Anthrax-Contaminated Facilities: Preparations and a Standard for Remediation

Order Code RL33191

CRS Report for Congress

Received through the CRS Web

Anthrax-Contaminated Facilities:

Preparations and a Standard for Remediation

December 16, 2005

Michael M. Simpson

Specialist in Life Sciences

Resources, Science, and Industry Division

Congressional Research Service ˜ The Library of Congress

Anthrax-Contaminated Facilities:

Preparations and a Standard for Remediation

Summary

Bacillus anthracis, the cause of the anthrax disease, was released into the

United States postal system in autumn 2001, resulting in five deaths and

contaminating several public and private facilities. Remediation costs were

significant. Subsequently, extant federal procedures and policies were clarified and

augmented, and new procedures and policies were created to fill identified gaps.

A number of additional emergency preparedness recommendations have been

made by stakeholders, researchers, and others, including the following:

!

Facility owners and managers should keep and maintain ownership

records of valuable and important items; they should have detailed

and current floor plans and information about air flow patterns,

under routine and nonroutine conditions.

!

Research and regulatory entities should consider having standardized

sampling and analysis protocols and consensus procedures for

developing protocols when needed; having standardized risk

assessment procedures; and conducting further research on human

dose-responses to bioagents, including anthrax, and developing

nonthreshold dose-response models.

!

Governmental entities should develop more extensive plans and

procedures to maximize involvement of all stakeholders; conduct

further training and drills, especially for sampling, analysis, and

coordination procedures; determine the appropriate number and

locations of devices to detect leaked remediation chemicals, and the

conditions under which the devices would be needed; and determine

the appropriate number, size, and locations of chlorine dioxide

generators, given that EPA has concluded that chlorine dioxide gas

shows the most promise for remediating contaminated facilities.

The criterion (not the standard) for determining a successful remediation has

been and remains zero growth of anthrax surrogates from all postremediation

samples. In conjunction with the recommendations above, and given remediation

experience since 2001, it may not be necessary to develop a remediation standard

because consistently achieving the zero-growth remediation criterion appears

possible and would likely be demanded by stakeholders. This report will be updated

as warranted.

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Remediating Anthrax-Contaminated Facilities in 2001 . . . . . . . . . . . . . . . . . . . . 2

On-Site Issues in 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

On-Site Remediation Details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Cross-Organization Issues in 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Managing the Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Determining a Successful Remediation in 2001 . . . . . . . . . . . . . . . . . . 5

Remediating Anthrax-Contaminated Facilities Today . . . . . . . . . . . . . . . . . . . . . . 6

On-Site Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

On-Site Remediation Details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Cross-Organization Issues Today . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Managing the Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Determining a Successful Remediation Today . . . . . . . . . . . . . . . . . . . 8

National Research Council Remediation Recommendations . . . . . . . . . . . . . . . . 9

American National Standards Institute: 9/11 Commission Recommendations . . 10

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Recommendations for On-Site Preparations . . . . . . . . . . . . . . . . . . . . . . . . 11

Recommendations for Cross-Organization Preparations . . . . . . . . . . . . . . . 11

Remaining Policy Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Appendix A: NRC’s Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Anthrax-Contaminated Facilities:

Preparations and a Standard for

Remediation

Introduction

When anthrax1 bacteria were released into the United States postal system in

autumn 2001, several public and private facilities were contaminated. In addition to

the five deaths that resulted, the cost of remediation — in dollars, time, and effort —

was significant.2 One private facility, four years after the bioterrorist incident,

remains closed. The incidents in 2001 led to experience and knowledge that may help

reduce the cost of future anthrax remediations. However, a few concerns remain.

This report provides background information on the 2001 anthrax incidents and

federal preparedness plans, but it focuses primarily on preparations for future

remediations and considerations for setting a remediation standard. Such a standard

would define the level of remediation needed to permit safe reuse and reoccupancy

of a facility contaminated with anthrax. Although such a standard does not exist, an

anthrax remediation criterion (zero growth of anthrax surrogates from all

postremediation samples) is commonly used to determine a successful remediation.

Policy questions exist regarding what preparations should precede the next bioagent

incident3 and whether to establish a remediation standard.

Background

Three releases of anthrax occurred in the United States in autumn 2001. In the

first release, letters containing anthrax spores were mailed from New Jersey to media

offices in New York City; the letters passed through the Hamilton Processing and

Distribution Center (P&DC) in Trenton, New Jersey on September 18. The second

release involved a package or letter sent in late September to American Media

Incorporated (AMI) in Boca Raton, Florida. In the third release, letters addressed to

1

The disease anthrax is caused by the bacterium Bacillus anthracis. The term anthrax will

be used in this report to mean both the disease and its cause.

