NY Virus Outbreak
Was A Model For
Bio Attack
The Salt Lake Tribune
WASHINGTON (Gannett) - Even before The New Yorker magazine planted the idea in the national subconscious, infectious disease experts thought the West Nile encephalitis outbreak in New York City was a good model for how a bioterrorism attack might occur.
The CIA says that the outbreak appears to have happened naturally. But the stealthy way it unfolded -- in a large urban area where something could easily have been overlooked -- sent shivers through scientists and those assigned to watch for outbreaks of any origin.
No one thinks they will get any warning of a biological-weapons attack, despite the profusion this year of fake anthrax threats at schools, abortion clinics and government buildings.
"The city was only able to detect the [encephalitis] outbreak as quickly as we did because of an astute clinician," said Marcelle Layton, chief of the Bureau of Communicable Diseases in New York.
Quickly is also a relative term: From the first call to the city health department to initial diagnosis, 11 days elapsed. The diagnosis proved wrong, and a new one was made 12 days later.
The second diagnosis, of West Nile encephalitis, came because a pathologist at the Bronx Zoo had been trying to figure out since July why exotic zoo birds and local birds alike were dying. The zoo investigation was moving on a parallel track to the human outbreak, and they took several weeks to converge.
New York is widely considered among the most sophisticated in planning a response to a terrorism attack of any kind, prompted by the 1993 bombing of the World Trade Center.
For example, the city closely monitors innocent outbreaks of flu or diarrhea-- and even tracks purchases of anti-diarrhea medicine as an early warning system -- in case those outbreaks are not so innocent.
But the way the encephalitis outbreak was spotted could happen anywhere that doctors are paying attention.
"Be prepared for the unexpected -- whether it be a naturally occurring event such as a worldwide influenza pandemic or the deliberate release of anthrax by a terrorist," said Scott Lillibridge, director of the Centers for Disease Control and Prevention's bioterrorism preparedness program.
What caught the attention of New York health officials was a call Aug. 23 from a Queens hospital where two elderly patients had the same baffling neurological symptoms. As city and state health officials sought the cause, more patients appeared.
Concerned that the still-undiagnosed illness was spreading, the city sent an e-mail message to all hospitals a week after the first cases appeared, telling them to report anyone with similar symptoms.
The CDC was on the case that weekend, and local, state and federal scientists arrived at a diagnosis -- St. Louis encephalitis -- on Sept. 3. The number of cases was growing, and public fear continued. But in general, everything seemed under control.
But with the CDC busy with the human outbreak, zoo officials called in favors from friends in the military, who ran tests on bird samples. And the state had sent samples to a California lab without telling the CDC.
Separately, but nearly simultaneously, the military, the California lab and the CDC came up with a new diagnosis, announced Sept. 23: West Nile encephalitis, a less virulent cousin of St. Louis encephalitis.
Now, doctors think it might be another virus altogether; in the Oct. 8 edition of Lancet, they said it might be a newly detected strain of encephalitis virus, but still a relative of West Nile.
As of October's end, health officials reported 56 cases of encephalitis in people and seven deaths.
Knowing the precise diagnosis earlier would not have changed anything the city or its doctors did; the remedies still would have been to treat the symptoms and spray neighborhoods with pesticide.
But it did point out the lags that can occur in an investigation and proved a timely reminder that an answer may not be instantly forthcoming if a man-made outbreak should occur. The New York incident may be as good as surveillance gets.
"It went pretty well," said Col. Edward Eitzen, a physician and chief of the operational medicine division of the Army's Medical Research Institute of Infectious Diseases. "When something like this happens, especially if it's a major event with lots and lots of casualties, nobody expects it to go perfectly."
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