New York-Born Disease Detective Returns Home to Assist Local Public Health Officials in Wake of Terrorist Attack
On September 11, Dr. McKenzie Andre was like all Americans – stunned by the events taking place in New York, Washington and Pennsylvania. But, for Andre, who recently finished his residency training, and at the time was in his third month as a CDC disease detective in Atlanta, the events in New York hit him particularly hard since he grew up in Brooklyn and all his immediate family and friends still lived there.
When the director of CDC's Epidemic Intelligence Service (EIS) sent out an e-mail that 30 officers were needed for the first wave heading to New York, Andre immediately volunteered.
"I definitely wanted to be there. New York is home – I felt like I should be there," he recalled, adding, "As part of our EIS training, we participated in bioterrorism preparedness practices and scenarios – but I don't think anyone thought this would happen."
Two days later, he flew to New York on a Royal Australian Air Force C130J military aircraft from Dobbins Air Force Base in Georgia.
Once on the ground, he and the other disease detectives were bussed to the New York City Public Health Department Laboratory – the staging area for the public health response. Andre and the other EIS officers were assigned to conduct surveillance at 15 hospitals around the city. A CDC EIS officer was at each hospital 24 hours a day. Stationed at Bellvue Hospital Center, Andre was well prepared to work in a New York emergency room since his residency was at St. Luke's-Roosevelt Hospital Center in New York City.
"We kept track of every single person who came into the hospital. We were doing syndromic surveillance – monitoring for a pattern of symptoms or injuries in the aftermath of the attack that could indicate a possible bioteorrorism event," said Andre, who worked 15-hour days in the first days of the crisis. "We were trying to answer questions like, 'Are hospitals being overrun?' 'Are there a lot of specific types of injuries or symptoms?'" The input was gathered daily and provided to New York public health officials for analysis. The information gave officials an accurate picture of the city's health needs in the critical days after the attacks, allowing the public health teams to focus on the rescue and recovery effort.
"Part of what we were responding to was public fears. If you can give people the most accurate information, it goes a long way," Andre said, noting that before people were assigned onsite, the public health department relied on busy hospital staff to track incoming patients and were only capturing 40% of the people being admitted. "Our team was able to capture 95 or 96%," he said.
A pivotal moment came when Andre went down to Ground Zero to fit firefighters and construction workers with respirators. Information gathered by EIS officers in the hospitals had demonstrated that first responders were suffering upper-respiratory symptoms. Fitting the masks correctly with the specific type of respirator was not simple but was essential to protect the people working at the site. The type of mask depended on the level of exposure or where the person was working. Once the masks were on, Andre physically tested each one to make sure they were sealed properly.
"I was standing in front of 20 stories of rubble. There were about six construction workers working in the basement in a nearby building and they didn't want to come out. So I went in and I tested them with a flashlight. It was dark in there. They were working 48 and 72 hours straight – they wouldn't stop," recalled Andre. "Their spirit really showed. It makes me feel good that we have this ability to respond. You hope you don't have to draw on it but at the same time you're glad to know it's there. I was never more proud to be from New York than I was at that moment."
Andre stayed on in New York for 15 days, and then returned again to New York on October 30, the day after a 61-year-old Bronx hospital worker was diagnosed with inhalational anthrax. He assisted local public health and law enforcement agencies as they retraced the woman's steps for the last two weeks of her life.
"We talked to her doctors, her neighbors and to her co-workers. We found out where she had lunch. We found out her train route. We got her metro card and learned what time she got on certain trains and traced her path." The investigation has not resulted in a definitive answer to how the woman was exposed and later died, but it did rule out how she got it – her apartment building and workplace were all clean.
"I never realized before what a dedicated group of people I work with," Andre said. "We really challenged each other."
He added that although public health work is not glamorous, it is work that has to be done. "It's my job. The same way the guys who were driving the truck to take away the debris, I felt like you have something to offer; you hope that it makes a difference."
Now, Andre is back at his regular EIS assignment – tuberculosis control in high-risk populations such as HIV-positive people, and homeless and immigrant groups. He looks forward to a career that will combine his clinical work with public health. As for his recent EIS experiences, Andre believes that they will make him a better doctor. He knew he wanted to join CDC's EIS program his first year as a medical student.
"I love medicine. I think of myself as a physician first but I wanted to understand a little more about what happens in communities. As September 11 showed, we don't live in a vacuum. The idea is to take the lessons you learned and bring that back with you to your patient interactions."
Andre is one of 140 EIS officers learning epidemiology at CDC through hands-on experience.
"It's a group of people who are dedicated to learning and having that kind of experience. And a lot of the people who work at state and local health departments are CDC-affiliated or EIS graduates. While I'm at CDC, I want to learn as much as I can about working in the public-health realm," Andre said.
