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NEW YORK (AP) – The cloud of dust caught Carl Sadler near the East River, bleaching his clothes and hair as he searched for a way out of Manhattan after escaping from his office at the World Trade Center .
Gray powder escaped from the open windows and patio door of Mariama James’ downtown apartment, settling, inches thick in places, in her rugs and the furniture in her room. children’s room.
Barbara Burnette, a police detective, spat soot out of her mouth and throat for weeks as she worked on the burning rubble pile without a protective mask.
Today, all three are among more than 111,000 people enrolled in the World Trade Center Health Program, which provides free medical care to people with health problems potentially related to dust.
Two decades after the collapse of the Twin Towers, people continue to report illnesses that could be linked to the attacks.
To date, the United States has spent $ 11.7 billion on care and compensation for those exposed to dust, about $ 4.6 billion more than it has given to families of the people killed or injured on September 11, 2001. More than 40,000 people received payments from a government fund for people with illnesses potentially linked to the attacks.
Scientists still cannot say for sure how many people have developed health problems as a result of exposure to the tons of sprayed concrete, glass, asbestos, gypsum and god knows what else that fell. on Lower Manhattan when the towers fell.
Many people enrolled in the health program suffer from ailments common to the general public, such as skin cancer, acid reflux or sleep apnea. In most cases, there is no test to determine whether a person’s illness is related to Trade Center dust or other factors, such as smoking, genetics, or obesity.
Over the years, this has led to friction between patients who are absolutely sure they have a 9/11-related illness and doctors who have doubts.
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“Most people thought I was crazy back then,” says Mariama James.
She initially struggled to persuade doctors that the chronic ear infections, sinus problems, and asthma that plague her children, or her own shortness of breath, had anything to do with the copious amounts of dust she had to deal with. cleaning up his apartment.
Years of research have produced partial answers to 9/11 health issues like his. The largest number of people enrolled in the federal health program suffer from chronic inflammation of their sinuses or nasal cavities or from reflux, a condition that can cause symptoms such as heartburn, sore throat and chronic cough.
The reasons for this are not well understood. Doctors say it could be related to their bodies getting stuck in cycles of chronic inflammation initially triggered by dust irritation.
Post-traumatic stress disorder has become one of the most common persistent health problems, affecting approximately 12,500 people enrolled in the health program. Nearly 19,000 registrants have a mental health problem that is believed to be linked to the attacks. More than 4,000 patients suffer from chronic obstructive pulmonary disease, a family of potentially debilitating breathing problems.
Time has helped cure some physical illnesses, but not others. Many first responders who subsequently developed a chronic cough have seen it subside or go away altogether, but others have shown little improvement.
About 9% of firefighters exposed to dust still report a persistent cough, according to a fire department study. About 22% say they suffer from shortness of breath. About 40% still have chronic sinus or acid reflux problems.
Tests on firefighters who spent time at Ground Zero found that their lung function declined 10 to 12 times more than the rate normally expected due to aging in the first year after 9/11.
On the encouraging side, doctors say their worst fears about a possible wave of deadly 9/11 cancers have not come true.
Not yet, at least.
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Nearly 24,000 people exposed to shopping mall dust have contracted cancer in the past two decades. But for the most part, it has been at rates consistent with what researchers expect to see in the general public. Most have skin cancer, which is usually caused by sunlight.
Rates of a few specific types of cancer, including malignant melanoma, thyroid cancer, and prostate cancer, have been found to be slightly elevated, but researchers say it could be because more cases are being taken taken into account in medical surveillance programs.
“We really don’t have the huge rises in cancer that I was afraid of,” says Dr. Michael Crane, director of the World Trade Center Health Clinic in Mount Sinai. “I was terrified that we were going to have epidemic lung cancer. “
One study found that cancer death rates were actually lower among city firefighters and paramedics exposed to Trade Center dust than most Americans, possibly because frequent medical screenings have detected. early cancers.
Beneficiaries of this screening include people like Burnette, who initially began seeking treatment at the Mount Sinai clinic for a lung disease – hypersensitivity pneumonitis with fibrosis – which she developed after spending three weeks in the hospital. swirling dust at Ground Zero.
