NEW YORK (AP) – A cloud of dust caught Carl Sadler near the East River, turning his clothes and hair white as he sought to leave Manhattan after escaping from his World Trade Center office.
Through the open windows and the door to the terrace of the apartment in the center of Mariama James, gray dust was placed, which was installed a few inches thick on her carpets and furniture. children’s bedrooms.
Barbara Burnette, a police detective, spit soot from her mouth and throat for weeks while working on the pile of burning debris without a protective mask.
Today, all three are part of more than 111,000 people enrolled in the World Trade Center Health Program, which offers free medical care to people with potentially dust-related health problems.
Two decades after the collapse of the Twin Towers, people continue to move forward to denounce diseases that could be related to the attacks.
To date, the United States has spent $ 11.7 billion in care and compensation for people exposed to dust, about $ 4.6 billion more than it gave to the families of people killed or injured on September 11, 2001. .More than 40,000 people have received payments from a government fund for people with potentially attack-related illnesses.
Scientists still can’t say for sure how many people developed health problems as a result of exposure to tons of powdered concrete, glass, asbestos, gypsum and God knows what else fell in Lower Manhattan when the towers fell.
Many people enrolled in the health program have conditions common to the general public, such as skin cancer, acid reflux, or sleep apnea. In most situations, there is no evidence to tell if someone’s illness is related to Trade Center dust or the result of other factors, such as smoking, genetics, or obesity.
Over the years, this has led to some friction between patients who are absolutely certain 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.
Initially, he had difficulty convincing doctors that chronic ear infections, sinus problems, and asthma affecting his children, or his shortness of breath, had nothing to do with the copious amounts of dust. that he had to clean his apartment.
Years of research have produced partial answers about 9/11 health issues like yours. Most people enrolled in the federal health program suffer from chronic inflammation of the breast or nasal cavities or reflux disease, 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 and persistent health conditions, affecting some 12,500 people enrolled in the health program. About 19,000 enrollees have a mental health problem that is believed to be related to the attacks. More than 4,000 patients have some form of chronic obstructive pulmonary disease, a family of potentially debilitating respiratory problems.
Time has helped to cure some physical ailments, but not others. Many of the first responders who developed a chronic cough later made it go away or disappear completely, but others have shown little improvement.
According to a Fire Department survey, about 9% of firefighters exposed to dust still report persistent cough. About 22% say they have difficulty breathing. About 40% still have chronic sinus problems or acid reflux.
Tests conducted on fire brigade personnel who spent time in the zero zone found that their lung function decreased 10 to 12 times more than the rate normally expected due to aging in the first year after September 11th.
On the encouraging side, doctors say their worst fears about a possible wave of deadly 9/11 cancers have not been met.
Not yet, at least.
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Nearly 24,000 people exposed to the dust of the mall have suffered from cancer in the past two decades. But for the most part, it has been at a pace in line with what researchers expect to see in the general public. The largest number have skin cancer, which is usually caused by sunlight.
Rates of some specific cancers, including malignant melanoma, thyroid cancer, and prostate cancer, have been found to be modestly high, but researchers say this could be due to the capture of more cases in cancer programs. medical check-up.
“We don’t really have the huge elevations of cancer that I was afraid of,” says Dr. Michael Crane, director of the World Trade Center health clinic on Mount Sinai. “I was afraid we were going to have epidemic lung cancer.”
One study showed that cancer mortality rates have actually been lower among city firefighters and paramedics exposed to Trade Center dust than for most Americans, possibly because frequent medical tests detected the cancers prematurely.
Beneficiaries of this screening include people like Burnette, who initially began receiving treatment at the Mount Sinai clinic for a lung disease (hypersensitivity pneumonitis with fibrosis) that he developed after spending three weeks in the swirling dust. of the zero point.
During one of those visits in 2017, a scan was completed to detect lung cancer.
“If I hadn’t been on the show or seen Dr. Crane, I don’t know they would have found him,” Burnette says. He has since had two rounds of chemotherapy. He has not cured her, but he has kept cancer at bay.
During the early years of the federal health program, many people enrolled were police officers, firefighters, and other people working in the garbage dump. More recently, however, most requests have been from people who worked or lived in Lower Manhattan: people like Carl Sadler, who was in the Morgan Stanley apartment office in the south tower of the Trade Center when he be beaten and shaken by one kidnapped. plane.
“There were millions of pieces of flying paper. Beliefs. Computers, “says Salder.” We saw chairs flying that looked like they had people. “
He went down the stairs and escalators to the street and then walked away from the people. “When we got to Water Street, just a block from the Fulton fish market, there was a big explosion and the clouds and everything just turned to black and gray ash and covered us with soot,” he says.
Initially, Sadler’s health seemed good. But, a few years after the attacks, he began to have air while exercising and suffering from recurrent bronchitis. At 60, he had to give up some outdoor activities such as skiing and football.
“I just had respiratory problems,” he says, “but I never knew what they were.”
At age 80, he has been diagnosed with acid reflux disease, asthma, thyroid cancer and skin melanoma over the years, for which he was successfully treated. He thought it was all just a part of aging until around 2017, when a friend suggested he enroll in the World Trade Center health program.
“He said,‘ You have a lot of health issues. You have had many health problems. You have to register, ”Sadler says.
Last year 6,800 more people joined the health program. Not all of its members are currently ill. Many have signed up in case they have cancer in the future. Some have been clear about their conditions. Last year, about 1,000 people in the program received inpatient treatment and about 30,400 received outpatient treatment, according to program statistics.
The Victims Compensation Fund, which pays people with attack-related illnesses, has an unlimited budget from Congress, but the medical program has grown so much that it could run out of money. Members of Congress have introduced a bill that would provide an additional $ 2.6 billion over 10 years to fill the funding gap projected from 2025.
Under the program, anyone who works or lives in Lower Manhattan or a small portion of Brooklyn is eligible to receive free care if they develop certain diseases. The list includes about a dozen types of digestive and respiratory disorders, 10 different psychological disorders, and at least two dozen types of cancer.
It is also being investigated to possibly add to the list of covered conditions. The administrator of the program, Dr. John Howard, says the conditions being studied now include autoimmune diseases, such as rheumatoid arthritis.
A first estimate was that up to 490,000 people could end up covered, in part because people don’t have to prove their illness is related to the Sept. 11 attacks to qualify. If a person has a condition on the list, they are supposed to be eligible.
“We cover lung cancer, regardless of attribution issues,” Howard says. “If you have lung cancer, we don’t go on to analyze how many years you’ve smoked during your packing.”
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Seen from a public health perspective, what might the next 20 years after 9/11 have for the people who were there that morning and the following days and weeks?
The average age of those enrolled in the federal health program is now in their 60s, and Dr. Jacqueline Moline, director of the Northwell Health Medical System’s World Trade Center health clinic, is concerned that people’s health problems will get worse. as they age. He noted that cancer caused by asbestos can take up to 40 years to develop after exposure.
“We’re getting to the point where we could start seeing things,” Moline says. She is also deeply concerned about the long-term effect of post-traumatic stress.
In addition to the psychological damage, there are fears that the constant shocks of adrenaline and other stress hormones presented with PTSD could worsen heart problems or weaken the immune system. And with that, the emotional and physiological waves of a September day 20 years ago could clash in new and debilitating ways.
Crane, who has been treating zero-response agents since the beginning, says one thing is clear based on the continuous flow of new patients: the problem will not go away.
“They keep coming,” he says. “They keep coming in the door.”
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David Caruso, New York City news editor for The Associated Press, has covered the aftermath of 9/11 for more than a decade. Follow him on Twitter at http://twitter.com/dcarusoAP