A Conversation About Health Concerns After 9/11

Gotham Gazette: Welcome everyone, and thanks for coming. Today we are talking about health concerns after September 11 with Dr. Jack Caravanos and Dr. Lung Chi Chen . Good afternoon, Dr. Caravanos and Dr. Chen.

Dr. Jack Caravanos: Good afternoon and thank you for the invitation to participate.

Dr. Lung Chi Chen: Hello. Thank you for inviting me to participate in this discussion.

GG: Dr. Chen, what is your scientific specialty and how did you get involved in assessing the health impact on lower Manhattan of September 11?

Dr. Chen: I am an inhalation toxicologist in training. New York University has been very active in the research into the health impact of WTC collapse. We have collected settled dust samples in the first few days after the collapse and also set up air quality monitoring at NYU downtown hospital from 9/14 to the end of 2001. We have been busy characterizing these samples.

Dr. Caravanos: I'm a Professor of Environmental Health at Hunter College coordinating a WTC study on personal exposures to dust and volatile organic chemicals. We are using new state of the art samplers that will hopefully make this type of monitoring simpler and therefore more prevalent.

GG: Peter H. Boyd asks, "What are the preliminary estimates of the extent and severity of health problems caused by WTC air pollution?"

Dr. Caravanos: This is the most important question but we're still in the investigatory phase. However, I suspect we will see adverse respiratory outcomes dominate.

Dr. Chen: We are in the process of getting an epidemiological study to investigate whether the residents in lower Manhattan have increased asthmatic like symptoms. The study is ongoing.

GG: The questioner asked if there were any preliminary estimates. Do you have anything preliminary to report?

Dr. Chen: From the characteristics of settled dusts, I do not believe that we will see a large increase in asthmatic like symptoms. However, these symptoms may occur in certain people that are more sensitive to these insults than others. We will know when we get the results.

Dr. Chen: We can also get some ideas whether we will see an increase by the adverse effects we have seen in studies investigating the changes in firemen and other rescue workers. These studies have shown that only a small percentage of the people developed adverse effects. Their exposures were considerably higher than residents, therefore we should see even smaller percentage of the residents would have these adverse effects.

Dr. Caravanos: Unfortunately, we still have not received air level data (dust and organic chemicals) from the laboratory yet. Probably in the next 3 months.

GG: The deadline is December 28th for residents of lower Manhattan to apply to the Environmental Protection Agency for free testing and, if necessary, cleaning up of their apartments. Isn't it awfully late to be cleaning up your apartment if you've been living there for a year now? Has the damage already been done?

Dr. Caravanos: The dust released and distributed is extremely fine and pervasive. I would absolutely encourage any resident living in the impact zone to take advantage of this offer. I realize there is some mistrust. However, the testing is done according to a scientifically validated protocol and I personally trust it. This is also a psychological issue here. Knowing your apartment was tested and professionally cleaned can only instill security and comfort.

GG: Mayor Bloomberg today unveiled an ambitious new plan for lower Manhattan, which includes the construction of 10,000 new apartments. Is there any lingering threat to public health which raises concerns over this new construction?

Dr. Chen: New construction would bring in lots of traffic in the area. This traffic would produce air pollution that maybe undesirable. The lingering effects of World Trade Center dusts would be much less than those produced by these diesel trucks.

Dr. Caravanos: I always said that the clean-up may possibly have created additional hazards. At one time there were 37 cranes operating twenty-four hours, seven days a week. The diesel emissions alone were quite extensive. Therefore the reconstruction will absolutely have a negative environmental impact on the community (air quality at least). I would encourage close monitoring of this effort.

GG: What can residents do about that?

Dr. Chen: They can demand that the diesel trucks and construction equipment use very clean diesel fuels. For example, low sulfur fuels, which produce less pollution.

Dr. Caravanos: Any reconstruction plan should have a well designed environmental monitoring component with a community outreach effort. I'm concerned about the long reconstruction effort. Exposure could be for years. The residents downtown must not be made to suffer additional inconvienances and possibly harm.

GG: Has this suffering made the residents more susceptible than residents would normally be in this kind of large construction project?

Dr. Caravanos: Yes, I think it does put them at increased risk.

GG: How so?

Dr. Caravanos: The area is extremely congested both in terms of building densities and reconstruction activities. The large number of closely spaced construction projects, traffic and population densities is unlike any ever encountered.

GG: Dr. Chen, some of your work has focused on the "World Trade Center cough," an ailment suffered by over 300 firefighters and rescue workers. What exactly is this condition -- how is it different from a "normal" cough -- and what, in your opinion, is the cause?

