9/11 survivors’ exposure to toxic dust and the chronic health conditions that followed offer lessons that are still too often unheeded
Those directly exposed to toxic dust and trauma on and after 9/11 carry with them a generation of chronic health conditions, which are placing them at higher risk during the pandemic and as they age.
Toxic dust hung in the air around Ground Zero for more than three months following the 9/11 terrorist attacks. Anthony Correia/Getty Images news
The 9/11 terrorist attack on the World Trade Center in New York resulted in the loss of 2,753 people in the Twin Towers and surrounding area. After the attack, more than 100,000 responders and recovery workers from every U.S. state – along with some 400,000 residents and other workers around Ground Zero – were exposed to a toxic cloud of dust that fell as a ghostly, thick layer of ash and then hung in the air for more than three months.
The dust also contained heavy metals that are known to be poisonous to the human body and brain, such as lead – used in the manufacturing of flexible electrical cables – and mercury, which is found in float valves, switches and fluorescent lamps. The dust also contained cadmium, a carcinogen toxic to the kidneys that is used in the manufacturing of electric batteries and pigments for paints.
One of the haunting images from 9/11: Smoke pours from the twin towers of the World Trade Center in New York after they were hit by two hijacked airliners.Robert Giroux via Getty Images
Polychlorinated biphenyls, human-made chemicals used in electrical transformers, were also part of the toxic stew. PCBs are known to be carcinogenic, toxic to the nervous system and disruptive to the reproductive system. But they became even more harmful when incinerated at high heat from the jets’ fuel combustion and then carried by very fine particles.
WTC dust was made up of both “large” particulate matter and very small, fine and ultrafine ones. These particularly small particles are known to be highly toxic, especially to the nervous system since they can travel directly through the nasal cavity to the brain.
Many first responders and others who were directly exposed to the dust developed a severe and persistent cough that lasted for a month, on average. They were treated at Mount Sinai Hospital and received care at the Clinic of Occupational Medicine, a well-known center for work-related diseases.
I am a physician specializing in occupational medicine who began working directly with 9/11 survivors in my role as director of the WTC Health ProgramData Center at Mount Sinai beginning in 2012. That program collects data, as well as monitors and oversees the public health of WTC rescue and recovery workers. After eight years in that role, I moved to Florida International University in Miami, where I am planning to continue working with 9/11 responders who are moving to Florida as they reach retirement age.
Remembering 9/11: As the north tower of the World Trade Center collapses, a cloud of toxic gas chases terrified residents and tourists.Jose Jimenez/Primera Hora via Getty Images
From acute to chronic conditions
After the initial “acute” health problems that 9/11 responders faced, they soon began experiencing a wave of chronic diseases that continue to affect them 20 years later. The persistent cough gave way to respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD) and upper airway diseases such as chronic rhinosinusitis, laryngitis and nasopharyngitis.
The litany of respiratory diseases also put many of them at risk for gastroesophageal reflux disease (GERD), which occurs at a higher rate in WTC survivors than in the general population. This condition occurs when stomach acids reenter the esophagus, or food pipe, that connects the stomach to the throat. As a consequence of either the airway or the digestive disorders, many of these survivors also struggle with sleep apnea, which requires additional treatments.
Further compounding the tragedy, about eight years after the attacks, cancers began to turn up in 9/11 survivors. These include tumors of the blood and lymphoid tissues such as lymphoma, myeloma and leukemia, which are well known to affect workers exposed to carcinogens in the workplace. But survivors also suffer from other cancers, including breast, head and neck, prostate, lung and thyroid cancers.
Some have also developed mesothelioma, an aggressive form of cancer related to exposure to asbestos. Asbestos was used in the early construction of the north tower until public advocacy and broader awareness of its health dangers brought its use to a halt.
And the psychological trauma that 9/11 survivors experienced has left many suffering from persistent mental health challenges. One study published in 2020 found that of more than 16,000 WTC responders for whom data was collected, nearly half reported a need for mental health care, and 20% of those who were directly affected developed post-traumatic stress disorder.
