Examining 'World Trade Center Cough'

Researchers are examinging respiratory illnesses among some of the first responders to the World Trade Center catastrophe. Scientists are looking at the effects of the dust from the collapsing, burning buildings, and how that dust may have interacted with an enzyme deficiency in some of the rescue workers to produce what has come to be known as the "World Trade Center Cough.'

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IRA FLATOW, host:

You're listening to TALK OF THE NATION: SCIENCE FRIDAY. I'm Ira Flatow.

This - I want to change gears now and talk about the World Trade Center. Because remember when the towers of the World Trade Center fell in downtown New York 5 years ago, a dense cloud of dust and ash filled the streets over lower Manhattan. Tens of thousands of people in the area, including local residents, firefighters, other emergency workers were inundated and some were overcome.

Recent medical studies suggest that the thick dust was anything but innocuous. The journal Environmental Health Perspectives, put out by the National Institutes of Health, recently published a comprehensive report on the health of emergency workers who went to Ground Zero. And the researchers found that almost three quarters of the workers at that site had new or persistent respiratory problems since 9/11.

Here to talk about their findings and what doctors are learning about the effects of the dust cloud is Dr. Jacqueline Moline, principal investigator of the World Trade Center Medical Monitoring Program at Mt. Sinai School of Medicine. Welcome to the program, Dr. Moline.

Dr. JACQUELINE MOLINE (Principal Investigator, World Trade Center Medical Monitoring Program, Mt. Sinai School of Medicine): Good afternoon.

FLATOW: Can you give us a little thumbnail of what you found in that study?

Dr. MOLINE: Sure. These are people that were seen from July 2002 to April 2004 in our programs. And what we saw is that people had significant upper and lower respiratory problems that started while they were working at the site and persisted up to the time that they were seen. The vast majority of people developed a symptom, as you mentioned, some type of symptom and often more than one symptom. And for most of these people, they still had symptoms at the time of their evaluation, which might have been up to 30 months after the event.

So we know that a large majority of the people that worked down there. And these are - the people in our study were rescue workers and volunteers, people who were at the site, at the (unintelligible) landfill where the debris was brought. So these are people who worked nearby; not nearby office workers but working on the site itself. They were significantly affected. Their health was affected in the immediate period afterwards, and for many it lingered on for years.

FLATOW: How many people are we talking about here?

Dr. MOLINE: Well, in our study we report on close 10,000. We've seen - today, the program has continued on and we're still seeing new patients. Today, we've seen about 18,000 individuals in our program. But the Fire Department of New York has a sister program, and they've seen about 14,000 or 15,000 people.

So we've seen well over 30,000 patients, and we continue to see similar findings. There are also many others who were affected who haven't joined our programs and others who wouldn't be eligible just because they weren't rescue workers and volunteers but may have had similar exposures. So we're talking about thousand upon thousands of people.

FLATOW: Has this - the illnesses, they're mostly respiratory illnesses, correct?

Dr. MOLINE: Well, we're reporting on the physical health findings, so the most striking findings are the respiratory. We also have a number of people who have - and it usually goes hand and hand with the respiratory - but they have persisted problems with the gastro esophageal reflux disease, persistent in severe indigestion that has lingered on. There's also a mental health component that isn't mentioned in our paper that will be the subject of other publications that will be coming out shortly. But we know that many of the individuals in our programs have been adversely affected from the mental health standpoint by their work down there.

FLATOW: And there was something I understand that was a persistent cough that was termed the World Trade Center cough.

Dr. MOLINE: Well, Dr. David Prezant, who's the chief medical officer for the Fire Department of New York, coined the phrase World Trade Center cough very early on. And he has got a strict definition that mandate you had a cough significant enough that lasted for 4 weeks and that requires you to be off work.

Patients all called the cough that they developed at the World Trade Center site the World Trade Center cough. And my colleagues and I used to say that we always knew who worked at the World Trade Center in our waiting room because these were the people who had the dry hacking cough that just wouldn't go away.

So there was a cough that so many of our patients developed. It went away for some people, but many of them still have it.

FLATOW: Would you not expect that people working for days, weeks, months, years at the site would develop something from the fumes that were given off?

Dr. MOLINE: Well, when you think back and you about the toxic mix that they were exposed to. First of all, the sheer of volume that they were exposed to in the early days, weeks and even months down there. And, you know, it isn't just the first day or when during the tower collapsed. Certainly, and our data shows that if you were there the first day, you were more likely to have symptoms but you were also likely to have symptoms if you started working there 3 weeks later. Because it was such a large debris pile, and there were often pockets were there was undisturbed debris. And if someone would walk in there or work in that area, then that would bring it all back up, and so the exposures continued for many months.

