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While many people across the country are worried about the threat of bioterrorism, especially given the recent rash of mailroom workers and others being exposed to anthrax at several locations across the country, perhaps the people who are most concerned about the problem are workers for the United States Postal Service.

"Imagine if you had to second-guess every action you took at work," says one Midwest postal worker. "I stop and think about every piece of mail I pick up. It''s like stopping to think every time you breathe. It''s driving us crazy."

Managers for the Postal Service recently received instructions detailing emergency response procedures for "mail allegedly containing anthrax."

The procedures note that the Postal Service "is committed to providing a safe and healthful work environment for its employees. Suspected bioterrorism threats or suspicious incidents require prompt action by health, safety, law enforcement and laboratory personnel. Coordination and communication are essential to protect first responders and employees."

An California postal worker says that he has doubts about safety in his workplace for the first time. "I''ve worked here for nearly 10 years, and this is the first time I''ve ever felt unsafe at work. It''s creepy," he complains. "How is management going to protect me from a piece of mail containing anthrax? I handle thousands of pieces of mail a day...many thousands of pieces of mail."

To protect employees, Postal Service management is asked to ensure that:

  • All employees, through safety talks, hazardous materials first-responder training and emergency action plan training, must be instructed on initial actions to take if there has been a suspected exposure to anthrax (or other biologically hazardous material).
  • Emergency action plans, crisis management plans, hazardous materials spills response instructions, medical service standing orders and other related operating procedures are modified to incorporate appropriate guidance. The emergency action plan must include the telephone numbers of the initial and secondary contacts.
  • Crisis management plans are revised to include appropriate actions to ensure initial coordination with the FBI and other responders through the Inspection Service; detail other initial actions to isolate and contain potential contamination and deal with potentially exposed employees; cover subsequent actions, including proper medical treatment, employee counseling and media liaison.

The procedures counsel employees that suspect mail is contaminated to avoid handling the letter or package; notify their supervisor, who will immediately contact the facility safety office or other designated person; and make sure that damaged or suspicious packages are isolated and the immediate area cordoned off. Employees who think they might have touched a contaminated package or letter are told to wash their hands and wait for further instructions from management and from outside emergency response experts.

Postal Service employees are told not to handle suspect packages, try to clean areas, or take any other response action other than to "retreat, isolate and notify management in accordance with the facility standard operating procedure." Management is asked to alert employees to stay in evacuation areas and not leave postal property so that they can receive necessary information and medical follow-up if appropriate. Management should also invoke the emergency action plan including:

  • Instituting mechanical shutdowns, including air handling equipment, isolation and evacuation.
  • Notifying the Inspection Service of the USPS.
  • Notifying Postal Service Aviation Mail Security Office.
  • Notifying postal and local community emergency responders, which may include the health department, fire department, or local law enforcement.

This is not the first time that the Postal Service has worried about anthrax. In 1998 and 1999, postal customers reported receiving letters or packages that allegedly contained anthrax. Although those incidents turned out to be hoaxes, the Postal Service classified them as "undeclared prohibited mailings" because they were "unsettling to employees and the community."

"The possibility that the mailings do contain hazardous materials cannot be ignored," says a memo from the Postal Service to managers. "Such mailings should be treated with all caution."

Anthrax spores (bacillus anthracis) can enter the body through open wounds, cuts or mucous membranes, or can be inhaled or ingested. It is not contagious, and cannot be transmitted from person to person. Bacillus anthracis spores can cause disease in two to 60 days.

Symptoms of inhalation exposure include flu-like symptoms (fatigue, body aches, fever and non-productive cough), which eventually progress to severe respiratory distress with the person experiencing difficulty breathing, cyanosis (bluish color in skin due to lack of O2 exchange due to lung damage), increased chest pain, tachycardia (excessively rapid heart rate) and diaphoresis (excessive sweating). Inhalation anthrax is usually fatal, according to the Centers for Disease Control and Prevention (CDC).

Intestinal anthrax, from ingested spores, is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax results in death in 25 to 60 percent of cases.

In the case of skin exposure (called "cutaneous"), the disease begins as a raised itchy bump that resembles an insect bite. Within several days, it develops into a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying) area in the center. Lymph glands in the adjacent area may swell. Such cases of anthrax are rarely fatal, especially when proper antimicrobial therapy.

For those interested in reliable information about anthrax, the Centers for Disease Control and Prevention offers answers to some of the most frequently asked questions at www.cdc.gov/ncidod/dbmd/diseaseinfo/anthrax_g.htm.

by Sandy Smith