Editor's note: In June 2002, we first reported on the health hazards following the September 11 tragedy. We reported that for months after the disaster, all Environmental Protection Agency reports to the media were screened by the National Security Council, which forced the EPA to omit tips on potential hazards from airborne dust containing asbestos, lead, glass fibers, and other contaminants.

CHI's special investigative report on the health fallout from the disaster included internal EPA memos and an interview with dissenting EPA asbestos expert Cate Jenkins, who did an independent analysis of air sampling commissioned by local officials. In June 2002, Jenkins told Consumer Health Interactive that the cleanup of buildings around ground zero was woefully "inadequate." A report released in 2006 confirmed that thousands of workers and volunteers around ground zero have ongoing lung problems.

The report shows that about 70 percent of nearly 10,000 rescue and recovery workers suffered new or worsened respiratory symptoms from exposures to caustic dust and toxic pollution. The study, led by Mount Sinai Medical Center in New York City, said that workers seen as recently as April 2004 continued to experience asthma, reactive airway disease, bronchitis, wheezing, chest tightness, and a persistent cough, which became known as the 'WTC cough.'

Remarkably, the emergency responders who were non-smokers were five times more likely than the general population to have abnormal lung capacity. Even more striking, the majority of workers who had had no respiratory symptoms for a year prior to 9/11 had continuing respiratory problems at their first exam, about 20 months after the disaster, according to the report in the September 6, 2006 issue of the online journal, Environmental Health Perspectives. Researchers stressed that the health of the heroic workers and volunteers should be monitored for decades to come.

The following is a reprint of our original investigation.

June 19, 2002 | The cleanup finally ended, just three weeks ago, with police and firefighters saluting a flag-draped girder, the last visible remnant of the World Trade Center to be hauled away. But what was invisible at Ground Zero continues to take its toll today.

Ask Frank Fraone how the cleanup affected his health, and the 41-year-old firefighter will tell you he used to be able to run a couple of miles and barely break a sweat. Now the smallest exertion takes the wind out of him. "I'll walk up a few flights of stairs and have to catch my breath at the top," he says.

Fraone lives a continent away near San Francisco, but he and a firefighters' emergency response task force based in northern California flew to New York just days after the September 11 attack. A division chief in the Menlo Park Fire Department, Fraone spent 12 grueling days supervising the recovery of bodies from the rubble. It was so dark under the smoky stew of asbestos, benzene from the jet fuel, and other burning chemicals that firefighters had to lay down a breadcrumb trail of light sticks to find their way back. Fraone guided 200 people in and out by radio. A respirator, he says, would have muffled his voice and only added to the confusion.

"I'm on inhalers and steroids, have constant soreness in my throat, and go into coughing spasms," Fraone says as he clears his throat, something he now must do continually. Medical tests revealed that Fraone's time at Ground Zero left him with diminished lung capacity and a constellation of respiratory symptoms so common there's a nickname for it: "the WTC cough."

Common symptoms of WTC illnesses include shortness of breath, frequent nosebleeds and skin rashes, wheezing, sinusitis, chest tightness, burning in the nose, throat, or lungs, as well as digestive problems, according to the Mount Sinai School of Medicine. Many people who already had asthma also suffered an upsurge in symptoms.

Thousands of others who responded to the attacks have the cough and the respiratory problems that go with it. No one is sure how many out-of-town firefighters are still suffering, but in New York, officials say that one-quarter of the city's 10,800 firefighters and emergency medical staffers have some form of illness related to the assault on the trade center. In addition, countless residents near Ground Zero have developed persistent respiratory illnesses and debilitating sensitivities to everyday chemicals that formerly affected them little, if at all.

Ariel Goodman, already afflicted with asthma, has an apartment opposite Ground Zero. She remembers watching as church volunteers cleaned her place last October. "Two hours into the cleanup I got dizzy. I had a real bad asthma attack and was sick for a week," says the 35-year-old financial consultant, who is living elsewhere until she's sure her apartment is safe. In the meantime, she says, "I feel dizzy and nauseous from diesel and bus fumes. They never bothered me before."

"I immediately react to smoke and any kind of strong smells," says Freed, who, on September 11, was close to finishing a 10-year term as a New York City councilwoman and spent day after day checking on constituents. "My nose, my throat, my lungs burn, I get heartburn, and I feel like I'm breathing dust."

