What we know about how 9/11 has affected New Yorkers' health, 15 years later

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Within days of the attack on the World Trade Center on September 11, 2001, then-EPA chief Christine Whitman infamously encouraged New Yorkers to head back to Lower Manhattan. "The good news continues to be that air samples we have taken have all been at levels that cause us no concern," she told reporters. A week later, she again assured the public that the air was "safe to breathe and their water is safe to drink." Her claims were echoed by then New York City Mayor Rudy Giuliani who, in his apparent eagerness to get the Financial District up and running again, told everyone "to go back to normal." He also called the air around Ground Zero "safe as far as we can tell, with respect to chemical and biological agents," even as experts warned that it was not. "You won't see any immediate problems," Mount Sinai's Dr. Philip Landrigan told the New York Daily Newson September 13, describing the risks of exposure to the wreckage of the Twin Towers. "It will take 25 to 30 years to develop."

Rescue and cleanup crews were permitted to dig through Ground Zero without respirators and neighborhood residents and workers attempted to return to their daily lives as poison was being released all around them. As Newsweek explained earlier this week:

By the time Whitman and Giuliani received significant criticism (Whitman was sued in 2006, and finally apologized this week; Giuliani faced protests during his 2007 presidential campaign), the damage was done, though its scope still isn't fully clear. Fifteen years after 9/11, here's some of what we know about how the destruction of the Twin Towers has affected New Yorkers' health:

Lots of people might not be getting treatment
According to the Centers for Disease Control, roughly 400,000 people – including "rescue and recovery workers, residents, students and school staff, building occupants, and passersby" – were exposed to "the immense cloud of dust and debris, the indoor dust, the fumes from persistent fires, and the mental trauma" of the Twin Towers' collapse. As of June 2016, only 74,968 were enrolled in the World Trade Center Health Program. (The program, established by the James L. Zadroga 9/11 Health and Compensation Act in 2011, provides federally-funded monitoring and treatment of health problems stemming from 9/11.) 56,580 of enrollees were FDNY or other responders – people who, at this point, know quite well that they are at risk of falling ill.

Meanwhile, only 8,881 civilians have enrolled: "I don't know, really, what the psychology is behind it all," WTC Environmental Health Center executive director Terry Miles told WYNC several years ago. "I believe people just don't want to be sick from 9/11. They just don't. And they don't want their kids to be sick from 9/11, either. But the fact is people are sick because of the fallout." Either way, as Newsweek noted, that means that hundreds of thousands of people susceptible to 9/11-related illnesses "remain untreated and unaccounted for."

The dust hung around for way longer than it should have
According to analysis published in 2002, the aforementioned dust that settled on the area around Ground Zero contained, among other things, "construction materials, soot, paint (leaded and unleaded), and glass fibers (mineral wool and fiberglass)," metals, and asbestos. The study concluded that, "These results support the need to have the interior of residences, buildings, and their respective HVAC systems professionally cleaned to reduce long-term residential risks before rehabitation." In many cases, that didn't happen. Cleanups involving asbestos are generally handled by specialists, but, as Discover reported:

Without clear guidance, the landlords were "free, if you will, to do whatever they wanted, or to do nothing," the New York Committee for Occupational Safety and Health's David Newman told the LA Times. "It was kind of a Wild West." A Tribeca resident who spoke to Discoversaid that she received a letter from the NYCDOH instructing her to clean her apartment herself using "a wet rag and use a High Efficiency Particulate Airfilter vacuum." A man who was living in a Brooklyn Heights dorm said that nobody ever told him that the dust he found in his vents and air conditioner was potentially dangerous. "When we turned it on, the dust would blast into the room," he said, explaining that he and his roommate repeatedly cleaned it up themselves. In 2007, the superintendent of a building located a couple blocks from Ground Zero told the New York Timesthat he was still finding the dust in the ceilings and walls. Meanwhile, much of the "professional" dust removal was performed by cleaners – many of them immigrants – who weren't properly trained or equipped for the task. Two such workers told the LA Timesthat they wore paper masks only "30% of the time" they spent vacuuming dust from air vents. All of those people subsequently developed respiratory problems.

