October 5, 2001

Signs of bioterrorism could be delayed

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Signs of bioterrorism could be delayed

If terrorists should choose biological weapons as a mode of attack, the possible scenarios may seem almost limitless. Under the right circumstances significant numbers of people could become infected. The act would likely be covert, showing its results days later.

“Let’s assume that we don’t see the event such as an airplane going overhead spewing out stuff, but rather the bioterrorist’s microbe has been implanted in the population in a stealth fashion,” said William Schaffner, chairman of Preventive Medicine. “What one would expect to happen with the bacteria that is high on the list for bioterrorism is for people to become ill and come into emergency departments presenting with the early signs of respiratory infection, which would progress to pneumonia.”

“We have patients who come to our emergency rooms and clinics on a daily basis with pneumonia. So the question is how would we pick out these cases?”

Schaffner says that anthrax is a good example because it is commonly discussed and is very high on everyone’s list as a potential biological agent. There would be nothing particularly distinctive about the cases in the earliest moments except that they might cluster in time and place and represent an unusual number.

According to the Centers for Disease Control and Prevention, anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. An anthrax infection can occur in three forms: cutaneous (skin), inhalation, and gastrointestinal. Symptoms usually occur within seven days of exposure. If detected early, anthrax can be effectively treated with antibiotics. If left untreated, the disease can be fatal.

“We need a good early surveillance mechanism and I think that physicians, particularly those in emergency rooms, and our first responders in the field have been alerted by events in the news,” Schaffner said. “If they see an unusual cluster or occurrence of disease they should notify the appropriate parties immediately. This early alert mechanism is absolutely imperative if we are going to be able to respond with some intelligence as a community.”

If a bioterrorist went into a public venue, such as a mall, and was able to distribute anthrax, the people exposed would begin to present at different hospitals. Once it became obvious that something unusual was going on, the local and state health departments would begin an investigation to try and find out a common denominator. Then cases would be counted to try and find out just how large the problem was. In the meantime, area hospitals would be doing their best to diagnose and treat patients.

“One of the concerns about the response to bioterrorism is how widespread is the organism, and whether the routine health care system can take advantage of it in terms of patient flow,” said Schaffner. “There is no doubt if the problem is large enough we will all be working overtime.”

Schaffner says there is relatively little the public can or should do to prepare for such an event. “We in the health care system should direct our attention to making sure we are the best-qualified and ready health care providers we can be because that is what the community is going to need,” he said.