Public Health: What's Next?

Every day in the aftermath of the World Trade Center attacks my colleagues and I have been asked about possible short- and long-term health threats. As people resumed life in the area, we tried to give them very specific advice that would empower them to take action to protect their families.

At the site itself, a major threat to the health of blue-collar and rescue workers—the group clearly at greatest risk—was the hundreds of tons of asbestos that were blasted free in the north tower's collapse and collected in the dust and debris. Air samples have shown that levels of airborne asbestos fibers have been generally below OSHA standards. Bulk samples of dust at the site, however, showed concentrations of asbestos ranging as high as 20%. During recovery work, there was the constant threat of a puff of asbestos being thrown into the air and inhaled. Without correct use of respirators, the long-term health risks of those exposures include lung cancer. Other risks, from inhaling smoke particles and dust, include persistent airways disease and asthma.

Although levels of airborne asbestos and other toxins in the surrounding neighborhood are generally low, the young population is particularly vulnerable. Approximately 48,000 children under 19 reside in lower Manhattan, and 3,000 of them live within a half-mile radius of the center of the disaster. The need exists to take aggressive steps to minimize pediatric exposure and also to create a registry of children of all ages who have been potentially exposed to dust. This includes children in utero: Researchers at the Columbia University Center for Children's Health and the Mount Sinai School of Medicine have been registering women who were pregnant, and in or near the WTC, at the time of the attacks.

For people reoccupying contaminated apartments and offices, risks appear potentially serious, unless those buildings are properly cleaned by licensed professional services. Cleaners should use HEPA vacuums (see page 7), and damp mops or cloths, and wear N-100 or P-100 disposable respirators. Air ducts, too, need to be cleaned, and filters changed. On the morning of September 11, many alert maintenance staff rapidly shut down their buildings- air-intake systems, keeping out much of the dust. All staff in buildings with central air should be trained to do this against the event of future toxic or biological releases.

Concern has existed since the earliest moments that the attacks might be the precursors of chemical or biological warfare. While health officials' efforts undoubtedly contributed to early detection of the anthrax cases, they also underscored several systemic weaknesses. We need to strengthen programs for disease tracking, establish training programs for doctors, nurses and other health providers, and provide hospitals with the resources and materials needed to develop response plans.

Many questions remain. The urgent need now is to invest in public-health preparedness, and start the studies and registries that will enable us to give evidence-based answers.

Dr. Landrigan is Director of the Center for Children's Health and the Environment and the Center for Occupational Medicine at Mount Sinai School of Medicine in NYC. For more about children's environmental health, visit www.childenvironment.org, www.healthy-kids.com.