See photos of the dust and ash:

29 PHOTOS
The dust and ash that caused illnesses after 9/11
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The dust and ash that caused illnesses after 9/11
People run from the collapse of World Trade Center Tower in this Sept. 11, 2001, file photo, in New York. Charlie Ross is seen fourth from the left. This year will mark the fifth anniversary of the attacks. (AP Photo/Suzanne Plunkett/FILE)
FILE - In this Sept. 11, 2001 file photo, three people make their way through a cloud of caustic dust after terrorists flew two airliners into the World Trade Center towers in New York. For New Yorkers in or near the World Trade Center on Sept. 11, 2001, the sights and sounds of everyday life can still trigger painful memories and strong psychological reactions. (AP Photo/Suzanne Plunkett, File)
FILE - In this Tuesday, Sept. 11, 2001 file photo, pedestrians flee the dust-filled area surrounding the World Trade Center following a terrorist attack on the New York landmark. (AP Photo/Amy Sancetta)
The remaining tower of New York's World Trade Center, Tower 2, dissolves in a cloud of dust and debris about a half hour after the first twin tower collapsed September 11, 2001. Each of the towers were hit by hijacked airliners in one of numerous acts of terrorism directed at the United States September 11, 2001. The pictures were made from across the Hudson River in Jersey City, New Jersey. REUTERS/Ray Stubblebine
394261 78: Civilians take cover as a dust cloud from the collapse of the World Trade Center envelops lower Manhattan, September 11, 2001. (Photo by Mario Tama/Getty Images)
People run from the collapse of World Trade Center Tower Tuesday, Sept. 11, 2001 in New York. (AP Photo/Suzanne Plunkett)
Destroyed mullions, the vertical struts which once faced the soaring outer walls of the World Trade Center towers, are the only thing left standing behind a dust covered bus stop and subway entrance, after a terrorist attack on the twin towers Tuesday, Sept. 11, 2001. The 110-story towers collapsed after two hijacked airliners slammed into them. (AP Photo/Mark Lennihan)
Dust and debris cover the ground and cloud the air near the site of the terrorist attack on the World Trade Center in New York, Tuesday, Sept. 11, 2001. (AP Photo/Bernadette Tuazon)
FIremen walk through a dust and debris covered street in lower Manhattan Tuesday, Sept. 11, 2001, after a terrorist attack at the World Trade Center. Two jet planes were crashed into the twin towers, collapsing them and covering the area with the debris.(AP Photo/Richard Cohen)
This file photo dated 11 September 2001 shows Edward Fine covering his mouth as he walks through the debris after the collapse of one of the World Trade Center Towers in New York. Fine was on the 78th floor of 1 World Trade Center when it was hit by a hijacked plane 11 September. Americans mark the fourth anniversary of the September 11, 2001 terror attacks Sunday nagged by new burning questions about their readiness to confront a major disaster after the debacle of Hurricane Katrina. AFP PHOTO/Stan HONDA (Photo credit should read STAN HONDA/AFP/Getty Images)
394261 63: Dust swirls around south Manhattan moments after a tower of the World Trade Center collapsed September 11, 2001 in New York City after two airplanes slammed into the twin towers in an alleged terrorist attack. (Photo by Spencer Platt/Getty Images)
Office towers of Lower Manhattan in New York's financial district engulfed in smoke and dust from the collapse of the World Trade Center buildings. (Photo by James Leynse/Corbis via Getty Images)
Dust and debris cloud the air near the site of the terrorist attack on the World Trade Center in New York, Tuesday, Sept. 11, 2001. (AP Photo/Bernadette Tuazon)
Destroyed mullions, the vertical struts which once faced the soaring outer walls of the World Trade Center towers, are the only things left standing behind a firefighter after a terrorist attack on the twin towers in lower Manhattan Tuesday, Sept. 11, 2001. The 110-story towers collapsed in a shower of rubble and dust after two hijacked airliners slammed into them. (AP Photo/Mark Lennihan)
FILE - In this Sept. 11, 2001 file photo, a man wipes ash from his face after terrorists flew two airplanes into the World Trade Center towers, causing them to collapse. A federal health official is expected to announce in early June, 2012, whether people with cancer will be covered by an aid program for New Yorkers sickened by World Trade Center dust. An advisory committee recommended in March that the government open up the $4.3 billion program to people who developed cancers after being exposed to the toxic soot that fell on Manhattan when the towers collapsed. (AP Photo/Amy Sancetta, File)
A fire truck is surrounded by dust and debris near the site of the terrorist attack on the World Trade Center in New York, Tuesday, Sept. 11, 2001. (AP Photo/Bernadette Tuazon)
People hold towels to their faces and put on masks for protection from the smoke and dust from the collapse of the twin towers at the World Trade Center in New York Tuesday, Sep. 11, 2001. Terrorists crashed two passenger jets into the twin towers causing them to collapse. (AP Photo/Richard Cohen)