2

“Remediation of United States Postal Service facilities alone cost more than $200 million,”

as reported in Reopening Public Facilities After a Biological Attack: A Decision Making

Framework. The National Research Council. Washington, D.C. July 2005.

3

Although this report focuses on anthrax, preparedness procedures for anthrax may be

useful for other bioagents as well.

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Senators Tom Daschle and Patrick Leahy in the Hart Senate Office Building entered

the Hamilton P&DC on October 9.

Numerous sites, including the Hart Senate Office Building, postal facilities,

media offices, and residences, were contaminated directly or through secondary

contamination. The contaminated postal facilities included physically large P&DCs

such as the Hamilton P&DC, the Morgan P&DC in New York City (which processes

all mail into and out of Manhattan), and the Curseen-Morris facility4 (which handles

all mail to and from the federal government in the D.C. metropolitan area).

Numerous smaller postal facilities also were contaminated, as were a number of

federal government mail facilities downstream of the Curseen-Morris facility.

The releases caused 23 cases of anthrax;12 were cutaneous, 11 inhalational.5

Five of the inhalational cases resulted in fatalities. Of the people who died, two

worked at the Washington, D.C., postal facility; one worked at AMI; one worked in

a New York City hospital; and one was an elderly woman who lived in Oxford,

Connecticut. No route of exposure has been established for the last two of these

deaths.6

Remediating Anthrax-Contaminated

Facilities in 2001

The term “anthrax-contaminated facility remediation” refers to the

decontamination of a large physical building or enclosed space, as opposed to the

decontamination of people or open areas exposed to anthrax.

In autumn 2001, most experience with anthrax contamination involved civilian

and military facilities, primarily facilities conducting anthrax research.7 However,

4

The name of this facility was changed from the Brentwood P&DC, to the Curseen-Morris

P&DC, in memory of the two postal workers who died as a result of contracting anthrax

there.

5

Cutaneous anthrax is the most common naturally occurring type of anthrax infection,

usually occurring after skin contact with contaminated meat, wool, or leather from infected

animals and sometimes resulting in a visible papule or ulcer on the skin. Deaths from

cutaneous anthrax are rare (fatality rates of 20% without antibiotic treatment, less than 1%

with it). Inhalational anthrax is the most lethal form of anthrax (the fatality rate for

inhalational anthrax is estimated at 75%, even with antibiotics and all possible supportive

care). Initial symptoms resemble a viral respiratory illness with a sore throat and mild fever;

symptoms may progress to respiratory failure. Gastrointestinal anthrax usually follows

consumption of raw or undercooked contaminated meat; symptoms include severe

abdominal distress. The fatality rate for this form of anthrax is estimated to be between 25%

and 60%.

6

“Investigation of Bioterrorism-Related Anthrax.” Morbidity and Mortality Weekly. United

States Centers for Disease Control and Prevention. December 7, 2001.

[http://www.cdc.gov/od/oc/media/mmwrnews/n011207.htm#mmwr1].

7

“Section VII - A Agent Summary Statements.” Biosafety in Biomedical and

Microbiological Laboratories. United States Department of Health and Human Services.

(continued...)

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little was known about addressing a simultaneous anthrax contamination in several

geographically dispersed facilities, with members of the general public in close

proximity to the anthrax and in various states of health (e.g., in the 2001 incidents,

some were young, healthy workers, whereas others were elderly and not

occupationally exposed). The facility remediation challenges that arose involved two

main foci: challenges involving on-site issues and challenges involving issues that

cut across organizations.

On-Site Issues in 2001

In autumn 2001, most remediation experience was based on civilian and military

involvement with anthrax research facilities. Drawing on then-current common

facility decontamination procedures, the on-site process to remediate public facilities

involved as many as nine steps:8 (1) assessing the site, including environmental

sampling to characterize the contamination; (2) isolating contaminated areas; (3)

removing items for off-site treatment; (4) reducing the sources of contamination; (5)

developing and designating risk zones and levels of required personal protection

equipment, such as Tyvek coveralls and full-face air-purifying respirators; (6)

cleaning and remediating contaminated areas; (7) sampling the environment

following remediation (often called postremediation environmental sampling); (8)

additional remediation and sampling, if the initial postremediation sampling showed

areas that were still contaminated; (9) and disposal of decontamination wastes.

Removing items for off-site treatment and reducing sources of contamination were

complicated by a lack of records and, hence, questions regarding the ownership of

items in a contaminated facility.9

On-Site Remediation Details. During the 2001 anthrax releases, important

decisions had to be made on-site, on a case-by-case basis. For example

!

