By Neely Tucker

With new evidence of anthrax over the past two weeks establishing a wider reach of the deadly microbe, emergency rooms and waiting areas of private clinics are seeing an onrush of people who are worried that anything from a rash to a persistent sniffle may be a precursor to the disease in some form or other.

These patients, who do not show up in any count of anthrax-related cases, are evidence that the fear of the disease is far outpacing its presence.

As the crisis has unfolded, doctors and their worried patients agree on one thing: The lack of knowledge on what to do next, even among the nation's most advanced disease specialists, has amplified the fear factor more than anything else.

After a D.C. postal worker died after being sent home from Southern Maryland Hospital Center with what an emergency room physician initially thought was the flu, no one seems sure that a cough is just a cough.

The volume of patients is now troubling because as flu season approaches, and as public health officials appear unable to offer consistent guidance about who is at risk, physicians say the "worried but well" patients could multiply rapidly.

Doctors are mindful of the misdiagnosis of the DC postal worker but are frustrated by their dilemma. "No one wants to be the doctor who misses the real thing," said David Milzman, an attending physician at Providence. "But the symptoms are so broad, and treatment is now so broad, that it makes it very difficult for us to turn people away, even when you immediately know that this person isn't really sick."

"We always have more patients in flu season, but these are flu patients who think they've got something worse," he said. "It's reasonable, given how little we know about the disease.

But we're trying to stress to people that if you came in a month ago with a cold, we would not have given you antibiotics. We're not going to give you antibiotics for a cold now. I spend most of my time with these patients trying to relieve their anxiety rather than a specific medical condition."

In a week in which anthrax has turned up at more than a half-dozen sites in the area, and killed a woman in New York who had no known exposure to large quantities of mail, people are reacting predictably. Many people with seasonal aches and colds are now nervous, wondering whether they are feeling the onset of the deadly disease.

In Bullock's examining room, the ill postal worker takes off his shirt, pulls on a gown, and answers Bullock's questions as she listens to his heart with a stethoscope and monitors his vital signs. He delivers mail, he tells her, though not from Brentwood.

An environmental test showed his post office to be free of anthrax spores, but the staff doesn't trust it. He had been given a supply of the antibiotic Cipro but thought it was needless because he had no symptoms.

Then he came down with a cough. Then the runny nose. Then a headache, so bad it made it difficult to complete his deliveries.

"I didn't want to be part of the hype," he tells Bullock. "You know, everybody running around, thinking they've got anthrax. But it started getting to me last night. I couldn't sleep, I guess because of the fear. My wife was after me about it, so I finally decided to come in."

Others who don't come in are confused and nervous, alarmed by news reports of anthrax findings but unable to discern whether they are at risk.

Elizabeth Loeb, a Justice Department employee, heard on television Tuesday morning that the Friendship post office tested positive for anthrax spores. She and her 2-year-old daughter had visited that post office Friday. She wanted to know, urgently, if they should be tested.

First, she called DC General Hospital, but the person answering the telephone was unaware of the anthrax finding reported two hours earlier. Then she called the DC Health Department's anthrax hot line. It was busy for 20 minutes. She called the mayor's call center, where an operator referred her to the same hot line.

"The operator said, 'This is the only number we have,' " Loeb said. "I said I'd really like to talk to someone more senior. That's when she hung up on me."

Loeb eventually got a call in to the Health Department, after insisting on speaking to the mayor's office. Finally, she was told she should be fine -- neither she nor her daughter needed to take any drugs or report to the hospital.

Her experience reflects something that Daniel Ein, a doctor in private practice and chairman of the DC Hospital Association's new emergency preparedness committee, says may be sending people to doctors' offices.

"The guidance we've all had in this has not been very good," he said, referring to some changing policy statements from the federal Centers for Disease Control and Prevention. "Many of us have tried to cobble together policies based on what has proven to be inadequate information.

Most of it, to be honest, has been coming from newspapers and television. The term of art is that this is an 'evolving science,' and that doesn't leave people feeling very secure. They want personal reassurance."

Washington Post November 1, 2001; Page B01

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