Welch Wanderings continued
EIS Investigates Attacks
Early on the morning of Sept. 14, only two planes were flying in
American airspace that weren't part of the U.S. military. One was
Air Force One, which was taking the president to New York.
The other was an Australian Air Force C-130, ferrying 34 Epidemic
Intelligence Service (EIS) officers from Georgia to New York, according
to Douglas Hamilton, EIS director. Faced with a commercial airline
industry slowly recovering from the shutdown of American airspace
and a U.S. military reluctant to lend out its planes, EIS accepted
the Australian offer of transport in the C-130 (which was being
retrofitted at an air base in Georgia).
Strapped to his seat in the belly of the huge transport plane and
surrounded by the duffel bags, suit-cases, and files of his fellow
officers was Reuben Varghese, MD, MPH '99. Varghese and his colleagues
were joining two EIS officers who had hitched a ride Sept. 11 on
a U.S. pharmaceutical stockpile plane that landed in New York hours
after the terrorist attacks. The EIS officers went there to monitor
for any signs of the release of communicable agents.
Alex Langmuir, MD, MPH '40, founder of EIS, would have been proud.
"Langmuir's spirit was that you didn't get answers by sitting
in an office," Hamilton says. "You only got information
by going in the field and collecting data there. That's the driving
force of this program."
Begun by Langmuir and staffed by numerous School alumni and faculty
over the past five decades, EIS retains a special connection to
Langmuir, a former associate professor of Epidemiology at the School,
wheedled funds in 1951 from a reluctant U.S. Congress by submitting
a report that detailed the dangers of biological warfare. Hamilton
suspects, however, that Langmuir had another motive for forming
an intelligence branch of disease detectives. "My sense was
he was a pretty clever guy and he started EIS with the primary goal
of increasing epidemiological capacity in the United States in general,"
he says. Ironically, Langmuir's EIS is a powerful resource in the
battle against the latest instance of biological warfare: this fall's
anthrax attacks by mail.
Since Sept. 11, 112 of the 146 current EIS officers have been deployed
to respond to the World Trade Center attacks and the anthrax mail
attacks, according to Hamilton. Four alumni from the School are
serving in their first year of the two-year commitment. (The number
of alumni in their second year at EIS was not available at press
EIS officers that answers were found in the field, not the
School alumni currently working as EIS officers join a long list
of School faculty who are veteran EIS officers, including: Alfred
Sommer, MD, MHS '73; D.A. Henderson, MD, MPH '60; Robert Lawrence,
MD; Neal Halsey, MD; Bernard Guyer, MD, MPH; Henry Mosley, MD, MPH
'65; Kenrad Nelson, MD; Kathy Helzlsouer, MD, MHS '88; Gordon Smith,
MD, MPH; and Stan Becker, PhD '78.
"A lot of people in EIS have come through Hopkins," Hamilton
says. "Hopkins certainly has one of the premier MPH programs
in the world. When we see someone coming through Hopkins, that credential
definitely gets our attention." -BWS
The School Post-9/11 On Oct. 24, Lynn Goldman, MD, got a call from the president of
the American Postal Workers Union, asking her to provide technical
advice to a group of Washington, D.C., postal workers on how to
protect against anthrax. Goldman, a professor of Environmental Health
Sciences, quickly pulled together a team at the School, and two
days later, she and Clifford Mitchell, MD, MS, MPH '91, an assistant
professor of Environmental Health Sciences, were meeting with the
postal employees. "It was obvious the workers had received
most of their information from the press," says Goldman, "so
we're now working on getting them consistent information."
the wake of Sept. 11 and the recent anthrax bioterrorist attacks,
students, faculty, and staff have taken on additional responsibilities
and endeavors as the School confronts the latest threat to public
On learning about how mail-sorting rooms operate, Goldman was struck
by how the letter-sorting equipment was cleaned by means of compressed
air. "I began to wonder, Could the cleaning machines blow anthrax
spores right out of a sealed envelope and then disperse them throughout
the room? Can spores be transferred between letters?" Goldman's
team will develop a training program for postal workers on recognizing
chemical and biological hazards and what to do about them.
In the past few weeks, the Office of Communications has seen
a tremendous spike in interest from the media and general public
requesting both information and interviews with faculty about bioterrorism.
"The School is an institution full of experts and, through
us, the media and general public can learn about bioterrorism and
public health," says Tim Parsons, associate director of Public
Affairs. "It is our responsibility to help inform the public
about these important issues, however we can."
On many days in October, Parsons and Ming Tai, media relations coordinator,
were together fielding more than 100 phone calls from CNN, the New
York Times, the BBC, the New Delhi Telegraph, and many
other news organizations.
