After years of incremental preparations for what once seemed the remote chance of an attack with biological or chemical weapons, Illinois emergency agencies have launched urgent efforts to strengthen their plans.
Galvanized by the Sept. 11 terrorist attacks, state public health experts in Springfield are hurrying to complete Illinois’ plan for distributing stockpiled vaccines and antibiotics in case of an emergency.
Chicago-area hospitals have scheduled immediate employee training on the symptoms caused by biological weapons.
And some suburban hospitals are confronting the issue for the first time. At Alexian Brothers Medical Center in Elk Grove Village, officials this week will draw up the institution’s first plan for dealing with a biological attack.
Emergency management officials say individual citizens need do little to prepare for an attack. Instead of buying gas masks, individuals should plan to follow specific instructions from health officials broadcast from TV or radio in the event of an attack, they say.
Although the chances of isolated terrorists mastering the technology needed to pull off a devastating attack are considered small, Bush administration officials have warned that terrorists such as Osama bin Laden may have access to chemical and biological agents.
Experts say a solid public health infrastructure could save thousands of lives.
Illinois already has taken vital steps; under a federal program started in 1999, the state has trained 1,000 physicians and emergency workers to treat patients struck by the myriad bacteria, viruses and toxic gases that terrorists might exploit. Last year, officials simulated an attack of the nerve gas sarin at Comiskey Park.
Yet the pivotal experiences of Sept. 11 have many health officials wondering what vulnerabilities they might have missed and where they can make improvements.
“We are completely re-evaluating our preparedness and ability to respond,” said Dr. John Lumpkin, director of the Illinois Department of Public Health.
There is some reason for concern. A readiness survey sent to state hospitals last year showed that most institutions needed more training and lacked sufficient equipment to handle a chemical attack, public health officials said.
A large-scale attack would present political leaders and public health agencies with tremendous logistical challenges and test the expertise of emergency workers. Perhaps most crucial is that medical personnel arm themselves with basic knowledge about the warning signs of diseases likely to be used in an attack.
Although the state Public Health Department focuses on nine potential biological weapons, experts say terrorists might exploit any one of dozens of diseases. Many of those ailments begin with similar, generic flulike symptoms, making early diagnosis difficult. Most are sicknesses that average emergency physicians never encounter.
“One of the jobs that we have now is to imagine the unimaginable,” said Susan Scrimshaw, dean of the School of Public Health at the University of Illinois at Chicago.
On Friday, infectious disease leaders from hospitals around the Chicago area met at Northwestern University Medical School to discuss ways of speeding up their reaction to a possible attack.
“It’s important that we have a concerted plan of attack,” said Dr. Steven Wolinsky, chief of infectious diseases at Northwestern.
Emergency agencies and physicians have to prepare for several different weapons–chemical, biological or even nuclear–each of which requires a distinct response.
A biological attack requires the most elaborate response and prevention measures, experts say. Even chemical weapons are easier to prepare for because their effects on victims are almost instantaneous.
By contrast, the toll of a biological weapon may not be felt for weeks after the original attack; inhaled anthrax spores, for instance, can take up to 48 days to incubate and cause symptoms.
“A biological event is more insidious,” said Dr. Moses Lee, director of emergency medical services at Cook County Hospital.
More Top Picks Best Light Therapy Lamps For Energy
Among biological agents for which treatments exist, most have different windows during which they can be treated effectively. For patients suffering from plague, antibiotics may be a lifesaver if used within 24 hours of the first symptoms.
In the case of inhaled anthrax, it’s usually too late by the time symptoms appear.
The first sign of a biological attack, experts say, is likely to be a trickle or flood of patients with suspicious symptoms showing up at their doctors’ offices and emergency rooms.
Some diseases are relatively easy to recognize from just one patient–smallpox causes a distinctive rash on the mouth and face. But the flulike symptoms of many potential biological weapons are so common that doctors would have to see a cluster of cases before spotting a disturbing pattern.
For example, one patient coughing up blood probably would not raise suspicions immediately, said Dr. Cai Glushak, medical director of emergency medical services at the University of Chicago. But three cases appearing in an emergency room at the same time could be a clue that they have been exposed to plague.
