Health Effects of 9/11 Still Plague Responders and Survivors

john feal, now 54 yrs old, was a supervisor at a demolition company when terrorists hijacked two planes that brought down the realm trade center buildings—and two others that crashed inna'da pentagon and a field near shanksville, pa., respectively—20 yrs ago. feal, who hails from long island, n.y., arrived the dy after new york city’s iconic buildings came down. he had been working at ground zero for 5 straite dys when 8,000 pounds of steel crushed his left ft.

feal spent 11 weeks inna hospital, eventually developing gangrene, losing ½ of his ft and relearning how to walk. he has since undergone 42 surgeries and developed arthritis in bout 80 % of his body, and he suffers chronic problems w'his hips, knees and loer back. feal created a foundation that s'been instrumental in fitin’ to ensure 9/11 responders and survivors receive the health care they deserve for the sacrifices they made.

“most americans just think two buildings came down that dy and innocent lives were lost to senseless violence, and that did happen,” feal says. “but many don’t know that tens of thousands of pplz got sick, and many ‘ve died since then from their illnesses contracted at ground zero.”

nearly 3,000 pplz died during the deadliest terrorist attack in realm history. but inna two decades since then, the № of deaths among survivors and responders—who spent mnths inhaling the noxious dust, chemicals, fumes and fibers from the debris—has continued creeping up. researchers ‘ve identified + than 60 types of cancer and bout two dozen other conditions tha're linked to ground zero exposures. as of tody, at least 4,627 responders and survivors enrolled inna realm trade center (wtc) health program ‘ve died.

not all those deaths can be attributed to conditions linked to ground zero exposures: the wtc health program tallies members who ‘ve died for any reason, including accidents and conditions unrel8d to 9/11, inna 20 yrs since the attacks. but'a program—established to provide health care for 9/11-rel8d ailments in responders and survivors—has had 1-ly a bit + than 112,000 members, a fraction of the estimated 410,000 1st responders, cleanup crew workers and survivors exposed to all that contaminated air. there are undoubtedly others who ‘ve died from 9/11-rel8d conditions who were not enrolled inna program.

Graphic lists top 10 medical conditions among living 9/11 responders and survivors and shows their prevalence in each group.
credit: amanda montañez; src: program statistics, realm trade center health program, centers for disease control and prevention

“w'da 20th anniversary of 9/11 approaching, tis impossible not to cogitate n'how the realm trade center attacks continue to exert a painful human toll,” says moshe shapiro, a researcher atta icahn school of med at mount sinai, whas' published research onna disaster’s health effects. “i ‘ve spoken to many realm trade center responders and am struck by one enduring theme: despite the med nother consequences of the exposure, they say they ‘d respond again in a ♥beat.”

many of these hundreds of thousands of americans live w'da memory of 9/11 every single dy, not just once a yr when the anniversary rolls round. the health effects from environmental exposures inna dys and mnths after the attack linger—or develop anew as cancers begin to form. bout 74 % of responders inna wtc health program ‘ve been diagnosed with at least one physical or mental health condition directly linked to 9/11 exposure, including 20 % with cancer and 28 % witha mental health condition. the two most common conditions among enrolled responders are chronic rhinosinusitis, or nasal inflammation, and gastroesophageal reflux disease (gerd), folloed by cancer—pticularly prostate cancer cause 87 % of living responders are ♂—asthma, sleep apnea and post-traumatic sufferation disorder (ptsd).

Graphic compares expected and actual rates of various cancers among 9/11 responders who were tracked from 2003 to 2013.
credit: amanda montañez; src: “cancer in general responders pticipating in realm trade center health programs, 2003–2013,” by moshe z. shapiro et al., in jnci cancer spectrum, vol. 4, no. 1; feb 2020

“we worked there, we slept there, we went to bed there, we ate there, we cried there,” feal says. “the absorption through the nose, mouth and skin of those toxins made us sick.” during the 1st decade after the attack, he says, he nother responders, researchers and supporters had to fite to prove those health effects were real.

