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New York Times

SPECIAL REPORT

The making of a health disaster
Officials failed to act on Ground Zero perils

July 25, 2006—Ground Zero workers were sent into 'the largest acute environmental disaster that ever has befallen New York City' without proper respiratory protection - and thousands are paying the price.

For Christopher Hynes, life as a forgotten victim of 9/11 is a battle for breath.

Five years ago, Hynes was a 30-year-old, healthy, nonsmoking New York City police officer. Then, in September and October 2001, he was assigned to Ground Zero duty, spending more than 100 hours patrolling the perimeter of the smoldering rubble of the twin towers. The air was thick with dust and smoky particles.

Today, Hynes, married and the father of a 4-year-old son, has sarcoidosis, a disease that scars lung tissues, and asthma, a disease that inflames and obstructs the airways of the lungs. He coughs constantly and cannot exert himself without losing breath. He survives with the help of steroids and performs restricted duties for the Police Department.

"I will probably have this for the rest of my life," he says.

For Winston Lodge, life as a forgotten victim of 9/11 is the torment of chronically inflamed and bleeding sinuses.

Five years ago, Lodge was a 44-year-old ironworker who helped build things. Then, called on to help dismantle The Pile, he pitched in at Ground Zero for 12 hours a day, seven days a week, for a month.

Today, Lodge's nose runs constantly and often bleeds. He suffers headaches from sinus pressure, has shortness of breath from chronic bronchitis and is bedeviled by acid reflux, a painful heartburn. He has undergone surgery to relieve sinus difficulties and is awaiting a second operation. Since 2004, Lodge, a divorced father of four, has been unable to work.

"I am sick to my bones and I need help," he says.

For Jeffrey Endean, life as a forgotten victim of 9/11 is a struggle with scarred lungs and ruined sinuses.

Five years ago, Endean was a 51-year-old division commander for the Morris County, N.J., sheriff's office. He was healthy, able to run several miles. Then, he was pressed into Ground Zero service because he had experience helping first responders cope at horrific scenes. He worked 12-hour shifts from Sept. 11 to Nov. 22, 2001.

Today, Endean has reactive airways dysfunction syndrome, or RADS, a rare, irritant-induced form of asthma, his sinuses often bleed and he is prone to headaches and upper-respiratory infections. Married, the father of three and grandfather of three, Endean retired in 2002.

"I start the day with four to five inhalers and a pill," he says. "Will I have cancer at 66? Will I live my life as long as I should?" The forgotten victims of 9/11 are legion among the 40,000 people who massed at Ground Zero in New York's hour of greatest need. Well over 12,000 are afflicted with conditions similar to those that plague Christopher Hynes, Winston Lodge and Jeffrey Endean.

They gasp for air with asthma or illnesses that scar deep in the lungs. They lose their breath from exertion. They endure pain from persistently swollen sinuses and constant burning from acid reflux. At a minimum, they cough and cough, hacking with a syndrome known fittingly as World Trade Center cough.

And, beyond all doubt, at least four responders — Firefighter Stephen Johnson, Police Officer James Godbee, Detective James Zadroga and Emergency Medical Service paramedic Debbie Reeve — died as a direct consequence of their service.

The magnitude of the epidemic has worsened for five years as every level of government has failed to face the reality of what happens when large numbers of people without proper respiratory protection are exposed for long periods to air thick with toxic substances.

Responsibility runs from the federal government, where then-Environmental Protection Administrator Christie Whitman falsely assured 9/11 responders that the air was safe, to the New York State Health Department, which abandoned a program designed to monitor the health of 9,800 state and National Guard personnel, to the New York City Health Department, which has yet to issue treatment guidelines for physicians.

The failure to create the comprehensive public health campaign that was so obviously called for is especially outrageous because public health officials have long had access to evidence of a public health disaster in the making. Medical researchers have published at least 27 studies detailing how the toxic cloud that erupted with the collapse of the World Trade Center ate at the lungs of the workers who labored to find survivors and cart away the massive rubble.

To read the studies is to confront both governmental inaction and a question: Why? Why were recovery workers put in harm's way, falsely assured they were safe and lacking respiratory protection? And why has so little been done to aid them? The answers, it seems certain, were, first, ignorance; second, a determination to get New York moving at all costs; third, bureaucracies that let everyone dodge responsibility, and fourth, a desire to minimize liability.

