Tracing Lung Ailments That Rose With 9/11

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Tracing Lung Ailments That Rose With 9/11 Dust

Angel Franco/The New York Times

http://www.nytimes.com/2006/05/13/nyregion/13symptoms.html?

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Some of the people working in the cleanup and recovery effort after

Sept. 11 wore masks, but the most effective ones were effective for

no more than 20 minutes.

By ANTHONY DePALMA

Published: May 13, 2006

As they push their investigation into the health risks to workers in

the recovery and cleanup operations at ground zero, medical

detectives are focusing on a group of lung diseases that can lead to

long-term disabilities and, in some cases, death.

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Angel Franco/The New York Times

and ph Zadroga console each other at the funeral of their

son, Detective Zadroga, in January. His death was the first to

be officially linked by an autopsy report to exposure to the ground

zero dust,

After nearly five years, it is still too early for these doctors,

scientists and forensic pathologists to say with certainty whether

any long-term cancer threat came with exposure to the toxic cloud

unleashed by the trade center collapse. But there are already clear

signs that the dust, smoke and ash that responders breathed in have

led to an increase in diseases that scar the lungs and reduce their

capacity to take in and let out air.

The Fire Department tracked a startling increase in cases of a

particular lung scarring disease, known as sarcoidosis, among

firefighters, which rose to five times the expected rate in the two

years after Sept. 11. Though that rate has declined, doctors worry

that the disease may be lurking in other firefighters. Experts who

regularly see workers who were at ground zero in the 48 hours after

the towers' collapse expect monitoring to show many more cases of

lung- scarring disorders among that group.

New evidence also suggests that workers who arrived later or worked

on the periphery may also be susceptible to debilitating lung

ailments.

" We have thousands of people who were down there with unprotected

exposures, " said Dr. M. Levin, a director of the World Trade

Center Worker and Volunteer Medical Screening Program. " Many will

develop asthma and a few will develop this terrible lung scarring

that leads to disability or death. "

But even in diseases closely related to dust, making a binding

connection to ground zero exposure is hard. For instance, the Fire

Department has linked sarcoidosis to working at the trade center

site, while the Police Department has not.

The clues that led to this new area of medical investigation were

stark reminders of what was lost on Sept. 11. They are drawn from

cases of statistically unexpected respiratory disease among young

responders.

The ailments now seen are far more serious than the general hacking

and congestion known as " World Trade Center cough " that initially

hit most responders. Rather, these are a set of diseases and

disorders that typically take a few years to develop, and in some

cases get progressively worse.

The most worrisome to medical experts are granulomatous pulmonary

diseases, which show a particular type of swirling marks left on the

lungs by foreign matter like dust. Doctors say the severity of the

disease is often dictated by a patient's genetic makeup. The

diseases include pulmonary fibrosis and sarcoidosis, a sometimes

fatal disorder that can be set off when exposure to dust causes the

body's immune system to attack itself.

Some people can live with the scarring if they limit their

activities, but in others the exposure to foreign material sets off

a cascade of ailments that can lead to more debilitating conditions

and, eventually, death. Detective Zadroga, 34, died in January

when his badly scarred lungs weakened and his heart gave out. The

coroner's report gave the cause of death as " granulomatous

pneumonitis, " and the autopsy found swirls throughout his lungs

caused by foreign material consistent with dust.

Detective Zadroga's death was the first to be officially linked by

an autopsy report to exposure to the ground zero dust, although the

electronmicroscope comparisons that could have proved the match

beyond a reasonable doubt were not done by the coroner's office.

The Uniformed Firefighters Association earlier this year linked the

deaths of two firefighters and a battalion chief — from lung disease

and respiratory ailments — to the air at ground zero, although the

Fire Department itself has not formally acknowledged that those

deaths were connected to ground zero work. And three young emergency

medical technicians who worked in the dust and smoke at ground zero

have died from pulmonary diseases and coronary problems aggravated

by their battered lungs, according to the union that represented

them.

The use of respirators and dust masks might have reduced the

incidence of respiratory ailments, but the most effective ones

issued to firefighters are meant to last only 20 minutes. Other

responders and volunteers who arrived after the first two days did

not use dust masks at all or were only given paper masks, an issue

raised in a pending class-action suit against the city and private

companies involved in the cleanup.