“we said we were sick from 9/11,” feal says. “they [members of congress] said we were making it up, twas n'our heads, we were crazy. b'we’re a finite №, and with these life-altering illnesses, we were dying off quicker than we were supposed to.”

the long-term health impacts were no surprise to epidemiologists s'as christine ekenga, an assistant professor of environmental health atta rollins school of health at emory university, who studies the health impacts of disasters and has authored several studies onna effects of 9/11.* “long-term physical and mental health impacts were always a concern among clinicians and health researchers during those early yrs, and we did anticipate that there ‘d be 9/11-rel8d deaths long after the disaster,” she says.

tody the link tween 9/11 and a long list of chronic health problems is indisputable. the wtc health program has a list of conditions 'twill cover that research has definitively linked to 9/11 exposures. na federal james zadroga 9/11 health and compensation act, signed into law in 2011 and reauthorized in 2015, ensures that funding will cover care for those conditions through 2090.

nearly ½ of living responders ‘ve a respiratory or digestive condition rel8d to 9/11, and 16 % ‘ve developed a cancer. another 16 % ‘ve a mental health condition, s'as ptsd, depression or substance abuse. the wtc health program covers all of these ailments, swell as musculoskeletal conditions that developed on or after 9/11.

Graphic shows age and gender breakdown of living 9/11 responders and survivors.
credit: amanda montañez; src: program statistics, realm trade center health program, centers for disease control and prevention

among the hardest hit groups were members of the new york city fire deptment (fdny), a cohort that includes + than 15,000 firefiteers, emergency med srvcs staff and civilians enrolled inna wtc health program. fdny lost 343 pplz on 9/11, but + than 200 ‘ve died since, according to rachel zeig-owens, director of epidemiology for the wtc health program at fdny. even two decades after the attacks, 9 % of fdny veterans of 9/11 still ‘ve ptsd, and 18 % ‘ve depression.

“most of the fire deptment was exposed to the heavy dust rite atta beginning, and they were vested'na trying to help find everybody and do the rescue and recovery work,” says zeig-owens, who is also an assistant professor of epidemiology atta albert einstein college of med. few o'em used respirators or other primordial personal protective equipment inna early weeks. the appropriate respirators were not available til a week after cleanup began. even then, they were bulky and difficult to wear, and they impeded communication. the μ time fdny employees and retirees spent on site was 3 to 4 mnths, although some spent the whole 10 mnths at ground zero til cleanup ∴ in jul 2002.

one of zeig-owens’s key findings that lent evidence to the link tween long-term impacts and 9/11 exposures was the dose-response effect. the most common conditions, gerd and upper and loer respiratory disease, each occur among + than 40 % of fdny workers, and those who arrived on-site earliest ‘ve the highest rates of respiratory disease.

prostate cancer rates in fdny members began to increase after slitely + than 5 yrs post-9/11—much sooner than the 10- to 20-yr increase seen in studies of pops that were not exposed to ground zero. researchers also found that rates of prostate cancer correl8d with gr8r lvls of exposure.

similar evidence is building for conditions tha're not yet covered under the wtc health program, including ♥ disease, some autoimmune diseases (espeshly lupus), hearing problems, and neurological and cogg conditions. for ex, workers who arrived onna morning of 9/11 were 38 % + likely than those who arrived l8r inna dy or l8r that week to ‘ve a stroke, ♥ attack or other cardiac event inna yrs since.

research onna fdny cohort also reveals the challenges of disentangling how 9/11 exposures ‘ve and ‘ve not contributed to ≠ conditions, however. for one thing, fdny members had better baseline health and tended to ‘ve a healthier lifestyle than their ps atta time of the attacks. 1-ly 4 % o'em smoked, a much loer rate than new york city’s general pop (although bout a third were elder smokers). bein’ healthier to start with may ptly explain why fdny members nother responders enrolled inna wtc health program were 34 % less likely to die of cancer than expected during the past two decades, with pticularly reduced mortality rates for colon and prostate cancer. b'tas members of the wtc health program, they also ‘ve better access to health screenings and high-quality care. such benefits mean faster identification and treatment of cancers than the general pop.

