Bioterrorism - US Unprepared
For An Attack
By Charlene Laino
CRYSTAL CITY, Va. - A lone terrorist creates a designer microbe deadly enough to annihilate most of Manhattan. After it's unleashed into the air, the virus will jump, silently, from person to person, infecting millions of unknowing victims. Air travelers will spread the microbe across the nation - and thousands will die within weeks. It hasn't happened yet, but it could, public-health experts said here Tuesday - and more importantly, America is woefully unprepared for such an attack.
The compelling tale is indeed fiction, but presents a potentially very real scenario, said U.S. Health and Human Services Secretary Donna Shalala, who gave the keynote address here Monday at the start of a groundbreaking meeting on bioterrorism.
More importantly, novels such as Richard Preston's "The Cobra Event" raise a logical question that has not been adequately answered: "How do we successfully contain and combat the emerging threat [of bioterrorism]?" Shalala asked the audience of political leaders, physicians, scientists and intelligence experts gathered to talk about what to do should an assault be launched on civilians in the United States.
While experts here stressed that the risk of a biological attack is extremely small - you're much more likely to be hit by a car, for example - they said the United States is woefully unprepared should an attack occur.
Bioterrorism presents unique challenges, they added. The effects of chemical warfare are often obvious immediately after an attack, allowing public-health officials time to mobilize and clean up the area within hours or days.
But a biological attack might not be evident until weeks after the initial infection. And by then, the silent microbes could have spread to thousands, killing most in their wake.
"Release of smallpox into the general population would be one of the most serious threats to mankind," said Dr. D.A. Henderson, director of the new Johns Hopkins Center for Civilian Biodefense Studies, which sponsored the meeting. "Unfortunately today, that is a very real scenario."
Diary of an anthrax attack
While there are any number of organisms that bioterrorists could use as weapons, smallpox and anthrax are the big two that are capable of causing disease and death sufficient to cripple a city, even a country, experts here said.
And if you thought smallpox was eradicated, think again, they said. Yes, the World Health Assembly announced in 1980 that smallpox had been obliterated and recommended that all countries cease vaccination. But that same year, the Soviet government embarked on an ambitious program to grow smallpox in large quantities and adapt it for use in bombs and intercontinental ballistic missiles.
"We now know unequivocally that the former Soviet Union continued to produce biowarfare agents even in the face of the 1970s ban on such weapons," said Dr. Christopher Davis, director of the ORAQ Consultancy Group in Marlborough, U.K. "The questions now are, What happened to the seed stocks? What about the planning documents? The equipment?"
Russia still maintains a research program that is thought to be producing more virulent and contagious strains, he added. "It's difficult to say what they are capable of, but it must be significant."
On Wednesday, attendees at the meeting hope to develop recommendations for a response plan. The first step toward planning for an attack is education - to be aware that an act of bioterrorism is a real possibility, Shalala said.
In addition, the government is spending more than $150 million this fiscal year to fund its "Anti-Bioterrorism Initiative," which is designed to increase medical response and build a stockpile of treatments, she said.
Some of the reasons bioterrorists prefer smallpox are its high fatality rates - it kills some 30 percent of its victims - and its long incubation periods - up to 14 days. While the victims do not experience symptoms during these two weeks, they can infect others.
About two weeks after infection, a victim may develop high fever, malaise, headache and backache. A rash then develops, spreading all over the body.
There is no treatment and it is easily spread from person to person, Henderson said. And since no one in the United States has been vaccinated during the past 25 years, even those immunized before that time are unlikely to still be protected.
Unlike smallpox, anthrax is not spread from person to person. But it is just as deadly: Given appropriate weather and wind conditions, 50 kilograms of anthrax released from an aircraft along a 2 kilometer line could create a lethal cloud of anthrax spores that would extend beyond 20 kilometers downwind.
The aerosol cloud would be colorless, odorless and invisible. And given the small size of the spores, they are as likely to infect people indoors as those on the street.
An analysis by the Office of Technology Assessment of the U.S. Congress estimated that 130,000 to 3 million deaths could occur following the release of 100 kilograms of aerosolized anthrax over Washington D.C., making such an attack as lethal as a hydrogen bomb.
Again, a long incubation period is a potential problem. Exposure to an aerosol of anthrax spores could cause symptoms as soon as two days after exposure. However, illness could also develop as late as eight weeks later - in Svedlovsk, one case developed 46 days after Further, early symptoms of anthrax resemble a flu and are therefore often misdiagnosed. Untreated, 90 percent of people die, most within one to three days. Antibiotics can significantly reduce the risk of death, but only if given within the first few days of symptoms.