20 years after the attack on the Twin Towers, there are still consequences on the health of rescuers and survivors

20 years after the attack on the Twin Towers

Firefighters, police officers, doctors, volunteers and citizens are still paying the price for exposure to toxic substances and the psychological stress of that tragic event

The 9/11 terrorist attack on the Twin Towers 2001 (Chris Collins / Corbis / Getty Images) No one will ever forget. Twenty years have passed since the September 11, 2001 attacks on the Twin Towers in Manhattan. About 3,000 victims, many of which still unidentified, and more than six thousand injured: this is the tragic toll of the attacks on the World Trade Center. Over the years, over the years, new deaths from diseases caused by the intense exposure to toxic dust and fumes spread after the explosion have been added to these deaths.

Among the most affected, in addition to the survivors, there are rescuers, firefighters, law enforcement, doctors and paramedics, but also volunteers and agents in charge of cleaning and restoring the Ground Zero area - the site where the Twin Towers stood - completed in July 2002. More than 250 firefighters, according to recent data published in the magazine Jama, and more than 200 police officers have died in these two decades due to cancers and other diseases.

For some time now, several large research projects, in particular the World Trade Center (Wtc) Health Program, have been monitoring over time the pathologies that have emerged over time and related to the attacks on the Twin Towers. According to the Centers for Disease Control and Prevention (CDC), the public health control body in the United States, 400,000 to 500,000 people breathed and absorbed toxic substances at various levels at Ground Zero after the attacks. Respiratory diseases, such as chronic rhinosinusitis and asthma, digestive tract disorders, such as gastroesophageal reflux, and cancers are among the most frequent. Without forgetting the psychological boulder, which in some cases is still present today: from post-traumatic stress disorder to anxiety and depression disorders.

When the air was burning

During an emergency, immediately after the attacks, most of the rescuers did not have adequate face protection. Some of them used inappropriate masks, such as dust masks or N95s (now known and used against coronavirus). The ideal option was instead represented by the P-100 respirators, which however were not available in the first week of operations. The materials spread in fragments and powders were of various kinds: from cement to glass, from plastic to cellulose, up to metal parts and asbestos (about 0.8% of the complex was made up of them).

Among the carcinogens were polycyclic aromatic hydrocarbons, polychlorinated biphenyls, heavy metals, benzene and dioxins. In the immediate and immediate following period almost all of the rescuers had cough, nasal congestion, sore throat, as explained in Jama by the New York pulmonologist David Prezant, who on 11 September 2001 was right under the World Trade Center and who since then he has followed rescuers injured and affected by diseases associated with exposure to dust. Over time, cough and sore throat improved, giving way to more lasting symptoms, such as chronic sinusitis and gastrointestinal tract disorders, in particular gastroesophageal reflux. According to studies by the Fire Department of the City of New York (Fdny), where Prezant is deputy medical director, these disorders are still present and reported by about 40% of rescuers and firefighters (out of a sample of over 15 thousand). br>

Diseases in numbers

The WTC Health Program has recruited more than 110,000 people, including 80,000 rescuers, as firefighters and volunteers, and more than 30,000 survivors of the attacks. In most cases they are male (79%) and the most common age range is the one ranging from 55 to 64 years. In order to receive reimbursement for treatment for economic and moral damages, the people involved must go through this program to obtain a certification.

So far, of the more than 110,000 WTC participants, 65,000 have obtained the recognition of the diagnosis of a disease correlated to the attacks of 11 September. Another approximately 4,600 (to be precise 4,627) have died in recent years. This means that more than half of the people involved have had one or more consequences for psycho-physical health. The project announces the updated data of the most widespread conditions, which, as we can see from the graph, have most affected the rescuers.

We remind you that these have been exposed for a long time (even weeks or months) for the conclusion of the you work at Ground Zero. The most common disorder is chronic rhinosinusitis followed in second place by gastroesophageal reflux disease (GERD).

Following there are tumors, then asthma, sleep apnea, post-traumatic stress disorder. And again chronic respiratory diseases, exacerbations of chronic obstructive pulmonary disease (Bpco), anxiety and major depression. These are the 10 most common conditions.

