What made people sick? Dust and aerosols at Ground Zero

by Elizabeth Grossman

Why some people who inhaled the airborne contaminants unleashed by the destruction of the World Trade Center on September 11, 2001 became sick for only a short time, why some have become chronically ill, and others terminally ill, may never be known. What is known, however, is that the dust and aerosols released in that disaster contained a potentially treacherous mix of everything that was in those enormous buildings and in those aircraft. What is also known is that, as Paul J. Lioy, professor and vice chair of the Department of Environmental and Occupational Medicine at the Robert Wood Johnson Medical School at the University of Medicine and Dentistry of New Jersey, says succinctly in his book, Dust: The Inside Story of its Role in the September 11th Aftermath, "no research had ever been done on the toxicology of such a mixture as WTC dust." Ten years later, the impacts of that mixture are all too real in the form of lung and gastrointestinal diseases for many of those who worked at or near the site on 9/11 and in the days, weeks, and months that followed.

Vividly recounted by doctors involved in the ongoing medical studies of those impacted by WTC material exposures who spoke at the September 16 NYCOSH meeting on worker and community disaster health protection and, in emotional testimony from those who are now ill, is the seriousness of these conditions. For most who've been stricken by severe chronic illness and worse, also vividly described was their lack of expecting that what they had encountered by breathing 'Ground Zero' air would or could take such a toll.

Denise and Rhonda Villamia, sisters who volunteered first "spontaneously," as they described it, and then with the Red Cross several days a week or more for about six months beginning in September 2001, said their lives are "permanently changed" as a result of Ground Zero exposures. The sisters helped maintain workers' sleeping areas as well as boot and hand washing stations and brought provisions to those working on 'the pile.' Both are now suffering debilitating chronic respiratory and gastrointestinal illnesses. Daniel Arrigo, who worked with Local 79 of the Laborers International Union of North America and spent four months clearing wreckage from the World Trade Center site, spoke while being supported by supplied oxygen. He now suffers from chronic lung diseases that include bronchitis and severe gastric reflux.

Dr. Laura Crowley, specialist in pulmonary health and assistant professor of preventive medicine at Mount Sinai School of Medicine, reported on the treatment and monitoring of people exposed to hazards at Ground Zero. She reported that more than 30,000 people are enrolled for monitoring and more than 15,000 are receiving treatment for a list of conditions that includes upper and lower respiratory illnesses, and gastrointestinal, musculoskeletal, neurological, and psychological disorders. Until the passage of the James Zadroga 9/11 Health and Compensation Act of 2010, the World Trade Center Medical Monitoring and Treatment Program provided screening and treatment to responders and community members, but the program's Congressional appropriations were never certain for more than a year at a time. Since July 1, 2011, the newly established World Trade Center Health Program has taken over the monitoring and treatment functions, and it has the advantage of being funded by mandatory spending through the end of fiscal year 2015.

Results from monitoring
Among what the program is tracking are emerging and long-term latency diseases that include cancers. One of those that appears to be occurring in excess of what might be expected, is sarcoidosis, explained both Crowley and Dr. David Prezant, Chief Medical Officer for the New York City Fire Department Office of Medical Affairs. This is a disease in which tiny clumps of abnormal tissue called granulomas (clusters of immune cells) form in certain organs. When these granulomas form in the lungs, they that can cause inflammation that impairs breathing, and possibly lead to pulmonary hypertension, among other effects. Some of these symptoms are similar to those of certain stages of silicosis and asbestosis.

While much of the environmental monitoring of World Trade Center dust focused on asbestos, Dr. Joan Reibman, director of the Health and Hospitals Corporation World Trade Center Environmental Health Center associated with Bellevue and New York University hospital, reminding the NYCOSH conference that the dust contained other materials, including silica, talc, titanium, copper, chromium, aluminum silicate, as well as other substances associated with pulverized cement. In his book, Lioy notes that the dust also contained lead, glass shards and fibers, and what came to be called slag wool, in particles that ranged from the coarse to the very fine. Among what's been found in lung tissue of people who were exposed to WTC dust are carbon nanotubes, explained Bruce Lippy, who was formerly industrial hygienist for the International Union of Operating Engineers and is now an independent consultant. Research suggests that carbon nanotubes may affect lung tissue in ways similar to asbestos fibers.