“If they all go to separate hospitals, the ambulance workers may see the cluster first,” Glushak said.
Once physicians suspect a biological attack, they are required to notify the local health department, which contacts the state health agency. The state sends samples for testing to the federal Centers for Disease Control and Prevention.
Remedies depend on the scale of the attack. Although the details of disaster response plans are not public information, officials say that if only a few people had been exposed, there would be targeted treatment and vaccination of victims and people with whom they had contact.
But an attack involving thousands of victims would require large-scale use of the National Pharmaceutical Stockpile of vaccines and medicines, said Leslee Stein-Spencer, chief of emergency medical services for the state Public Health Department.
“In a severe case there might be a quarantine,” Stein-Spencer said.
Lessons learned from drill
The best clues as to what a biological attack might be like come from a May 2000 exercise, the largest drill of its kind, by the Department of Justice and the Johns Hopkins Center for Civilian Biodefense Studies. Called TOPOFF because it included top officials of the U.S. government, the drill simulated attacks with weapons of mass destruction in three cities.
The biological attack took the form of an aerosol release of pneumonic plague bacteria in the Denver Performing Arts Center. Officials encountered about a thousand new mock cases each day, with nearly 1,000 mock deaths in the four-day drill.
By the third day, the governor of Colorado had issued a mock executive order prohibiting travel into or out of the state. Healthy people were directed to stay in their homes and avoid public gatherings. Experts argued for hours about whether scarce antibiotics should be reserved for the most at-risk patients or given to the general population.
The simulated influx of victims and thousands of uninfected people–the “worried well”–meant that local hospitals “were beyond capacity in less than 24 hours of the epidemic,” according to a Hopkins report on the exercise.
Illinois officials say they have learned valuable lessons from such drills and have modified their preparations accordingly.
The best protection for individuals in such an attack would be to follow the directions of political leaders and public health officials, experts say. Individuals should never stockpile antibiotics because they have a limited shelf life and should be used only under direction of a physician.
People should always keep basic supplies for any emergency–such as bottled water, canned goods and battery-powered radios. Beyond that, Lumpkin said, biological and chemical weaponry “really is something people as individuals cannot prepare for, other than to support a strong public health system.”
Chemical weapons present a more straightforward challenge for emergency planners. Victims of such an attack would most likely be decontaminated immediately with showers at a hospital–or, if the victim toll was heavy, in portable outdoor shower facilities.
During a 1995 attack with the nerve gas sarin that killed 12 people in a Tokyo subway, hospitals were overwhelmed with patients who walked in or took taxis from the scene. Last year’s Comiskey Park exercise also simulated such an influx, which can pose serious decontamination problems.
Most hospitals are not equipped to deal with a serious chemical attack. A national survey last year of 156 trauma centers found that only 6 percent had the right equipment, personnel and training to handle hazardous materials.
“They weren’t mentally or physically prepared to accept patients that might have chemical contamination,” said Dr. David Ghilarducci, an emergency room resident at Michigan State University in Kalamazoo and former hazmat specialist who co-authored the study.
The Tokyo subway attack shows how difficult a biological or chemical attack can be to pull off. The Japanese cult Aum Shinrikyo spent huge sums of money to build a state-of-the-art laboratory and hire trained chemists, but their sarin attack killed surprisingly few people, and their attempts to release anthrax failed completely.
It turned out the group had chosen a harmless strain of anthrax, said Dr. Anthony Tu, a professor of biochemistry and molecular biology at Colorado State University who helped Japanese authorities track down the cult’s clandestine laboratory. They also made an impure strain of sarin; a pure preparation could have killed thousands.
“They were failures because they didn’t know how to make the stuff,” Tu said.
A nuclear attack would require even greater sophistication. Although it should be nearly impossible for terrorists to obtain a nuclear bomb, officials have considered how to respond to a nuclear dispersal device, which would use conventional explosives to scatter radioactive material. But even that makes an unlikely weapon, experts say.
