The WTC ‘Cough’?

by Howard Fienberg
April 15, 2002

When the World Trade Centers came crashing down, the casualties and the impact were obvious. But you may have heard of a threat to New York City which some worry could be much more insidious the so-called World Trade Center cough.


According to MSNBC’s Francesca Lyman (Mar. 11), “Just as people once traded tragic stories about lives lost in the terror attacks ... New Yorkers now circulate stories about people whose health has been injured in the line of duty.” Estimates of the number of people suffering from the WTC cough vary dramatically, because they are based on anecdotal evidence. Some sources gauge only a few hundred cases, but the Uniformed Firefighters Association thinks about 3,000 of its members suffer from it and the National Resources Defense Council believes there are at least 10,000 cases.


The implications are pretty big. A new bill in the New York State legislature proposes to extend workers compensation benefits to rescue and recovery personnel at the trade center for “exposure-related illnesses” (AP, Apr. 7). Those illnesses will presumably encompass the WTC cough. Meanwhile, 1300 people gave notice in early February that they may sue New York City for as much as $7.8 billion “over the aftermath of the WTC attack.” And the Federal Emergency Management Agency is both coordinating the professional cleanup of Manhattan buildings and footing the bill (at a projected cost of $12 million).


Politicians, activists and lawyers have identified a WTC cough. It envelopes a vague collection of symptoms and ailments, including colds, asthma, nosebleed, headache, sinus infection, pneumonia, bronchitis, nasal congestion, diminished lung capacity, hoarseness of voice, chest tightness, flu and, of course, coughing.


Are all these ailments connected? If so, what could have caused them?


Toxic culprits?


Many environmental health researchers have fingered the release of toxic pollutants on September 11 as the cause of the WTC cough. The mix of dust, melting steel, jet fuel, asbestos and dozens of other chemicals spread around Manhattan, often in huge plumes which took days to dissipate. The EPA claimed to have tested the air and told residents it was safe to breathe.


But independent tests, and there are lots of them, have found elevated levels of all kinds of substances in and around lower Manhattan, ranging from fiberglass to PCBs. Dozens of private firms have run tests for pollutants, but the results are usually controversial. There are many methods of testing for each pollutant and getting folks to agree on one can be difficult, if not impossible. Many of the testing methods used are either not acknowledged or not understood by federal scientists.


University of California at Davis professor Thomas Cahill was one of the first researchers to go public with his test results. He claimed to have analyzed the air pollution at ground zero and found lots of ultra-fine particulate matter. Cahill told New York Congressman Jerold Nadlers hearing in February that the EPA had the technology and resources to do the same tests but chose not to do so.


Indeed, tests with wickedly high levels of sensitivity can detect such ultra-fine particles (.001 inches in diameter, according to the AP), but the higher the sensitivity, the higher the chances for false positives (the Mar. 18 column “Mexican Jumping Genes" illustrates the perils in false positives). That may be the reason that the EPA chose not to run those kind of tests.


Regardless, scientists are not even certain that a lot of these substances, even in large doses, can have a negative health impact. The presumed minimal exposure over a short period of time makes it unlikely there will be any noticeable health effects that can be tied to the substances themselves.


The USA Today (Feb. 7) quotes Manhattan resident Dennis Gault, who worries that, for a 3-year-old, there are no safe levels of toxins. Most scientists, who deliberately set safety limits for toxic exposure levels lower than doses at which any health effects could be detected, do not share Gaults opinion. While the many different tests that found elevated levels of some substances may be cause for concern, they should not necessarily scare the bejeebers out of Manhattanites, even their children.


Still, some scientists believe that the scientific understanding of safe levels for individual toxins may overlook the possibility that, taken together, they may combine synergistically, creating unsafe effects far in excess of their simple addition. This precise argument was invoked in some media coverage, raising fears that although the toxic exposure at ground zero may have been minute, the combination of substances might cause adverse health effects.


However, the best known example of synergistic effects, involving endocrine disrupting chemicals, turned out to be based on a study so pathetic that it could not be replicated. The study’s authors eventually retracted it.


Environmental Health Studies


There is no obvious shortage of people researching the possible health impacts at ground zero. The Mount Sinai School of Medicine is monitoring pregnant women for possible exposure outcomes. The fire department is monitoring all of its potentially exposed emergency personnel.


Queens College doctors are trying to study all of the day laborers that helped with the clean up at ground zero. The College’s Dr. Steven Markowitz ran a mobile van offering health care to day laborers and was surprised by how many people flocked to us for free medical advice, many of whom were sick months after having stopped cleanup work (MSNBC, Mar. 11).


Unfortunately, this should have come as no surprise to the doctor. Workers on the low end of the socioeconomic pole are unlikely to have medical insurance or receive regular health examinations and are prone to poor diet and exercise. Day laborers are strong candidates for health problems anywhere, not just in Manhattan, inevitably skewing the results of any study.


The New York Academy of Medicine is trying to build a registry of everyone who worked for even a moment at ground zero. That would make the environmental health studies significantly more accurate.


Even so, all the studies will be confounded by the city’s demographics, which mix residents, tourists and commuting office workers. Many of them no longer live or work there. Because we lack reasonable data about the number of people exposed, epidemiological estimates based on these studies will be weak at best. There will be no way to accurately derive a sample of the 9-11 population.


Could Something Else Be Causing the WTC Cough?


Experienced emergency workers have pointed out that the WTC, despite its frightening scale, did not differ all that much from other disaster scenes, like Oklahoma City. Despite the myriad of tests and studies under way, there are other possible explanations for the WTC cough than toxic exposure.


Kerry Kelly, chief medical officer of the NYCFD, told the Washington Post (Feb. 12) that the number of firefighters who have taken medical leave because of stress and respiratory problems had doubled since 9-11. But perhaps this should not have surprised the Post. Menlo Park Deputy Fire Chief Ed Greene, whose force sent many volunteers to ground zero, told the San Francisco Chronicle (Dec. 25), “Its not unusual for firefighters to come back from an operation with colds or other ailments, especially after a lengthy, exhausting deployment that batters the immune system.”


Presuming that we can even lump together all those disparate symptoms and illnesses under one simple rubric, what could have brought on the WTC cough? Stress, fatigue, seasonal allergies and seasonal illnesses are all likely candidates. Exposure to any kind of dust, toxic or not, is bound to aggravate any of the above ailments, but not necessarily to cause them.


Science Trumps Politics

Media coverage of the WTC cough has mostly focused on political stories: an alleged EPA cover-up; officials so eager to reopen Manhattan for business that they sounded the all-clear without sufficient evidence; and legislative and courtroom jostling for money. Scientific and medical issues have only been raised to color the political narratives. Approaching from the other direction science, first -- makes the stories much more accurate. Although, perhaps they are less exciting.   

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