Are We Ready?: Public Health since 9/11

Introduction: Remembering the Moment

INTRODUCTION Remembering the Moment . 1 How can we understand the emotionally charged events surrounding September 11, 2001? How can we begin to comprehend the impact on our psyches, our institutions, and our people of the World Trade Center collapse, the attack on the Pentagon, and the crash of a jetliner in the fields of Pennsylvania? To what extent have these events permanently altered the political, cultural, and organizational life of the country? To what extent is the nation better prepared to withstand another potentially devastating attack? To what extent are we better prepared to deal with possible chemical, biological, or radiological attacks? Half a decade after the events, we can begin both to evaluate the impact of 9/11 on the nation’s public health infrastructure and responses and to analyze the long-lasting, perhaps permanent, changes that have reshaped our public health system. How best can we capture the immediacy of the moments when the planes hit? Perhaps most poignant are the memories of one official who, ironically, was then about as far removed from New York City as possible . Richard Jackson, at the time the director of the Centers for Disease Control and Prevention’s National Center for Environmental Health, recalls that he had gone hiking as part of his annual vacation. On September 7 I went off to do my annual hike with my old med school roommates. . . . We were going to hike the Wind River wilderness in Montana. We started out in Green River lakes on about the 7th or 8th of September, and hiked up to about 11,000 feet, through the snow. . . . I’d left my pager and cell phone, because I figured, “Even if there’s a death in my family, I don’t want to know about it. I just need to go and be alone, just chill out.” I remember lying on a rock over an alpine meadow, and looking up at the sky—perfectly blue sky, and thinking, “God, I haven’t seen the sky without a jet contrail in it for years. This is really remote.”1 He had no idea that terrorist attacks had taken place until he was on his way out and “a backpacker coming in . . . told me that the World Trade Center had fallen down. I had family here in New York, including a couple of sisters. Obviously, I was very concerned about extended family. When I finally got out and was able to get to a pay phone that worked, my wife was frantic. I didn’t appreciate until I got home just how psychologically traumatized even someone . . . living in Atlanta was, watching these images on TV and then just how stressful it had been.” While Jackson was enjoying his vacation, back in Atlanta at the CDC months of preparation were being put to the test. He says, “By five minutes after the first plane hit, they had already begun to mobilize. . . . People obviously didn’t realize that this was a terrorist event for another twenty minutes or so, and when that began to dawn on people, the CDC headquarters were closed, and [soon] the CDC executive staff were moved out of the Clifton Road facility, and over to my center, which is about eight, ten miles away from the headquarters facility on a secure exnaval air station.” This emergency operations center was equipped “with TV screens and various clocks and very good and secure communications and the rest. . . . Barbed wires surround our laboratories and everything else.” After 9/11, points out Jeffrey Koplan, then the director of the Centers for Disease Control and Prevention, “for the first time in history the people at the CDC in Atlanta themselves felt vulnerable. . . . We had a walled fortress for an entrance and armed police patrolling the halls whereas prior to September 11 the police were unarmed.”2 Jackson later learned that “on the afternoon of the 11th, Jeff Koplan and the CDC leadership were there in my offices, looking out at the Peachtree DeKalb Airport. . . . It’s where all the corporate jets go in and out of, and we had a contract for the National Pharmaceutical Stockpile, to have a jet available if we needed it.” On September 11, 2001, the federal government activated the National Disaster Medical System and, over the course of the next two days, sent five teams of doctors, nurses, and emergency medical technicians to New York and four teams to the Pentagon; placed thirty-five CDC epidemiologists in hospitals in New...