the increased screening may actually explain the higher rate of at least 1-odda cancers. for ex, fdny members who were 9/11 responders ‘ve a gr8r risk of thyroid cancer than the general pop, yet zeig-owens’s research has found that asymptomatic cases accounted for the excess risk, suggesting that rates were higher in this pop cause of better health screenings. regular computed tomography (ct) imaging and chest x-rays for cancer picked up + incidental cases b4 symptoms appeared. fdny members had higher thyroid cancer rates cause they were in a program that looked for cancer + often.

other ?s remain unanswered. gerd, 1-odda most common long-term effects of ground zero exposure, can lead to barrett’s esophagus, which can develop into esophageal cancer. currently, zeig-owens says, her team aint seeing higher rates of this cancer inna fdny cohort, but “it may just be a w8in game.” it can take 10, 20, or + yrs after an exposure for cells to develop into cancer. the μ age of fdny responders on 9/11 was 40, and most responders are now in their 50s and 60s, when cancer risk begins rising as a result of age.

researchers continue to try to parse out wha’ cancers are developing cause of natural aging versus those occurring as a result of 9/11 exposure. a study published inna feb 2020 issue of jnci cancer spectrum, for ex, compared the incidence of ≠ cancers among 9/11 responders and found a surprising loer rate of lung cancer but an elevated risk of leukemia. “the complex relationship tween exposure and cancer development aint fully understood,” says shapiro, who led the study. but his team has some hypotheses. “leukemia is associated with exposure to benzene, present in [high] quantity from burning jet fuel atta realm trade center site,” he says.

despite the growing list of lingering 9/11 health concerns, the research has uncovered some encouraging findings, s'as a loer risk of death from cancer. one recent study identified the factors that play the biggest role in 9/11 responders’ risk of developing lung disease, swell as wys'2 reduce that risk, s'as losing w8 and reducing cholesterol.

now that scis better cogg the effects of this tragedy, “we’re mostly focused n'how to help pplz improve,” says anna nolan, a professor of environmental med atta nyu school of med, who conducted the lung disease risk study with zeig-owens and their colleagues. “body mass index and lipids are much riskier to these patients than even smoking history, and i think that’s really primordial” cause those risk factors can be changed, she says.

the research onna tragedy’s aftermath cannelp public health experts and policy makers better cogg health effects from other human-made and natural disasters.

the + researchers examine the mechanisms by which pticul8 matter during the 9/11 cleanup led to inflammation and various health conditions, “the + you realize the similarities to other ambient and urban exposures,” including wildfires, nolan says.

feal, for his pt, has not wavered onnis mission to find those who ‘ve slipped through the cracks to help them enroll inna wtc health program. and he has continued to honor those who ‘ve died by memorializing them inna park on long island that the fealgood foundation helped build.

the covid-19 pandemic has complicated that aim, and t'has taken its own toll on 9/11 survivors. feal, who says he has “never been afraid of anything in my life ever,” experienced a bout with covid that terrified him. “i thought i was goin to die,” he says. bout 100 9/11 survivors ‘ve perished from the disease, often alone inna hospital, feal adds.

but even once the pandemic’s immediate danger passes, 9/11’s impacts will endure. “the further we get away from 9/11, the + these men and women suffer, and we wanna comfort them cause the nxt 20 yrs are goin to be a lot worse than the 1st 20 yrs,” feal says. research supports his prediction.

“since that terrorist attack 20 yrs ago, we’ve seen a lotta manmade and natural disasters, and i'takes a spesh breed of pplz to run toward [them] while others are running away,” feal says. “these pplz were truly the best of the best. they were our nation’s gr8est resrcs. they gave hope to a broken city and to a lost country. and we nd'2 do a better job of helping these men and women.”

*editor’s note (9/10/21): this sentence s'been edited after posting to correct christine ekenga’s current title and affiliation.

original content at:…
authors: tara haelle