Sept. 27, 2001, 1:17PM

Many fear nation unprepared for probability of germ attacks

By DANIEL Q. HANEY Associated Press

Stashed in secure government warehouses around the country are 400 tons of antibiotics and other medical supplies ready for what seemed until two weeks ago to be an unimaginable catastrophe -- a terrorist germ attack.

BIOTERRORISM Despite federal preparations, many medical experts say the U.S. health system is ill-equipped to manage the fallout from a large-scale bioterrorist attack. But the threats are clear. Five biological agents have been given high priority because of their risks to national security. -------------------------------------------------------------------------------- SMALLPOX Background: It killed more than 500 million people in the 20th century before being eradicated in 1977. Vaccinations stopped in 1980. Early symptoms: About 12 days; fever, headache, nausea Disease: Chickenpoxlike rash transform into hard blisters. Highly contagious, smallpox kills one-third of its victims. Treatment or prevention: No cure. Only 12 million doses of vaccine remain to protect the uninfected, enough for one of every 23 Americans. -------------------------------------------------------------------------------- ANTHRAX Background: A government study estimated that about 200 pounds of anthrax released upwind of Washington, D.C., could kill up to 3 million people. Early symptoms: Two to 10 days, or as long as seven weeks; flulike symptoms Disease: Then, within one to three days, shock and breathing problems cause death for close to 100 percent. Treatment or prevention: If given early enough, antibiotics can prevent exposed people from falling sick. The vaccine is reserved for military use. -------------------------------------------------------------------------------- PLAGUE Background: Between 1980 and 1994, 18,739 cases of history's most feared contagious disease were reported in 20 countries. Early symptoms: Symptoms occur within one to six days after inhaling the pneumonic form. Disease: High fever, cough and labored breathing lead to respiratory failure and death. Unlike anthrax, it is contagious. Treatment or prevention: Rapid use of antibiotics can be effective. A vaccine is not currently being produced in the United States. -------------------------------------------------------------------------------- BOTULISM TOXIN Background: The single most poisonous substance known is typically foodborne, but could be developed as an aerosol weapon. Early symptoms: 24 to 36 hours; blurred vision and difficulty swallowing and speaking. Disease: The nerve toxin paralyzes muscles, leading to respiratory failure and death. Treatment or prevention: The Centers for Disease Control and Prevention maintain the botulism anti-toxin supply. -------------------------------------------------------------------------------- TULAREMIA Background: The United States studies this infectious organism as a weapon in the 1950s and 1960s. Early symptoms: Three to five days; fever, chills, head-ache, weakness Disease: Resulting inflammation and hemorrhaging of the airways can lead to death. Treatment or prevention: Without antibiotics, one-third die. A vaccine is under review by the Food and Drug Administration. -------------------------------------------------------------------------------- HEMORRHAGIC FEVERS, SUCH AS EBOLA Background: The origin of Ebola, for example, is unknown, but it is probably transmitted to humans by animals. Early symptoms: Three to five days; fever, muscle aches, diarrhea Disease: Hemorrhaging of fluids out of tissues and orifices. 30 to 90 percent of victims die. Treatment or prevention: Some diseases respond to antiviral drugs, but these are in short supply. SOURCES: Centers for Disease Control and Prevention; "Living Terrors," by Michael T. Osterholm and John Schwartz; Dennis Kunkel Microscopy Inc.

The stockpile is already packed in hundreds of air freight containers, which can be shipped on 12 hours notice. There are enough pills, IV solution and other supplies to fill eight 747s, enough to treat thousands of victims of an intentional release of anthrax or plague or other germs.

The medicines are the most tangible centerpiece of federal preparations for a bioterrorist attack on the United States. But reassuring as they are, many health experts fear the country has hardly begun to get ready for such a disaster.

"How prepared are we? We are more prepared than we were two years ago. A lot of efforts are under way. But we are woefully unprepared," says Bruce Clements, associate director of St. Louis University's Center for the Study of Bioterrorism and Emerging Infections.

The possibility -- or probability -- of a bioterrorist attack was already near the top of some experts' worry lists long before Sept. 11. The Centers for Disease Control and Prevention published its strategic plan for dealing with one last year.

