The capital region's bioterrorism crisis deepened yesterday after two employees at Washington's primary mail-handling facility died of suspected inhalation anthrax, and two others were seriously ill with the same illness.
Health authorities said they were also awaiting test results on at least nine other people in the Washington area - not necessarily all postal employees - whose illnesses might also prove to be anthrax.
Both fatalities were from Prince George's county, and both died within hours of arriving at hospital emergency rooms. Thomas L. Morris Jr., 55, of Suitland died Sunday and Joseph P. Curseen Jr., 47, of Clinton died yesterday.
In announcing the new cases, Homeland Security Director Tom Ridge said the nation was fighting two fronts in the same war. "There's a battlefield outside this country and there's a ... battlefield inside this country," he said
Ever since a Florida tabloid newspaper company became the first target of an anthrax attack last month, a string of poisoned letters and traces of deadly powder have surfaced in New York, New Jersey and Washington. But investigators remained puzzled yesterday by the trail of contamination - from the letter mailed to Senate Majority Leader Tom Daschle or another still undiscovered - that has infected postal workers.
Mitchell Cohen of the Centers for Disease Control and Prevention acknowledged that he did not understand how the victims had inhaled anthrax because the letter to Daschle was taped shut. "This phenomenon ... is an evolution," he said. "How it's actually occurring isn't clear."
More than 2,200 employees at Brentwood central mail facility, about 15 blocks north of the Capitol, and at an express mail facility in Linthicum were urged to report for testing and to begin a 10-day course of antibiotics.
Both facilities have been closed for at least a week while investigators work to locate the source of the contamination.
Last night, the Centers for Disease Control and Prevention recommended that all workers in 36 local post offices that receive mail from the Brentwood station take antibiotics as a precaution. Officials said about 2,000 employees would be covered.
As hundreds of postal workers waited outside D.C. General Hospital for testing yesterday, some expressed anger that they went untested for anthrax exposure and remained on the job last week, even after Congressional staffers who might have been exposed were examined and sent home.
"We're the ones taking the risks, and no one has been telling us the truth about the danger we've been in," said Willard Tucker, 44, a letter carrier from Forestville. "If I'm infected, I'm already in trouble because they waited so long before we got tested."
In an effort to safeguard postal workers, Deborah Willhite, a Postal Service official, said yesterday that the CDC and other health authorities had reversed their previous position and now advised that postal workers be furnished with gloves and masks.
Postmaster General John E. Potter said the Postal Service also was increasing security at its facilities and would introduce ultraviolet technology to sanitize mail. He also said that post offices had halted cleaning their machinery with blowers, which could possibly circulate anthrax spores.
The Brentwood mail center was targeted by investigators because they believe an anthrax-laced letter mailed from New Jersey on Oct. 9 and addressed to Daschle passed through the facility en route to Capitol Hill.
The Linthicum express mail facility near Baltimore-Washington International Airport was closed after Leroy Richmond, 57, a postal employee who worked there and at Brentwood, became sick during the weekend with the inhaled form of anthrax.
Ridge defended the actions of the Centers for Disease Control and others agencies yesterday. He said it took investigators a while to "follow the chain" of the Daschle letter back to Brentwood and determine there might be a problem at the facility.
"I think they moved quickly, as quickly as they could," Ridge said.
Cohen said that, much like the D.C. incident, previous investigations in Florida and New York, where anthrax-tainted letters also turned up, did not initially show anthrax in postal offices.
Spores have now turned up at a regional facility in Trenton, three post offices in South Florida and at a postal substation in Washington, as well as mailrooms in several House and Senate office buildings.
Since Oct. 4, health authorities have confirmed 10 cases of anthrax infection in the United States, all apparently connected to a flurry of tainted letters sent to newspaper and broadcast news offices and to the Senate.
Four cases were of the inhaled form of the disease, and one of those - in Florida - was fatal. The other six cases have been the more easily treated anthrax skin infections.
At least 32 more people - in New York and Washington - have tested positive for anthrax exposures.
Curseen, one of the postal workers, had seemed fine to neighbors who saw him Friday morning, distributing newsletters from his Cambridge Estates Homeowners Association - of which he was the longtime president - and again Saturday. When neighbor Kathy Ball and her husband awakened yesterday, Ball said, they saw an ambulance outside the home where Curseen had lived since 1986 with his wife, Celestine.
Officials at Southern Maryland Hospital Center in Clinton said Curseen died there at 11:30 a.m. yesterday, less than six hours after he was admitted to the emergency room with "flu-like symptoms and respiratory distress."
His wife told doctors that her husband passed out in church Saturday but did not want to go to the hospital.
At 2 a.m. Sunday, however, he went to the emergency room with what the hospital described as stomach cramps, nausea and flu-like symptoms.
Doctors performed blood tests and X-rays but saw nothing that suggested anthrax. Hospital officials said the man was given an antacid and sent home.
"At that time we were not aware he was a postal worker," said Dr. Venkat Mani, chief of the hospital's infectious disease unit. Even with the heightened state of alert for anthrax, he said, "making a diagnosis is not that easy early in the disease."
At 5:45 a.m. yesterday, Curseen was taken back to the emergency room by ambulance. Doctors found he had a serious infection and was slipping into shock. They also put him on a ventilator to help him breathe.
At that point, Mani said, chest X-rays showed signs of infection in the mediastinum - the area between the lungs - typical of anthrax.
Doctors administered "massive" doses of antibiotics, but the man died at 11:30 a.m. Mani said the cause of death was listed as "presumptive pulmonary anthrax with septic shock."
Morris, the second fatality, lived with his wife, Mary, in an apartment building in Suitland.
Officials at Greater Southeast Community Hospital in Washington said he reported to the emergency room at 5:55 a.m. Sunday.
Doctors tested him for anthrax exposure and administered "the regimen indicated for possible anthrax exposure" - chiefly antibiotics.
Morris died at 8:45 p.m. Sunday. The cause of death was listed as undetermined pending an autopsy.
Dr. Ivan Walks, the district's chief health officer, said he had "other medical concerns" that might have complicated the case. But he said that blood cultures were "consistent" with anthrax, and "our index of suspicion is very high."
Leroy Richmond, the first Brentwood worker to become ill, was listed yesterday in serious but stable condition at Inova hospital in Fairfax, Va.
Lisa Wolfington, a hospital spokeswoman, confirmed that another patient with inhalation anthrax was being treated there and was also in serious condition.
After Richmond became ill, workers at the Brentwood center and 120 more at the express mail facility near BWI where Richmond worked three days a week were told to report for nasal swab tests and a 10-day supply of antibiotics.
But postal inspectors said yesterday that the growing number of anthrax cases at Brentwood makes them believe the contamination that sickened Richmond occurred there and probably not at the BWI sorting center.
Clarence Kenner, 54, a heavy equipment operator at the BWI postal facility, finished his overnight shift early yesterday morning. But instead of going home, he and 14 co-workers piled into two vans and drove to Washington for testing. He returned home to Middle River with the antibiotic Cipro.
"It's nothing that can be preventable," Kenner said of the threat of anthrax.
There was no evidence yesterday of anthrax at the BWI facility. "The steps being taken at BWI are strictly precautionary," said Anne Arundel County Health Officer Frances Phillips at a news conference. The county opened a hot line - 410-222-7256 - to answer questions about anthrax.
Sun staff writers Michael Stroh, Rona Kobel, Greg Garland and Susan Baer contributed to this article.