthrax that was used in the second mailing.

I pointed out that there were also two inhalation anthrax cases in Florida (one died, the other recovered) from the Sept. 18 mailing.

But his response was to question me about the St. Petersburg mailing, and whether or not that was definitely just a hoax.  He clearly didn't share my viewpoint that the letter sent to American Media in Boca Raton, Florida, was part of  the Sept. 18 mailing from Trenton.

The conversation ended at that point, but we agreed to talk further at a later time.

The Anthrax Cases

Isn't it far more likely that Kathy Nguyen contracted anthrax from one of the letters mailed on Sept. 18?  The only real question seems to be: how did she come in contact with the anthrax?   The fact that her case occurred at a time when people were getting anthrax from the Oct. 9 mailing doesn’t mean her anthrax came from those letters.  At about that same time, people at the New York Post had contracted anthrax while hunting for the lost Sept. 18 letter, and a police officer and two lab assistants were contaminated by the NBC letter postmarked Sept. 18.  And, presumably, people were also hunting for letters at ABC and CBS.  Clearly, Kathy Nguyen’s location in New York seems more important than the timing.

According to an article in the April 2, 2002, issue of the New York Times, the various investigators "interviewed 232 co-workers, 27 neighbors and 35 acquaintances in an effort to reconstruct her final two months. They searched her apartment and swabbed surfaces there and in her workplace and the subway stations she used. They vacuumed her clothes in search of spores. They used her subway fare card to trace her path around the city, studied her phone records and inspected her usual laundry, post office and grocery store.

"They never found a single spore or any other clue to how Ms. Nguyen became infected.

"Describing the investigation at a medical meeting last week in Atlanta, Dr. Timothy Holtz, a preventive medicine fellow at the New York City Health Department, concluded with a slide that said, 'We will likely never know.' "

232 co-workers, 27 neighbors and 35 acquaintences - but no interviews of anyone from NBC, ABC, CBS or The New York Post may have been covered with spores during the hunt for the Sept. 18 letters, no interviews of the people who cleaned their mail rooms where loose anthrax had been tossed into trash baskets, and no interviews of the people who handled that trash.

Yes, indeed, they will likely never know.

They have traced Kathy Nguyen's movements.  All they need to do is track the movements of the anthrax that was thrown away to see if the two paths intersect.

Here’s a table summarizing the anthrax cases:  RED = Sept. 18 mailing BLUE - Oct. 9 mailing
 

     Victim                   Type         Location                           Onset     Confirmed
   ("first wave")

1. Bob Stevens, 63*         Inhalation   American Media, Boca Raton, FL       Sep. 30    Oct. 4
2. Erin O’Connor, 38        Cutaneous    NBC in New York                      Sep. 25    Oct. 12
3. Casey Chamberlain, 23    Cutaneous    NBC in New York                      Sep. 28
4. Boy, 7 months            Cutaneous    ABC in New York                      Sep. 29    Oct. 15
5. Ernesto Blanco, 73       Inhalation   American Media, Boca Raton, FL       Sep. 28    Oct. 15
6. Richard Morgano, 39      Cutaneous    New Jersey Post Office               Sep. 26    Oct. 17
7. Claire Fletcher, 27      Cutaneous    CBS in New York                      Oct. 1     Oct. 18
8. Teresa Heller, 32        Cutaneous    West Trenton Post Office, NJ         Sep. 28    Oct. 18
9. Joanna Huden, 30         Cutaneous    New York Post, NY                    Sep. 22    Oct. 19

   ("second wave")

10. Norma Wallace, 56       Inhalation   Hamilton Township mail center, NJ    Oct. 14    Oct. 19 
11. Female, 43              Inhalation   Hamilton Township mail center, NJ    Oct. 15    Oct. 19
12. Patrick O’Donnell, 35   Cutaneous    Hamilton Township mail center, NJ    Oct. 14    Oct. 19
13. Leroy Richmond, 57      Inhalation   Brentwood Mail Center, D.C.          Oct. 16    Oct. 21
14. Unk, 56                 Inhalation   Brentwood Mail Center, D.C.          Oct. 16    Oct. 22
15. Male, 34                Cutaneous    New York Post, NY                    Oct. 19    Oct. 22
16. Thomas Morris, 55*      Inhalation   Brentwood Mail Center, D.C.          Oct. 16    Oct. 23
17. Joseph Curseen, 47*     Inhalation   Brentwood Mail Center, D.C.          Oct. 16    Oct. 23
18. Linda Burch, 51         Cutaneous    Hamilton Township, NJ                Oct. 17    Oct. 24
19. David Hose, 59          Inhalation   State Department Mail Center, D.C.   Oct. 22    Oct. 25
20. Mark Cunningham, 38     Cutaneous    New York Post, NY                    Oct. 23    Oct. 28
21. Kathy Nguyen, 61*       Inhalation   Manhattan Eye Ear & Throat Hosp., NY Oct. 25    Oct. 30
22. Ottilie Lundgren, 94*   Inhalation   Oxford, Connecticut                  Nov. 14    Nov. 21

* died

This table was compiled from information found at various sources, but verified by checking data at UCLA.  If you want to see the information displayed in graph form or if you want to research the UCLA data in more detail, click HERE.