All of which should have been swept aside as scientists reported their findings; all of which must be swept aside today. Too many people have gone without proper monitoring and treatment, and too many are threatened by worse illnesses, to allow further denial and lethargy.

The reports are available in publications such as the New England Journal of Medicine, the Journal of Occupational and Environmental Medicine, the American Journal of Respiratory and Critical Care Medicine, Chest, and the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. Many were written by the Fire Department's own doctors, who are among a handful of officials who have performed in exemplary fashion since 9/11.

The collapse of the twin towers was, in the words of a 2004 report in the journal Environmental Health Perspectives, "the largest acute environmental disaster that ever has befallen New York City." The air became laden with highly alkaline concrete dust, glass fibers and particles of lead, chlorine, antimony, aluminum, titanium, magnesium, iron, zinc and calcium. Flaming fuel and plastics released carcinogens including dioxins, polycyclic aromatic hydrocarbons, polychlorinated biphenyls and polychlorinated furans.

Three days after the attack, rain helped cleanse the atmosphere, but particulate levels rose and fell for weeks, dropping at night when the air was still and rising with flareups in The Pile. Construction machinery added diesel exhaust to the stew, and caked gray-white dust was omnipresent. It was not until December 2001 that the fires were extinguished and dioxin levels returned to normal. The final pieces of steel were trucked away five months later.

The devastating consequences of laboring amid poisons became immediately evident.

In the first 24 hours, 240 firefighters and Emergency Medical Service workers sought treatment, half for dire respiratory symptoms. Three were hospitalized for life-threatening inhalation injuries, two of whom went into acute respiratory arrest.

Within 48 hours, more than 9,000 firefighters — 90% of the FDNY's earliest responders — suffered acute cough, nasal congestion, chest tightness or burning. Three out of four told researchers that for the first week, they didn't wear respirators, which cover the nose and mouth and filter out contaminants. Some used paper masks that were practically useless.

Two weeks after 9/11, a 38-year-old firefighter was admitted to Bellevue Hospital with acute eosinophilic pneumonia, a rare disease caused by exposure to extreme amounts of dust, according to the description of his case published in the American Journal of Respiratory and Critical Care Medicine. He had ash, fiberglass, silica, metal particles and asbestos in his lungs.

The firefighter, whom the FDNY declined to identify, had arrived at the Trade Center 20 minutes after the collapse and worked 16 hours a day for 13 days, wearing no respiratory protection for at least the first week. Early on, he coughed up black phlegm, and for two days before he was hospitalized he complained of fatigue, muscle pain, fever, dry cough, chest discomfort and breathlessness. He required three weeks of treatment before recovering.

A team of doctors, including David Prezant, the Fire Department's deputy chief medical officer, wrote up the case as an example of a condition known as interstitial lung disease. ILD affects tissues deep in the lungs that extract oxygen and is far rarer than illnesses that obstruct breathing passages, such as asthma. It is the type of illness that led to the deaths of Johnson, Zadroga and Godbee.

In October, doctors diagnosed almost 60 firefighters as suffering from airway hyperreactivity, a narrowing of breathing passages commonly found in miners after years of exposure to airborne particles. The firefighters' conditions worsened over the next six months. In November and December, researchers for Beth Israel Medical Center and Johns Hopkins and Columbia universities examined hundreds of cops and cleanup workers and found that they, too, had coughing, wheezing and other lung ailments. For example, Beth Israel doctors checked 240 Emergency Service Unit cops and found that 77% had developed new or worsening respiratory symptoms within days after 9/11, and that one-quarter of the 240 still had symptoms three months later.

In February 2002, a study of 97 ironworkers who were at Ground Zero during the first five days found 77% had respiratory symptoms such as cough, chest tightness and wheezing.

Symptoms emerged among people who had not been on The Pile. Two-thirds of the residents in 414 randomly selected households in Battery Park City, Southbridge Towers and Independence Plaza reported eye or throat irritation six weeks after the attack, and nearly half had persistent coughs.

A survey of downtown women who were pregnant on 9/11 found shorter gestation periods and smaller babies than normal. The maternal and cord blood of women who lived within a mile of Ground Zero had elevated levels of PAHs in the month after the attack. PAHs are associated with genetic damage.