Medical and emergency workers, who are standing in front of the Millenium Hilton, look towards where the World Trade Center towers used to be, after a terrorist attack on the twin towers of lower Manhattan Tuesday, Sept. 11, 2001. In an unprecedented show of terrorist horror, the 110-story towers collapsed in a shower of rubble and dust after two hijacked airliners carrying scores of passengers slammed into the sides of the twin symbols of American capitalism. (AP Photo/Mark Lennihan)
In this Sept. 13, 2001 photo, a first responder works in the rubble of the former World Trade Center in New York. A decade's worth of study has answered only a handful of questions about the hundreds of health conditions believed to be related to the tons of gray dust that fell on the city when the trade center collapsed, from post-traumatic stress disorder, asthma and respiratory illness to vitamin deficiencies, strange rashes and cancer. (AP Photo/Beth Keiser, Pool)
Policeman wear dust masks as they work in the rubble at the World Trade Center in New York Wednesday, Sept. 12, 2001. Clearing the rubble and the search for survivors continues a day after terrorists crashed two hijacked jets into the structure collapsing both towers. (AP Photo/Virgil Case)
A man in a clothing store along lower Broadway in New York arranges a shirt in the window as clothes covered in dust and soot from the World Trade Center disaster sit on racks September 19, 2001. The attacks in New York and Washington left more than 5,000 people dead or missing and over 300 police and fire fighters were believed lost in the September 11 attack. REUTERS/Kai Pfaffenbach MS
Chris Tibbet of Shelton, Conn., stands about two blocks from the World Trade Center in New York Tuesday, Sept. 11, 2001, as he was photographed by a co-worker in a street covered with dust and debris following the terrorist attack that devastated the World Trade Center. Tibbet and his co-worker Paul Christley were staying at a hotel in the World Trade Center and had just left a few minutes before the attack to go to J.P. Morgan office a block away where Tibbet works and Christley was training employees for a new software application. (AP Photo/Paul Christley)
FILE- In this Sept. 11, 2001 file photo, a shell of what was once part of the facade of one of the twin towers of New York's World Trade Center rises above the rubble that remains after both towers were destroyed in the terrorist attacks. New York City has agreed to pay up to $657 million to settle more than 10,000 lawsuits filed by ground zero rescue and response workers who say they were sickened by World Trade Center dust. (AP Photo/Shawn Baldwin, File)
A group of firefighters walk near the remains of the destroyed World Trade Center in New York on September 11, 2001. Two hijacked U.S. commercial planes slammed into the twin towers of the World Trade Center early on Tuesday, causing both 110-story landmarks to collapse in thunderous clouds of fire and smoke. REUTERS/Shannon Stapleton JC/SV
A group of firefighters stand in the street near the destroyed World Trade Center in New York on September 11, 2001. Two hijacked U.S. commercial planes slammed into the twin towers of the World Trade Center on Tuesday, causing both 110-story landmarks to collapse in thunderous clouds of fire and smoke. REUTERS/Shannon Stapleton JC/SV
An office filled with dust and damage has a view of the wreckage of the World Trade Center 25 September, 2001 in New York. Search and rescue efforts continue in the aftermath of the 11 September terrorist attack. AFP PHOTO/Eric FEFERBERG (Photo credit should read ERIC FEFERBERG/AFP/Getty Images)
Graffiti for victims of the World Trade Center are written on windows covered in dust from the collapse 22 September 2001 New York. War appeared imminent as the United States stepped up the deployment of military forces south and west of Afghanistan, the base of Saudi-born Osama bin Laden, who is pinpointed as the chief suspect in the deadly September 11 terrorist onslaught on the World Trade Center and the Pentagon. AFP PHOTO Eric FEFERBERG (Photo credit should read ERIC FEFERBERG/AFP/Getty Images)
398760 04: This image captured by a satellite on September 12, 2001 shows an area of white dust and smoke at the location where the 1,350-foot towers of the World Trade Center once stood in New York City. Terrorists slammed two hijacked airliners into the twin towers on September 11, killing some 3,000 people. (Photo by Spaceimaging.com/Getty Images)
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Survivors suffer from alarming rates of asthma, gastroesophageal disease, PTSD, cancer, and other illnesses
In 2009, a study of World Trade Center Health Registry enrollees showed that 10.2 percent had received a new diagnosis of asthma in the five to six years following the attack. Rescue and recovery workers were the exposed group most likely to develop asthma (12.2 percent did), followed by passersby (8.6 percent). "Intense dust cloud exposure on September 11 was a major contributor to new asthma diagnoses for all eligibility groups: for example, 19.1% vs 9.6% in those without exposure among rescue/recovery workers. ... Asthma risk was highest among rescue/recovery workers on the WTC pile on September 11." Other "persistent risks" included "not evacuating homes, and experiencing a heavy layer of dust in home or office." A study conducted from 2011 to 2012 found that of 2,500 people diagnosed with asthma in the two years after 9/11, two-thirds reported continued symptoms "that interfered with their usual activities."

