Initially, it might show up as five or six isolated cases of odd symptoms in emergency rooms or family physician offices. If it's not recognized and reported early, it could quickly mushroom into 25 cases, then 500 cases, 5,000 cases.
The first line of defense would be the nation's public health system, a network of local, state and federal health agencies. Among its roles is the early detection of outbreaks of infectious diseases. That national surveillance system - neglected for years - is getting renewed attention and financial support because of the role it would play in detecting and responding to a biological attack.
"It's a role we're familiar with. We've had a lot of experience in detecting newly discovered diseases," says Dr. James Hughes, director of the National Center for Infectious Diseases, one of the Atlanta-based Centers for Disease Control and Prevention. He ticks off a list of unknown illnesses - "Legionnaire's disease, Lyme disease, toxic shock syndrome, HIV in the '80s, in the '90s the hanta virus in the southwest United States" - detected by CDC.
But Hughes acknowledges that early recognition of a biological attack might be difficult. The diseases best suited for use as biological weapons - bubonic plague, smallpox, hemorrhagic fevers such as the infamous Ebola virus and anthrax, among others - are rarely seen by American doctors.
To understand the difficulty that can create, consider the example of measles. It was so common 30 years ago that many parents could make an accurate diagnosis of its early symptoms themselves. Now that the disease has been all but eradicated, the few cases that do occur can be misdiagnosed even by trained doctors.
"Today, a person could complete pediatrics training and never see a case of measles," says Hughes. Through conferences, training programs, the Internet and articles in prominent medical journals, officials hope to educate emergency room personnel and physicians in the symptoms of diseases likely to be used in a biological attack.
Once an attack is discovered, the goal becomes to contain its impact and treat those affected. The CDC has stationed eight "push packages" of antibiotics and other medical supplies around the country, ready to be delivered within 12 hours of an attack. A more extensive supply of medicine and equipment could be delivered within 24 to 36 hours. The CDC has also contracted for delivery of 40 million vaccines against smallpox, a disease officially declared eradicated worldwide in 1980.
Overall, federal money to combat nuclear, chemical and biological terrorism more than doubled between 1998 and 2000, from $645 million to $1.45 billion. That money has been spread among a variety of military, law enforcement, public health and social agencies, each eager to claim a share of the resources generated by fear of terrorism.
Assessments by independent analysts suggest that much of the money is being wasted in duplication and porkbarrel projects. The Henry L. Stimson Center, a national security think tank in Washington, released an extensive report last year on the nation's preparations for unconventional terrorism. Based on interviews with local and state emergency response officials, the report claimed that fear of unconventional terrorism had become "an inside-the-Beltway justification for a spending carnival."
"These heroes of everyday emergencies, many of whom have seen firsthand the misfortune of headline-making natural and man-made tragedies, are a candid lot," the report concluded. "They know when pork is taking precedence over preparedness. So far, that is their assessment of the federal effort."
Copyright 2001 The Atlanta Journal-Constitution
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