One woman told researchers at the Johns Hopkins Bloomberg School of Public Health in Baltimore that she had had an abortion because she feared birth defects.

Still, the Ground Zero recovery workers suffered the worst illnesses. Thirteen firefighters contracted pneumonia in the first three months, and by month six more than 30 firefighters had come down with reactive airways dysfunction syndrome, the asthma that struck Jeffrey Endean. An additional 332 firefighters and one EMS worker had a severe enough cough to require four weeks of sick leave — the first medical definition of what became know as World Trade Center cough.

All of them had coughed up black or gray phlegm containing pebbles or particles in the first days after the attack, and one year later, more than half of those 332 showed only partial improvement. Almost nine out of 10 also suffered from persistent, severe heartburn or acid reflux, an ailment common among the forgotten victims of 9/11.

(Doctors believe that breathing concrete dust inflamed lungs and sinuses, and swallowing it damaged digestive systems, causing the release of acids. Vapors generated by those acids then worsen the respiratory inflammation, creating a vicious cycle. One retired firefighter had a cough so severe that the constant jarring of his teeth knocked out most of his fillings, said the FDNY's Prezant.) Most stunningly, FDNY doctors calculated that the average lung capacity of Ground Zero firefighters and EMS workers had decreased by the equivalent of 12 years of aging. The doctors also saw sarcoidosis, the lung-scarring disease that afflicts Christopher Hynes, at more than five times the usual rate in the first two years.

That's where the scientific measurements of the Ground Zero health crisis end for the moment, but more is known because Fire Department physicians and doctors at the Mount Sinai World Trade Center Medical Monitoring Program have monitored or treated tens of thousands of patients.

Their conditions are similar to those suffered by Hynes, Lodge and Endean: asthma, RADS, interstitial lung diseases, bronchitis, sinusitis, acid reflux and, most commonly, World Trade Center cough. The doctors say that while aggressive treatment has helped many to improve, few have been restored to the health they enjoyed before 9/11. Many are severely debilitated.

The Daily News is calling on Mayor Bloomberg to lead a public health drive on behalf of the forgotten victims of 9/11. His long dedication to public health, his command of municipal resources and his ability to get things done ideally suit Bloomberg for the job. Not incidentally, he also occupies a position from which to mobilize the state and federal governments into fulfilling their responsibilities to the Ground Zero responders.

And those responsibilities are, indeed, huge. They belong to, among others, Gov. Pataki and his successor in Albany come January, state Health Commissioner Antonia Novello and her successor come January and U.S. Health and Human Services Secretary Michael Leavitt, who assigned Dr. John Howard, head of the National Institute for Occupational Safety and Health, to serve as federal WTC health coordinator. All must begin to accept their obligations.

Bloomberg responded to our call with a commitment to study "whether we are doing everything that we can," and a promise to do what he can "consistent with what our resources are, to make sure that this city acts responsibly and recognizes the great sacrifice and the hard work that people made down at the World Trade Center site."

To which we say, "Good, Mr. Mayor, take a close, hard look." Action will surely follow, and we look forward to seeing the start of a comprehensive, aggressive crusade, because the facts demand it. Even a cursory study will show that Trade Center responders were falsely assured the air was safe. And that they didn't get or use proper respiratory protection.

And that the primary medical program for most responders, the one run by Mount Sinai, has never been adequately funded so that cops and construction workers must wait four months for an appointment for treatment.

And that doctors at Mount Sinai and affiliated hospitals are experiencing a surge of new patients five years after 9/11.

And that many of Mount Sinai's patients arrive after having been misdiagnosed or ineffectively treated.

And that medical experts, including Dr. Kerry Kelly, FDNY's chief medical officer, and Prezant; Dr. Robin Herbert and Dr. Stephen Levin, who run Mount Sinai's program, and Dr. Alvin Teirstein, a noted Mount Sinai pulmonary specialist, are concerned that the forgotten o f9/11 may be on the verge of more serious illnesses. Tumors and lung-scarring diseases have been known to emerge between five and 20 years after a toxic exposure. The responders are about to cross that five-year milestone.

They served New York and it cost them their health and even their lives. They deserve nothing less than long-term, gold-standard health care — now.

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