Today, while the long-term affects remain a mystery, health professionals are still working overtime treating the short-term health effects that continue to emerge. People like Diane Van Dyke, whose cuts wont heal and whose breathing is bad, continue to complain to their doctors. Levin said in March that 50 percent of the 2,500 workers he had examined experience upper and lower respiratory problems. The National Resources Defense Council Environmental Impact report estimates that as many as 10,000 New Yorkers living or working near Ground Zero suffer health effects related to air pollution from 9/11. Earlier this month an article in the Journal of the American Medical Association asserted that dozens of newborns had a low birth weight after their mothers were exposed to dust from the Trade Center collapse. And according to Dr. Stephen Markowitz, who heads the Center for Biology and Natural Systems at Queens College, nearly all of the 400 laborers who worked on building cleanups and consulted a mobile medical clinic exhibited lasting health affects, including respiratory infections, allergies and skin rashes. The workers breathed the same dust that is in residents apartments.

Surprisingly, its the pulverized concrete that presents the greatest short-term health threat, Levin said, because its highly alkaline. A U.S. Geological Survey study of the particulate matter at Ground Zero conducted from Sept. 17-18, 2001 found that the pulverized concrete in the dust had a comparable alkalinity to liquid ammonia. Breathing in concrete dust into moist internal organs is like re-mixing cement in the lungs, and once it becomes a liquid again, it will burn and scar the tissue it contacts.

But heavy metals, organic compounds and asbestos present the greatest long-term threat. According to the Centers for Disease Control, breathing larger fibers of asbestos deeply over prolonged periods of time can cause a condition called asbestosis, a swelling and irritation that will permanently scar the inside of the lungs, impairing breathing, and possibly even leading to death. It can also cause mesothelioma, a usually fatal cancer of the thin membrane that surrounds the internal organs, or other cancers of the lung, pancreas, or stomach.

Levin said that while he does expect respiratory ailments and immune deficiencies to increase, he does not expect to see a significant rise in cancer rates related to the Trade Center dust. His optimism is a gut feeling based on health histories of workers with career-long exposure to similar contaminants, like plumbers who work in dusty, asbestos-filled basements. But ultimately, he doesnt know. In either case, he said, the governments wait-and-see attitude is an irresponsible approach to public health. "Finding illnesses after the fact," Levin said, "its what you could call in crude epidemiological terms, counting the bodies."

Nadler agrees, warning that what seems like minimal contamination now will add up over years of consistent exposure. Thousands of workers and residents may breathe minimal amounts of lead or asbestos unwittingly over the next decade because their buildings were never cleaned. "The problem you have in things like asbestos and fine particulate matter is the length of exposure," then-EPA director Whitman said in the PBS Newshour interview. "Its not so much one hit, its if you live with it over time." Still, it could be 20 or 30 years before doctors and residents fully understand the public health implications of the dust exposure. And there are other implications too.

In a January 2003 draft report of a scathing, as yet unreleased assessment of the EPAs response in lower Manhattan, the agencys own Inspector Generals office concluded that the EPA did not have the proper information to assure residents that the air was safe to breathe, that the standards the agency set for asbestos levels were unusually low and inconsistent with EPA regulations, that the clean-up was compromised by cost-cutting, and finally, that the Bush administration played an unusual and inappropriate role in editing and shaping all of the information released by the EPA to the public. This indicting report is due out this September, long after the damage has been done.

Each time the EPA told the public the air was safe, each time it reversed a decision, or changed a statement, it lowered the publics confidence in its expertise. "The loss of credibility is a serious concern because now that people are still wrestling with questions they dont feel that they can trust the government to speak honestly to them," Levin said.

Clearly, New Yorkers' trust in the Bush administration on these issues is already at the breaking point -- or past it. Just before Christmas last year, the New York City Council held an acrimonious hearing to evaluate what the federal government was doing to ensure the health of residents. About 80 residents, environmental and occupational health professionals, lawyers, and politicians packed the chamber seats; inscribed on the ceiling overhead, Lincoln's famous words -- "a government of the people, by the people, for the people" -- hung like a gold-lettered question in the air.

Almost a year and a half after the attacks on the World Trade Center, the council and its audience were still seeking clear explanations from the EPA. Lopez and other council members wanted to know why the EPAs health risk standard for New York was 100 times less stringent than the standards used by the agency for asbestos cleanup across the country. They wanted to know why residents were still being instructed to mop up contaminated dust in their own apartments despite federal laws that require respirators, protective body suits and professionally trained staff for the removal of cancer-causing asbestos material. And they wanted to know why, after so many meetings and so much debate and criticism, the EPA still could not explain the science behind its methods.

Kathleen Callahan, assistant regional EPA administrator for New York City response and recovery operations, was there on behalf of the Bush administration. Council member Margarita Lopez braced both hands firmly on the long oak bench and took the microphone, then leaned toward Callahan and in a voice seething with anger, told her that the EPAs patronizing manner of response to months of criticism and pleas for help would no longer be tolerated.

"I am not satisfied with your answers to these questions, in all honesty, and I think that this committee should not be satisfied," Lopez said, her tone rising. "This is reality. The air down here was filthy like hell with pollutants that can kill each and every one of us. Its not that people down here are just paranoid about what happened."

The audience broke into applause.

Little has improved since then, critics say. The EPA, which had originally received close to 6,000 requests by residents to clean residential units, closed the cleaning program after cleaning or testing about 3,950 apartments as of July. About 5 percent of the apartments cleaned were listed as "not cleared" or "not determined," meaning that they were found to contain an abundance of harmful material or that so much dust was present the machines that measure it were clogged and could not obtain an accurate reading. Either way, they need to be re-cleaned, and re-tested.

Nadler worries the issue will go beyond public discontent, and will result in millions of dollars in claims against the city and state. It was the environmental and health agencies that gave advice against their better knowledge when they told people to clean contaminated dust, or to return to their contaminated apartments in lower Manhattan, he said.

"People 20 years from now who come down with various illnesses will sue the city," Nadler warned at the December council meeting. "Theyll say: 'But for your negligent advice I would not have done that, I would not have gotten sick.'"

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