Whether to remediate the entire facility at one time (e.g., the

Curseen-Morris site) or to remediate the facility in subsections (e.g.,

the Hart Senate Office Building). This decision depended, to some

extent, on the degree to which parallel facilities existed (i.e., other

7

(...continued)

Available at [http://bmbl.od.nih.gov/sect7a2.htm].

8

Compiled from numerous reports of the time and from “Lessons Learned: Remediation of

Anthrax Contamination,” Dorothy A. Canter, Ph.D. U.S. Environmental Protection

Agency. Presented at the 2003 Eighth International Kilmer Memorial Conference in Osaka,

Japan. Polyscience Publications, Inc. Laval, Canada. 2004.

9

Personal communication with Sabre Technical Services, September 2005. Sabre is the

firm that remediated the former-AMI building. In 2001, AMI published newspapers from

that building, which contained large numbers of photographs and other valuable documents

when the building was contaminated. AMI sold the building, which remains closed, and the

items included in the building, mainly due to a dispute over ownership. The issue of

maintaining precrisis records of ownership is described later in this report.

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locations where the functions of the contaminated facility could be

accomplished without excessive difficulty).10

!

To determine which chemical should be used to remediate the

contaminated facilities. In 2001, no chemicals or pesticides were

registered by the United States Environmental Protection Agency

(EPA) for remediating anthrax sites. This remains the case today.

Prior to 2001, different chemicals and physical agents had been used

against anthrax. The process of choosing the appropriate chemical

for each facility slowed the pace of remediation.

!

To determine which bacterium should be used to indicate the

effectiveness of remediation actions. For example, when the

decision is made to fumigate, biological indicators are placed

throughout the facility prior to fumigating. (The biological

indicators are species that are not pathogenic to humans but are

similar to anthrax in terms of genetics and resistance to the

fumigation chemicals.) Typically, a million spores of surrogate

indicator species are placed on a carrier, such as a paper strip or disk.

A species that is more resistant than anthrax to the fumigation

chemicals could be used to add a margin of safety to the remediation

efforts (i.e., if a species more resistant to the chemicals is killed by

the treatment, then there is a greater likelihood that the anthrax will

be killed by that treatment).

!

To determine the number and placement of spore strips used to

indicate the effectiveness of the remediation. Typically, at least one

spore strip is used for every 100 square feet fumigated; however, a

different number could be used. In fact, the space in the Hart Senate

Office Building was tested with one spore strip for each square foot

fumigated.11

In addition, decisions were made for each site concerning the quality of the test

strips, the handling of biological and other samples, and the methods used to analyze

the data.12

Cross-Organization Issues in 2001

Managing the Situations. Managing the anthrax contamination situations

involved more than on-site efforts. Several other decisions and actions, involving

10

“Fumigating Buildings Containing Anthrax.” Center for Infectious Disease Research and

Policy. University of Minnesota. December 2003.

11

EPA reported that 3,000 test strips were used in the 3,000 square foot Daschle suite in the

Hart Senate Office Building. “Senate Hart Building Decontamination Progressing” United

States Environmental Protection Agency. December 2, 2001.

[http://yosemite.epa.gov/opa/admpress.nsf/0/f93e59a8346b3cf985256b1700590dcb?Ope

nDocument].

12

Canter, op. cit.

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various off-site organizations, were discussed and made in concert: establishing a

unified command, an incident command system (including a federal on-scene

coordinator, the Federal Bureau of Investigation, the facility manger or owner, and

local incident commanders, such as local public health officials), and a command

post; identifying funding sources for the response; assessing occupational and public

hazards; developing and implementing prophylaxis and monitoring plans for exposed

workers and members of the general public (e.g., administration of antibiotics such

as Cipro); and developing and implementing long-term remediation plans, including

procedures to certify that the site was safe to reoccupy. These cross-organization

decisions and actions related to, and generally complied with, plans and procedures

contained in the interagency Federal Response Plan, which was issued in 1992 and

updated and reissued in April 1999.

Determining a Successful Remediation in 2001. In 2001, there was no

established, acceptable limit for exposure to anthrax, either in workplace or public

settings. Trying to set such a limit posed several difficulties: microorganisms such

as anthrax live, thrive, or die at different rates in different hosts; some hosts may have

or may develop immunity; different strains of the same bacterial species may show

significantly different degrees of infectivity;13 the virulence of the microorganism

may differ significantly among laboratory animals and humans, making it difficult

or impossible to extrapolate safe limits from laboratory animal findings to humans;

possible interventions of vaccines and antibiotics could complicate efforts to set an

occupational or public anthrax exposure limit; and differences exist between the

lethality of anthrax found in nature and anthrax that has been deliberately altered, or

weaponized, to increase infectivity and virulence. Moreover, it was not known how

few anthrax spores, natural or altered, a person would have to inhale to get sick or

die. 14

Given the variabilities and difficulties in trying to set an exposure limit and

remediation endpoint15 for anthrax, the criterion used in 2001 to judge the

effectiveness of site remediation efforts was zero growth of anthrax surrogates from

all postremediation environmental samples. This criterion did not ensure that all

13

Infectivity is the proportion of persons exposed to an infectious agent who become

infected by it. Virulence is the ability of an infectious agent to produce disease.