When studying such data, interesting things can be learned.  For example, when looking at all the anthrax cases that are known or suspected of being connected to the September 18 mailing, there is an interesting question that is posed when the data is sorted by the age of the victim:
 

Age    Location   type        name               Onset

7 mos  ABC - NY   cutaneous   child              Sep. 29
23     NBC - NY   cutaneous   Casey Chamberlain  Sep. 28
27     CBS - NY   cutaneous   Claire Fletcher    Oct. 1
30     NY Post    cutaneous   Joanna Huden       Sep. 22
32     NJ PO      cutaneous   Teresa Heller      Sep. 27
34     NY Post    cutaneous   male               Oct. 19
38     NBC - NY   cutaneous   Erin O'Connor      Sep. 25
38     NY Post    cutaneous   Mark Cunningham    Oct. 23
39     NJ PO      cutaneous   Richard Morgano    Sep. 26
61*    NYC        inhalation  Kathy Nguyen       Oct. 25
63*    AMI - FL   inhalation  Bob Stevens        Sep. 30
73     AMI - FL   inhalation  Ernesto Blanco     Sep. 28

The question: How come the younger people only got cutaneous anthrax while the older people only got inhalation anthrax?

The data for the October 9-related cases is not as clearly defined, but here, too, all the cutaneous cases show up at the younger end of the age range.

The simple conclusion is that the older you are, the more easily you can get inhalation anthrax.  One might conclude that this is because the human immune system becomes less effective as we grow older, but that's oversimplifying.  That would indicate that HIV-infected people with damaged immune systems are especially prone to inhalational anthrax.  That may not be true.  Compromised immune systems may not really describe the problem.  It could be more accurate to focus on the lung and its macrophages and how well they were doing their job.  Age doesn't mean a compromised immune system but it might mean that macrophages don't function well and transport spores to the lymph nodes where the spores germinate.

It may also mean that the older you get, the fewer spores you need to inhale to get inhalation anthrax.  That opens up all sorts of possibilities for the source of Kathy Nguyen's infection.

But whatever aspect of age caused the inhalation cases from the September 18 mailing, it's eerie to see it so clearly illustrated as in the chart above.

Anthrax Attack Charts

I find it difficult to understand why the CDC and other health organizations cannot see that their charting practices need to be re-thought for terrorist situations like the anthrax attacks.

Anthrax is not a contageous disease, and charting multiple attacks on a "wave chart" as if it were a contageous disease can lead to incorrect conclusions, as was almost certainly the situation with the Kathy Nguyen case.  When one separates the anthrax cases by attack number, it becomes clear that Kathy Nguyen was part of the first attack.  When not buried within the "second wave" of Attack #2, it becomes clear that her case (#22) must somehow be related to the other cases in New York that happened at the same time.

Both attacks had "after effect cases" which occurred much later than the initial cases, and a different chart is required to clearly show such cases.  Here is the CDC data rearranged into separate charts for each of the two attacks:

When the data is arranged this way, other important information is more accurately illustrated.

One can see more clearly the delays between postmark dates and first case onset.

One can see that the second attack was more of a sudden "spike" than a wave, and this is what would be expected in a bioweapons attack.

The compact "spike" of the second attack indicates a much more deadly type of attack.

It's more easy to see unusual "after effect" cases caused by factors not normally associated with contageous diseases.  In Attack #1 there were cases caused by sorting through trash.  In Attack #2
there was a death from cross-contaminated mail.

The causes of "after effect" cases need to be understood so they can be prevented.  They are very different from "second wave" cases in a contageous epidemic.  If there ever is another anthrax attack, new "attack charts" like the ones above are needed to pinpoint and understand exactly what caused them.

For what it's worth, I'm not the only one who thinks that Kathy Nguyen was infected with anthrax from the media mailing.  One of the foremost experts on anthrax, Martin Hugh-Jones of Louisiana State University wrote me this on June 8, 2003, after I asked him to consider my evaluation of the Nguyen case:

That the Nguyen case is ascribed to the second [Oct. 9]posting follows from a simplist epidemiological view of incubation periods. You go for the nearest source event. However the NY Post cases just before hers suggests that there may have been a local recycling of the NY risk and she tragically caught the back end of it because of her age increasing her risk. What that "recycling"/ regeneration could have entailed I have no idea.


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