Dr. Chen: The cough itself is not much different than "normal" cough. It is the result of inhaling very large, alkaline particles at very high concentration. These large particles are mainly lodged on the upper airways (throat and trachea). The body's natural defense is to cough it out. It should only occur when the dusts concentrations were high.

GG: Could one exposure to dust during the World Trade Center collapse cause permanent damage?

Dr. Chen: We don't know. It is unlikely, as I said before, except for those sensitive individuals. But the results of the firemen's study may require additional investigation.

Dr. Caravanos: While not a respiratory specialist, I believe such an exposure, may produce or activate RADs (reactive airway disorder).

GG: What is reactive airway disorder, briefly?

Dr. Chen: The airways become more twitchy in response to a low concentration of irritants, such as pollens, dusts, etc.

GG: What can or should be done about it?

Dr. Chen: Anyone who suspects they have more "twitchy" airways should consult their doctors.

Dr. Caravanos: My strong recommendation is to go directly to a pulmonary specialist with experience in identifying pneumoconiosis (dust disease).

Dr. Chen: An inhaled broncho dilator usually works very well in reducing the symptoms.

GG: Melissa asks, "What are the long-term health risks for young people in the schools downtown, such as Stuyvesant High School, who were exposed over the last 14 months to air-borne contaminants like asbestos that were tracked into their school by rescue workers and passed throughout the school by the ventilation system. How high is the risk for these young people and what does it mean for their health in the future? Should their parents be worried? What about students who smoke?"

Dr. Caravanos: Lets start at the end of your question first. It's widely known and agreed that the risk of smoking is orders of magnitude greater than city exposure to asbestos. My true belief is that given the relatively short exposure period AND relatively low levels, the exposure would not be measureable.

Dr. Chen: I agree. The concentrations of asbestos in the studies that showed adverse effects were orders of magnitude higher than that found in the school last year.

Dr. Caravanos: I would demand that Stuyvesant be monitored continously for several years. For example, dust wipe testing and some air testing.

GG: Marilyn Gaull asks, "I am among the many residents (as opposed to the uniformed personnel and the rescue volunteers) who are deeply offended by this research--as well as several other projects in which we have been asked to answer questionnaires about trauma. Many of us have severe problems: we inhaled at the time and for some months thereafter toxic fumes, human ashes, contamination of all sorts, which we were assured did not exist. Why don't you stop wasting our money on this research and start finding all those people who are sick, and depressed, and unable even to reach out for help or unable to find people who are capable of helping?"

Dr. Caravanos: Well said and I believe the New York City Department Of Health should be more active in this effort.

Dr. Chen: The Federal Emergency Management Agency, or city and state government should help these people, not the researchers.

Dr. Caravanos: The city Department Of Health is assembling a registry of "damaged" persons. However, they (to my knowledge) have not extended neighborhood walk-in clinics for the affected population.

GG: It seems she was asking was why the money should be spent on resesarch. Why is research so important?

Dr. Chen: The funds we received for our research are very modest. We actually had to use our own resources for the investigation, particularly in the first few days.

GG: RBrooke asks, "Emergency personnel and residents have been tested. Have you reached out to the volunteers who worked in the area and tested them as well?"

Dr. Chen: We have advertised in the area before. The response rate is very low.

Dr. Caravanos: No, I did not. However, I believe Mount Sinai Hospital received a sizable award for medical screenings for ANY worker who essentially worked during the first few months. I believe it's Dr. Coluccio at Mount Sinai Hospital doing the preparatory work.

GG: Have the government agencies in charge of health and environment issues (i.e. the city’s Department of Health, the federal Environmental Protection Agency) been helpful in your research?

Dr. Chen: Dr. Reibman, my collaborator in our study, is working with Department of Health in the resident health questionaire study.

Dr. Caravanos: Unfortunately, neither Department of Environmental Protection or Environmental Protection Agency or Department of Health are involved or even knowledgeable. I think this reveals a problem, eh?

GG: Margaret Pas says, "I am the Manager of Adult Services at the Brooklyn Public Library. I am always interested in finding ways to help provide important information to our patrons. Is there information on post 9/11 health concerns, i.e., online resources, pamphlets, etc. that we can highlight or provide to Brooklynites and other New York residents through the Library?"

Dr. Caravanos: I believe Dr. Chen can speak to New York University's effort to maintain a clearinghouse on this exact topic.

Dr. Chen: We have a web site that contains information on our research.

GG: Thanks for dropping by our live chat today. Thank you very much, Dr. Caravanos and Dr. Chen.

Dr. Chen: Thank you.

Dr. Caravanos: Thank you.