Many have told me that the contact they had with parts of human bodies or with the deadly scene and the tragic days afterward left a permanent mark on their lives. They are unable to forget the images, and many of them suffer from mood disorders as well as cognitive impairments and other behavioral issues, including substance use disorder.
Now, 20 years on, these survivors face a new challenge as they age and move toward retirement – a difficult life transition that can sometimes lead to mental health decline. Prior to retirement, the daily drumbeat of work activity and a steady schedule often helps keep the mind busy. But retirement can sometimes leave a void – one that for 9/11 survivors is too often filled with unwanted memories of the noises, smells, fear and despair of that terrible day and the days that followed. Many survivors have told me they do not want to return to Manhattan and certainly not to the WTC.
Aging can also bring with it forgetfulness and other cognitive challenges. But studies show that these natural processes are accelerated and more severe in 9/11 survivors, similar to the experience of veterans from war zones. This is a concerning trend, but all the more so because a growing body of research, including our own preliminary study, is finding links between cognitive impairment in 9/11 responders and dementia. A recent Washington Post piece detailed how 9/11 survivors are experiencing these dementia-like conditions in their 50s – far earlier than is typical.
The COVID-19 pandemic, too, has taken a toll on those who have already suffered from 9/11. People with preexisting conditions have been at far higher risk during the pandemic. Not surprisingly, a recent study found a higher incidence of COVID-19 in WTC responders from January through August 2020.
The health risks posed by direct exposure to the acrid dust was underestimated at the time, and poorly understood. Appropriate personal protective equipment, such as P100 half-face respirators, was not available at that time.
But now, 20 years on, we know much more about the risks – and we have much greater access to protective equipment that can keep responders and recovery workers safe following disasters. Yet, too often, I see that we have not learned and applied these lessons.
For instance, in the immediate aftermath of the condominium collapse near Miami Beach in June, it took days before P100 half-face respirators were fully available and made mandatory for the responders. Other examples around the world are even worse: One year after the Beirut explosion in August 2020, very little action has been taken to investigate and manage the physical and mental health consequences among responders and the impacted community.
A similarly dire situation is occurring in the immediate aftermath of a July 2021 chemical fire in Durban, South Africa.
Applying the lessons learned from 9/11 is a critically important way to honor the victims and the brave men and women who took part in the desperate rescue and recovery efforts back on those terrible days.
Roberto Lucchini receives funding from CDC/NIOSH to study the cognitive impacts associated to the WTC exposure to neurotoxins and to intense psychological trauma.
The SNF Institute for Global Infectious Disease Research announces new advisory board
From identifying the influenza virus that caused the pandemic of 1918 to developing vaccines against pneumococcal pneumonia and bacterial meningitis in…
From identifying the influenza virus that caused the pandemic of 1918 to developing vaccines against pneumococcal pneumonia and bacterial meningitis in the 1970s, combating infectious disease has a rich history at Rockefeller. That tradition continues as the Stavros Niarchos Foundation Institute for Global Infectious Disease Research at Rockefeller University (SNFiRU) caps a successful first year with the establishment of a new advisory board.
Credit: Lori Chertoff/The Rockefeller University
From identifying the influenza virus that caused the pandemic of 1918 to developing vaccines against pneumococcal pneumonia and bacterial meningitis in the 1970s, combating infectious disease has a rich history at Rockefeller. That tradition continues as the Stavros Niarchos Foundation Institute for Global Infectious Disease Research at Rockefeller University (SNFiRU) caps a successful first year with the establishment of a new advisory board.
This international advisory board was created in part to give guidance on how to best use SNFiRU’s resources, as well as bring forward innovative ideas concerning new avenues of research, public education, community engagement, and partnership projects.
SNFiRU was established to strengthen readiness for and response to future health crises, building on the scientific advances and international collaborations forged in the context of the COVID-19 pandemic. Launched with a $75 million grant from the Stavros Niarchos Foundation (SNF) as part of its Global Health Initiative (GHI), the institute provides a framework for international scientific collaboration to foster research innovations and turn them into practical health benefits.