“Probably, you’re not going to see the type of radiation dose that would cause immediate injury,” said Edwin Lyman, scientific director at the Nuclear Control Institute, a group that works on nuclear non-proliferation issues.
Radiation protection limited
Potassium iodide is the only medication that can protect against radiation–but it protects only against radioactive iodine, one of hundreds of radionuclides that people might be exposed to.
“If you’re beneath a cloud of radioactive fallout from a blown-up nuclear reactor, there are hundreds of other radionuclides to worry about,” said Daniel Hirsch, president of the Committee to Bridge the Gap, a nuclear watchdog group.
“It’s not as effective as evacuation,” said Jan Strasma, a spokesman in the Midwest office of the Nuclear Regulatory Commission.
In 1998, the NRC agreed to provide potassium iodide tablets to states that want to distribute them. Illinois declined. The state stockpiles potassium iodide only for emergency workers and people who live near nuclear plants but aren’t mobile, such as those in nursing homes.
Readiness won’t come on the cheap. The federal government needs to develop more vaccines against the germs that are most likely to be used, said Dr. Olaf Schneewind, a U. of C. microbiologist and a member of the National Institutes of Health’s panel on bioterrorism.
Developing safe vaccines for mass distribution may take about 10 years and cost $50 million to $100 million a year, but that would provide the widest safeguard against a bioterrorist attack, Schneewind said.
Expending so much time and money to guard against attacks that have never hit this country would have seemed impossible at one time. But Lumpkin said the rationale for readiness now is all too clear.
“Before this, some people in the target group we want to reach may have thought we were doomsayers,” Lumpkin said. “We have a new reality after Sept. 11.”
What you need to know about biochemical weapons
Experts have identified dozens of biological diseases and chemical agents that could be used as weapons. The risk of such an attack remains very low. But since Sept. 11, many U.S. agencies are taking steps to educate the public about the dangers of a biological or chemical attack.
Biological diseases
The Illinois Department of Public Health focuses on nine biological threats:
DISEASE
ANTHRAX
A deadly infection caused by bacteria spores commonly found in cows and sheep. It is not contagious.
SYMPTOMS: Infection from inhalation resembles common cold, progresses to severe breathing problems and shock after several days. Inhaled anthrax is usually fatal.
TREATMENT: Antibiotics such as penicillin or ciprofloxacin must be taken immediately.
VACCINE?: Yes. Generally given only to active duty military personnel.
POSSIBILITIES AS A WEAPON: Relatively easy to manufacture and store, but difficult to disperse in large quantities. Bright sunlight kills the spores, and thousands must be inhaled for an infection to develop.
BOTULISM
A muscle-paralyzing disease usually caused by a toxin found in contaminated food.
SYMPTOMS: About 18 to 36 hours after exposure, victims develop blurry vision and slurred speech, and paralysis spread through the body. About 8 percent of those infected die.
TREATMENT: If diagnosed early, an antitoxin can block spread of toxins. Hospital care is essential.
VACCINE?: No.
POSSIBILITIES AS A WEAPON: Lethal strains are hard to grow in large quantities and would be difficult to disperse.
CHOLERA
An acute diarrheal illness transmitted through contaminated food and water.
SYMPTOMS: Often mild. About 1 in 20 cases are severe, with diarrhea, vomiting and leg cramps. Fewer than 1 percent of those infected die if treated promptly.
TREATMENT: Replace lost fluids and salts. Antibiotics are sometimes used.
VACCINE?: Yes, but not in U.S.
More Top Picks Page 2
POSSIBILITIES AS A WEAPON: Likelihood of use as a weapon is very low.
PLAGUE
Highly contagious disease has killed millions through history but is very rare today.
SYMPTOMS: Fever, chills and a cough with blood appear one to six days after exposure. Is fatal in almost all untreated cases.
TREATMENT: Antibiotics (for pneumonic plague, the type most likely to be spread in a terrorist attack).
VACCINE?: No
POSSIBILITIES AS A WEAPON: Bacteria is widely available in microbe banks around the world. Could be transmitted by infecting fleas or by aerosol.
SALMONELLOSIS
Infection caused by bacteria usually spread by eating foods tainted by animal feces.
