For Anthrax Survivors, a Halting, Painful Recovery

 May 7, 2002

By SHERYL GAY STOLBERG


 WINCHESTER, Va. - When he was laid up in the intensive care
 unit of the Winchester Medical Center with intravenous
 tubes sticking out at every angle, bleeding ulcers gnawing
 at his gut and the lymph nodes in his chest swollen up like
 cherry tomatoes, David Hose believed that anthrax would
 surely kill him.

 When he left the hospital in a wheelchair 16 days later,
 Mr. Hose expected that certainly within a few months he
 would be back to normal, or at least well enough to return
 to his job supervising the distribution of diplomatic mail
 at a State Department center in Sterling.

 Reality, for Mr. Hose and most of the tiny corps of
 survivors of inhalation anthrax, has been somewhere in
 between. Of the 11 people who came down with the deadliest
 form of anthrax after germ-laced letters were sent through
 the mail in October, six survived. Of those, one is well
 enough to return to work, even though the typical recovery
 period for a serious infection is three to six months. The
 others are caught in the limbo of recovery, grateful to be
 alive but wondering whether the aftereffects, both physical
 and psychological, will ever subside.

 Some have nightmares. One has begun seeing a psychiatrist
 to cope with flashbacks that transport him, without
 warning, back to intensive care. Others complain that they
 are tired, short of breath and plagued by losses of
 short-term memory, symptoms that puzzle their doctors, as
 well as government experts.

 "It's like we are going through an accelerated aging
 process," said Norma Jean Wallace, a postal worker who
 became infected in Hamilton, N.J. "I guess I have grown to
 accept it as a way of life."

 If scientists learned anything last fall, it was just how
 little they knew about the germ and the disease it causes.
 Seven months later, the survivors are reinforcing that
 lesson. Before the attacks, just 18 cases of inhalation
 anthrax had been reported in the United States in the last
 100 years, and nearly all of the victims died.

 Mr. Hose, Ms. Wallace and the others, by contrast, offer a
 whole new window on those who catch the deadly disease -
 and live. Having rewritten the book on anthrax treatment,
 they may well write the first book on anthrax recovery. For
 now, though, the pages are mostly blank.

 "There are more questions than there are answers," said Dr.
 Arthur M. Friedlander, an anthrax expert at the Army
 biological defense laboratory at Fort Detrick, Md., who has
 met with the six. "We know only about this disease
 historically, for the most part, up until the recent tragic
 events. So this represents an opportunity to learn."

 Now that the survivors are past the six-month mark by which
 they would have been expected to recover from serious
 infections, the federal Centers for Disease Control and
 Prevention, which has been collecting their blood for
 research, is contemplating more elaborate studies.

 "We are sort of at the cusp," its chief anthrax expert, Dr.
 Bradley Perkins, said. "As we get further out from the
 original infection and these individuals do not return to
 their normal activities, that is going to be of great
 concern to us. It will be a clear indication that we need
 to pursue all avenues to find out what's going on."

 Mr. Hose, a strapping 59-year-old, said he woke up feeling
 weary most mornings and took naps most afternoons. Once he
 recalled the arcana of international postal codes with
 ease. Now he finds himself searching, midsentence, for his
 thoughts.

 His weeks are circumscribed by return trips to the hospital
 every Monday, Wednesday and Friday for exercises to improve
 his endurance. When he started in November, he spent three
 minutes on each machine. Today he is up to six. The color
 in his cheeks, once ashen, has returned to pink. But his
 respiratory therapist, Laurie Giangola, said, "It's going
 to be a long road."

 There are several possible explanations for the lingering
 symptoms, Dr. Perkins said. One holds that toxins released
 by the bacteria have damaged the cells and tissues in ways
 that scientists do not fully understand. The side effects
 from long-term use of antibiotics may play a role. Or maybe
 the convalescence is simply longer than anyone thought.

 Then there is the stress of having been involved in a
 terrorist attack. Besides feeling anxious, several
 survivors have become deeply suspicious of the government.
 Ms. Wallace is convinced that federal authorities know who
 carried out the anthrax attacks - a government scientist,
 she conjectured in a theory rooted in unconfirmed news
 reports - but are "protecting that person for some reason."


 Mr. Hose is convinced that government scientists know more
 than they let on about the dangers of anthrax infection.
 "I'm sure they know how much it can really do to you," he
 said. "But they're not letting it out."

 Such sentiments are hardly surprising, experts said, in
 view of the circumstances.

 "The whole issue of having been attacked cannot be
 underestimated," says Dr. Jonathan Rosenthal, a specialist
 in infectious diseases at the Mid-Atlantic Permanente
 Medical Group who cares for two survivors. "These patients
 were very much aware that someone tried to assassinate
 them, and there is an enormous amount of anxiety and fear
 about that."

 One of those patients is Leroy Richmond, 57, a postal
 worker who contracted anthrax while cleaning near a
 contaminated mail-sorting machine in Washington. Two
 co-workers died, and had he not been aggressive in
 demanding treatment, Mr. Richmond, too, would probably be
 dead. So not a day goes by that he does not count his
 blessings.

 Still, there are things that he misses. On a recent
 afternoon, Mr. Richmond's young son Quentin was riding his
 bicycle outside their house in Stafford.

 "I don't have the energy to do that," Mr. Richmond said. "I
 can't go swimming. I can't do the soccer things he wants me
 to do. I don't know what's happening inside my body. I
 don't think the doctors know."

 Ernesto Blanco, 74, is the sole survivor who has been well
 enough to return to work. An employee of American Media
 Inc. in Boca Raton, Fla., publisher of supermarket
 newspapers, Mr. Blanco said he woke up early in the morning
 to jog around the block with his dogs, in an effort to keep
 himself fit. He went back to work at the end of February,
 but not to the company mailroom, where employees are
 wearing masks to guard against biological attacks.

 "Right now," Mr. Blanco said, "I am just in the stockroom
 doing light work."

 At the Centers for Disease Control in Atlanta, scientists
 have learned a good deal about anthrax just from studying
 the blood of Mr. Blanco and the others. They were surprised
 to discover, for example, that patients with inhalation
 anthrax, in which spores are inhaled into the lungs,
 produce a much stronger immune response than those infected
 with the cutaneous, or skin, form of the disease.

 "The cutaneous form of anthrax," Dr. Perkins said, "is a
 very substantial skin infection, and we would have expected
 a similar immune response."

 The specimens have also helped the agency verify that the
 blood test that it used to diagnose anthrax was reliable.
 Dr. Perkins said the government hoped to use the survivors'
 blood to help develop an improved vaccine.

 Understanding the lingering symptoms, however, will be a
 challenge, experts said. Because there are so few
 survivors, it will be difficult to draw conclusions and
 establish patterns.

 Nonetheless, Dr. Thomas V. Inglesby, deputy director of the
 Johns Hopkins Center for Civilian Biodefense Strategies,
 said it was essential for scientists to try - not only to
 ease the patients' suffering, but also to improve the
 public health response to a biological attack.

 "What is it about their infection, their hospitalization,
 their immune responses?" Dr. Inglesby asked. "What about
 these things made them survivors?"

 That is a question that the survivors still ask
 themselves.