NEW YORK – A cloud of dust whitewashed Carl Sadler near the East River as he sought his way out of Manhattan after escaping from his office in the World Trade Center.
Gray powder seeps through the open windows and ceiling doors of Mariama James’s downtown apartment, inches thick in place, in her rugs and the children’s bedroom furniture.
Barbara Burnett, a police detective, spit soot out of her mouth and throat for weeks while she worked on a pile of burning rubble 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 associated with dust.
Two decades after the Twin Towers collapsed, people are still coming forward to report illnesses that may have been related to the attacks.
To date, the US has spent $11.7 billion on care and compensation for those exposed to dust—more than $4.6 billion given to the families of those killed or injured on September 11, 2001. More than 40,000 people have received payments from a government fund for people with illnesses potentially linked to the attacks.
Scientists still can’t say for sure how many people developed health problems as a result of exposure to tons of pulverized concrete, glass, asbestos, gypsum, and god knows what else fell on Lower Manhattan when the towers collapsed .
Many people enrolled in health programs have conditions common to the general population, such as skin cancer, acid reflux or sleep apnea. In most situations, there is no test that can tell whether someone’s illness is related to trade center dust, or is the result of other factors such as smoking, genetics or obesity.
Over the years, this has caused some friction between patients who are absolutely sure they have the illness linked to 9/11, and doctors who are skeptical.
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“Most people thought I was crazy then,” Mariama James says.
She initially had a hard time convincing doctors that her kids suffering from chronic ear infections, sinus issues and asthma, or her own shortness of breath, had anything to do with the huge amount of dust she had to clean from her apartment. was not.
Years of research have provided partial answers to the health problems of 9/11 like theirs. The largest number of people enrolled in the federal health program suffer from chronic inflammatory or reflux disease of their sinuses or nasal cavities, a condition that can cause symptoms including heartburn, sore throat and chronic cough.
The reasons for this are not well understood. Doctors say this may be related to their bodies being trapped in a cycle of chronic inflammation, initially caused by dust irritation.
Post-traumatic stress disorder has emerged as one of the most common, persistent health conditions, afflicting approximately 12,500 people enrolled in the health program. About 19,000 enrollees are believed to have a mental health problem linked to the attacks. More than 4,000 patients have some form of chronic obstructive pulmonary disease, a family of potentially debilitating breathing problems.
Time has helped heal some physical ailments, but not others. Many first responders who developed a chronic cough later found it faded, or disappeared entirely, but others have shown little improvement.
According to fire department research, about 9% of firefighters exposed to the dust still report a persistent cough. About 22% report experiencing shortness of breath. About 40% still have chronic sinus problems or acid reflux.
Tests on fire department personnel who spent time at Ground Zero found that their lung function declined at 10 to 12 times the normally expected rate as they aged in the first year after 9/11.
On the encouraging side, doctors say their worst fears about a potential wave of deadly 9/11 cancers have not come true.
Not now, at least.
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About 24,000 people exposed to trade center dust have been diagnosed with cancer over the past two decades. But for the most part, it has been in line with the rates researchers expect to see in the general public. The highest number of skin cancers occur, which is usually caused by sunlight.
Rates of certain types of cancer – including malignant melanoma, thyroid cancer and prostate cancer – have been found to be moderately elevated, but researchers say this may be due to more cases being caught in medical surveillance programs. .
“We really don’t have the height in cancer that I was afraid of,” says Dr. Michael Crane, director of the World Trade Center Health Clinic at Mount Sinai. “I was scared we were going to have epidemic lung cancer.”
One study showed that cancer mortality among city firefighters and paramedics exposed to trade center dust was actually lower than among most Americans, possibly because cancer is often caught early in medical screening. .
Beneficiaries of that screening include people like Burnett, who initially began treatment at the Mount Sinai Clinic for a lung disease — hypersensitivity pneumonitis with fibrosis — which he developed after spending three weeks in swirling dust at Ground Zero. Was.