A 2011 study of the same population found a significant number of post-9/11 gastroesophageal reflux symptoms (GERS). (The symptoms are associated with gastroesophageal reflux disease [GERD], which can lead to esophageal cancer.) Twenty percent of those surveyed reported GERS two to three years after the attack, while 13 percent said that the symptoms persisted for five or more years. Of the people who developed symptoms right after the attack, 46.5 percent still had them 10 years later. As with asthma, the illness was most common among responders (41 percent), but people exposed to the initial dust cloud and those who didn't evacuate their homes were also at an elevated risk.

These and other studies also noted that both asthma and GERS occurred more frequently in patients who also had PTSD (which affected at least 15 percent of people in the vicinity of the attack), though plenty of people without the psychological condition developed one (or both) of the physical illnesses.

The 2011 Annual Report on 9/11 Health also pointed to continuing cases of sarcoidosis (inflammatory cells on the lungs, skin, eyes, and lymph nodes) among responders, residents, and passersby. It also noted a host of ongoing respiratory sickness among exposed firefighters, including sinus inflammation (17.2 percent), bronchitis (13.2 percent), and COPD/emphysema (1.5 percent).

Technically, researchers have yet to definitively link Ground Zero exposure and cancer, but the connection has become obvious. Earlier this week, Newsweek reported that, "As of June, 5,441 of the 75,000 people enrolled in the World Trade Center Health Program have been diagnosed with at least one case of 9/11-related cancer. ... And many of them have multiple cancers, with the total number of cancers certified at 6,378 as of June." The FDNY told the magazine that cancer rates among firefighters and EMTs who worked at Ground Zero are now "19 to 30 percent higher" than they were before 2001.

Meanwhile, from the NYC Health Department:

Unfortunately, the worst is probably yet to come. As former NYC Health Commissioner Dr. Thomas Farley pointed out during the 2012 battle to make funds from the James Zadroga Act available for cancer treatment, "Cancers take 20 years to develop...and we might see something different 20 years down the line." (Ultimately, nearly 60 types of cancer were added the list of illnesses eligible for coverage.) Other doctors who have worked with 9/11 survivors have said that they expect to see an increase in cancer in the coming years.

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