Philip J. Landrigan, M.D., M.Sc.
Chair, Department of Community and Preventive Medicine
Professor of Pediatrics
Director, Center for Children’s Health and the Environment
Mount Sinai School of Medicine
September 11 Attacks on the World Trade Center
Subcommittee on Clear Air, Wetlands, and Climate Change
Committee on Environment and Public Works
United States Senate
New York City
Monday, February 11, 2002
Mr. Chairman and members of the Subcommittee: My name is Philip J. Landrigan, M.D. I am a pediatrician, Chairman of the Department of Community and Preventive Medicine and Director of the Center for Children’s Health and the Environment of the Mount Sinai School of Medicine. A copy of my curriculum vitae is attached to my testimony. Thank you for having invited me to testify before you today.
I will focus my testimony on the impacts of the September 11th World Trade Center attacks on the health of children.
Demographics. On September 11, 2001, 46,000 children ages 0-19 resided in lower Manhattan below 14th street. Approximately 11,000 of these children were under the age of 5 years, and 3,000 lived within a half-mile radius of the tower. Twelve hundred children were attending the three primary schools closest to the World Trade Center (P.S. 89, P.S. 150, and P.S. 234); 300 children were in attendance at I.S. 89; and 4,000 children were at Stuyvesant High School, the Leadership High School and the High School for Finance. We estimate that 1,700 women in lower Manhattan were pregnant on the morning of September 11th.
Exposures. When the twin towers were destroyed, the communities of lower Manhattan were enveloped in smoke and soot. Women, children and persons of all ages were placed at risk of exposure to dust, debris, asbestos, fibrous glass, products of combustion, volatile organic compounds (VOCs), polychlorinated biphenyls (PCBs) and dioxins. For many weeks last fall and into early winter these communities were subjected intermittently to the smell of acrid smoke from the long-burning fires. Many offices and apartments were coated with dust that entered those structures through shattered windows or inadequately protected air handling systems.
You have learned much today already about these exposures. In particular you have been informed of the risks to workers by my Mount Sinai colleague, Dr. Stephen Levin. To provide further background on the nature of these exposures, I attach to my testimony articles prepared by our group at Mount Sinai that were published in November in Environmental Health Perspectives, the journal of the National Institute of Environmental Health Sciences (NIEHS).
· Children’s developing lungs and other organ systems are more sensitive than those of adults.
Prenatal Toxicity. Potential for toxicity in utero affecting the next generation is a further dimension of the September 11 disaster. The possible physical and psychological consequences of the attacks on pregnant women and their children are not known and need to be explored.
To address this issue, researchers at Columbia University Center and the Mount Sinai School of Medicine have developed a joint project to examine infants born to women who were pregnant on 11 September 2001 and who were either acutely or chronically exposed to the fires and explosions. The acute exposure group will consist of pregnant women who actually were in the World Trade Center or in nearby office buildings at the time of the attacks. The chronic exposure group will consist of women who live and work in the communities of lower Manhattan. Samples of blood and other biological fluids will be taken from these women to assess their exposures. Their infants will be evaluated at birth and periodically over the first several years of their lives. Outcomes will be assessed.
Community Health Needs. Protection of the health of community residents in lower Manhattan, particularly young children and pregnant women, requires that we take strong and consistent action on several fronts.
Sound Health Recommendations. The most immediate need in the communities of lower Manhattan is for scientifically sound, evidence-based guidance (1) about the risks to children and families and (2) about what families can do to minimize those risks.
To formulate health recommendations for families and communities in lower Manhattan, we have relied heavily on the extensive environmental assessment data collected by the U.S. Environmental Protection Agency, State and City Agencies, the Board of Education and private consultants. Although there is always room for more sampling, the aggregate amount of data that has been collected in lower Manhattan since September 11th is astounding. It represents the most comprehensive environmental sampling that has ever been undertaken in any community in the United States. Most of these data, including all the data collected by governmental agencies, are of high quality and very credible.
