9/11: Long-Term Health Monitoring

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9/11: Long-term Health Monitoring

World Trade Center Health Registry Quarterly Report

New York City Government Report

By: New York City Department of Health and Mental Hygiene (DOHMH)

Date: May 13, 2004

Source: New York City Department of Health and Mental Hygiene

About the Author: In 2003, the New York City Department of Health and Mental Hygiene (DOHMH) began to recruit people that had lived and worked in Lower Manhattan during and after the World Trade Center attacks of September 11, 2001, to participate in a long-term study of health effects: the World Trade Center Health Registry (WTCHR).


Persistent smoke and fumes from the nation's longest burning commercial fire contaminated the air over Manhattan and parts of New Jersey in the months following the September 11, 2001 attacks on the World Trade Center. The New York City and federal governments were faced with mounting pressure from environmental groups such as the Sierra Club to explore the long-term health effects of the fire. Health effects had to be determined not only for emergency personnel, firefighters, police, cleanup and construction workers and volunteers active at Ground Zero, but also for hundreds of thousands of people that lived and worked in Lower Manhattan. Air contamination by dust from the disaster persisted even after the fire was extinguished as windblown particulate matter that had not been cleaned up continued to circulate around the area.

Early claims by the United States Environmental Protection Agency (EPA) that it was safe to live and work in the area were met with skepticism by environmental and public health critics. Additionally, the formation of the World Trade Center registry was not simply a response to political and popular pressure; in fact individuals within city government had initiated plans to study the effects soon after September 11, 2001. New York Senator Hilary Rodham Clinton was outspoken in her determination to hold the EPA accountable for monitoring any potential long-term health effects.

The city, backed with federal government funding, hired Research Triangle Institute (RTI), a major governmental consulting firm, to administer a disease registry that would enroll as many residents and workers in the target area as possible. The operating epidemiological assumption has been that many of the health effects of the airborne toxins from the fire at Ground Zero would be of low frequency and would not be detected unless tens of thousands of people were tracked over the long term. The source document excerpts cited in this article offer insight into the complex issues involved in maintaining this study and making sure that it does what it purports to do—detect the incidence and prevalence of long-term respiratory problems, cancers, and other conditions that could be attributed to toxins in the smoke from Ground Zero. Some adverse health effects, such as respiratory disorders, are already being discovered.



Immediately following the World Trade Center terrorist attacks of September 11, 2001, the New York City Department of Health and Mental Hygiene (DOHMH) and other environmental health experts became concerned about several health issues of the exposed populations.

First, it was not immediately known what environmental toxins were released from the building collapse and ensuing fires, and how such toxins or irritants would affect the health of residents and office workers in the vicinity, and emergency responders. Second, there was equal concern about the mental health needs of the population attacked as well as those responding. Additionally, there were concerns about the injuries suffered by survivors and responders. After deliberations between NYC DOHMH, the Environmental Protection Agency (EPA), the Agency for Toxic Substances and Disease Registry (ATSDR), and the Federal Emergency Management Agency (FEMA), it was decided that a registry of persons exposed to the dust, airborne particulates, and fumes from the fires and the events of 9/11 was necessary to document baseline health and mental health status; and would be an investment in the City's ability to understand any long term health effects.

Registries have been used for over 30 years to study the extent of health problems from exposures to environmental contamination and disasters. A registry, unlike most epidemiological studies, allows participation of all exposed persons willing to enroll. Registries can enable long-term evaluation of health effects, since subjects for more structured studies can be selected from the registry cohort.

After extensive careful planning and expert consultation on the development of the scientific approach the WTCHR began data collection on September 5, 2003. Data collection continued through November 20, 2004. Over 70,000 persons were registered . . .


In the aftermath of September 11, 2001, many people in New York and on the Jersey Shore, where the smoke plume from the World Trade Center most often settled, talked about "the World Trade Center Flu," a complex of symptoms that included cough and hyper-reactivity. Although many people reported such symptoms, others experienced no symptoms, even on September 11. Therefore, the EPA initially asserted that the air quality in Lower Manhattan presented no known long-term health risks.

A presentation by scientists at the American Chemical Society (ACS) convention in 2003 concluded that rescue workers, volunteers, and others close to Ground Zero in the months after September 11 were exposed to dangerous pollutants and that these same pollutants posed little threat to people in New York and New Jersey away from the neighborhood of Ground Zero. Conditions were toxic for workers at the site without respirators and slightly less so for people living and working in adjacent buildings. The study focused on the persistent fires at Ground Zero that burned until mid-December. Tests were conducted in October from a rooftop site a mile from Ground Zero. High readings were recorded only on days when the wind was blowing directly toward the test site.

The ACS presentation came only a week after the Inspector General of the EPA released a statement that the agency had bowed to pressure to tone down public warnings about air quality, to refrain from issuing cautions and cleanup instructions, and to issue a claim that the air was safe to breathe. The inspector general said that the EPA lacked data to make such a claim.

Former EPA Administrator Whitman said EPA testing revealed similar high spikes of pollutants based on wind shifts, but they always dissipated rapidly, a position that was supported by the scientists' study. She reiterated that no study had disproved what the agency had said from the beginning.

The University of California at Davis study, based on 8,000 air samples, collected from the rooftop at 201 Varick St. in Manhattan, showed that the smoke and dust cloud contained:

  • fine toxic metals that interfere with lung chemistry
  • sulfuric acid, which attacks cilia and lung cells
  • fine glass particles
  • high temperature organic matter, possibly carcinogenic.
  • It is clear that residents and workers near Ground Zero were exposed to erratic but sometimes high levels of poisonous pollutants. New studies by epidemiologists are revealing that toxic chemicals in the smoke plume over Lower Manhattan are indeed having at least short-term health effects on worker and resident populations exposed to the smoke and dust from the destruction of the World Trade Center.



Geyh AS, Chillrud S, Williams DL, et al. "Assessing Truck Driver Exposure at the World Trade Center Disaster Site: Personal and Area Monitoring for Particulate Matter and Volatile Organic Compounds during October 2001 and April 2002." Journal of Occupational and Environmental Hygiene. 2:179–193(2005).

Lin S, Reibman J, Bowers JA, Hwang SA, et al. "Upper Respiratory Symptoms and Other Health Effects among Residents Living Near the World Trade Center Site after September 11, 2001." American Journal of Epidemiology.

Reibman J, Lin S, Hwang S.A., et al. "The World Trade Center Residents' Respiratory Health Study: New Onset Respiratory Symptoms and Pulmonary Function." Environmental Health Perspectives. 113:406–411(2005).

Chambers S. "Ground Zero air study shows a 'chemical factory.' Series: 9/11 Two Years Later." The Newark StarLedger. September 11, 2003, page 8.

Rich, M., "Ground Zero Health Worries Linger Amid More Questions." The Wall Street Journal, Feb 10, 2003.

Web sites

World Trade Center (WTC) Health Registry. <http://www.nyc.gov/html/doh/html/wtc/index.html> (accessed July 6, 2005).