Anthrax Patients' Ailments Linger

Fatigue, Memory Loss Afflict Most Survivors of October Attacks

By Lena H. Sun, Washington Post Staff Writer

Six months after inhaling anthrax spores, several of the mail workers who survived the deadly disease have yet to make a full recovery and are experiencing serious fatigue and memory loss.

In interviews with five of the six survivors of inhalational anthrax, four spoke of frequent exhaustion. Only one person, a 74-year-old Florida man (case 7), has returned to work. But others said they require daily naps after the slightest exertion. They and their families say they have also noticed marked problems with memory and concentration.

"The question is, why aren't these people back to normal?" said Mark Galbraith, an infectious disease specialist in Virginia who is treating one of the victims.

The extent of the problems has highlighted for Galbraith and other physicians how little is known by the medical community about this illness and the potency of the toxins.

Eleven Americans, from Florida to Connecticut, contracted the inhaled form of anthrax after a rash of terrorist mailings to politicians and media outlets. Five died, including two postal workers from the Brentwood Road NE mail processing center in Washington. Six were treated and survived; of those, three live in the Washington area.

"I'm just so tired," said David Hose, 59 (case 20), of Winchester, Va., who was released from the hospital in November after 16 days of intensive treatment. Hose worked at the State Department's diplomatic mail facility in Sterling, where, investigators believe, he inhaled anthrax spores from a letter addressed to Sen. Patrick J. Leahy (D-Vt.) that was accidentally routed to the facility. He is trying to regain his strength through physical therapy but spends most of his time watching television because he has little energy to do much else, he says.

Bradley Perkins, the top anthrax expert at the federal Centers for Disease Control and Prevention in Atlanta, said in a telephone interview this week that the CDC is aware of "complaints and concerns" among some of the inhalation survivors. The CDC is not currently conducting any systematic study of their health, he said, except for collecting blood samples to develop better vaccines.

"We're just now approaching the kind of time period where one would normally expect a full recovery," he said. But "a number of survivors have not returned to their normal daily activities.

"We have concern about the level" of their recovery, he added, and the CDC is "actively discussing" whether to conduct a formal study of their symptoms.

Perkins said memory loss and fatigue could be results of the infection. Anthrax produces toxins, "and some could have impact on nerve tissues," he said. It is also possible that survivors are experiencing some form of post-traumatic stress syndrome, he added.

Until the outbreak last year, inhalational anthrax was almost always fatal. Consequently, little is known about the experience of survivors and whether the infection has long-term effects.

The recent inhalational cases are unlike the other few dozen recorded in the United States in the last half-century, most of which were contracted by workers exposed to contaminated animal hides.

Medical experts know that severe illness can have unexpected emotional consequences in addition to physical effects. That could be particularly true in this case, because the anthrax attacks were an act of terrorism accompanied by intense media attention. Also, no one has been arrested in the attacks, which may cause the survivors more stress.

Leroy Richmond, 57 (case 14), one of two Brentwood postal workers to survive inhalational anthrax, discovered by talking with a postal worker in New Jersey that he was not the only survivor having memory problems. Norma Wallace, 57 (case 11), who worked in a facility in Hamilton Township, N.J., and was hospitalized with inhalational anthrax for 18 days, told him that she would often lose her train of thought in the middle of a conversation.

Richmond's wife, Susan, had noticed the same thing in her husband. "We know he's getting old," she said, "but it's not normal for him, in the middle of a conversation, to say he can't remember what the questions were."

Until he talked to Wallace, Richmond says, he was reluctant to acknowledge that he was having memory trouble. "I was trying to be brave and strong," he said. On his doctor's orders, Richmond is now undergoing a series of memory tests.

The other Brentwood postal employee who survived inhalational anthrax, a man in his fifties (case 17), wishes to remain unidentified, said a spokeswoman for the U.S. Postal Service.

The only survivor who appears to have made a full recovery is Ernesto Blanco, 74 (case 7), who returned in February to his job handling mail for American Media Inc. at its new office building in Boca Raton, Fla.

"I feel good," Blanco said in an interview. He said he has not experienced fatigue or memory problems. "I remember everything. I feel 100 percent fine. Honest to God, you won't believe me, but I almost feel better than before."

The five other survivors, however, are recovering at home, receiving a portion of their pay in worker's compensation benefits. Unlike the families of those who died or were injured in the Sept. 11 terrorist attacks in New York, at the Pentagon and in Pennsylvania, the anthrax survivors and their families have received limited or no financial assistance from private charities.

Richmond says he wants to go back to his Postal Service job as soon as his doctor says he is ready. On his doctor's orders, he takes a walk each morning, but he needs to stop halfway through at a nearby gas station to rest. After returning home, "I'm so tired I have to take a nap," he said.

Postal worker Wallace, of Willingboro, N.J., said she has to do her chores in 20-minute segments so she can rest. Wallace believes she breathed anthrax spores that were in at least one of three tainted letters officials say passed through the Hamilton Township facility.

Like some of the other survivors, she also has joint pain -- in her shoulders, ankles and hips -- that was not present before the illness. She doesn't know when she will be able to go back to work, but she has resumed her correspondence classes for a bachelor's degree in literature because she thinks it might help her memory.

"That's one reason why I stick with school," she said. "It forces me to focus and try to remember."

Wallace's co-worker Jyotsna Patel (case13), of Princeton Junction, N.J., also has chronic fatigue, joint pain and memory loss. Before she got sick, she said, "my joints never hurt, and I never sit down for one minute -- I'm so active." This spring, her doctor told her, "Hey, you also have the same symptoms like the other patients,' " recalled her husband, Ramesh Patel.

She was hospitalized for only eight days and did not receive an inhalational anthrax diagnosis until the day she was discharged. When she first returned home, her husband said, she would often wake up in the middle of the night screaming from nightmares. The nightmares still occur, but less often, he said.

"The frustration is she is not getting better at the rate she should be," he said, adding that he is worried she might have suffered permanent damage.