14

It has been estimated and reported in different studies that half the population of primates

exposed to as few as 2,500 inhaled anthrax spores would die from that exposure, but large

uncertainties accompany extrapolations to lower exposures, making lower dose-response

estimates highly speculative. Mark Keim et al., “Principles for Emergency Response to

Bioterrorism,” Annals of Emergency Medicine, August 1999, volume 34, number 2, pp. 177182. John Jernigan et al., “Bioterrorism-Related Inhalational Anthrax: The First 10 Cases

Reported in the United States,” Emerging Infectious Diseases, Nov-Dec 2001, volume 7,

number 6, [http://www.cdc.gov.ncidod/EID/vol7/no6/jernigan.htm ]. Lydia Barakat et al.,

“Fatal Inhalational Anthrax in a 94-Year-Old Connecticut Woman,” Journal of the

American Medical Association, February 20, 2002, volume 287, number 7, [http://jama.amaassn.org/cgi/content/full/287/7/863]. Matthew Meselson et al., “The Sverdlovsk Anthrax

Outbreak of 1979,” Science, November 18, 1994, volume 266, pp. 202-208.

15

A remediation endpoint is the point at which remediation efforts would be aimed and the

point at which, when reached, remediation efforts could stop.

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anthrax spores had been killed by the remediation efforts, nor that there was zero risk

of disease, but that the level of risk of developing disease was acceptably small.16

There was no science-based minimum number of spores known to cause disease in

a person; however, two women in 2001 died from inhalational anthrax without any

identified sources of exposure, supporting the idea that a very low number of anthrax

spores could be enough to cause disease and even death.17

Remediating Anthrax-Contaminated Facilities Today

Remediation experiences since the autumn 2001 anthrax releases have led to

higher levels of knowledge about, and preparedness for, decontaminating facilities.

On-Site Issues

In general, current steps to remediate a facility are refinements of steps that

evolved during the 2001 incidents. The steps today are practiced in drills to increase

the likelihood of successful remediation of another anthrax situation. However, a

few remaining on-site issues exist.

For example, determining ownership of items in a contaminated facility, such

as valuable documents, remains an issue. Remediation and other recovery efforts

could be facilitated if facility owners, managers, and insurers maintained ownership

records of important items within a facility (note the situation involving the formerAMI building, described earlier in this report).

Another issues involves limiting public exposure to chemicals being used in a

facility undergoing remediation, and determining the analytic method used to

measure levels of chemicals outside the facility. In the past, EPA has deployed its

Trace Atmospheric Gas Analyzer (TAGA) to check for inadvertent releases of

remediation fumigant. TAGA is a self-contained mobile laboratory, resembling a

bus, capable of real-time sampling and analysis in the low parts per billion range for

various chemicals in the air. Other means of analyzing for trace gases exist, but they

do not use a single unit like a TAGA and do not necessarily work in real-time or with

concentrations so small. EPA now has two TAGAs, one based in Las Vegas,

Nevada, and one in Edison, New Jersey.18 It is important to consider the appropriate

level of protection for people living and working near a remediation site, and the

appropriate methods for providing such protection, especially for simultaneous

events involving several contaminated facilities in separate locations.

16

Canter, op. cit.

17

Barakat, op. cit., and Jernigan, op. cit.

18

It may be useful to note that both TAGAs were deployed to check for air contaminants in

areas affected by hurricanes Katrina and Rita, which raises questions about the appropriate

numbers and prepositioning of TAGAs, and the mix of public versus private monitoring,

especially given monitoring demands in terror and nonterror incidents. Further information

about EPA’s TAGAs can be found at [http://www.epa.gov/earth1r6/6lab/taga.htm].

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On-Site Remediation Details. Important site-specific details include the

following:

!

On-site decisions whether to remediate an entire facility, or to

remediate in subsections, must continue to be based on site-specific

conditions. One factor that slowed remediation activities in 2001

was the lack of information about ventilation in the contaminated

structures. Remediation could be facilitated if building owners,

managers, and insurers maintained information about air flow in a

facility.

!

On-site decisions regarding the best remediation chemicals or

physical agents to use must continue to be based on site-specific

conditions, including the types of important items (e.g., books,

photographs, or computer equipment) and ventilation in the facility.

