Cleaning Up is Hard to Do

When Dr. Craig Spencer became ill with Ebola in New York City following his return from West Africa, the City government was faced with difficult decisions about whether to decontaminate the now famous bowling alley, where the doctor bowled a few games before he felt feverish. Available scientific evidence suggests that remediation was probably unnecessary -- once Dr. Spencer became symptomatic, he isolated himself and reported to the New York City health authorities. Yet, the decision was made to retrace Dr. Spencer’s steps in the days before he became ill and to inspect and decontaminate the places he visited, including the bowling alley.

He’s not a bioremediation expert, but he plays one on TV

Enter Sal Pane and his company Bio-Recovery Corp–contracted by the City to carry out decontamination of the bowling alley and Dr. Spencer’s residence. Upon receipt of the contract to decontaminate, Mr. Pane proceeded to grant interviews to major media outlets, touting his decades of experience and presenting himself as a kind of Harrison Ford of bioremediation. Unfortunately, as reported in a recent BuzzFeedNews article, Sal Pane’s confident claims about his qualifications and certifications as a bioremediation consultant are now being called into question. On paper, Bio-Recovery Corp had the appropriate experience in biological assessment and cleanup, as it had contributed to the post-anthrax 2001 clean-up operation (under another company name and owner) before coming under the direction of Mr. Pane. In reality, BuzzFeedNews reported that while the company “claimed to have certifications from EPA and the New York Department of Environmental Conservation,” BuzzFeedNews “could not find any evidence of this.” In addition, BuzzFeedNews found that Bio-Recovery Corp’s “state permit to haul medical waste expired in 2012, before Pane was associated with the company.” So, now it is unclear whether the work this company did was effective (regardless of whether it was necessary in the first place).

This is not to suggest that the midst of the crisis was the time for the City to be tracking down and verifying the bonefides of remediation companies. I am sure that the City relied on the information it had at hand, which indicated that Bio-Recovery Corp was legitimate–a reasonable approach in an emergency. I do find it disheartening, however, that we are still caught off guard when biological decontamination issues arise.

It’s not as though we didn’t know this could be a problem. In 2001, anthrax spores from the Amerithrax letters contaminated media office buildings in New York City. At that time there were no guidelines available for the cleanup process and no registry of reputable companies qualified for remediation work. And, in 2010, I worked with the US Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism to revisit this issue and research federal progress in preparedness to decontaminate after a bioterrorism attack on a US city. Again, and we found major gaps in preparedness, including gaps in determining safe levels of contamination and in vetting and engaging remediation companies.

For me, this incident illustrates that there are two major outstanding questions which we need to address:

First, what is our process for assessing the risks from biological contamination and making decontamination decisions?

The decision to decontaminate public spaces in NYC was incongruous with the public health messaging that Ebola transmission does not occur unless a person is symptomatic. Based on public health and medical evidence and on CDC guidance, decontamination of public spaces was not necessary in the case of Dr. Spencer, and yet it was still carried out.

Now, the science we have on Ebola is not perfect–there is still some uncertainty about Ebola transmission, and there was also some uncertainty about when Dr. Spencer started feeling ill. This uncertainty, along with a desire to reassure the public, may have influenced the decision to decontaminate, and rightly so. Science cannot be the only factor considered in response to complex situations.

However, the decision to decontaminate, and the public way it was carried out under Mr. Pane, resulted in mixed messages that were intended to reassure the public, but instead confused the issue. What we really needed in this situation was open communication on what we know about the risks to public health, the uncertainties about the science that informs risk, the options we have to manage the risks, and the social, political, and economic consequences of the risk-based decisions we make.

Second, what systems should we have in place decontaminate when it is necessary?

There are many companies that do biological remediation, most of which are legitimate, and some of which have the requisite knowledge, certifications, and skills to perform remediation in a bioterrorism event or other bio-contamination emergency. There are major differences between the routine remediation of medical settings, and the skill-set that will be needed following a large-scale incident. It is likely that snake oil salesmen will try to take advantage of an emergency situation, so how does the responsible local official tell the difference? The key will be to think through these issues and vet companies prior to an emergency. A registry of companies maintained by the state or federal government would be a good start.

Fortunately, despite this example, progress has been made in other areas on this issue since 2010. DHS, in partnership with the DoD, sponsored two major projects on response and recovery for biological terrorism: the Integrated Biological Restoration Demonstration (IBRD) project in Seattle, and the Wide Area Recovery and Resilience Project (WARRP) in Denver. These projects brought the federal government together with state and local officials to develop and pilot remediation plans in those cities. The work resulted in a number of planning documents that may be useful to other cities, research on remediation, and a research agenda for the future. Also helpful was  the 2013 White House Biological Response and Recovery Science and Technology Roadmap, which calls attention to the issues of biological remediation, and lays out a research agenda which DHS has begun to address.

It’s clear that our ability to remediate following a biological contamination emergency remains incomplete. I am hopeful that we are moving the right direction, but let’s not forget that cleaning up is hard to do.