Knowing what was in the mix and the alkalinity - it was very alkaline. It was -pH was 10, 11, similar to Drano - very, very irritating. It's not surprising that people developed health effects. Also the sheer volume of the particles, the number of particles in the glass fibers and all the other constituents of the building collapse. It's not surprising people had immediate health effects.

I think that it is a little disturbing that many of these health effects have continued to linger in such a large proportion of patients.

FLATOW: Yeah, and that's what the study does document also, how over the years it has lingered and perhaps gotten worse.

Dr. MOLINE: It has. You know, some people have gotten better, and I don't want to make it appear as if no one has gotten better, because certainly some patients have gotten better. But there is a large number of patients who continue to be symptomatic. Then there's also a lot of patients who do okay as long as they take their five medicines a day, when they didn't have to take anything stronger than an aspirin every so often in order to maintain their health. And there are some people that have just not gotten been better and are disabled as a result of their exposures.

FLATOW: You said you'd be reporting on it a little bit later, but maybe you can share some of the preliminary findings about the mental health problems that you're coming up with.

Dr. MOLINE: Well, we know the most common mental health problems that we've seen in our responders have been problems with post-traumatic stress disorder, anxiety and depression and substance abuse, and these are things that are typically seen after major disasters.

I think - excuse me - for the people who worked at the World Trade Center site, you know, you had first responders there who may not have been what we consider our traditional first responders - firefighters, police officers, EMTs. They all have some aspect of training.

No one was trained for the scope of this disaster. But you also had first responders who were construction workers, who were people restoring essential services, and some of the things that they saw down there in the days, weeks, months that followed just are too horrific to fathom for us, and many of them, just, you know, it's hard to process.

You know, it didn't just go away. We know that over 3,000 body parts were found in May - in March, 2002, for example, so it just, it continued. These exposures continued for many, many people. So those are the main categories of diseases that we've seen in our patients.

FLATOW: Will the - and you know, we heard just this last week there were another hundred body parts or more that continue to be discovered.

Dr. MOLINE: Yeah...

FLATOW: Would survivors or families or relatives be included in any sort of mental health study?

Dr. MOLINE: There are some studies that are ongoing of the survivors, people who were the evacuees. There are some federally funded studies for evacuees. There's also been some studies of family members of survivors. Some, I believe, have been carried out at my colleagues at Mount Sinai. There have been others carried out by other investigators in the metropolitan area, in the New York metropolitan area as well. Certainly we would hope that help would be available for these people.

FLATOW: Talking with Dr. Jacqueline Moline, a principal investigator of the World Trade Center Medical Monitoring Program at Mount Sinai Hospital School of Medicine. Our number, 1-800-989-8255. Let's go to Joe in Lansing, Michigan. Hi, Joe.

JOE (Caller): Yeah, hi, Ira. Great program. I saw a television program on this as well, and boy, you know, from that program you get the - just a general disgust at the federal government, I mean from the EPA to the administration. What they've done to these first responders is a disgrace. You know, they have just let these people fall through the cracks and constantly said oh, no, no, we monitored this and we monitored that.

And you know, they even had several guys like your guest who's speaking, you know, healthy individuals that can't even walk up a flight of stairs now, you know, can't carrying their five-year-old kid around. And the federal government is just, they're not helping them. There's just a constant denial that these people need help, whether it's medical or financial assistance.

It's a shame. I just - it really just even, you know, it makes you even that much more depressed about what actually happened on 9/11, and our federal government would just let these people fall through the cracks. You know, one firefighters even said, yeah, you know, President Bush held up a shield of my buddy who died, and he should give that shield back because what he's done to these people, he doesn't deserve to have that shield.

FLATOW: Doctor...

JOE: What does that tell us about, you know, our society?

FLATOW: Dr. Moline, your reaction?

Dr. MOLINE: Well, Joe, thank you for those comments, and you know, we deal - we see these patients day in and day out and see how their lives have been affected, and in many cases they've lost their jobs because they're disabled, they've had difficulty paying their bills, their families may have disintegrated due to the stress. And certainly we need to do more for them as a society.

There is a small amount of money that's finally been appropriated for federal treatment - and it should be announced probably within the next couple days or so - that will be able to provide federal funds.

We've had philanthropic agencies help with treatment for these individuals, and the federal government is stepping up. The issue is, will they continue to step up to the plate? And we're very grateful that we're getting any money for treatment, but we need to make sure that it's more than just a one year infusion of cash and that - this is a national problem. We had people come from all over the country, and we were attacked as a nation. It wasn't just New York being attacked. And we had responders who went down and are heroes, trying to help those people, and we need to provide for their care, and we need to make sure that funds are available to care for these people, to help them get the care they need without worrying about bills and co-pays and is this treatment going to be approved or not, to just get them treated when they need to be treated.

And we need to make sure that there's adequate funding going forward in the future to do this.

