Investigators determine whether an anthrax case is natural or intentional by combining epidemiology, microbiology, and context, not by a single test alone. They look at the pattern of cases (isolated vs. clustered, geographic spread), exposure history (animals, hides, soil vs. mail or enclosed spaces), and timing. In labs, specialists perform genetic fingerprinting (whole-genome sequencing) to compare the strain with known natural and laboratory reference strains, which can suggest a source or manipulation history. Environmental sampling and supply-chain tracing add clues. In short, it’s the overall pattern plus genetic evidence, rather than symptoms alone, that distinguishes a natural event from an intentional release.