The signs of the continuing anthrax scare pour into a lab on Baltimore's Preston Street at the rate of 80 to 120 a day. They come in every imaginable form:
A batch of nasal swabs from District of Columbia mailroom workers. An unexpected letter from overseas. Powder-coated threats to abortion clinics, signed by the "Army of God." A tube of bacteria from a hospital patient who might be gravely ill with anthrax.
"Wherever powder occurs, you get people who are afraid," said Dr. Joseph M. Joseph, director of the Maryland state public health laboratory.
Joseph said the Maryland lab, which has been receiving specimens from all over the state, Washington, and even from New York, has been as heavily burdened by the events of the past few weeks as any state health department in the nation.
While no new anthrax cases have been diagnosed in the Baltimore-Washington area in more than a week, the lab remains busy with a backlog of tests to be finished and a steady stream of new samples - the result of hoaxes or innocent mix-ups, Joseph said.
The laboratory began rehearsing for a bioterrorist release of anthrax three years ago, but no one foresaw that the attack would come in the mail. Each day brings an unexpected complication.
Nervous courier companies have canceled all deliveries. FBI agents have been showing up with samples in the middle of the night. County health departments are worried that irradiation of the mail to kill anthrax spores might destroy other essential medical tests.
'We're getting tired'
The lab is on a wartime schedule, according to its staffers. The costs are measured in dollars - $153,000 so far in disposable lab coats and masks alone - and in weariness.
"We're getting tired. I know I am," said Dr. Ken Wilde, chief of the division of environmental microbiology and one of three pathologists who take turns working in the lab until 10 p.m.
The lab workers say they're not afraid. "Rabies is far more dangerous. We deal with that all the time," said Joseph, 73, who has directed the state lab for 34 years. Still, he has asked the federal government for a care package from the Pentagon - about 17 doses of anthrax vaccine from the military's stockpile, enough for every clerk, technician and doctor in the lab.
Wilde and his crew of 10 technicians and doctors work in a "level 2" biohazard lab, specially equipped to protect the workers, from contagion.
Before the samples arrive in packages or letters, swabs or phials, law officers must check them to make sure they aren't radioactive, rigged to explode or doused in toxic chemicals, Wilde said.
Dressed in disposable gowns, surgical masks and gloves, the pathologists and technicians work inside a biological hood - a stand with a glass top half and a bottom half made of a curtain of continuously flowing air that forms an invisible wall.
Workers soak each sample in distilled water, then put the extract in a petri dish like the ones used in high school biology classes. Inside is a growing medium derived from sheep's blood, an ideal food supply for livestock diseases such as anthrax.
Three tests required
The petri dishes go into an incubator for a 24-hour bake at 95 degrees. The result, said Wilde, is a gray lump of bacteria colonies.
It takes three tests to definitively identify anthrax and determine its strain.
Officially, the workday begins at 8 a.m. and ends at 10 p.m., but Wilde and the other pathologists often linger, waiting for a late-night call from an FBI agent. Those calls have come as late as 1:30 a.m., Joseph said.
Because the public health investigation is also a criminal investigation, federal officers are being very careful to ensure they can document every step of the process, and will give samples only to the person who'll process them.
"We aren't used to dealing with the criminal side" of an investigation, Joseph said, "but we're learning."
Awaiting federal grants
The CDC has invited Maryland, the District of Columbia and four other states to apply for grants to help cover the costs of the investigation. Maryland's share would be $500,000, Joseph said, but the lab has already spent about $650,000 on overtime and supplies.
Joseph and Wilde have a combined total of 65 years' experience at the lab, and Joseph has about 40 years' experience with anthrax. He was one of the Maryland pathologists who monitored the biological warfare program at Fort Detrick in the 1960s, to help assure state officials that the Army's pathogens were not likely to escape.
Both say they have never seen a public health crisis trigger greater uncertainty among scientists, or more fear among the public.
"The panic and alarm we're seeing now, the way it's disrupting the operations of government and all that - it's what the terrorists want," Joseph said.