Since the 2001 anthrax releases, EPA has approved seven chemicals

for use against anthrax, which may be used only by authorized

personnel following the specific requirements of the crisis

exemption, and only with approved decontamination plans.19 In

addition to these chemicals, other ways to remediate anthrax

facilities are now more widely known.20 However, available

remediation technologies remains an issue.

Following its

examination of myriad approaches to remediation, EPA reported that

“chlorine dioxide has shown the most promise for use as a fumigant

for biologically contaminated buildings.”21 For remediating large

facilities, chlorine dioxide is produced by a machine on-site. It may

be useful to consider how many, and how large, chlorine dioxide

generators, private and public, are appropriate nationwide, and

where they should be prepositioned to facilitate future remediations.

!

Decisions about which indicator species to use, the number and

placement of indicator strips, the quality of the strips, and the

methods for handling and analysis, continue to be made based on

site-specific conditions. One could argue, however, that given the

greater level of experience and expertise now available, these

19

EPA evaluates pesticides to ensure that they meet federal safety standards, before they can

be marketed and used domestically. The agency can issue exemptions for various reasons,

including public health emergencies. See CRS Report RL31921, Pesticide Law: A Summary

of the Statutes, by Linda-Jo Schierow. The seven chemicals approved by EPA for use

against anthrax, to be used by authorized personnel following the specific requirements of

the crisis exemption (which includes having approved decontamination plans), are vaporized

hydrogen peroxide, chlorine dioxide, sodium hypochlorite (bleach), paraformaldehyde,

methyl bromide, peroxyacetic acid with hydrogen peroxide, and ethylene oxide.

20

Compilation of Available Data on Building Decontamination Alternatives. United States

Environmental Protection Agency. EPA/600/R-05/036. March 2005.

21

Decontamination and Consequence Management Synopsis Report. United States

Environmental Protection Agency. EPA/R-05/031. April 2005. This information is

available at [http://www.epa.gov/NHSRC/news/news041205.htm].

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decisions could be incorporated into a remediation standard and not

left to site-by-site determinations, which may slow remediations and

increase costs.

Cross-Organization Issues Today

Managing the Situations. There have been many cross-organization policy

and procedure changes since 2001. The National Response Plan (NRP) has

superseded the Federal Response Plan. The NRP is now accompanied by six other

national priorities, which are part of the National Preparedness System (NPS).22 The

NRP “establishes a comprehensive all-hazards approach to enhance the ability of the

United States to manage domestic incidents,” according to the United States

Department of Homeland Security (DHS).23

In addition to the NRP, the NPS includes the National Incident Management

System (NIMS), which identifies standard operating procedures to ensure that

emergency responders communicate and cooperate to achieve the best response to

disasters. One important element of NIMS is the Incident Command System (ICS).

ICS operates in the framework of five functional areas: command, operations,

planning, logistics, and finance. ICS requires the identification of responsible

officers and staff prior to a disaster to ensure that functions and assignments are

carried out during the response.

It is beyond the scope of this report to discuss in detail ways to improve the

NRP or NPS, but it may be useful to note that all the cross-organization procedures

and policies continue to evolve, sometimes driven by incidents that illuminate

possible areas for improvement.24

Determining a Successful Remediation Today. Today, no public or

occupational exposure limit for anthrax exists, for the same reasons that existed in

2001. The criterion used to define a successful remediation in 2001 (i.e., zero

growth of anthrax surrogates in all postremediation samples) continues to be used.

Despite the similarity between 2001 and today with regard to exposure limit and a

successful remediation criterion, several recommendations have been made by

various organizations for ways to improve remediation efforts.

22

“A Common Approach to Preparedness.” United States Department of Homeland

Security. Available at [http://www.ojp.usdoj.gov/odp/docs/Goal_041305.pdf]. See CRS

Report RL32803, The National Preparedness System: Issues in the 109th Congress, by Keith

Bea.

23

“Emergencies and Disasters.” United States Department of Homeland Security.

Available at [http://www.dhs.gov/dhspublic/interapp/editorial/editorial_0566.xml].

24

The United States Government Accountability Office has reported on cross-organization

improvements for handling anthrax situations, including Agencies Need to Validate

Sampling Activities in Order to Increase Confidence in Negative Results, GAO-05-493T;

Better Guidance Is Needed to Ensure an Appropriate Response to Anthrax Contamination,

GAO-04-239; and Public Health Response to Anthrax Incidents of 2001, GAO-04-152.

