Rich man, spore man: if the elite want to survive bioterrorism, they'll have to make sure the poor do, too.

• Author: Mencimer, Stephanie

ON OCTOBER 21, GOVERNMENT VANS, chartered buses, and even neighborhood mail trucks delivered a steady stream of postal workers to the ambulance bay of D.C. General Hospital. Nearly 4,000 people lined up to have their noses swabbed for anthrax spores and to pick up Ziploc bags of antibiotics. The parking lot of the 195-year-old public hospital swarmed with TV crews, network reporters, and Salvation Army volunteers in full uniform handing out Gatorade before faded signs that read: "D.C. General: Where Miracles Happen Every Day." Even New York Times columnist Maureen Dowd, who'd never before seen fit to write about the hospital, claimed to have dropped in.

Many of the luminaries seemed oblivious to an irony not lost on the postal workers, who were surprised to have been summoned to D.C. General. "I thought it was closed," said Anita Burrell, an employee of the Washington Square post office.

Indeed, it was. In June, the District of Columbia government had officially ceased to operate the city hospital, which had been bleeding money for years and, at the end, could barely keep X-ray machines operational due to lack of investment. As with other public hospitals nationwide, D.C. General had always been viewed by the city's elite as a grimy, mismanaged dump, grudgingly kept open so that less desirable elements could be steered clear of the better hospitals, which routinely dumped their own poor patients there. (D.C. General was once the only hospital in the city that would admit blacks.) It's no coincidence that the hospital shares a compound with the morgue, the sexually transmitted disease clinic, the detox clinic, and the jail.

Yet even in its neglected state, the hospital served a critical function, treating inmates with tuberculosis and drunks with feet broken from staggering in front of cars, and nursing tiny crack-addicted babies. During the early years of the AIDS epidemic, D.C. General took in hundreds of middle-class white gays kicked out of private hospitals when their insurance ran out. Five minutes from Capitol Hill, the old hospital even treated Russell Weston, the schizophrenic man who, in 1998, shot up the Capitol and killed two security guards.

During the recent boom times, though, the city's congressional overseers decided that D.C. General's $50-million annual city subsidy was government waste in need of trimming. Members of a Republican Congress led the charge to shut it down. Of course, almost every other hospital in the city was bleeding money, too, even private ones like Georgetown University Medical Center, which lost $90 million last year. Tax-exempt Georgetown was also subsidized by the federal government. But no one suggested closing it down. After all, Georgetown catered to the Establishment. By contrast, D.C. General was a place the Establishment never anticipated needing. Four months after it closed, though, the wisdom of that decision was seriously challenged, since no other hospital in the city has the capacity to handle the influx of postal workers in need of anthrax tests.

A rich society with a viable public health system would have directed the postal workers to a gleaming, modern facility configured to handle afflicted populations, complete with microbiology labs and cafeteria. Instead, the jittery federal employees ended up at a crumbling, closed public hospital where health authorities relied on improvisation and the Salvation Army to battle terrorism.

The makeshift operation exposed the toll that 30 years of neglect has taken on our collective ability to provide everything from standard emergency medical service to disease surveillance. Prior to September 11, people of means never treated the breakdown as a crisis, in large part because they thought they could buy their way around the holes in the public-health system. Those who fell through the holes--the poor--landed at places like D.C. General and were never heard from again.

The recent rash of bioterrorism, however, has made the poor, the middle class, and Maureen Dowd equally vulnerable to the failings of our public health system. Those very same underfunded health services that would have helped the poor before September 11 are exactly what's needed to save the rest of us now.

Save Yourself

Government officials trying to assuage our fears of a bioterrorism attack have frequently pointed to the successful containment of the New York City smallpox outbreak of 1947. Back then, New York hadn't experienced such an outbreak in almost 50 years, and much like today, few doctors and nurses had ever seen a smallpox case. City health officials lacked the proper tools even to diagnose it.

But the New York public health department had a lot of other things working in its favor, including the remarkable capacity to manufacture its own smallpox vaccine. The city health commissioner sent the lab into 24-hour-a-day production, turned every public building into a vaccination station, and sent nurses out to knock on doors and track down the infected. The city managed to vaccinate six million people in just a few weeks, limiting the outbreak to 11 cases and two deaths.

The containment was a tremendous response by American public health officials, but there's no guarantee of a repeat performance today. In 1947, the country had not yet launched its hospital construction boom, and it boasted a fairly comprehensive network of neighborhood public...