She may be. After leaving Manhattan residents on their own for eight months, the Environmental Protection Agency announced in early May that residents could have their apartments tested and cleaned of dust and debris by calling a special hotline. The unprecedented program came about after the EPA was besieged by residents afraid that their homes were contaminated with asbestos or other life-threatening chemicals in dust that settled after the twin towers went down.

In fact, the dust and smoke from the numerous fires at Ground Zero formed a veritable cauldron of irritants and hazardous chemicals. Included in the long list were silica, gypsum, fiberglass, paper, polyvinyl chlorides, pulverized concrete, cancer-causing benzene, and asbestos. During the cleanup, due to the risk of exposure to contaminated dust, city health officials urged residents of lower Manhattan to use special vacuum cleaners and to wipe and remove their shoes and even "wet-wipe" pets' paws before entering their homes.

Many residents are particularly concerned about exposure to asbestos, a common insulating material that was widely used until many forms of it were banned in 1978. Breathing airborne asbestos can cause lung cancer and other life-threatening lung diseases. The 110-story World Trade Center towers were built in 1973.

In November and December 2001, the city tested 59 apartments in different parts of lower Manhattan and detected asbestos above background levels in 20 percent of the buildings, but only two outdoor samples were high enough to require cleanup, according to the New York City Department of Health. Fiberglass, which can cause a cough as well as eye, nose, skin, and throat irritation, turned up in nearly half the samples.

Now, so many months after the disaster, the EPA's offer to test and clean everyone's home upon request seems belated, according to the nonprofit New York Committee for Occupational Safety and Health (NYCOSH).

"It's a shame that these measures were not taken at a time when they could have prevented the heavy exposure to the toxic dust that covered lower Manhattan," says Joel Shufro, the executive director of NYCOSH.

The New York City Fire Department lost 343 members in the 9/11 attack, but still more firefighters fell ill during the cleanup. An estimated one-fourth of the firefighters and emergency personnel doing cleanup -- or about 2,700 people -- became sick after doing their duty at Ground Zero, according to the New York City Fire Department's most recent internal survey.

Dr. Kerry Kelly, the NYC Fire Department's chief medical officer, told members of Congress last February that 25 percent of the department was reporting shortness of breath on exertion. Medical leaves had jumped two-fold, Kelly added, attributing the increase to a rise in respiratory problems and post-traumatic stress.

The confidential medical record of one 40-year-old, 14-year veteran New York City firefighter is typical. "Future exposures to smoke, dust, noxious fumes and/or toxins may precipitate life-threatening bronchospasm, and /or may worsen the progression of his underlying disease," Kelly wrote in the man's record. The firefighter had exercised regularly and had never smoked or had any lung problems before 9/11.

Before the disaster, Freed says she never had allergies or difficulty breathing. But that suddenly changed. From September 11 until the end of January, she had nosebleeds every other day. Now she uses an inhaler twice in the morning and twice at night.

Physical ailments haven't been the only problems resulting from 9/11. Until very recently, Freed and her neighbors were under constant siege. Their 5,000-unit complex, five blocks north of where the World Trade Center towers stood, is right next to the barge on the Hudson River that hauled away all the WTC debris. Every day, 24 hours a day, diesel trucks dumped massive loads of concrete and steel, throwing up clouds of dust. The debris was then shoveled up by giant cranes and dropped with a thundering crash onto the barge. "Every time you hear it," Freed said while the cleanup was still under way, "it's like the planes hitting again."

There are still plenty of reminders near Ground Zero that keep bringing people back to those terrifying moments when two hijacked jet planes plowed into the towers and more than 3,000 people lost their lives.

A study of New York City residents two months after the attacks showed, not surprisingly, that many suffered from post-traumatic stress disorder (PTSD). The syndrome is characterized by acute anxiety following a traumatic event and may include flashbacks, sleep disturbances, and panic attacks.

Among 1,008 adults interviewed who live less than 7 miles from Ground Zero, 7.5 percent reported symptoms consistent with a diagnosis of post-traumatic stress disorder related to the attacks, according to the study, published in the March 28 issue of the New England Journal of Medicine. Of those residents living up to a half-mile away, about 20 percent were found to be suffering from PTSD.