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National Research Council Remediation

Recommendations

The Department of Homeland Security funded the Restoration and Domestic

Demonstration and Application Program to study and develop, among other things,

the criteria that must be met for a remediation effort to be declared successful. The

National Research Council (NRC)25 convened a committee of experts, and their

findings and recommendations were reported in Reopening Public Facilities After a

Biological Attack: A Decision Making Framework, released in summer 2005.26 The

committee did not recommend an actual standard for defining a successful anthrax

remediation. It did describe criteria that, if met, would facilitate the reoccupation and

reuse of the facility with minimal attendant risk. The committee’s 28

recommendations are condensed here and presented with more detail in Appendix

A. NRC committee recommendations fell into four categories.

!

Planning and preparing — including building managers having

detailed physical information about their facilities (e.g., air flow

patterns and floor plans); health department and law enforcement

authorities having predrawn agreements for information flow;

deployment of effective bioagent monitoring and health surveillance

systems; facility operators having training for prompt responses to

emergencies; and the NRP containing detailed technical information

about remediation and clear lines of responsibilities among

authorities.

!

Basing future actions on experience rather than establishing new

procedures with each incident — including having a response plan

that can be tailored for a specific situation but not creating a new

response plan for every situation; using a standard method for

assessing risk; and using standardized sampling and analytical

techniques, so that results are comparable and consistent. All of

these will help reduce costs and increase confidence in the

estimation of the extensiveness of remediation needed.

!

Involving representatives of all stakeholders, and independent

experts free of conflicts of interest, in all decisions and actions —

including creating precrisis agreements for using relevant sampling

protocols where they exist and agreements on how to develop

protocols where they don’t, and jointly developing risk assessment

and management procedures, which will increase acceptance of

remediation decisions and actions.

25

On its website, the National Academies says that it brings together scientific and

technological experts to advise the federal government and the public. The National

Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and

the National Research Council, compose the National Academies.

[http://www.nationalacademies.org/about].

26

Reopening Public Facilities After a Biological Attack, op. cit.

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!

Conducting research to accelerate threat identification and improve

understanding of human responses to different doses of bioagents —

including developing a system that can inexpensively and quickly

identify threat agents; conducting research to clarify human doseresponses to bioagents while further developing nonthreshold doseresponse models; and targeting research to improve the validity of

interspecies dose-response extrapolations. These actions will help

clarify the minimum remediation level needed to insure safe

reoccupany and reuse of facilities.

American National Standards Institute:

9/11 Commission Recommendations

Known generally as the 9-11 Commission, the National Commission on

Terrorist Attacks Upon the United States27 noted that the private sector, which

controls 85% of the critical infrastructure in the nation, remains largely unprepared

for a terrorist attack, with the principal contributing factor being the lack of a widely

embraced private sector preparedness standard. The Commission asked the

American National Standards Institute (ANSI)28 to develop a consensus on a

“National Standard for Preparedness” for the private sector. The proposed standard

would establish a common set of criteria and terminology for preparedness, disaster,

and emergency management and business continuity programs. Included in the

standard is consideration of risk assessment methodologies for anthrax and other

biological hazards, a recommendation also made in the NRC study. In its final

report, the Commission endorsed ANSI’s recommended standard for private

preparedness.29

Conclusions

The actions and recommendations following the 2001 anthrax incidents have

not resulted in the adoption of a specific, numeric remediation standard. The general

remediation criterion continues to be for zero growth of anthrax surrogates from all

postremediation environmental samples taken from a contaminated facility. What

has developed since 2001 is a set of recommendations, mostly relating to preparation

before a crisis, compiled from comments by public and private sector researchers,

remediators, facility managers, and others. The recommendations tend to fall into

27

On its website, the 9-11 Commission states that it is an independent, bipartisan

commission created by law in late 2002. [http://www.9-11commission.gov].

28

On its website, ANSI states that it is a nearly 90-year-old, “private, non-profit organization

that administers and coordinates the U.S. voluntary standardization and conformity

assessment system,” with a membership of approximately 1,000 company, organization,

governmental, institutional, and international members. [http://www.ansi.org].

29

The National Commission on Terrorist Attacks Upon the United States. The 9/11

Commission Report. U.S. Government Printing Office. July 22, 2005. Pages 397-398.

CRS-11

two categories: on-site preparations and cross-organization preparations. Congress,

in its EPA and DHS oversight responsibilities, may wish to consider the benefits and

costs of recommending, or not recommending, the implementation of these steps

preparing for future bioagent incidents.

Recommendations for On-Site Preparations

!

Have and maintain records of ownership of valuable and important

items in facilities.

!

Have detailed and current floor plans and information about air flow

patterns, under both routine and nonroutine conditions.

Recommendations for Cross-Organization Preparations

!

Have standardized sampling and analysis protocols and consensus

procedures for developing protocols, when needed.

!

Have standardized risk assessment procedures.

!

Conduct more research on human dose-responses to bioagents,

including anthrax, and develop nonthreshold does-response models

more fully.