SNFiRU’s mission is to better understand the agents that cause infectious disease and to lower barriers to treatment and prevention globally. To speed this work, the institute launched numerous initiatives in its inaugural year. For instance, SNFiRU awarded 31 research projects in 29 different Rockefeller laboratories for over $5 million to help get collaborative new research efforts off the ground. SNFiRU also supports the Rockefeller University Hospital, where clinical studies are conducted, and brought on board its first physician-scientist through Rockefeller’s Clinical Scholars program. “One of the surprises was the scope of interest from Rockefeller scientists in using their talents to tackle important infectious disease problems,” says Charles M. Rice, Maurice R. and Corinne P. Greenberg Professor in Virology at Rockefeller and director of SNFiRU. “The research topics range from the biology of infectious agents to the dynamics of the immune response to pathogens, and also include a number of infectious disease-adjacent studies.”
In the past 12 months, SNFiRU often brought together scientists studying different aspects of infectious disease as a way to spur new collaborations. In addition to hosting its first annual day-long symposium, SNFiRU initiated a Young Scientist Forum for students and post-doctoral fellows to meet regularly, facilitating cross-laboratory thinking. A bimonthly seminar series has also been established on campus.
Another aim of SNFiRU is to develop relationships with community-based organizations, as well as design and participate in community-engaged research, with a focus on low-income and minority communities. To that end, SNFiRU is helping develop a research project on Chagas disease, a tropical parasitic infection prevalent in Latin America that can cause congestive heart failure and gastrointestinal complications if left untreated. The project will bring together clinicians practicing at health centers in New York, Florida, Texas, and California and basic scientists from multiple institutions to help the communities that are most impacted.
“The SNFiRU international advisory board convenes globally recognized leaders with distinguished biomedical expertise, unrivalled experience in pandemic preparedness and response, and a shared commitment to translating scientific advancements into equitably distributed benefits in real-world settings,” says SNF Co-President Andreas Dracopoulos. “The advisory board will advance the institute’s indispensable mission, which SNF is proud to support as a key part of our Global Health Initiative, and we look forward to seeing breakthroughs in the lab drive better outcomes in lives around the globe.”
The new advisory board will hold its first meeting on April 11th, 2024, following the second annual SNF Institute for Global Infectious Disease Research Symposium at Rockefeller.
Its members are: Rafi Ahmed of Emory University School of Medicine, Cori Bargmann of The Rockefeller University, Yasmin Belkaid of the Pasteur Institute, Anthony S. Fauci, the former director of the National Institute of Allergy and Infectious Diseases, Peter Hotez of Baylor College of Medicine and Texas Children’s Hospital Center for Vaccine Development, Esper Kallas of of the Butantan Institute, Sharon Lewin of the University of Melbourne Doherty Institue, Carl Nathan of Weill Cornell Medicine, Rino Rappuoli of Fondazione Biotecnopolo di Siena and University of Siena, and Herbert “Skip” Virgin of Washington University School of Medicine and UT Southwestern Medical Center.
Congress’ failure so far to deliver on promise of tens of billions in new research spending threatens America’s long-term economic competitiveness
A deal that avoided a shutdown also slashed spending for the National Science Foundation, putting it billions below a congressional target intended to…
Federal spending on fundamental scientific research is pivotal to America’s long-term economic competitiveness and growth. But less than two years after agreeing the U.S. needed to invest tens of billions of dollars more in basic research than it had been, Congress is already seriously scaling back its plans.
A package of funding bills recently passed by Congress and signed by President Joe Biden on March 9, 2024, cuts the current fiscal year budget for the National Science Foundation, America’s premier basic science research agency, by over 8% relative to last year. That puts the NSF’s current allocation US$6.6 billion below targets Congress set in 2022.
And the president’s budget blueprint for the next fiscal year, released on March 11, doesn’t look much better. Even assuming his request for the NSF is fully funded, it would still, based on my calculations, leave the agency a total of $15 billion behind the plan Congress laid out to help the U.S. keep up with countries such as China that are rapidly increasing their science budgets.
Our data shows how underfunding basic research, especially in high-priority areas, poses a real threat to the United States’ role as a leader in critical technology areas, forestalls innovation and makes it harder to recruit the skilled workers that high-tech companies need to succeed.