During one of those visits in 2017, a scan lesioned to detect lung cancer.
“If I hadn’t been on the show, or hadn’t seen Dr. Crane, I wouldn’t have known they would have found it,” says Burnett. Since then, two rounds of chemotherapy have been done. It hasn’t cured him, but it has kept the cancer at bay.
In the early years of the federal health program, many of the enrollees were police officers, firefighters, and others who worked on rubble piles. Until recently, however, most applications have been from people working or living in Lower Manhattan – people like Carl Sadler, who was at Morgan Stanley’s 76th floor office in the South Tower of the Trade Center when it was struck by a hijacked plane. Went and was shaken.
“Millions of pieces of paper were flying. Credenza. computer,” says Salder. “We saw the chairs flying, it looked like there were people in them.”
He worked the stairs and escalators to get down the street, then walked away with the crowd. “As soon as we got to Water Street, just a few blocks from Fulton Fish Market, there was a huge explosion and the clouds and everything just turned black ash and gray and we were covered with soot,” he says.
Initially, Sadler’s health seemed fine. But a few years after the attacks, he began to wind up while exercising and suffering from frequent bronchitis. In his 60s, he had to give up some outdoor activities like skiing and soccer.
“I just had breathing problems,” he says, “but I never knew what they were.”
Now in his 80s, he has also been diagnosed with acid reflux disease, asthma, and thyroid cancer and skin melanoma, for which he was successfully treated. He thought it was all a part of growing up around 2017, when a friend suggested him to register with the World Trade Center health program.
“They said, ‘You’ve got a lot of health problems. You’ve got a lot of health problems. You should register,'” Sadler says.
Another 6,800 people attended the health program last year. At present not all its members are ill. Many have signed up in case they have cancer in the future. Some have made their terms clear. Last year, about 1,000 people got inpatient treatment in the program and about 30,400 people got outpatient treatment, according to program data.
The Victims Compensation Fund, which pays people with illnesses linked to attacks, has Congressional budget unlimited, but the Medicare program has grown so much that it may run out of money. Members of Congress have introduced a bill that would provide an additional $2.6 billion over 10 years to cover the expected funding gap starting in 2025.
Under the program, anyone who works or lives in Lower Manhattan or a small piece of Brooklyn is eligible for free care if they develop certain diseases. The list includes about a dozen types of airway or digestive disorders, 10 different psychiatric disorders, and at least two dozen types of cancer.
Research is also underway to add to the list of potentially covered conditions. Program administrator Dr. John Howard says the conditions now being studied include autoimmune diseases such as rheumatoid arthritis.
An initial estimate was that 490,000 people could be covered, partly because people did not have to prove that their illness was related to the September 11 attacks. If a person has a condition in the list, he is considered eligible.
“We cover lung cancer, regardless of attribution issues,” Howard says. “If you have lung cancer, we don’t analyze how many years you smoked.”
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Viewed through the prism of public health, what could the next 20 years after 9/11 be like for those who were there that morning, and what will happen in the days and weeks that follow?
The average age for those enrolling in a federal health program is now about 60, and Dr. Jacqueline Molin, director of the World Trade Center health clinic at Northwell Health Medical System, is concerned that people’s health problems will worsen with age. Cancer caused by asbestos can take up to 40 years to develop after exposure, he said.
“We’re just getting to the point where we can start seeing stuff,” Molin says. He is also deeply concerned about the long-term effects of post-traumatic stress.
In addition to the psychological harm, there are fears that the constant jolts of adrenaline and other stress hormones that come with PTSD may worsen heart problems or weaken the immune system. And with that, 20 years ago the emotional and physical waves of a day in September could collide in new and debilitating ways.
Crane, who has been treating Ground Zero responders since the beginning, says one thing is clear based on the constant stream of new patients: The problem isn’t going away.
“They keep coming,” he says. “They keep coming to the door.”