Tags: Ricin | Assumptions | Could | Prove | Deadly

Ricin Assumptions Could Prove Deadly

Tuesday, 10 February 2004 12:00 AM

“Ricin has been around a long time,” he said in an effort to keep people calm. “We have a great deal of information about it.” His words of comfort were reminiscent of a similar effort in the fall of 2001 when he described a Florida anthrax victim as “just an isolated case.”

Let us hope his assurance about ricin proves more on target than about anthrax. The Florida victim turned out to be the first of 22 people diagnosed with anthrax, five of whom died. Moreover, despite the secretary’s assurance, much is unknown about ricin’s effects on humans.

The two materials differ in many respects—ricin is a toxic product of castor beans and anthrax bacteria are living microorganisms. But a speck of either can be deadly. Hours after inhaling a quantity of ricin smaller than an ant’s eye, the toxin may begin to destroy lung and other cells. An equivalent volume of inhaled anthrax spores can infect cells and, like ricin, eventually leave a victim gasping for breath. Both are considered likely agents of terrorism and warfare.

The bioterrorism assault in 2001 was conducted by mail. Perhaps a half-dozen letters containing anthrax spores were addressed to media and political targets. The source of the ricin has not yet been determined, though officials consider the mail a strong possibility.

Further, it is not yet known whether the ricin found on Capitol Hill is just one among several releases to various targets, as happened with the anthrax.

The fact that no one has yet been found ill or that only one target has been identified does not foreclose the possibility of worse to come. Not until two weeks after anthrax letters were mailed was a patient first found with the disease. And not until a month after the mailing was an actual letter found.

Thus the anthrax experience underscores the folly of premature assurances.

The mechanism of anthrax infection differs from that of ricin poisoning, and health authorities think it likely that illness from ricin occurs either in a few days or not at all.

But inhalation ricin poisoning is so rare that assumptions are drawn largely from experiments with animals. Here again, the anthrax experience reminds us how such assumptions may be mistaken.

Until 2001, inhaling anthrax was considered an irreversible death sentence unless the victim was treated with antibiotics before symptoms appeared. That belief was based on experiments with monkeys, which are also the basis of the current thinking about ricin.

In fact all 11 inhalation anthrax victims in 2001 were very sick before they received treatment, and still, six survived. (Another 11 had the less dangerous skin form of the disease.)

Inhaled ricin may also prove less problematic than now believed. But it is no less possible that current assumptions understate the real risk and that in some people the effects of inhaled ricin might become evident only long after exposure.

An added concern is that unlike with anthrax, antibiotics are ineffective against ricin poisoning. Nor are there antidotes to counter the effects of the poison. Thus at least for some months, people who had been in the vicinity of the powder should be monitored for symptoms.

One of the most stunning surprises about the anthrax episode was how widespread the leakage of the bacteria had become. No one realized that for a month, micron-wide anthrax spores were leaking through pores of the envelope paper, then contaminating buildings and killing people.

Apparently the ricin powder in Senator Frist’s office is not as finely graded as the powder in the anthrax letters. Still, even if the poison did not seep through envelope paper, it might have leaked from the corner seams. Tests for ricin in the Senate office buildings thus far have been negative. But tracing the path of a letter to Senator Frist from the likely postal sorting facility, and testing for ricin along the way, would seem imperative.

Another important lesson from the anthrax episode relates to the response of health care workers. Several physicians who made preliminary anthrax diagnoses in 2001 faced skepticism. One doctor hesitated for days before sharing with a colleague her belief that a patient she was treating might have anthrax.

“I didn’t want to make a fool of myself,” she told me. Another physician recalls that after he diagnosed anthrax at a suburban New Jersey hospital a colleague said, “Don’t be silly--this isn’t New York, this is Mount Holly.”

In both instances, tests later confirmed that the patients had anthrax. People should now assume that ricin could show up in the mail anywhere. Doctors around the country should be alert to the symptoms and the treatment, limited though it is, of ricin poisoning.

Mistaken assumptions during the 2001 anthrax outbreak delayed full understanding of its gravity. Realizing sooner that postal facilities were contaminated with the bacterium, for example, might well have led to quicker treatment and fewer deaths.

We must not now make the mistake of relying on unproven assumptions about ricin. Experience with ricin sent through the mail and then inhaled is nil. Recognizing this fact should prompt more caution before officials give an all-clear signal.

Leonard Cole is a bioterrorism expert who frequently appears on MSNBC. His latest book, The Anthrax Letters: A Medical Detective Story, was published by the Joseph Henry Press.

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"Ricin has been around a long time," he said in an effort to keep people calm."We have a great deal of information about it."His words of comfort were reminiscent of a similar effort in the fall of 2001 when he described a Florida anthrax victim as "just an isolated...
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2004-00-10
Tuesday, 10 February 2004 12:00 AM
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