The variety of particle size, the presence of so many large particles, and the high alkalinity of much of the dust, explains Lioy, are likely contributing factors to the health effects of exposure to World Trade Center dust.

The role of aerosols
For those at or near the World Trade Center on 9/11 or immediately following before the initial dust clouds had completely settled or were damped down by rain, exposure was not only to the components of what's come to be called WTC dust, but also to aerosols - a mixture of gasses and particulates. Lioy writes:

In retrospect, during the first twenty-four to forty-eight hours post-collapse, we should have been calling the WTC dust the WTC aerosol. ... That WTC aerosol contained both the dust and gases that were the net result of the emissions for the collapse of the WTC. Unfortunately we will never know completely what was in this WTC aerosol because we did not measure the gaseous phase of the combusted material released into the atmosphere.

As for the aerosols' likely effects on people, Lioy explains, "Those gases have been known for years as being very toxic in human lungs," and would likely have contained a mix of hydrocarbons associated with fuels as well as from burning of various other petroleum-based materials.

"We have no idea how toxic it was but you couldn't have dragged me off that pile. You couldn't have dragged any of us off that pile. We have an unwritten bond, if any of us go down, we have an obligation," said Patrick Bahnken, president of Uniformed EMS, Paramedics and Fire Inspectors with the New York City Fire Department, of the time he spent at 'Ground Zero.' But he said, "Until we start talking about cancer and hold people in power accountable, we'll continue to hear the bagpipes play, and personally, I'm tired of hearing them."

What was made clear from speaker after speaker at the NYCOSH conference was continued anger and frustration at the government assurances of safety in the days immediately following 9/11. "What we were told at that time was quite remarkable," said Micki Siegel De Hernandez, health and safety director of Communications Workers of America District 1. "This has informed every decision that followed. We are still living with those decisions."

Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Salon, The Washington Post, The Nation, Mother Jones, Grist, and the Huffington Post. Chasing Molecules was chosen by Booklist as one of the Top 10 Science & Technology Books of 2009 and won a 2010 Gold Nautilus Award for investigative journalism.

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Another little-noted impact in the aftermath of the WTC collapse was the increase in dioxin/furan exposure, especially to those on-site. EPA (in 2002) estimated a 10% increase in body burden for these workers, but calculated that this would make little difference in their long-term health. Other analyses of dust levels on buildings nearby (S. Rayne, et al., ES&T, 2005) suggest that the exposure may have been higher, but in any case the full range of health effects would not be observed yet. Stay tuned.

By Dick Clapp (not verified) on 30 Sep 2011 #permalink

As far as I know, no one measured alpha emitting particles in the dust (that would have come from the thousands of smoke detectors containing amercium 231 that burned) and cause lung cancer.

By Alice Freund (not verified) on 30 Sep 2011 #permalink

Emphasis on "complexity" of exposure or agents like dioxin (which have not previously been associated with respiratory and GRDS) distracts from generalizing the health effects observed among WTC responders and the community. It was the dust! Conventional measurements were made. The scientific questions are: whether the conventional measurements are appropriate for a fire and building collapse site (wherever it is); or, is the conventional interpretation of the conventional measurements appropriate. Specifically, what are the appropriate particulate criteria for protection at the site.

In the absence of such a consensus, the next time this happens we will be back to saying that even though measurements say there's no violation, we are asking all workers to all wear respirators all the time.

By Frank Mirer (not verified) on 30 Sep 2011 #permalink

Much of this could have been mitigated had First Responders
been provided with proper FFPR (respirators).

By Dr. Gabor Lantos (not verified) on 30 Sep 2011 #permalink