- The Washington Times - Monday, November 5, 2001

Three calls to the District's anthrax hot line late last week received three different answers about the possible symptoms for the cutaneous form of the disease and a misdiagnosis on all three occasions.
The D.C. health department advertises its toll-free hot line number on its Internet Web site, (www.dchealth.dc.gov) and has given the number out at several news conferences. Calls from The Washington Times revealed that staffers are not giving consistent and accurate information.
Answers from the health department's call center, staffed by three to four operators 24 hours a day, were not clear. The three staffers who responded to calls did not seem to know the symptoms for cutaneous anthrax. None of the operators is a doctor or trained in medicine, which they explain when the interview begins.
"I am not a doctor, and I don't have a medical background," said Alex, a health department hot line operator.
"Symptoms for cutaneous anthrax are black spots, kind of. Do you have black spots?" he asked.
Cutaneous anthrax is contracted through a cut or scrape on the skin, yielding a painless blister, on the hand in most cases, that is red around the edges and later turns into an open sore with a black center of dead tissue, reads the Center for Disease Control and Prevention's Web site (www.cdc.gov).
Alex asked: "Have you handled any mail with anthrax on it," which could not be answered by anyone who had not already been tested positive for the disease. Three requests for symptoms were made, but only one symptom was given during the 10-minute interview.
"We have physicians and nurses from the CDC on standby so our operators can consult with them during calls," said Leila Abrar, communications officer for the health department.
"We are trying to be careful about what we say to people so we don't scare them."
The correct answer for cutaneous anthrax symptoms was given by another operator, Donna, on a second call to the hot line.
"When you told me it was a reddish rash, I was pretty sure you didn't have the symptoms because a sore with a black center is the symptom," Donna said.
She then read and recited the symptoms for inhalation anthrax, the deadlier of the two: "If you have cold or flulike symptoms, run a fever over 100 degrees and [experience] chills, you should see your doctor right away or go to an emergency room."
That statement is accurate.
A third operator, who did not give his name, also said "a reddish rash is a symptom for cutaneous anthrax." He said "a blister will form in the center of the rash with a black spot in the center of the blister." He also said a doctor should be consulted immediately.
"We are having a meeting today to inform our staff that the information being given out must be uniform and accurate," Mrs. Abrar said when told how the hot line staff had handled the calls. She said their performance was "unacceptable."
Emergency rooms at Washington Hospital Center and Providence Hospital are reporting lines of people in some cases out the door coming in to find out if they have anthrax, said D.C. Health Director Dr. Ivan C.A. Walks at a recent Metropolitan Washington Council of Governments meeting.

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