After Sept. 11, the work of Ellen Silbergeld, PhD, on how agriculture's
overuse of antibiotics produces drug-resistant superbugs, took on
increased urgency. One of the antibiotics used in factory farms
to boost the growth of chickens and turkeys is enrofloxacin, which
is largely metabolized by the birds into a drug called ciprofloxacin,
or Cipro the principal drug now used to fight anthrax in
are now using B. anthracis as a warfare agent,
shouldn't we be asking whether our agricultural practices
are compromising Cipro's ability to fight anthrax in humans?
"The organism that causes anthrax, Bacillus anthracis,
like most bacteria which are smarter than we are can
develop resistance to Cipro," notes Silbergeld, a professor
of Environmental Health Sciences. "If people are now using
B. anthracis as a warfare agent, shouldn't we be asking whether
our agricultural practices are compromising Cipro's ability to fight
anthrax in humans? And hadn't we better be doing something about
this milieu of resistance that's being inadvertently created by
the uncontrolled use of enrofloxacin in poultry?"
The Student Outbreak Response Team (SORT) organized a weeklong
lecture series on the topic of bioterrorism in early November. Angeline
David, MHS candidate in Epidemiology and co-coordinator of SORT,
felt that informing students was important. "As future public
health practitioners, we wanted to be proactive and help students
be more aware of the current issues," she says.
The series examined bioterrorism and its public health effects from
various perspectives, including risk perception and management,
public health preparation for bioterrorism, and psychological concerns.
- Jennifer Hudman & Rod Graham
The Wounded Mind
a month of Sept. 11, David Vlahov, PhD '88, launched a telephone
survey of 1,000 people to look at post-traumatic stress disorder
(PTSD) and other early psychological reverberations among New
"This initial rapid assessment is to provide a sense of the
magnitude and scope of the psychological impact," explains
Vlahov, an adjunct professor of Epidemiology and director of the
New York Academy of Medicine's Center for Urban Epidemiologic
Studies. "Our results will be used by the Commissioner of
the New York City Department of Health to help plan services and
allocation of resources when the city applies to the Federal Emergency
Management Agency for assistance."
Although PTSD has been called shell shock and battle fatigue,
this common mental disorder (estimates of its prevalence range
from 3 to 10 percent of the U.S. population) is by no means the
exclusive province of combat veterans. Survivors of rape, domestic
violence, child abuse, accidents, natural disasters and
terrorist attacks are all susceptible to the flashbacks
and nightmares, the avoidance behaviors, and the emotional numbing
that mark PTSD.
Vlahov, who also plans to recruit another 2,600 adults and children
in New York for long-term follow-up, is not the only person from
the School interested in PTSD. Howard Chilcoat, ScD '92, MHS '91,
studies the disorder as well.
"If almost 6,000 people died in the Sept. 11 catastrophes,"
says Chilcoat, "then every member of each of those 6,000
families, as well as those close to the deceased, are at risk
Asked what the signs of the disorder are, Chilcoat, an associate
professor of Mental Hygiene, explains that, to be diagnosed with
PTSD, a person must first have been exposed to a traumatic event
and then have exhibited at least some features from each of three
symptom clusters: 1) intrusive memories, fantasies, and nightmares
of the trauma, as well as physiological or psychological distress
when exposed to cues that remind of the event; 2) hyperarousal
symptoms like insomnia and an exaggerated startle reaction; and
3) emotional numbing and avoidance of situations resembling the
What about all the millions who watched the World Trade Center
towers collapse on TV? While Chilcoat is quick to note that PTSD
can at times be overdiagnosed, he does think some people who watched
the catastrophes unfold on television could now be at risk for
"There are definitely people out there not related to the
victims of Sept. 11 who should be on guard for signs of PTSD,"
he cautions. "If after watching the catastrophes you notice
yourself losing interest in people and activities, or feeling
emotionally numb or hopeless or both, these are red flags for
post-traumatic stress disorder." - RG
Debugging Trauma Care
For much of her career, Ellen MacKenzie, PhD, has tracked the
outcomes of traumatic injuries and studied the workings of trauma
centers hospitals that have the equipment and expertise
to handle the most gravely injured patients. She got an earful
from her surgeon friends after Sept. 11.
"The trauma surgeons I spoke with in New York worried that
even though they were well prepared, they would have been utterly
swamped if things had turned out well [and there had been] many
more survivors," says MacKenzie, a professor of Health Policy
and Management and director of the School's Center for Injury
Research and Policy.
Although not focused specifically on bioterrorism, much of MacKenzie's
research is, in fact, aimed at streamlining disaster relief efforts.
She and her colleagues, for instance, have been analyzing emergency
triage decisions to pinpoint exactly which injuries pose the greatest
threat of death or future disability. "We are also investigating
whether a person with a particular injury who is sent to a trauma
center fares better than another person with the exact same injury
who ends up at a regular hospital," she says.
Another problem many of the New York surgeons noticed: the lack
of communication among hospitals and between hospitals and the
broader public health system. As it happens, MacKenzie and her
colleagues are working with the American Trauma Society to compile
a complete inventory of U.S. trauma centers, with an eye toward
linking them up via the Internet and an electronic newsletter.