A promised investment
Less than two years ago, in August 2022, university researchers like me had reason to celebrate.
The CHIPS act authorized US$81 billion for the agency, promised to double its budget by 2027 and directed it to “address societal, national, and geostrategic challenges for the benefit of all Americans” by investing in research.
But there was one very big snag. The money still has to be appropriated by Congress every year. Lawmakers haven’t been good at doing that recently. As lawmakers struggle to keep the lights on, fundamental research is quickly becoming a casualty of political dysfunction.
Research’s critical impact
That’s bad because fundamental research matters in more ways than you might expect.
For instance, the basic discoveries that made the COVID-19 vaccine possible stretch back to the early 1960s. Such research investments contribute to the health, wealth and well-being of society, support jobs and regional economies and are vital to the U.S. economy and national security.
Lagging research investment will hurt U.S. leadership in critical technologies such as artificial intelligence, advanced communications, clean energy and biotechnology. Less support means less new research work gets done, fewer new researchers are trained and important new discoveries are made elsewhere.
Businesses nationwide thrive by selling the goods and services – everything from pipettes and biological specimens to notebooks and plane tickets – that are necessary for research. Those vendors include high-tech startups, manufacturers, contractors and even Main Street businesses like your local hardware store. They employ your neighbors and friends and contribute to the economic health of your hometown and the nation.
Nearly a third of the $10 billion in federal research funds that 26 of the universities in our consortium used in 2022 directly supported U.S. employers, including:
A Detroit welding shop that sells gases many labs use in experiments funded by the National Institutes of Health, National Science Foundation, Department of Defense and Department of Energy.
A Dallas-based construction company that is building an advanced vaccine and drug development facility paid for by the Department of Health and Human Services.
More than a dozen Utah businesses, including surveyors, engineers and construction and trucking companies, working on a Department of Energy project to develop breakthroughs in geothermal energy.
When Congress shortchanges basic research, it also damages businesses like these and people you might not usually associate with academic science and engineering. Construction and manufacturing companies earn more than $2 billion each year from federally funded research done by our consortium’s members.
A lag or cut in federal research funding would harm U.S. competitiveness in critical advanced technologies such as artificial intelligence and robotics.Hispanolistic/E+ via Getty Images
Jobs and innovation
Disrupting or decreasing research funding also slows the flow of STEM – science, technology, engineering and math – talent from universities to American businesses. Highly trained people are essential to corporate innovation and to U.S. leadership in key fields, such as AI, where companies depend on hiring to secure research expertise.
In 2022, federal research grants paid wages for about 122,500 people at universities that shared data with my institute. More than half of them were students or trainees. Our data shows that they go on to many types of jobs but are particularly important for leading tech companies such as Google, Amazon, Apple, Facebook and Intel.
That same data lets me estimate that over 300,000 people who worked at U.S. universities in 2022 were paid by federal research funds. Threats to federal research investments put academic jobs at risk. They also hurt private sector innovation because even the most successful companies need to hire people with expert research skills. Most people learn those skills by working on university research projects, and most of those projects are federally funded.
High stakes
If Congress doesn’t move to fund fundamental science research to meet CHIPS and Science Act targets – and make up for the $11.6 billion it’s already behind schedule – the long-term consequences for American competitiveness could be serious.
Over time, companies would see fewer skilled job candidates, and academic and corporate researchers would produce fewer discoveries. Fewer high-tech startups would mean slower economic growth. America would become less competitive in the age of AI. This would turn one of the fears that led lawmakers to pass the CHIPS and Science Act into a reality.
Ultimately, it’s up to lawmakers to decide whether to fulfill their promise to invest more in the research that supports jobs across the economy and in American innovation, competitiveness and economic growth. So far, that promise is looking pretty fragile.
Jason Owen-Smith receives research support from the National Science Foundation, the National Institutes of Health, the Alfred P. Sloan Foundation and Wellcome Leap.
What’s Driving Industrial Development in the Southwest U.S.
