“I as- sumed they were tourists.” One of Jarrah’s neighbors, Nancy Adams, recalled the young man with close-cropped hair al- ways carried a briefcase.
Dr. Tsonas concluded the man had a minor infection, an encrusted boil or infected scrape. He removed the dry scab over the wound, cleansed it, and prescribed Keflex, an an- tibiotic that is widely used to combat bacterial infections. Keflex is ineffective against cutaneous anthrax. Dr. Tsonas took no cultures and had no thoughts of anthrax. At that time it was an unheard-of disease in the United States and unfamiliar to most doctors. Anthrax was “regarded as an obscure, rarely seen disease that had caused only a few deaths.” Cutaneous anthrax has a low fatality rate. Without treatment victims might heal on their own.
Dr. Tsonas’s encounter with the two men had lasted per- haps ten minutes. By October, he had entirely forgotten about them until federal agents showed up after Bob Ste- vens died. They showed the physician pictures of Alhaz- nawi and Jarrah. The FBI had discovered Dr. Tsonas’s prescription among possessions Alhaznawi left behind when he moved out in late August. The agents gave Dr. Tsonas a copy of his own notes from the emergency room visit on June 25 and he read them over. Amid news reports about the first anthrax victims, Dr. Tsonas, like other doc- tors, had thrown himself into learning more about the dis- ease. He wanted to be prepared. His hospital was relatively near AMI, so victims there might come to Holy Cross for treatment.
As he examined his notes, he said, “Oh, my God, my written description is consistent with cutaneous anthrax.” He was astonished and discussed the disease and its symptoms with the agents, explaining that it could possibly explain the leg wound. A spider bite was unlikely, he said. As for the hijacker’s explanation, a suitcase bump: “That’s a little un- usual for a healthy guy, but not impossible,” he said.
Both men were suspected of participating in the hijacking of United Airlines Flight 93 on 9-11. Jarrah died along with Alhaznawi on the Boeing 757, which crashed into a Somer- set County, Pennsylvania, field after passengers on the
plane fought back. Jarrah was thought to have taken the controls. When the wreckage was fine-combed no anthrax spores were found. Nor were any ferreted out in the two terrorists’ condominium.
Upon closer scrutiny, another question arose. Alhaznawi was examined only days after he entered the U.S., an indi- cation that the infection developed before his arrival. And Lisa recalled it as a “gash.” There was simply not enough intelligence to draw a specific conclusion. Thomas W. Mc- Govern, the leading authority on anthrax for the American Academy of Dermatology’s bioterrorism task force, said it was “highly unlikely” for someone to contract cutaneous anthrax on his lower leg.
“So there’s just no there there,” said one investigator. “But it sure is intriguing.” After his meetings with the FBI, Dr. Tsonas was contacted again by a senior federal medical expert, who asked him detailed questions about his tentative diagnosis. Experts at Johns Hopkins also called Dr. Tsonas, saying they, too, were studying the evidence. Much later, the FBI asked Tara O’Toole and Thomas V. Inglesby, who head the Johns Hopkins Center for Civilian Biodefense Strategies, to evaluate Tsonas’s diagnosis. They prepared a two-page memo, which was circulated among senior gov- ernment officials. They concluded that Tsonas’s diagnosis of cutaneous anthrax was “the most probable and coherent interpretation of the data available.” After the memo became public later that conclusion was endorsed by D. A. Hender- son, the top bioterrorism official at the Department of Health and Human Services, and plain-speaking Richard Spertzel, former head of the UN’s biological weapons inspections in Iraq.
Dr. O’Toole said that after consulting with other medical experts on the Alhaznawi
Dr. Tsonas concluded the man had a minor infection, an encrusted boil or infected scrape. He removed the dry scab over the wound, cleansed it, and prescribed Keflex, an an- tibiotic that is widely used to combat bacterial infections. Keflex is ineffective against cutaneous anthrax. Dr. Tsonas took no cultures and had no thoughts of anthrax. At that time it was an unheard-of disease in the United States and unfamiliar to most doctors. Anthrax was “regarded as an obscure, rarely seen disease that had caused only a few deaths.” Cutaneous anthrax has a low fatality rate. Without treatment victims might heal on their own.
Dr. Tsonas’s encounter with the two men had lasted per- haps ten minutes. By October, he had entirely forgotten about them until federal agents showed up after Bob Ste- vens died. They showed the physician pictures of Alhaz- nawi and Jarrah. The FBI had discovered Dr. Tsonas’s prescription among possessions Alhaznawi left behind when he moved out in late August. The agents gave Dr. Tsonas a copy of his own notes from the emergency room visit on June 25 and he read them over. Amid news reports about the first anthrax victims, Dr. Tsonas, like other doc- tors, had thrown himself into learning more about the dis- ease. He wanted to be prepared. His hospital was relatively near AMI, so victims there might come to Holy Cross for treatment.
As he examined his notes, he said, “Oh, my God, my written description is consistent with cutaneous anthrax.” He was astonished and discussed the disease and its symptoms with the agents, explaining that it could possibly explain the leg wound. A spider bite was unlikely, he said. As for the hijacker’s explanation, a suitcase bump: “That’s a little un- usual for a healthy guy, but not impossible,” he said.
Both men were suspected of participating in the hijacking of United Airlines Flight 93 on 9-11. Jarrah died along with Alhaznawi on the Boeing 757, which crashed into a Somer- set County, Pennsylvania, field after passengers on the
plane fought back. Jarrah was thought to have taken the controls. When the wreckage was fine-combed no anthrax spores were found. Nor were any ferreted out in the two terrorists’ condominium.
Upon closer scrutiny, another question arose. Alhaznawi was examined only days after he entered the U.S., an indi- cation that the infection developed before his arrival. And Lisa recalled it as a “gash.” There was simply not enough intelligence to draw a specific conclusion. Thomas W. Mc- Govern, the leading authority on anthrax for the American Academy of Dermatology’s bioterrorism task force, said it was “highly unlikely” for someone to contract cutaneous anthrax on his lower leg.
“So there’s just no there there,” said one investigator. “But it sure is intriguing.” After his meetings with the FBI, Dr. Tsonas was contacted again by a senior federal medical expert, who asked him detailed questions about his tentative diagnosis. Experts at Johns Hopkins also called Dr. Tsonas, saying they, too, were studying the evidence. Much later, the FBI asked Tara O’Toole and Thomas V. Inglesby, who head the Johns Hopkins Center for Civilian Biodefense Strategies, to evaluate Tsonas’s diagnosis. They prepared a two-page memo, which was circulated among senior gov- ernment officials. They concluded that Tsonas’s diagnosis of cutaneous anthrax was “the most probable and coherent interpretation of the data available.” After the memo became public later that conclusion was endorsed by D. A. Hender- son, the top bioterrorism official at the Department of Health and Human Services, and plain-speaking Richard Spertzel, former head of the UN’s biological weapons inspections in Iraq.
Dr. O’Toole said that after consulting with other medical experts on the Alhaznawi
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