!

Further develop plans and procedures to maximize involvement of

all stakeholders.

!

Conduct additional training and drills, especially for sampling,

analysis, and coordination procedures.

!

Determine the appropriate number, capabilities, and locations of

private and public TAGAs or other leak detectors and the conditions

under which they would be necessary.

!

Determine the appropriate number, size, and locations of chlorine

dioxide generators, given that EPA has concluded that chlorine

dioxide gas has shown the most promise for remediating

contaminated facilities.

Remaining Policy Questions

There remains a policy question that has relevance both on-site and across

organizations: Is there a need for a nonzero standard? Some researchers are

concerned that if several important facilities were simultaneously contaminated, and

if there were little or no parallel capability for those facilities, there might be

significant pressure to abandon the zero growth remediation criterion and remediate

to a less stringent level. Given lessons learned since 2001, it may now be possible

to use chlorine dioxide gas to remediate a large facility to the zero growth criterion,

at the cost of one week and $4 per square foot, compared with approximately 14

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weeks and $27 per square foot for the Hart Senate Office Building in 2001-2002.30

If this estimate can be reliably confirmed, in conjunction with the recommendations

described earlier, it may not be necessary to accept a remediation criterion less than

zero, nor to develop a remediation standard, because consistently achieving the zero

growth remediation criterion would appear to be reasonable and would likely be

demanded by stakeholders.

30

On the Hart Senate Office Building, Capitol Hill Anthrax Incident: EPA’s Cleanup Was

Successful; Opportunities Exist to Enhance Contract Oversight. United States

Governmental Accountability Office. June 2003. GAO-03-686. On the current remediation

estimate, personal communication with Sabre Technical Services, in September 2005.

Insurance is a related concern; Sabre reports an insurance arrangement with American

International Group, Inc., which requires remediation to the zero growth criterion. It may

be helpful to note that continuity of operations is a segment of federal contingency planning,

linked to continuity of government. See CRS Report RL31594, Congressional Continuity

of Operations (COOP): An Overview of Concepts and Challenges, by R. Eric Petersen and

Jeffrey W. Seifert; CRS Report RL31857, Continuity of Operations (COOP) in the

Executive Branch: An Overview, by R. Eric Petersen; and CRS Report RL31978 Emergency

Preparedness and Continuity of Operations (COOP) Planning in the Federal Judiciary, by

R. Eric Petersen.

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Appendix A: NRC’s Recommendations

A summary of NRC’s twenty-eight recommendations, in preparation for reopening

public facilities, follow.31

1. Remediation decisions and plans should consider the infectivity and virulence of

the biological agent in the particular situation at hand. Infectivity and virulence

can vary between natural and weaponized forms of anthrax, and given that

uncertainty, it is impossible to set an acceptable threshold below which

exposure would pose zero risk.

2. In considering how to respond to new biological attacks, authorities should base

their plans on lessons learned from prior experiences, rather than try to develop

a new response plan for each new incident. Important considerations should

include the critical policy dimensions of the biological quality of the hazard, the

public nature of the building, the people’s perception of the attack, and the

national security implications of the event.

3. Representatives of affected parties, as well as independent experts who are free

of conflicts of interest, should be involved in risk management decision making.

Stakeholder involvement in risk assessment and management would contribute

to more widespread acceptance of the legitimacy of the results.

4. After a facility has been remediated, some type of medical monitoring is critical

to ensure confidence that a facility is safe. The purpose and outcome of the

monitoring must be transparent to affected parties. There should be a

centralized and sustained effort to track the health of those exposed to the

bioagent.

5. Risk managers should assume that any given contamination incident could be

worse than initially perceived. Information about remediation efforts should be

made available widely, which will facilitate broader participation in risk

management activities.

6. Agreements among health departments and law enforcement agencies should be

drawn up in advance of incidents to facilitate the flow of information during a

crisis. Efforts to get broader participation in, and acceptance of, remediation

efforts will be helped by the unobstructed and transparent flow of information

during a crisis.

7. A standard risk assessment approach, developed and validated over the past 20

years, should be used as one part of decision making to determine the adequacy

of remediation efforts. Use of a well-validated method for assessing risk will

increase acceptance of its results.

8. A practical, as opposed to theoretical, analysis of risk also will increase its

acceptance, but more sampling source and dose-response data are needed for

31

Reopening Public Facilities After a Biological Attack, op. cit.

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this. Gathering and validating as much data as possible should be done in

preparation for a crisis. Trying to gather and validate data during a crisis will

impede remediation efforts.

9. Research should be conducted to develop a system that can inexpensively and

quickly identify threat agents. Remediation efforts can be facilitated with sound

and detailed information about the threat agent.