The post-COVID-19 pandemic pipeline, supply imbalances, investment and construction challenges: these are just a few of the topics address by a powerhouse…
The post-COVID-19 pandemic pipeline, supply imbalances, investment and construction challenges: these are just a few of the topics address by a powerhouse panel of executives in industrial real estate this week at NAIOP’s I.CON West in Long Beach, California. Led by Dawn McCombs, principal and Denver lead industrial specialist for Avison Young, the panel tackled some of the biggest issues facing the sector in the Western U.S.
Starting with the pandemic in 2020 and continuing through 2022, McCombs said, the industrial sector experienced a huge surge in demand, resulting in historic vacancies, rent growth and record deliveries. Operating fundamentals began to normalize in 2023 and construction starts declined, certainly impacting vacancy and absorption moving forward.
“Development starts dropped by 65% year-over-year across the U.S. last year. In Q4, we were down 25% from pre-COVID norms,” began Megan Creecy-Herman, president, U.S. West Region, Prologis, noting that all of that is setting us up to see an improvement of fundamentals in the market. “U.S. vacancy ended 2023 at about 5%, which is very healthy.”
Vacancies are expected to grow in Q1 and Q2, peaking mid-year at around 7%. Creecy-Herman expects to see an increase in absorption as customers begin to have confidence in the economy, and everyone gets some certainty on what the Fed does with interest rates.
“It’s an interesting dynamic to see such a great increase in rents, which have almost doubled in some markets,” said Reon Roski, CEO, Majestic Realty Co. “It’s healthy to see a slowing down… before [rents] go back up.”
Pre-pandemic, a lot of markets were used to 4-5% vacancy, said Brooke Birtcher Gustafson, fifth-generation president of Birtcher Development. “Everyone was a little tepid about where things are headed with a mediocre outlook for 2024, but much of this is normalizing in the Southwest markets.”
McCombs asked the panel where their companies found themselves in the construction pipeline when the Fed raised rates in 2022.
In Salt Lake City, said Angela Eldredge, chief operations officer at Price Real Estate, there is a typical 12-18-month lead time on construction materials. “As rates started to rise in 2022, lots of permits had already been pulled and construction starts were beginning, so those project deliveries were in fall 2023. [The slowdown] was good for our market because it kept rates high, vacancies lower and helped normalize the market to a healthy pace.”
A supply imbalance can stress any market, and Gustafson joked that the current imbalance reminded her of a favorite quote from the movie Super Troopers: “Desperation is a stinky cologne.” “We’re all still a little crazed where this imbalance has put us, but for the patient investor and owner, there will be a rebalancing and opportunity for the good quality real estate to pass the sniff test,” she said.
At Bircher, Gustafson said that mid-pandemic, there were predictions that one billion square feet of new product would be required to meet tenant demand, e-commerce growth and safety stock. That transition opened a great opportunity for investors to run at the goal. “In California, the entitlement process is lengthy, around 24-36 months to get from the start of an acquisition to the completion of a building,” she said. Fast forward to 2023-2024, a lot of what is being delivered in 2024 is the result of that chase.
“Being an optimistic developer, there is good news. The supply imbalance helped normalize what was an unsustainable surge in rents and land values,” she said. “It allowed corporate heads of real estate to proactively evaluate growth opportunities, opened the door for contrarian investors to land bank as values drop, and provided tenants with options as there is more product. Investment goals and strategies have shifted, and that’s created opportunity for buyers.”
“Developers only know how to run and develop as much as we can,” said Roski. “There are certain times in cycles that we are forced to slow down, which is a good thing. In the last few years, Majestic has delivered 12-14 million square feet, and this year we are developing 6-8 million square feet. It’s all part of the cycle.”
Creecy-Herman noted that compared to the other asset classes and opportunities out there, including office and multifamily, industrial remains much more attractive for investment. “That was absolutely one of the things that underpinned the amount of investment we saw in a relatively short time period,” she said.
Market rent growth across Los Angeles, Inland Empire and Orange County moved up more than 100% in a 24-month period. That created opportunities for landlords to flexible as they’re filling up their buildings. “Normalizing can be uncomfortable especially after that kind of historic high, but at the same time it’s setting us up for strong years ahead,” she said.