"Many experts believe that it is no longer a matter of if but when such an attack will occur," said Dr. James M. Hughes, the CDC's chief of infectious diseases, in congressional testimony seven weeks before the attacks in New York and Washington.

After those attacks, however, many say the risk is being taken much more seriously. The government has twice grounded crop dusters because of fear they could be used to spray germs or chemicals over large areas.

While some experts maintain that relatively advanced technology would be needed to make and release large batches of germs, others say resourceful terrorists can almost certainly find ways to do it on a shoestring.

Dr. Michael Osterholm of the University of Minnesota, author of Living Terrors, argues that launching a smallpox epidemic, for instance, could be as easy as leveling the World Trade Center using planes hijacked with box cutters: Intentionally give the virus to 40 or 50 suicidal terrorists, wait a few days until they are highly infectious and then send them out to walk through airports, ride subways or go to ballgames.

Thousands of people would catch it and pass it on. Scientists say the protection many people had from their childhood smallpox vaccine has largely worn off.

Osterholm doubts the country could competently deal with a medical disaster of that scope or even one less catastrophic. "We are just not ready for even a moderate-size event," he says.

The CDC leads government planning for the medical effects of such terrorism. Over the past two years, besides stockpiling drugs, it has underwritten state and local bioterrorism planning and education, strengthened communications among health officials and improved labs' ability to identify unusual bugs.

However, many experts say that on the local level, preparation has been scattershot, and doctors, nurses and hospitals are simply untrained and unprepared to deal with tens of thousands of patients with a deadly infection.

The first problem will be recognizing that a germ attack has even taken place. Bugs could be sprayed, invisible and odorless, through buildings, into train stations and across entire cities, but they cannot be detected with any monitoring equipment.

The first hint of disaster might come days later, when unusual numbers of otherwise healthy people turn up at emergency rooms with aches and fever.

Most doctors have never seen a case of anthrax, smallpox or plague. The early signs of many bioterror infections could easily be mistaken for the flu.

Bioterrorism training programs, aimed especially at emergency room doctors, encourage them to report odd clusters of common ills. "We need a system where a physician who sees a flulike illness doesn't just say, `Go home and rest. It's the flu,' " says Dr. Ronald Atlas of the University of Louisville, president-elect of the American Society for Microbiology.

Identifying an attack quickly is critical. Once symptoms start, the outlook is grim, even with plenty of medicine. But prompt doses of antibiotics can keep outwardly well but infected people from falling ill. Most of the bacterial threats, such as anthrax and plague, can be treated with ordinary antibiotics like Cipro and doxycycline.

But who will get treated first when demand will far outstrip hospital supplies? Probably hospital personnel, since they need to stay healthy for everyone's sake, as well as police, firefighters and ambulance crews. Many will demand it for their families, too. City officials will argue they also deserve protection.

Stockpiled drugs could arrive a day or two later, depending on how long it takes the CDC to acknowledge the crisis and get moving. But distributing them will be a herculean job.

The medicines are divided around the country into eight lots, called push packages. One or more would be sent, depending on the situation. Each weighs 50 tons and takes up more than 100 air cargo containers. They include more than 900 cases of pills and 2,500 cases of intravenous medicines, as well as catheters, breathing equipment, intravenous fluid and bandages.

Most of the antibiotics -- 432,000 Cipro tablets and 5 million doxycycline -- would be in bulk bottles. Somehow they would have to be sorted into handfuls of individual doses in plastic bags. And these would somehow have to be distributed to hundreds of thousands of people frantic that they are infected.

Osterholm says the stockpile is useless without the manpower and plans to distribute the drugs quickly, and "those plans are not in place throughout most of the country."

http://www.chron.com/cs/CDA/printstory.hts/special/terror/impact/1064008

-- Martin Thompson (mthom1927@aol.com), September 27, 2001

Answers

That's right. With more than 10 years warning, as I see it, the nation is still pitifully unprepared for biological warfare. The terrorists, all, it seems with suicidal tendencies, would have little trouble walking through all kinds of diseases, spreading them into the population, leading to millions of deaths.

-- Big Cheese (bigcheese@multimax.net), September 27, 2001.

In all sports it is said that the best defense in a good offense. I'm with Bush all the way on this. I say go get 'em.

-- Uncle Fred (dogboy45@bigfoot.com), September 27, 2001.