Perhaps the area of greatest controversy is asbestos. The New York City health department had urged residents not to worry and insisted, as the EPA has, that there are no elevated levels of asbestos in people's homes. In addition, according to hundreds of air samples taken at the trade center site in the second, third, and fourth weeks of the cleanup, workers were not exposed to hazardous levels of the substance. But the testing didn't begin until an entire week after the buildings collapsed, a federal official told reporters.

Since the cleanup began, dust and air samples taken by the EPA have found no unsafe level of asbestos. But Cate Jenkins, an asbestos expert and environment scientist at the EPA, says the agency's own testing methods were inadequate: "It was like using a magnifying glass when you should be using an electron microscope."

In a January 11 internal EPA memo based on independently gathered sampling data, Jenkins called the contamination in at least one area near the fallen towers "alarming." She says samples taken four blocks away from Ground Zero revealed that asbestos levels were 22 times higher than those in Libby, Montana, a town made virtually uninhabitable by asbestos contamination from a nearby mining operation, according to the EPA. The government had to replace furniture, draperies, and carpeting in every home in Libby before it was deemed safe to live in again.

"If they had used one of the more sensitive testing methods, [researchers] would be picking up asbestos contamination way outside Ground Zero," says Jenkins.

At Stuyvesant High School, four blocks north of Ground Zero, parents have been disturbed about poor air quality and possible lead contamination. Last October the New York City Board of Education assured them that the school was safe to return to. But the school's indoor air quality was unacceptable under EPA standards as recently as April 17, according to readings taken by the board's environmental consultant, ATC Associates.

Marilena Christodolou, president of the Stuyvesant Parents' Association, says the school district did not clean and never bothered to test the air ducts or the ventilators in the classrooms until recently. This spring tests discovered lead, and the parents and the school board are arguing over whether the lead is at dangerous levels and requires cleaning.

Whether or not the lead is linked to the towers' collapse, parents want the board to act. "We have to take any available precautionary measures," insists Christodolou, "and the Board of Education failed to do that." Parents are now preparing a lawsuit aimed at forcing the New York City Board of Education to clean the high school's air ducts and ventilators.

There's no consensus among scientists and public health officials on the long-term health risks of working and living at Ground Zero, however, more than 60 investigations are under way to help determine the health fallout from the collapse of the twin towers, according to Dr. Bruce Bernard, a physician with the National Institute for Occupational Safety and Health. Meanwhile, some experts say that people should not worry needlessly.

According to the New York City Department of Health, for example, the likelihood of developing asbestos-related disease from short-term, low-level exposure is low.

As a result of exposure to asbestos dust after the twin towers' collapse, an estimated 20,000 people are at possible risk of developing the rare cancer mesothelioma, but few are likely to actually come down with the disease, according to Dr. Stephen Levin, medical director of the Mount Sinai-J. Irving Selikoff Occupational Health Center. "There is not a magnitude of risk that I think people ought to be terrorized about," he told reporters this spring.

Christodolou's son Peter, 18, no longer suffers from the sinus infections and headaches that struck him after 9/11. Still, Christodolou, like other parents, worries about the possible long-term impact on her child's health.

"These children were in the middle of the plume and got a heavy dose of contamination," she says. "My son is better, but we're concerned about the delayed effects."

So are many rescue workers. Firefighter Randy Shurson has recovered from an apparent WTC-related illness, a constant cough that plagued him for four months after searching for bodies and clearing debris at Ground Zero. "There were pretty nasty chemicals burning there," recalls Shurson, a California firefighter who went to New York as part of Fraone's unit. "What scares me is what the effect will be on my body 10 or 20 years from now."

-- Laurie Udesky is an award-winning San Francisco-based reporter and a regular contributor to Consumer Health Interactive.

Further Resources

Environmental Protection Agency
http://www.epa.gov

New York Committee for Occupational Safety and Health
http://www.nycosh.org

National Institute of Occupational Safety and Health
http://www.cdc.gov/niosh/homepage.html

References

First published June 19, 2002
Last updated February 20, 2008
Copyright © 2002 Consumer Health Interactive