(This is one in a five-part series on steps ordinary citizens should take -- and avoid -- to prepare for several types of terrorist attack. The series originally ran on Sept. 6, 2002.)
Even though biological agents do represent a threat to the general population, people can protect themselves and their families from a bioterror attack using everyday supplies and common sense, medical and terrorism specialists told United Press International.
The most likely biowarfare agents fall into three categories: bacteria, viruses and toxins, according to the Henry L. Stimson Center, a Washington think tank.
Among bacteria, anthrax, the culprit in the 2001 mail-borne attack, is the most dangerous, although plague, brucellosis and tularemia also present potential hazards. The infectiousness of each agent varies -- the average person needs to inhale several thousand anthrax spores to become ill, while fewer than 50 tularemia bacteria are enough to start that disease.
Smallpox probably is the best-known possible bioterror virus, but yellow fever and a variety of equine encephalitis could be used as well, according to the Stimson Center. Smallpox is particularly feared because it is highly contagious and few Americans have been vaccinated against it in several decades.
Toxins such as botulinum and ricin are created by a variety of organisms. They could be particularly effective, experts said, because even minuscule doses can cause injury or death.
The primary dilemma with a biological attack, no matter the source, is its lack of obvious warning signs while under way, said Dr. Tee Guidotti, a senior member of George Washington University Medical Center's School of Public Health in Washington. Such stealth can seem frightening, but it also has drawbacks for the attackers.
"We will probably not know for several days or even a week that there's been an assault," Guidotti told UPI. "Most of these agents, if they are aerosolized, don't last more than a few hours. Over a relatively short period of time the infectivity drops considerably."
Because terrorists usually attempt to sow fear, they might try to publicize their attack. If so, citizens would have a chance to react before becoming infected, said Amy Smithson, director of the Stimson Center's Chemical and Biological Weapons Nonproliferation Project. Seeing a crop-dusting aircraft operating over a city, for example, should prompt people to go inside, shut all their windows and doors, turn off air conditioners and notify the authorities, she said.
Official notices via radio or television would be a good method of alerting the public if an attack was detected, several sources said.
People caught some distance from buildings, such as in a park, would not necessarily be more vulnerable to infection, said Dr. C. Gary Hurst, chief of the Army Medical Research Institute of Chemical Defense's Chemical Casualty Care Division. The best course of action would be to move away from a possible attack site, he said. Move at right angles to the wind or upwind of the source, and get indoors, he said.
"Get a piece of clothing, even if you have to take the shirt off your back, (fold it a couple of times) and hold it over your face for a makeshift mask," Hurst told UPI. "(A military study) looked at primates and anthrax. One thickness of T-shirt didn't protect them, but a double layer worked. Anything that could diminish or dilute the amount of poison getting through to you would be helpful."
Even though people should filter their nose and mouth during a bioterror attack, they should not add gas masks or particulate filters to their shopping list. Every official and specialist contacted by UPI said such items tend to give a false sense of security unless they are properly fitted and maintained.
The masks are no guarantee of safety -- they can be made ineffective by such factors as a beard or long hair, said Kevin Yeskey, director of the Bioterrorism Preparedness and Response Program at the federal Centers for Disease Control and Prevention in Atlanta.
Both Hurst and Smithson said Israeli adults and children have died during suspected chemical or biological attacks due to problems with the masks themselves. Even experts can suffer from poorly maintained equipment, Hurst said.
"In an exercise in Germany, a mask I was given had been exposed to moisture so long the charcoal had congealed, and I had no airflow," Hurst told UPI. "Eventually I had to (pull) it off because it wasn't functional."
Pets represent a dilemma, Yeskey said. If a biological attack occurred in a suburban residential area, families would have to choose between their own safety and that of any pets caught outside. His family has dogs and he cares for them greatly, he told UPI, but in a biological attack, he would keep them outside rather than have their fur and paws contaminate his house and family.
Several medical specialists, including Dr. Mohammad Akhter, president of the American Public Health Association in Washington, also warned against bringing pets inside after a known bioattack.
"The damage has been done; bringing it in isn't going to help anymore," Akhter told UPI. "Fleas for plague could be brought in by a pet. Let's leave them be until instructions come via the TV, radio or phone, saying 'This area was contaminated and this is what we're going to do.' There will certainly be a provision for the pets."
People who suspect they have been exposed to a biological attack can take several steps to reduce or prevent further contamination. The first involves setting modesty aside and taking off contaminated clothes before going inside, Yeskey said. Then, double-bag contaminated items in plastic bags left outside. This will keep dangerous substances out of the house and provide evidence of the attack for investigators, he said. Decontaminating these items is well beyond the capability of household chemicals such as bleach, Akhter said.
"(Washing contaminated clothes) is not a safe bet at all," Akhter said. "If a family member comes home in a situation like this ... let the experts come and pick up the clothes and take them for testing, decontamination or even destruction, for that matter."
Whether people know an attack has occurred, its effects would start appearing hours or days afterward. The first symptoms of illnesses caused by bioweapons primarily are the sorts of fevers, aches and other complaints common to upper-respiratory infections such as a cold or flu, said Dr. Ed Thompson, state health officer for Mississippi in Jackson.
"The simplistic but very realistic approach is: If you're sick enough to go to the doctor, go to the doctor," Thompson told UPI. "That's before we identify an attack; once we know the disease, we can say, 'Here are some particular symptoms to look for and come (get care).' Seek medical care when you need it."
What will tend to tip off officials about a possible attack is when similar cases begin to appear in the healthcare system, Thompson said. If the suspect agent is a communicable disease such as smallpox, officials would respond immediately by getting in touch with people who have come in regular contact with known victims to provide vaccinations and other care, he said.
The only reason people should leave the area of a suspected attack is if officials have ordered such a move to free up local resources, GWU's Guidotti said.
In terms of preparing for the possibility of an attack, the best thing to do is gather the sorts of items found in a natural disaster kit: canned food and bottled water supplies, a battery-operated radio and flashlight, extra batteries and a first aid kit. The next step is learning the contact information and basic response plans of local emergency services, the CDC's Yeskey said.
Dr. Jonathan Fielding, Los Angeles County's director of public health, suggested families should pre-plan their communications in case of an emergency. This could include designating an out-of-state relative as a contact point, because long-distance phone lines are less likely to clog up during an episode.
All of UPI's sources strongly discouraged people from stockpiling medicines -- especially antibiotics such as Cipro, which was widely used during the mail-borne anthrax incident. There is no way to predict which bioagent might be used, experts said, so whatever drug you try to accumulate probably will be ineffective.
Guidotti said there's another good reason to avoid second-guessing appropriate treatment methods: Doing so actually might interfere with the public health response to a known attack.
For instance, during the 2001 anthrax incident, many people went straight to their physicians for nasal swabs to check for spores. The action was unnecessary, Guidotti said, because it is a poor indicator of possible infection and the disease's extended incubation periods provide ample time to start treatment.
"When an assault occurs, it's terribly important the authorities get information on what the pattern of infection and exposure is," he said. "(Going to private doctors) deprived the public health authorities of extremely valuable information that was urgently needed to determine who was at high risk and who was at low risk."
The bottom line is the public health system is responsible for dealing with any bioattack, Yeskey said. With the federal government ready to ship pre-positioned supplies to any U.S. city within 12 hours, a rational response from the public will help to keep any incident manageable, he said.
(UPI Photo WAP2002081550 available.)