In the early weeks after the disaster, while the sampling data were still quite incomplete, we urged prudent avoidance. At that time the smell of acrid smoke hung heavy over lower Manhattan, especially at night and on days with little wind. Although the actual measured levels of airborne pollutants where below federal standards, there were intermittent peaks of exposure. Accordingly we developed recommendations in collaboration with the Ground Zero Elected Officials Task Force and the Manhattan Borough President that urged families to take the following prudent steps:
· Limit the amount of time you spend out of doors near the WTC site.
· Limit vigorous outdoor exercise and vigorous play by children in the affected area. Both increase the rate of breathing.
· For ongoing clean-up, use a HEPA vacuum (they can be rented) and a damp mop or rag on floors, walls and furniture to clean your apartment. Brooms stir up dust.
· Be sure all air-handling systems in your building are properly cleaned.
· Frequently change filters on air conditioners and other ventilation equipment, and run air conditioners on ‘recirculate’ with vents closed.
· Use HEPA air filters at home or in the office.
· Keep windows closed.
· Take your shoes off at the door.
A copy of these recommendations is attached to my testimony.
More recently, now that the fires have largely been extinguished, we have continued to monitor health risks to community residents, particularly to children. Much of this assessment has focussed on the schools and on the question of whether to reopen the schools and playgrounds in lower Manhattan.
School Health Risks. Based on our review of the most recent data, we are comfortable that the indoor environment of the schools in lower Manhattan is now clean and safe for children and adults.
The public schools in lower Manhattan have undergone an extensive array of environmental tests more thorough than any that have been performed in any other New York City Public school. Measurements of contaminants (fine particulates, PCBs, dioxins, lead and other metals, asbestos, and volatile organic compounds) have found levels that in virtually every instance are well below applicable standards and background levels. The following paragraphs summarize our interpretation of these data:
PCBs, Dioxins, and related compounds. These compounds are produced by almost any sort of combustion and are found widely in our industrialized society. If one were to test air and surfaces in any large city, trace levels of these compounds would frequently be detected. The air and surface test results undertaken in the schools in lower Manhattan found all levels to be either undetectable or far below even the most conservative standards. For instance, the highest reported wipe sample level of dioxin in P.S. 89 was 0.032 ng/M2. This is nearly 1,000 times below the New York State Department of Health standard.
Fine Particulates (PM2.5). These particles are ubiquitous in a city environment. They arise principally from the combustion of fuel in car, truck, and bus engines as well as industrial exhaust. The U.S. EPA guideline of 40 micrograms/m3 is based on a 24-hour average. All of the EPA 24-hour average measurements of fine particles near the schools in recent months have been well below this level. In any urban environment, levels of fine particulates fluctuate from moment to moment and day to day. In fact, spot measurements taken at 13th Street, where P.S. 234 was temporarily housed, revealed levels greater than 100 micrograms/m3. The levels of fine particulates in lower Manhattan are now more a reflection of background urban air pollution than a result of the continuing WTC clean up. Indeed these levels may increase when the roadways are re-opened to general traffic.
Asbestos. Although “no asbestos is good asbestos”, the levels of asbestos fibers in the air in lower Manhattan and in and around P.S. 89 are at background levels for the city, and the levels in the schools are well below the AHERA standard of 70 structures/mm2.
That said, however, we need to be watchful for the long-term consequences of exposure to asbestos. Almost no data exist on the possible long-term consequences of low level asbestos in early childhood. Causes of malignant mesothelioma have, however, been reported in the grown children of asbestos workers who were exposed to take-home asbestos; among non-working women in the asbestos mining townships of Quebec who were exposed in the community; and among long term residents of a community near an asbestos-cement plant in Northern Italy.
Lastly, with regard to the question of playgrounds, we have advised that they be kept closed for the present time, because trucks are still rolling by on the West Side Highway carrying construction materials and potentially asbestos. Although measured levels of particulates and asbestos are below federal standards, we believe that prudence should dictate that children not play outdoors in immediate proximity to the highways where these trucks are running.
