[iwar] [fc:The.Best.Antidote?.Acting.Rationally]

From: Fred Cohen (fc@all.net)
Date: 2001-10-07 09:49:33
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Date: Sun, 7 Oct 2001 09:49:33 -0700 (PDT)
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The Best Antidote? Acting Rationally
By Wendy Orent

Sunday, October 7, 2001; Page B03 

For the past four weeks, Bush administration officials have warned us to
expect further terrorist attacks.  Last weekend, White House Chief of
Staff Andrew Card suggested that future terrorism could involve
biological or so-called poor man's nuclear weapons, which disperse
lethal bacteria or viruses into the air or water supply.  And while the
federal government has been preparing scientists to face this threat for
several years (emergency pharmaceutical supplies, including antibiotics
and vaccines, are stockpiled in eight secret locations around the
country), it hasn't begun preparing its citizenry for what to expect and
how to cope if something were to happen. 

The training exercises that have been conducted suggest that a
biological attack would rapidly achieve the very goals a terrorist
covets: widespread panic, flight, a frenzied scramble for personal
safety at any cost.  Based on elaborate scenarios developed in Denver in
May 2000 and at Andrews Air Force Base earlier this year, experts
predicted diseases spiraling out of control and spreading across the
country.  If people were to panic as envisioned, the public health
community would find it very hard to reach and identify victims and the
people they had had contact with, and our limited supply of emergency
drugs would soon run dry. 

But the horrifying events of Sept.  11 suggest that American citizens
are less willing to be tools in the terrorists' hands than these
scenarios would have us believe.  After the attacks on the World Trade
Center and the Pentagon, people were extraordinarily amenable to reason
-- and even performed acts of self-sacrifice.  Tens of thousands
managed, in some semblance of calm and order, to evacuate the 110-story
buildings, some stopping to help others as they went.  Stories of
courage abounded, not only among emergency workers, but also among
civilians, including, most notably, the passengers of United Flight 93
who tackled the hijackers. 

The specter of biological terrorism is frightening.  But well-prepared
citizens, armed with the kind of presence of mind displayed last month,
are much less likely to let it become the catastrophic horror it might
otherwise be. 

Experts in biological defense, including Ken Alibek, a former Soviet
bioweapons expert who defected to the United States in 1992, cite dozens
of agents that could be used as biological weapons.  But three are
generally of most concern: anthrax, plague and smallpox.  The bacteria
that cause plague and anthrax are available in nature, although
preparing and dispersing them as weapons would be challenging; the
smallpox virus, which was eradicated in the general population in 1978
and now only exists in laboratories, would be harder for terrorists to
obtain -- unless, as some experts have speculated, it is already in the
hands of several unfriendly nations.  In the event of contamination with
any of these diseases, the natural human tendency to flee would be the
worst thing we could do -- for ourselves and for the nation. 

Anthrax, the bacterial disease most feared by American experts, produces
durable spores that can contaminate land for years.  Obtaining,
processing and disseminating these spores is a sophisticated process,
but once inhaled they produce a lethal respiratory infection -- and they
do so very quickly.  The disease is not contagious, though, so there's
no need to isolate patients, and, if treated within a few hours of
exposure, it can be cured.  After an attack, we would need to stay put,
so emergency antibiotics could quickly reach people in the affected
area.  Afterward, new disinfection technology, developed at Sandia
National Laboratories in Albuquerque, could be used to disinfect the
environment -- as could ordinary diluted household bleach. 

Plague, once known as the Black Death, terrifies us with its very name,
and a small natural outbreak in Surat, India, in 1994 triggered the kind
of mass flight we need to avoid.  An airborne attack using this agent
(which was made into weapons by the Soviets) would be far more dangerous
than that.  If we reacted the same way as the people of Surat, we would
plunge into chaos.  Airborne plague is extremely contagious.  If
antibiotic treatment is not started within hours of symptoms appearing,
pneumonic plague, the inhaled form of the disease (as opposed to bubonic
plague, which is carried by rat fleas) is almost always fatal. 

Exploiting the terrors of plague, Soviet bioweapons scientists developed
antibiotic-resistant plague strains.  But even this does not mean an
inevitable revisit of the Black Death.  Wu Lien-Teh, a
Cambridge-educated Chinese physician, is widely credited with breaking
the back of the Manchurian plague epidemic that cost about 50,000 lives
in 1910-11 -- long before the invention of antibiotics.  Wu demonstrated
that plague cannot spread effectively from person to person in the open
air.  He and his staff protected themselves by wearing simple gauze
masks, which blocked the tiny infectious droplets from reaching their
lungs.  Furthermore, we now know that plague germs are relatively
fragile, compared with anthrax and smallpox, so ground contamination
outdoors is unlikely. 

Normal disinfection processes in hospitals should eliminate the germs,
and sick people would have to be isolated, along with all their
contacts.  Anyone working with them would have to wear masks -- as would
members of the public whenever they left their houses.  With aggressive
isolation and treatment of infected individuals, if the rest of the
public stayed mostly at home, avoided crowds and did necessary errands
wearing a mask covering their noses and mouths, those who had not been
affected by the initial attack would have a good chance of remaining
plague-free, even in the terrible event of an antibiotic-resistant
outbreak. 

Smallpox is both contagious and durable.  But it isn't as deadly as
plague or anthrax.  Before its eradication, the most virulent strains
killed between 30 and 50 percent of those infected.  Like plague
victims, smallpox sufferers would have to be quarantined, and anyone
they had contact with would have to be vaccinated -- as well as others
at risk of contracting the disease.  Wearing masks in public places
would also help prevent the spread.  Supplies of smallpox vaccine are
still quite low, since the United States stopped routine childhood
vaccination in 1972, and adults who received the shots probably have a
very low level of immunity now.  Staying put would increase one's
chances of receiving vaccination or one of the antiviral drugs now being
tested. 

Running from an epidemic is all very well if you are not infected.  But
how could you be sure? Contagious diseases have differing incubation
periods.  Pneumonic plague comes on quickly; you might feel fine one
hour and deathly ill the next.  Smallpox may take two weeks to show
itself, and it often begins with mild flu-like symptoms -- but people
are contagious even before they show symptoms.  The terrorists may not
have the technological ability to infect the population of a whole city
or even a football stadium, but they might be able to introduce one of
these diseases to a much smaller gathering of people.  Panicked flight
could spread the disease around the country and the world.  Staying
where you are, therefore, serves both selfish and national interests. 

If the threat of bioterrorist attack becomes a reality, we are not
completely helpless, no matter how deadly or infectious the agent. 
There are things we can do to protect society and ourselves.  Rather
than simply letting people know that we now face another hideous threat,
the administration and those who are in charge of planning for such
catastrophes both at the federal and local levels should talk directly
to the American people.  Tell them what could happen, even under the
worst circumstances.  Explain to them how panic and flight would
exacerbate the problem.  And trust them to do the right -- and rational
-- thing. 

Wendy Orent writes frequently about biological weapons and emerging
infectious diseases. 

© 2001 The Washington Post Company

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