10. Characterizing the threat agent should be done before selecting the approach for

large scale remediation. The remediation approach chosen should be able to

destroy the amount of agent present at the start of the procedure (i.e., at its

highest concentration, prior to any dispersal).

11. Existing monitoring and surveillance systems need to be evaluated for their

abilities to detect and limit the spread of bioagents in a cost-effective manner.

Systems that prove effective could be deployed in public facilities that are likely

targets for attacks. Such systems could help better inform remediation

decisions.

12. Because bioagents can spread beyond their point of initial release through airhandling systems, reaerosolization, foot traffic, air currents, and adhesion to

people and clothes, an extensive survey should be done to determine the extent

to which biological contamination has spread. This consideration can affect the

extensiveness of remediation required.

13.

Building operators should, in preparation for a crisis, gain a thorough

understanding of how air flow occurs in their buildings, under both routine and

unusual conditions, such as during partial breakdowns or maintenance.

Remediation efforts can be impeded by needing to determine air flow, a process

made more difficult in a crisis by the presence of a bioagent.

14. The training and education of facility managers and building designers should

include information about vulnerabilities to weaponized agents, so they will be

better prepared to respond to bioterror attacks and subsequent remediation

efforts.

15. The concept of a threshold below which no risk to a population exists is not

supported by current data; dose-response data for most pathogens of concern are

incomplete. As such, nonthreshold dose-response models should be developed

further and used more extensively to reduce the possibility of remediating to an

arguable endpoint.

16. Targeted research should be conducted to help inform decision making based

on extrapolations of dose-response data between species for pathogens of

concern. Dose-response data from nonhuman species may be relevant and

useful to humans, if the proper mechanisms for extrapolation are discovered.

17. Samples of bioagents should be collected and handled by protocols that are

appropriate to the threat. Accepted protocols should be used where they exist,

and new protocols should be developed with the involvement of relevant public

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and private entities (e.g., the Centers for Disease Control and Prevention [CDC]

and the American Society for Microbiology).

18. Because surface sampling with dry wipes led to false negatives in one instance,

and to inconclusive results in another, wet surface-swipe techniques should be

used, with complementary vacuum surface-sampling.

19. Sampling and analyses should be standardized. Knowing that the sampling and

analyses are consistent and comparable will increase confidence in the estimate

of the initial extent of contamination and, therefore, the extensiveness of

remediation needed.

20. A general sampling plan, to guide more specific surface-, air-, and bulk-sampling

methods, should be a consensus document drawn up by stakeholders. This

would increase acceptance of sampling results, a step toward acceptance that

remediation was successful.

21. EPA precluded use of paraformaldehyde for remediation because of fears of its

possible carcinogenicity, despite its proven efficacy against bioagents. The

NRC committee recommended that the National Cancer Institute lead an

interagency task force to reevaluate the chemical’s possible carcinogenicity.

This could result in the addition of another available remediating agent.

22. Chlorine dioxide has been used successfully to remediate several buildings

contaminated by anthrax. The committee recommended that the chemical be

considered, at this time, the standard for remediation and that new methods and

processes should be expected to be at least as effective, safe, and cost-effective.

23. The committee recommended that EPA and CDC should establish standards for

remediation and validation of contaminated buildings, and for the training of

remediation teams.

24. A remediation technique that meets the current federal sterilization standard

could possibly leave a large number of viable anthrax spores in a contaminated

setting, possibly resulting in unacceptable residual risk. The committee

recommended that current and emerging remediation techniques should be

thoroughly evaluated to determine how efficiently they kill bioagents, including

anthrax.

25. Owners and managers of high-value facilities should plan and prepare for a

prompt and well-organized response, which will minimize the time that a

facility will be nonoperational due to remediation efforts. The committee

recommended that the NRP be augmented with more scientific and technical

information on bioweapons, remediation, sampling and surveying,

epidemiology, and forensics. There should be descriptions of how response and

recovery teams should operate, clear lines of responsibility for actions, from the

short through the long term.

26. Expanding on the previous recommendation, the committee recommended that

airport operators should assemble, adopt, and maintain detailed plans to

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identify, contact, and mobilize the diverse and specialized resources needed to

facilitate remediation and recovery. These plans and resources should be

updated periodically and stored in locations that would be accessible in a crisis.

27.

Physical information about facilities, including floor plans, material

characteristics, air flow patterns, and air sampling data should be included in

preparation plans.

Current contact information for individuals and

organizations that would be needed in a crisis also should be included in

preparation plans.

28. Planning should identify the interested parties, form them into working groups,

and have them interact regularly in anticipation of coming together to guide an

actual recovery effort. The committee recommended that actions be taken to

maximize trust among the participants and stakeholders.