Is U.S. still vulnerable to anthrax attack? - Public Health

A reasonable defense against an airborne anthrax attack requires more aggressive action by the Federal government than the current protocol outlines. Washington is relying too heavily on biosensors to pinpoint a potential outbreak and not doing enough to get large quantities of drugs and medical personnel to affected areas within hours, argues Lawrence Wein of the Graduate School of Business, Stanford (Calif.) University

Wein, professor of operations, information, and technology, and his fellow researchers considered the possibility that drug intervention against anthrax could start earlier if the attack was detected by biosensors--devices that sniff out anthrax spores Although the Federal government is spending millions of dollars to develop them, their use alone is insufficient and could create a false sense of security Huge numbers of costly sensors would have to be spread throughout the nation in order to be in proximity of where the spores are released and to detect them, an unrealistic goal Also needed, according to clinicians, are the aggressive distribution of prophylactic antibiotics, such as Cipro, and the ability to ready a large capacity of emergency medical personnel for rapid deployment in affected areas. "There is still no substitute for getting people antibiotics and medical care as last as possible," Wein asserts.

In the same vein, the researchers make a plea for speedy mass vaccinations as soon as a case of smallpox appears in a population rather than the more time-consuming practice advanced by the government of identifying individuals the victim had been in contact with, locating, and then vaccinating them.

"Our country has made great strides in the past year at preparing for a potential smallpox attack." Wein reasons Although smallpox is a contagious disease, it is also a slower moving disease and as my colleagues and I showed in a study published [in 2002], postattack mass vaccination would nip even a large smallpox [outbreak] in the bud. Unfortunately, controlling the consequences of an anthrax attack may be a bigger challenge."

Airborne anthrax, while not contagious, is a swift and vigorous pathogen. Treatment for those exposed must begin within hours of the first cases being diagnosed, rather than days, as with smallpox. Without antibiotic intervention, 90% of people exposed to the inhalation form of anthrax will die. Because anthrax is durable, lethal, and available, it is a likely weapon in a bioterrorist attack. "It call survive an explosion which makes it ideal for weaponization." Wein warns.

Wein and his coauthors--David L. Craft, a doctoral student at the Massachusetts Institute of Technology's Operation Research Center. Cambridge, and Edward H. Kaplan professor of management sciences at Yale University's School of Management. New Haven, Conn.--analyzed a variety of possible responses to a scenario whereby two pounds of anthrax are dropped in a city of 11,000,000 people (the approximate size of New York) and 1,500,000 are infected. Based on move than 30 years of data, including a 1993 report from the now defunct Congressional Office of Technology Assessment, they propose the following as a reasonable of scenario:

In their base case, every individual in each Neighborhood in which one person shows symptoms and is promptly diagnosed must take antibiotics to survive. However, approximately 123,000 people in targeted city would die within four days despite distribution of the drugs.

The reason: If people don't get antibiotics quickly to keep the infection Item developing, too many will become symptomatic and will overwhelm hospitals and medical facilities. Most will succumb before they get medical aid. Five of the 11 inhalation anthrax patients in the 2001 attacks through the U.S. Postal Service died despite being given aggressive treatment by teams of doctors far larger than would be available in a more widespread attack.

Wein envisions a four-pronged approach for avoiding such a catastrophe. First, the person in charge--either Pres. Bush, individual state governors, or city mayors--needs to act decisively: As soon as danger is detected, the public must be informed and directed to medical aid. "The first people develop symptoms within two days of exposure, and many more would ... over the next week," declares Wein. "Our response needs to be measured in hours, not in days or weeks." Moreover, antibiotics have to be delivered as quickly as possible. Consequently, Wein contends that it is best to distribute them prophylactically prior to proof that any attack has occurred. "Give it to the people now so that they can just turn on CNN and wait for Secretary [of Homeland Security Tom] Ridge to tell the people in their region to take their Cipro now." if this is deemed too risky, then Washington needs to set a goal of providing antibiotics within 12 hours "If we can vote in a single day, we should be able to hand out pills in a day." This might mean changing laws so that non-medical personnel can dispense the antibiotics.