During one of these visits in 2017, a scanner detected lung cancer.
“If I hadn’t been in the program, or if I hadn’t seen Dr. Crane, I don’t know if they would have found him,” says Burnette. Since then, she has had two cycles of chemotherapy. It didn’t heal her, but it kept the cancer at bay.
In the early years of the Federal Health Program, many of the people who signed up were police officers, firefighters and others working on the debris heap. More recently, however, the majority of applications came from people who worked or lived in Lower Manhattan – people like Carl Sadler, who was in Morgan Stanley’s 76th-floor office in the South Tower of the Trade Center when he arrived. been hit and rocked by a hijacker. airplane.
“There were millions of pieces of paper flying away. Credences. Computers, ”says Salder. “We saw chairs flying that looked like they had people in them.”
He walked down the stairs and escalators to the street, then walked away with the crowd. “As we got to Water Street, just a block from the Fulton Fish Market, there was a huge explosion and the clouds and everything turned black and gray ash and we were covered in. soot, ”he said.
At first, Sadler’s health seemed good. But a few years after the attacks, he started to run out of breath while exercising and suffered from recurrent bronchitis. In his 60s, he had to give up certain outdoor activities such as skiing and soccer.
“I just had breathing problems,” he says, “but I never knew what it was.”
Now 80, he has been diagnosed over the years with acid reflux, asthma, as well as thyroid cancer and skin melanoma, for which he has been successfully treated. He thought it was all part of aging until 2017, when a friend suggested he enroll in the World Trade Center health program.
“He said, ‘You have a lot of health problems. You’ve had a lot of health problems. You should register, ”says Sadler.
Last year, another 6,800 people joined the health program. Not all of its members are currently sick. Many have signed up in case they get cancer in the future. Some have seen their conditions clear up. Last year, around 1,000 people participating in the program received inpatient treatment and around 30,400 received outpatient treatment, according to program statistics.
The Victims Compensation Fund, which makes payments to people with illnesses linked to the attacks, has an unlimited budget from Congress, but the medical program has grown so much it could run out of money. Members of Congress introduced a bill that would provide an additional $ 2.6 billion over 10 years to cover a projected funding gap from 2025.
Under the program, anyone who has worked or lived in Lower Manhattan or a small part of Brooklyn is eligible for free care if they develop certain illnesses. The list includes about a dozen types of respiratory or digestive tract disorders, 10 different psychological disorders, and at least two dozen types of cancer.
Research is also underway to eventually complete the list of conditions covered. Program administrator Dr John Howard says diseases under study now include autoimmune diseases, such as rheumatoid arthritis.
An early estimate was that up to 490,000 people could end up being covered, in part because people don’t have to prove their illness is related to the 9/11 attacks to qualify. If a person has a condition on the list, they are presumed eligible.
“We cover lung cancer regardless of attribution issues,” Howard says. “If you have lung cancer, we don’t do an analysis of how many years you have smoked. “
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From a public health perspective, what might the next 20 years after 9/11 hold for those who were there that morning, and the days and weeks that followed?
The average age of those enrolled in the Federal Health Program is now around 60, and Dr. Jacqueline Moline, director of the World Trade Center Health Clinic in the Northwell Health Medical System, is concerned that people’s health problems do not get worse with age. Cancer caused by asbestos, she noted, can take up to 40 years to develop after exposure.
“We’re just getting to the point where we could start to see things,” says Moline. She is also deeply concerned about the long-term effects of post-traumatic stress disorder.
In addition to the psychological damage, there are concerns that the constant jerks of adrenaline and other stress hormones that accompany PTSD may worsen heart problems or weaken the immune system. And with that, the emotional and physiological ripples of a September day 20 years ago could collide in new and debilitating ways.
Crane, who has treated Ground Zero responders from the start, says one thing is clear based on the continuous flow of new patients: The problem is not going away.
“They keep coming,” he said. “They keep coming in through the door.”
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David Caruso, editor of the Associated Press in New York City, has been covering the aftermath of 9/11 for more than a decade. Follow him on Twitter at http://twitter.com/dcarusoAP
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