Issues that owners and landlords are facing with not as much movement in the market is driving a change in strategy, noted Gustafson. “Comps are all over the place,” she said. “You have to dive deep into every single deal that is done to understand it and how investment strategies are changing.”
Tenants experienced a variety of challenges in the pandemic years, from supply chain to labor shortages on the negative side, to increased demand for products on the positive, McCombs noted.
“Prologis has about 6,700 customers around the world, from small to large, and the universal lesson [from the pandemic] is taking a more conservative posture on inventories,” Creecy-Herman said. “Customers are beefing up inventories, and that conservatism in the supply chain is a lesson learned that’s going to stick with us for a long time.” She noted that the company has plenty of clients who want to take more space but are waiting on more certainty from the broader economy.
“E-commerce grew by 8% last year, and we think that’s going to accelerate to 10% this year. This is still less than 25% of all retail sales, so the acceleration we’re going to see in e-commerce… is going to drive the business forward for a long time,” she said.
Roski noted that customers continually re-evaluate their warehouse locations, expanding during the pandemic and now consolidating but staying within one delivery day of vast consumer bases.
“This is a generational change,” said Creecy-Herman. “Millions of young consumers have one-day delivery as a baseline for their shopping experience. Think of what this means for our business long term to help our customers meet these expectations.”
McCombs asked the panelists what kind of leasing activity they are experiencing as a return to normalcy is expected in 2024.
“During the pandemic, shifts in the ports and supply chain created a build up along the Mexican border,” said Roski, noting border towns’ importance to increased manufacturing in Mexico. A shift of populations out of California and into Arizona, Nevada, Texas and Florida have resulted in an expansion of warehouses in those markets.
Eldridge said that Salt Lake City’s “sweet spot” is 100-200 million square feet, noting that the market is best described as a mid-box distribution hub that is close to California and Midwest markets. “Our location opens up the entire U.S. to our market, and it’s continuing to grow,” she said.
The recent supply chain and West Coast port clogs prompted significant investment in nearshoring and port improvements. “Ports are always changing,” said Roski, listing a looming strike at East Coast ports, challenges with pirates in the Suez Canal, and water issues in the Panama Canal. “Companies used to fix on one port and that’s where they’d bring in their imports, but now see they need to be [bring product] in a couple of places.”
“Laredo, [Texas,] is one of the largest ports in the U.S., and there’s no water. It’s trucks coming across the border. Companies have learned to be nimble and not focused on one area,” she said.
“All of the markets in the southwest are becoming more interconnected and interdependent than they were previously,” Creecy-Herman said. “In Southern California, there are 10 markets within 500 miles with over 25 million consumers who spend, on average, 10% more than typical U.S. consumers.” Combined with the port complex, those fundamentals aren’t changing. Creecy-Herman noted that it’s less of a California exodus than it is a complementary strategy where customers are taking space in other markets as they grow. In the last 10 years, she noted there has been significant maturation of markets such as Las Vegas and Phoenix. As they’ve become more diversified, customers want to have a presence there.
In the last decade, Gustafson said, the consumer base has shifted. Tenants continue to change strategies to adapt, such as hub-and-spoke approaches. From an investment perspective, she said that strategies change weekly in response to market dynamics that are unprecedented.
McCombs said that construction challenges and utility constraints have been compounded by increased demand for water and power.
“Those are big issues from the beginning when we’re deciding on whether to buy the dirt, and another decision during construction,” Roski said. “In some markets, we order transformers more than a year before they are needed. Otherwise, the time comes [to use them] and we can’t get them. It’s a new dynamic of how leases are structured because it’s something that’s out of our control.” She noted that it’s becoming a bigger issue with electrification of cars, trucks and real estate, and the U.S. power grid is not prepared to handle it.
Salt Lake City’s land constraints play a role in site selection, said Eldridge. “Land values of areas near water are skyrocketing.”
The panelists agreed that a favorable outlook is ahead for 2024, and today’s rebalancing will drive a healthy industry in the future as demand and rates return to normalized levels, creating opportunities for investors, developers and tenants.
This post is brought to you by JLL, the social media and conference blog sponsor of NAIOP’s I.CON West 2024. Learn more about JLL at www.us.jll.com or www.jll.ca.
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