September 11: 20 years after their collapse, the Twin Towers are still killing people!

The terrorist attacks of September 11 on World Trade Center (WTC), in New York, caused the death of 2,753 people, in the Twin Towers and their immediate surroundings. After the attack, more than 100,000 responders and rescuers from all over the United States – as well as some 400,000 residents and other workers around Ground Zero – were exposed to a toxic dust cloud fell back in the form of a thick layer of ash. A ghostly cloud that remained in theair for more than three months.

A mixture of toxic compounds vaporized

The dust plume of World Trade Center consisted of a dangerous mixture of dust and particles of cement, asbestos and several types of persistent organic pollutants. These latter chemicals include dioxins carcinogens and hydrocarbons polyaromatics, or PAHs, which are by-products of combustion fuels.

The dust also contained other dangerous elements. From heavy metals known to be toxic to the human body and brain, as the lead (used in the manufacture of flexible electric cables) or the mercure (present in switches or fluorescent lamps), or cadmium, a carcinogen that attacks reins (which goes into the elaboration of electric batteries or pigments for paintings).

Polychlorinated biphenyls (PCB), chemicals used in transformers electric, were also present. PCBs are known to be carcinogenic, toxic to the nervous system and capable of disrupting the reproductive system. Dangerous already in normal times, they have become even more harmful when heated to high temperatures by the combustion of aircraft fuel – before being transported by very fine particles.

The dust raised by the fall of the WTC was thus composed of both “big” and very small particles, fine and ultra-fine. These particularly small particles are known to be highly toxic, especially to the nervous system since they can pass directly through the nasal cavity and reach the brain.

Many rescuers and other personnel directly exposed to this dust developed a severe and persistent cough that lasted an average of a month. They were treated at Mount Sinai Hospital and received treatment at the Occupational Medicine Clinic, a well-known center for work-related illnesses.

I specialize in occupational medicine and started to follow these survivors as director of the Data center of the WTC Health Program, at Mount Sinai since 2012. This program collects data and ensures the monitoring and supervision of the public health of the workers in charge of the rescue and recovery in connection with the World Trade Center. After eight years in this position, I joined the Florida International Universityin Miami, where I plan to continue working with 9/11 responders who move to Florida when they reach retirement age.

From acute symptoms to chronic disease

Because, after the initial acute health problems, it is a wave of chronic diseases which started and continues to affect them 20 years later. The persistent cough has given way to respiratory illnesses such asasthma, the chronic obstructive pulmonary disease (BPCO) and upper respiratory tract diseases such as chronic rhinosinusitis, laryngitis and rhinopharyngite.

The litany of respiratory diseases also exposed many of them to the risk of reflux gastroesophageal (GERD), which occurs at a higher rate in survivors of the Twin Towers than in the general population. This condition occurs when the acids of the’stomach go back to theesophagus, which connects the stomach to the throat. Due to respiratory tract disorders or digestive disorders, many of these survivors also suffer fromSleep Apnea, which requires additional treatments.

To add to this tragedy, some eight years after the attacks, the first cancers also began to appear in survivors. These include tumors blood and tissue lymphoid such as lymphoma, the myeloma and the leukemia – tumors known to affect workers exposed to carcinogenic substances in the workplace. And the survivors still suffer other cancers : breast, head and neck, prostate, of lung and some thyroid.

Some have also developed a mesothelioma, an aggressive form of cancer linked to exposure to asbestos. Asbestos was used early in the construction of the North Tower until public opinion and greater awareness of its health hazards end its use.

The mind also touched

The survivors of September 11 also had to overcome psychological trauma, which resulted in many lingering mental health problems. A study published in 2020 found that of more than 16,000 WTC responders, for whom data was collected, nearly half reported a need for care in Mental Health. In addition, 20% of those who were directly affected developed a post-traumatic stress.

Many have told me that discovering torn bodies, walking through scenes of carnage and experiencing the tragic atmosphere of the days following the event marked them for life. They are unable to forget the terrible images seen and many suffer from mood disturbances, cognitive impairments and other behavior problems, including substance use disorders.

Survivors, an aging generation

Twenty years later, these survivors face a new challenge as they age and head into retirement – a difficult life transition, which can lead to declining mental health. Before retirement, the daily rhythm of professional activity and a regular schedule often help to keep the mind occupied …

But retirement sometimes leaves a void – a void which, for this fragile audience, is too often filled with unwanted memories of the noises, smells, fear and despair of that terrible day and those that followed. Many survivors have told me that they do not want to return to Manhattan, and certainly not to the site of the World Trade Center.

Aging can also be accompanied by loss of memory and other cognitive problems. However, studies show that these natural processes are accelerated and more serious in 9/11 survivors, as in war zone veterans. This trend is worrying, all the more so as a growing number of studies, including our own preliminary study, establishes links between cognitive disorders in the victims of 9/11 and dementia. A recent article from Washington Post explained how these people experience dementia-like disorders in their 50s, much earlier than normal.

The pandemic from Covid-19 also wreaked havoc on those who had already suffered from 9/11. People with pre-existing conditions experienced a much higher risk during the pandemic. A recent study has thus, logically, revealed a incidence highest Covid-19 among WTC responders between January and August 2020.

Tribute to the survivors

The health risks posed by direct exposure to acrid dust were underestimated at the time, and poorly understood. In addition, the appropriate personal protective equipment, such as the P100 half-face respirator, was not available at the time. We now know much more about the risks – and we have much greater access to protective equipment that can keep disaster responders and rescuers safe. Yet too often I find that we have not learned and applied these lessons …

For example, immediately after thecollapse of a condominium near Miami Beach in June 2021, it took several days for P100 half-face masks to become available and mandatory for responders. Other examples around the world are even worse: a year later the explosion of Beirut, as of August 2020, very little action has been taken to study and manage the health consequences physique and mental health among responders and the affected community. An equally dire situation arose in the aftermath of a July 20 chemical fire in Durban, South Africa.

Applying the lessons learned from September 11 is an essential way to honor the victims and the courageous men and women who participated in the desperate rescue and recovery efforts in those terrible days.