The impact of the Gerd, second for incidence, which hit about 25,000 rescuers and 5,000 survivors, should not be underestimated. The appearance of reflux and other disorders of the gastroesophageal tract is probably due to the fact that the esophagus is very exposed, due to accidental ingestion, to toxic substances in the air. A study in Scientific Reports conducted for 15 years after the attacks estimates that the number of cases of Barrett's esophagus (precancerous condition) among the Twin Towers firefighters could be at least 6 times higher than that of the general population. >
Entering the list of associated tumors, there are, in order: skin neoplasms (non-melanoma), prostate, breast, melanoma, lymphomas, thyroid, lung, kidney, leukemia, colon, bladder, myeloma, oropharynx, rectum and neuroendocrine.

Tumors

Nearly 15,000 people, including rescuers and survivors, have developed a tumor which was contributed to by the attack on the Twin Towers and nearly 800 have died to date. In a first 2011 Lancet study, coordinated by pulmonologist Prezant, the increased risk of cancer was modest. There is also a 2013 study that found a 15% growth in all types of cancer among rescuers in the period from 2001 to 2008, with a higher frequency among those who had been most exposed. And again, a 2016 study indicated an 11% increase in cases among rescuers and 8% among survivors.

The data are to be taken with caution and no conclusions can yet be drawn. In general, while the aforementioned respiratory and gastric diseases occurred within five years of exposure, as indicated by the CDC Centers, tumorigenesis (the appearance of neoplasms) occurs over decades, and this is not a positive element. , and due to multiple mutations. For example, in the 2011 Lancet research, the authors did not detect an increase in lung cancer, despite the respiratory tract being the most affected. Unfortunately, this neoplasm takes many years to manifest itself and for this reason it is not excluded that even more cases may arise in the future. This is why it is more essential than ever to monitor the health of these people over time.

A trauma that leaves its marks for a long time

The psychological burden associated with trauma continues to weigh on the shoulders of many survivors and rescuers (often even greater for first responders). In the World Trade Center Program group, nearly 9,000 rescuers and 4,000 survivors have had or are diagnosed with post-traumatic stress disorder (PTSD), a mental health disorder - the only one whose precise cause is known and which is the result of trauma - involving various symptoms, including anxiety, nightmares, flashbacks, recurrent and obsessive thoughts and memories.

In many cases this problem is still present today, after 20 years. But the trauma also affected those who were not in the immediate vicinity of the Twin Towers. According to a 2002 study of Jama, in the metropolitan city of New York the likely prevalence of cases within 1 to 2 months of the event was 11.2%, higher than in Washington (2.7%) and the rest of the United States (4%).

PTSD is also not the only mental health disorder associated with 9/11. There are many cases of anxiety, major depression, and substance use disorder. A recently published study found that about a fifth of the police force members intervened and half of the "non-conventional" rescuers (non-traditional responders, i.e. volunteers, operators of associations and organizations, medical personnel with the exception of firefighters and other police forces) needed mental health care and assistance.

Participants responded approximately 6.5 years after the event. The most requested treatments were psychotropic drugs, individual psychotherapy and stress management counseling. Against the stigma it is good to remember that anyone can and has the right to ask for help. The data indicate that female people and individuals not belonging to the categories of law enforcement agencies on average perceived the need for psychological and psychiatric support and help more.

The stories of rescuers

When his brother was found missing, firefighter Daniel Foley searched desperately for him and managed, as he had promised, to find his body in the rubble. He could have stopped working but he did not: he assisted at Ground Zero until May 2002. Foley, as reported by the BBC, is one of the last more than 200 firefighters to die from diseases following the terrorist attacks of 2001, a long list of people which is added to that of the 343 firefighters who died during and immediately after the attack.

Fortunately, there are also stories with a happy ending. For three weeks after the attacks, Scott McDonough, an FBI agent, flew over the World Trade Center area by helicopter to monitor the rubble. The aim was to check that large debris and heavy materials did not collapse, causing further damage and an environmental catastrophe. McDonough held the helicopter doors open to take photos as the toxic-contaminated air burned his throat. Almost 16 years later, in August 2017, he received a diagnosis of colorectal cancer. But after 2 surgeries and six rounds of chemotherapy, McDonough has been over the disease for some time, even though he is always under control. The story is told on the page of the FBI website which lists 17 agents who died from diseases related to the attacks of September 11th.


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