FLATOW: They're like veterans.

Dr. MOLINE: They are veterans. They're veterans of a different kind of war, but we need to recognize that they do need - they do need ongoing care. They do need people who are specialized in that care and can provide it, who understand what they're going through, and we need to provide the best care we're able to do.

You know, we're very proud of the treatment programs that we set up at Mount Sinai and our partners at Stony Brook and UMD and the University of Medicine and Dentistry of New Jersey and Queens College in Bellevue. We all have programs that we're very proud of and the service that we've been able to provide to these heroes. And we really hope that we're able to continue this beyond the next year.

FLATOW: 1-800-989-8255 is our number. We're talking with Dr. Jacqueline Moline of Mount Sinai School of Medicine on TALK OF THE NATION: SCIENCE FRIDAY from NPR News.

Go to the phones to Cora in the Bay area - in the Bay are, in California. Hi, welcome to SCIENCE FRIDAY.

CORA (Caller): Yes, hello. My question has to do with whether the people who were working at Ground Zero used respirators. I understand that in the first couple of days after the attack, they might not have been available, but afterwards, was that kind of equipment standard and would that have affected what kind of symptoms people had afterwards?

Dr. MOLINE: Well, there were some respirators that were available. There were a couple problems. One, they weren't available in a systematic fashion in the early weeks. People didn't get trained on how to use them. And a lot of people had cartridge respirators that they didn't realize weren't one-use respirators, so they would toss them after they used them once.

A lot of the filters got clogged, and people didn't know how to change them, so they might have been using a respirator that was no longer effective. It was also very hard to communicate with a respirator, and the only way to communicate was by voice, so people had to take them off.

Overall, though, if respirators had been available, if people had been trained in how to use them and been given the proper respirators, then it is possible that we would see less disease now. I think that certainly, you know, we wish we could go back in time and say it should've, you know, this should've happened. And we can do that for the next disaster if one should occur. You know, hopefully, that won't be the case. But to make sure that people are properly trained and fitted to wear a respirator and know how to use it so that they can cut down on their respiratory inhalation.

FLATOW: Is this a lesson that has been learned?

Dr. MOLINE: I would hope so. I don't think it has. I think that it needs to be part - in the same way that we have push-packs for antibiotics in case of, you know, some major infectious disaster, we need to have push-packs of respirators that can be responsibly allocated to various sites, rapidly deployed.

But it isn't enough just to give someone a respirator. You need to show someone how to use it, and we need to make sure that there are people available to show people how to use these properly. It's the first line of defense, but if it's not used effectively, then it's no defense at all.

FLATOW: It's like CPR training. You have to teach people.

Dr. MOLINE: In essence, it is.

FLATOW: Do it the right way.

Dr. MOLINE: You know, if you have a beard, then a regular respirator isn't going to help you, because you're not going to get a tight seal.

FLATOW: I'm talking with Dr. Jacqueline Moline of Mount Sinai School of Medicine. Just a couple more minutes. Let's see if we can get another phone call in. Let's go to Everly in Burlington, North Carolina. Hi, quickly.

EVERLY (Caller): Hi, how you doing?

FLATOW: Yes.

EVERLY: Thanks for taking my call. My question is about if there have been any studies related to the exposure to asbestos, or if there will be any studies done about that. I will take the answer off the air. Thank you.

FLATOW: Thank you.

Dr. MOLINE: Well, in terms of asbestos, you know, certainly there have been hundreds of studies done about asbestos exposures over the years, many of which were done at Mount Sinai. In terms of the World Trade Center asbestos, you know, asbestos was part of the overall mix.

We know that health effects from asbestos don't show up immediately. Normally it takes a minimum of 10, but usually 15, 20, 30 years for any health effects related to asbestos to show up. But what you're asking raises a very important issue, which is that we have to be able to monitor the health of the people who worked at the site for years and decades to come, because many of the diseases that might result from the inhalation of toxic particles and fibers don't show up immediately. The body's response to these particles takes a long time to develop, and we'll see the disease years from now. But we need to make sure that we have the funds to be able to follow these people to see what, if anything, does develop.

I mean, one of our big concerns is that people will develop scarring lung diseases. It's just about the time we would expect them to start, you know, the four or five year mark, but we need to be able to follow them out in the future.

In terms of asbestos alone, you know, it wasn't a sole exposure. So people had multiple exposures. But we certainly would hope to look at that as one of the factors.

FLATOW: Well, thank you very much, Dr. Moline, for joining us today.

Dr. MOLINE: My pleasure.

FLATOW: And have a good weekend.

Dr. MOLINE: Thank you.

FLATOW: Dr. Jacqueline Moline is principal investigator of the World Trade Center Medical Monitoring Program at Mount Sinai's School of Medicine here in New York.

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