Managing the Threat of Anthrax in the Mail:
Occupational Health Principles

Claus-Peter Polster
Health and Safety Branch
The OPCW
The Hague, The Netherlands

          Recent attacks within the United States of America resulted in 12 cases of anthrax infection. In addition, thousands of subsequent hoaxes and false alarms have caused severe disruptions throughout the US and in other nations. This paper describes how application of the standard principles of risk management and occupational health can be applied to address the issue of potential biohazards in the mail. These principles were successfully implemented by the Health and Safety, Security, and Mailroom staff of the OPCW (Organisation for the Prohibition of Chemical Weapons) in The Hague, and were able to prevent disruption from a number of false alarm incidents, that might otherwise have caused significant impact.
          In the post-9/11 climate, the high profile media coverage of the US anthrax attacks caused fear and concern to mail workers and other staff around the globe. This was intensified in many international organisations, due to their higher visibility and international profile. Most organisations found themselves having to assess and manage a completely new type of threat, and one for which little previous experience was available. As was the case with many other international organisations, the Management of the Technical Secretariat of the OPCW decided that the threat and the concomitant concerns of staff had to be taken seriously. The question, though, was what steps to take. The standard steps of the risk management process provided a structure for action.
          The first step was to identify the potential hazards and to assess the related risks. At that time, delivered mail (including a good deal of personal mail) was received in a location inside the main administrative building. Mail clerks then opened the official mail for registration, and delivered it together with unopened private mail to respective addressees. Delivery of Anthrax tainted mail opened within the mailroom or offices would have resulted in an exposure of the staff present in the room, potential contamination of the entire building, an immediate building evacuation, and the associated cleanup costs. Mailroom and other staff may have had to undergo personal decontamination and begin medical treatment with antibiotics. An important consideration was that even a false alarm or hoax would have had similar impact for the initial investigative phases before an all-clear could be announced. This would include building evacuation, the need for prophylactic antibiotics, and the psychological issues associated with such an event.
          Once the hazards had been identified, and the risks assessed, the second step was to develop appropriate risk control measures to reduce the identified risks to an acceptable level. Possible attitudes could have been:

1. "Find out what others are doing, and copy the best solution."
2. "Ignore the problem and hope nothing happens."
3. "Develop a plan, applying the principles of occupational safety."

          1. Many organisations at this time primarily used Individual Protective Equipment for the mail handlers as the only method of risk reduction. Although a seemingly obvious solution, the provision of individual protective equipment to the mailroom personnel would actually not have solved any of the problems related to an actual or suspected contamination of the building. Additionally, the protection provided even by well-fitted air-filtrating respirators (AFR) is rather low (protection factor (PF) 50 - 400 depending on the type of AFR). A number of other solutions encountered (such as radiating the mail with high energy particle radiation, or treatment with formaldehyde vapours) would have been potentially destructive to the mail, or just too expensive and technically too extravagant in relation to the available means, and in relation to the level of assessed risk.
          2. Taking potential costs into account, and particularly if one only uses the objectively assessed risk of an actual attack as an indicator, the approach of implementing none of the potential solutions and to conduct business as normal could be adopted. However this does not take into account the concerns of staff, and may be perceived as a "shoot the messenger" type of attitude. An employer has the obligation to address the concerns of employees even if they are related to low probability events. In this case, the high media visibility of the Anthrax scares, and the understandable fears this generated in millions of people around the world, had to be taken into account. The impact even of a false alarm or hoax on unprotected personnel could have been days of uncertainty and fear, since the "all-clear" time might have taken that long.
          3. After examining the alternatives, it was decided that application of the basic principles of occupational health would be effective. By first introducing administrative and engineering controls, it is possible to eliminate the requirement for IPE for most staff, and to minimise it for the few remaining people that have a reduced potential risk to deal with. This was achieved in the following way:

• the entire mail-handling process was relocated to an available external facility, that importantly was not connected to the ventilation system of the headquarters building (administrative control). A mobile fume cabinet usually used for the analysis of highly toxic substances, was installed to provide a safe working area in which to open all mail (engineering control). The cabinet, although not Bio Safety Level (BSL) 4 rated, is equipped with a HEPA filter (99.99% efficiency at 0.3 micron) and a variable airflow (0.25 - 1.00 m/sec), capable of providing containment equivalent to the BSL 4 requirements.
  
• further administrative controls were then implemented requiring that all mail be x-rayed (to detect weapons, explosives, etc.) prior to being transported to the auxiliary building, prohibiting any unopened mail from entering the main building, and implementing a phased process requiring all employees to begin making arrangements to reduce the amount of personal mail received at work. Mailroom personnel were trained in the use of the fume cabinet.

          Housekeeping controls used in the contained mail-opening process consist of plastic bags for the collection and transport of envelopes, and a small quantity of decontamination solution and a shallow tray located within the cabinet to allow for the immediate decontamination of suspicious mail. All surfaces within the fume cabinet are easily cleaned and disinfected. The only individual protective equipment required is a pair of impermeable gloves worn by the clerk actually opening the mail inside the fume cabinet. Respiratory protection is not required due to the efficiency of the cabinet HEPA filter system (PF > 10.000).
          Utilising this approach, two subsequent false alarms incidents were detected and managed before the suspicious mail reached the main building. In both cases there was no disruption of operations. The necessary actions were initiated quickly, at minimal cost, using resources that were immediately available. Finally, and perhaps most importantly, the staff that are actually involved with the mail opening operations are reassured that their employer is concerned with their welfare, and they expressed their satisfaction with the solution that was implemented.

Editor's Note: Claus-Peter Polster's paper and presentation at the CBMTS IV were outstanding. For additional information on this area, please contact Claus-Peter at the Health and Safety Branch, The OPCW in the Hague: tel: 31-70-376 1700, fax: 31-70-360-0944 and e-mail: healthbr@opcw.org.