I have attached to my testimony a copy of a letter that we submitted on February 5, 2002 to the parents, staff and community of P.S. 89. Previously we had submitted a similar letter to the family of P.S. 150. We have provided similar advice pro bono to the New York City Board of Education.
Home Health Risks. Many apartments in lower Manhattan were heavily inundated by dust on September 11. Dust entered these apartments through shattered windows and also through air handling systems.
Cleanup of apartments has been very uneven. Some have been effectively and thoroughly cleaned with HEPA vacuums, while others appear not to have been adequately cleaned. Although data are more fragmentary and incomplete than for the schools, there appear to have been apartments and buildings where children may have been significantly exposed to particulates and asbestos.
Follow up Assessment. It will be very important to continue to follow up vulnerable populations who were present in lower Manhattan on September 11 and in the succeeding weeks and who were therefore placed at risk of exposure to toxic materials liberated from the fires and explosions at the World Trade Center. Specific follow up assessments that are needed are the following:
Follow up of women in lower Manhattan who were pregnant on September 11 and their children. As I have noted above, studies are already underway as a joint endeavor between the Columbia University School of Public Health and the Mount Sinai School of Medicine. They need to be sustained for at least 3-5 years.
Follow up of children residing in and attending schools in lower Manhattan. To date, only scattered assessments of children in lower Manhattan have been undertaken; these initial studies are proceeding under the leadership of CDC, ATSDR, the New York City and New York State Departments of Health. While these studies will provide useful information on the impact of the environmental exposures on September 11 on the health of children in New York, with a particular focus on asthma and other respiratory problems, they have some shortcomings. One problem is that the number of children included is relatively small. Secondly, the planned duration of follow up is limited - - only one year. This will limit these studies’ ability to address parent’s concerns about the possible long term consequences of the events of September 11 on their children’s health. Thirdly, the studies currently underway are not assessing the impacts on children’s mental health of the events of September 11. Those psychological impacts are expected, however, to be substantial.
A need exists therefore to generate high quality information on the short and long term health consequences, including the mental health consequences on children, of the events of September 11th.
Broad National Needs. The events of September 11 and the anthrax attacks that followed underscored the weakness, deterioration and current state of disarray of the public health infrastructure in the United States. They underscore how ill prepared are most doctors and hospitals to recognize, response and care for victims of chemical and biological attack. Most American physicians have never seen anthrax or smallpox, the two agents judged most likely to be used in biological terrorism. Most hospitals do not have plans for the proper isolation of victims or the protection of their staff.
The lack of preparedness for chemical weapons is equally low. It is sobering to note that in the aftermath of the Tokyo subway attack with sarin in 1995 many secondary cases of chemical poisoning occurred in hospital workers caring for the victims of the attack. These cases resulted because health care workers were untrained and because hospitals had no plans in place for the chemical decontamination of the victims prior to treatment.
A major need exists in the United States to strengthen programs for disease tracking. The extremely sensible recommendations of the Pew Commission on Public Health need to be heeded by health officials at every level of government. Training programs in public health and disaster preparedness need to be established for doctors, nurses, and other health care providers. Hospitals, particularly major hospitals in urban centers, need to be provided the resources and materials needed to develop response plans. These plans need to be closely coordinated with prehospital responders including fire departments, emergency medical technicians, and the Federal Emergency Management Agency.
Conclusion. Many questions of profound importance for public health were raised by the attacks on 11 September. Many of these questions remain to be answered, and some will not be answered for decades. The urgent need now is to put in place the studies and to establish the registries and the disease tracking systems that will enable us to answer these questions in the future. New York, Washington and all of the United States need to press forward and not be paralyzed by these terrible attacks. At the same time, we must put in place the prudent safeguards that will prevent further loss of life.
Thank you. I shall be pleased to answer your questions.