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/The New York Times

Officer J. Godbee Jr., who died in 2004, had scarred lungs.

Although the reported cases of lung disease affect a tiny portion of

the 40,000 people who responded to the trade center collapse, they

have already caused widespread concern among the survivors, lending

urgency to medical efforts to understand the risks and illnesses

involved.

" When these cases come to public attention, every individual down

there who has some problem breathing thinks, 'I'm next,' " said Dr.

Levin, a professor at Mount Sinai School of Medicine.

Dr. Levin's screening program offers the most complete picture of

the health consequences of Sept. 11, apart from statistics

maintained by the Fire Department on the firefighters. Nearly 12,000

union employees and other workers who were exposed to the trade

center dust and debris have been examined.

Dr. Levin said that more than 60 percent of those people developed

respiratory problems like sinusitis. He said continued monitoring

was beginning to suggest that more serious lung problems might

follow; he will complete a new epidemiological study of responders

in a few months.

In testimony before a Congressional committee in February, Dr. Kerry

J. , chief medical officer of the Fire Department, outlined the

department's concerns about lung diseases. She said one responder

awaiting a lung transplant had died of pulmonary fibrosis. And the

department was alarmed to find that 20 firefighters had come down

with sarcoidosis in the first two years after Sept. 11, " a

substantial increase from prior years " that was believed to be

linked to " massive dust inhalation " at ground zero.

The high rate, five times the expected level, has since returned to

the expected range — a clear sign, doctors say, of a link to Sept.

11. But there is still cause for concern. The disease may take

longer to develop in some people than others, doctors said, just as

certain groups — including Northern Europeans and African-Americans —

have been shown to have a higher incidence of sarcoidosis than the

general population.

Medical experts say that proving that exposure to a known toxin

caused an illness is notoriously difficult, even in situations where

the hazards are as obvious as the thunderhead of dust and smoke that

rolled through Lower Manhattan on Sept. 11 and lingered over the

rubble pile for weeks.

In some cases, making such links causes so much discord that

government agencies have come to conflicting conclusions, extending

the misery of those involved.

For example, firefighters who have developed sarcoidosis since Sept.

11 are thought to have contracted the disease because of their work

at ground zero. Yet the Police Pension Board has ruled that working

at ground zero did not cause the death of a police officer who

developed the disease.

" This rift between the Police and Fire Departments is ridiculous, "

said Haskett-Godbee, whose husband, Police Officer J.

Godbee Jr., died in December 2004. She said that Officer Godbee, who

had worked at or near ground zero for more than 850 hours, suddenly

developed a hacking cough and grew progressively weaker, although he

had to keep working.

After his lung collapsed in March 2004, Officer Godbee, a former

marine and 19-year police veteran, grew frail and listless. In the

weeks before he died, he could barely get out of an easy chair at

his Stuyvesant Town apartment, Mrs. Godbee said.

The autopsy done by the New York medical examiner's office found

that Officer Godbee's lungs were pitted with the blisters and scars

caused by sarcoidosis.

Despite the Fire Department's well-researched information on

sarcoidosis, the Police Pension Board last June denied Mrs. Godbee's

application for a line-of-duty death benefit, which would have

provided her widow's benefits — equal to half her husband's annual

salary — every year for the rest of her life. The board said that

sarcoidosis is " not known to be related to employment in the police

force. "

Mrs. Godbee said her husband worked multiple shifts over several

months in the area below Canal Street that was clouded in dust from

the collapsed buildings. He often came home with the stench on his

clothes, and he was never given anything but a paper mask for

protection.

" There's no way you can't get sick after smelling all that dust and

dirt, " said Mrs. Godbee, a school guidance counselor.

Her lawyer, Rudden, is trying to force the Fire

Department to open the medical records of the firefighters with

sarcoidosis, in the belief that such information would strengthen

Mrs. Godbee's legal challenge of the pension board decision.

T. Murray, general counsel of the Patrolmen's Benevolent

Association, said he expected the appeal to succeed because " the

government can't treat two similarly positioned people differently. "

J. Browne, a police spokesman, did not defend the board's

decision, but he said police officers were usually not exposed to

the same smoke and dust as firefighters. He said it was the board,

which includes medical experts, and not the department that made

pension decisions.