SYMPTOMS: Diarrhea, fever and abdominal cramps 12 to 72 hours after infection. Very rarely causes death.
TREATMENT: Often not required unless dehydration is severe. Recovery is usually 5 to 7 days.
VACCINE?: No
POSSIBILITIES AS A WEAPON: Relatively easy to obtain and manufacture.
SMALLPOX
Eradicated from people in 1970s, highly transmissible virus is universally feared as most devastating infectious disease.
SYMPTOMS: About 12 to 14 days after exposure, high fever and headache give way to rash on the mouth and face. It is fatal about 30 percent of the time.
TREATMENT: There is no proven treatment. Vaccine within four days of exposure can lessen severity.
VACCINE?: Yes. Emergency supplies are available.
POSSIBILITIES AS A WEAPON: U.S. and Russia have only known stores but other countries may have samples. Large-scale manufacture is difficult; would be hard to spread through aerosol.
TULAREMIA
Hardy, highly infectious organism usually transmitted by rabbits and mice.
SYMPTOMS: Flulike symptoms usually begin within three days of exposure. Affects the lymph glands; can be fatal in up to 60 percent of untreated cases.
TREATMENT: Antibiotics are usually effective.
VACCINE?: Yes, but not FDA approved. Not available to public.
POSSIBILITIES AS A WEAPON: As few as 10 organisms, which can survive for weeks, can cause disease. Has been stockpiled in the past by U.S., Soviet Union and Japan militaries.
Q FEVER
Very infectious, airborne agent commonly found in livestock. A single organism can cause disease.
SYMPTOMS: About half of victims show signs, ranging from high fever and headache to pneumonia. Fewer than 2 percent of infected people die.
TREATMENT: Antibiotics are effective, though most patients recover without treatment.
VACCINE?: Yes, but not widely used.
POSSIBILITIES AS A WEAPON: Organism is resistant to heat and drying.
VIRAL HEMORRHAGIC FEVERS
Highly contagious fevers such as Ebola and Marburg diseases are usually caught from animals.
SYMPTOMS: Vary greatly, but generally include high fevers and dizziness with signs of bleeding under the skin. Shock follows, and most cases are fatal.
TREATMENT: Generally none.
VACCINE?: No.
POSSIBILITIES AS A WEAPON: Manufacturing, storing and transporting a little-understood virus like Ebola would be very difficult.
Chemical agents
AGENT
SARIN
A colorless, odorless gas dispersed in a droplet or mist form.
SYMPTOMS: Runny nose, bronchial secretions, tightness in the chest, dimming of vision, drooling, excessive perspiration, nausea, muscle tremors, coma, death.
TREATMENT: Wash exposed areas with soap and water and get an immediate antidote at a hospital.
VACCINE: Vaccines do not apply to chemicals.
POSSIBILITIES AS A WEAPON: Can be manufactured with fairly simple chemical techniques. The raw materials are inexpensive and generally readily available.
VX
Looks like motor oil and is 100 times more lethal than sarin when it enters through skin.
SYMPTOMS: Runny nose, bronchial secretions, tightness in the chest, dimming of vision, drooling, excessive perspiration, nausea, muscle tremors, coma, death.
TREATMENT: Wash exposed areas with soap and water and get an immediate antidote at a hospital.
VACCINE: Vaccines do not apply to chemicals.
POSSIBILITIES AS A WEAPON: Can be manufactured with fairly simple chemical techniques. The raw materials are inexpensive and generally available.
MUSTARD GAS
Can be yellow to dark brown and can smell like burning garlic.
SYMPTOMS: Sneezing, coughing, loss of appetite, diarrhea, fever, apathy, blistering.
TREATMENT: Wash exposed areas with soap and water and get antidote at a hospital.
VACCINE: Vaccines do not apply to chemicals.
POSSIBILITIES AS A WEAPON: Has been used frequently as a weapon in past wars.
Sources: Centers for Disease Control and Prevention, Center for Civilian Biofense Studies, Journal of American Medical Association, Johns Hopkins University
More Top Picks Best Electrostatic Sprayers
baiduhai