Jitters are not among the clinical symptoms of anthrax. The spore-borne illness that has so far killed tabloid photo editor Robert Stevens and contaminated dozens of people in media and government is usually treatable with antibiotics and perhaps a follow-up vaccine. But the arrival of those spores threatens to unbalance an already anxious nation. As I write, the story changes hourly. On Tuesday, the anthrax is described as potent--laboratory-grade; on Wednesday it's declared "naturally occurring." Spores are reported in Congressional ventilation ducts; then the report is declared false. The House closes for a five-day sweep, while Tom Daschle--thirty-one of whose staff members are found to have spores in their nasal passages--says the Senate will remain open. Governor Pataki's New York City office tests positive for spores; an infant who visited ABC News contracted the infection. The scale is nothing like the September 11 attacks; but just as the box-cutters made it clear that mass destruction requires neither nuclear weapons nor even machine guns, so the spread of anthrax through envelopes turns upside down James Bond images of nerve gas and death rays.
The people sending those envelopes know what they're doing: infecting first the media, the retinal nerve of democratic perception, before turning to the pols. A nervous press means a nervous public. What is striking about the initial round of white-powder letters is the sophisticated consideration of media dynamics and demographics: the ultratabloid Sun, the ultrarespectable New York Times; old-media Tom Brokaw, dot-com Microsoft. (Some militia-watchers theorize that the anthrax is coming from McVeigh type scaremongers piggybacking the current crisis. But the circumstantial evidence--particularly the fact that one of the first letters went to the Times's Middle East and terrorism specialist, Judith Miller--does suggest Al Qaeda adherents, as does the apparent purity of the strain.)
A few things about the anthrax scare need to be said. First, at its current scale--with doctors nationwide now on the lookout for anthrax symptoms--it is indeed a scare rather than a medical nightmare. Second, should the number of cases or the distribution of spores grow more widespread, the greatest danger comes not from the easily treatable disease but from the long degradation of the nation's public-health infrastructure. For the past twenty years, Republicans and Democrats alike have regarded public health, and any excess capacity in the healthcare system, as an insult to the free market. In large cities, public hospitals have been closed and privatized and community clinics converted to bottom-line-driven HMOs. Understaffed and underfunded city and state health departments track illness with out-of-date computer software; 10 percent of local health departments don't even have e-mail. Last year, the federal government spent less than $50 million on improving state and local public health infrastructure--a piddling amount when spread among fifty states.
It's a problem not just of funding but of management philosophy--one that has left the public less protected from epidemics and terrorism than a decade ago. "One of the responses to financial pressures has been to cut out excess capacity," Tara O'Toole, MD, …