If you're sleeping poorly because of the anthrax reports of the last week, you're not alone. Many people are worried since federal health officials determined that the anthrax did not naturally appear. Someone delivered the deadly bacteria, making more real the nightmarish possibility of a biological attack that could kill millions.
U.S. authorities are taking the outbreaks as a cue to speed their preparations against a large-scale biological attack. Good. The country is more vulnerable than it should be. That's deplorable since policy-makers and lawmakers have long been aware of the great risk.
As associates of the affected Floridians and New Yorkers ingest preventive antibiotics and Americans cope with their fear, President Bush should try to educate and calm his countrymen, much as he did after Sept. 11, when he promised to implement measures to prevent air hijackings. For although the United States is vulnerable, it is not completely defenseless. He could explain the nature and severity of the threat, the state of U.S. defenses and the steps that he, Congress and state and local governments are taking to improve readiness.
Here is some of what Americans should know about the most likely biological weapons, anthrax and smallpox:
Both are lethal. However, anthrax does not pass from person to person, is less lethal if absorbed through the skin than if inhaled and is treatable with Cipro or other recommended antibiotics if they are administered within days of exposure. Federal health officials say that within hours of an attack they could rush enough antibiotics to treat 2 million people for 60 days. They do not recommend that people stockpile their own antibiotics in anticipation of a threat that may never materialize. Neither do they recommend that people try to obtain vaccines, which may have adverse side effects, require many injections, and are reserved for the military.
Smallpox is a bigger worry because it is highly contagious, is untreatable, and no American has been vaccinated against it since 1972. However, the virus would be difficult for a terrorist to obtain because the United States and Russia have the only known samples (though reports persist that Iraq and North Korea may have clandestine supplies). The United States has 15 million doses of a smallpox vaccine, expects to receive 40 million more doses next year, and intends to keep increasing its supply until it has enough for all Americans. Federal health officials do not recommend that people be vaccinated because of the risk of side effects and the absence of confirmed cases anywhere in the world; in case of an outbreak, they would rush vaccine to people in affected areas.
Mr. Bush would have to confess that the U.S. public health system is spotty. It might not even be accurate to call it a system. Ten percent of the nation's public health departments do not even have e-mail, meaning that they might not receive the latest advisories about possible biological attacks. In recent testimony to Congress, Donald Henderson, director of the Johns Hopkins University Center for Civilian Biodefense Studies, said, "It is difficult to exaggerate the deficiencies of our present public health capacities." That needs to change.
Richard Betts, a political science professor at Columbia University in New York, takes solace from the Florida case: The fact that only one person died demonstrates the difficulty of disseminating anthrax in an aerosol form that would be capable of killing many people. On the other hand, he says, "If there's an organized group that has anthrax, they may keep trying until they get it right."
The United States must do its utmost to prevent anyone from getting it right. The toll from an efficient biological attack could be truly horrendous. A 1993 congressional study found that a small airplane releasing 100 kilograms of anthrax over Washington, on a clear, calm night could kill 1 million to 3 million people. The first line of defense is good intelligence: uncovering and thwarting attacks before they happen. But after an attack happens, the United States must have public health and civil defense systems capable of containing the damage. It must treat the threat of biological attack as a clear and present danger.
"We can't take bugs for granted anymore," Michael Osterholm and John Schwartz wrote a year ago in Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe. The continuing biological threat and the inadequate state of the country's anti-germ defenses underscore that truth.
In his Sept. 20 address to Congress, Mr. Bush told the nation's armed forces to "be ready." He should deliver that same message to the country's public health and civil defense establishments, and then work with Congress to give them what they need to succeed.
A second sneeze-bomb of anthrax exploded this weekend, when it was confirmed that Erin O'Connor, an assistant to NBC anchor Tom Brokaw, had been infected with anthrax.
It appears that Miss O'Connor acquired the cutaneous (skin-level) form of anthrax after opening a threatening letter. If that envelope contained the anthrax-causing Bacillus anthracis bacteria, a cut on Miss O'Connor's skin could have easily given it the entrance it needed. She is being treated with antibiotics, which should help her fully recover from the infection.
The anthrax may well have come from al Qaida operatives. Bill Gertz of The Washington Times recently reported that he had been told by a senior defense official, "What we believe is that they (al Qaida terrorists in Afghanistan) have a crude chemical and possibly biological (weapons) capability."
While it appears that anthrax was not contained within a suspicious envelope recently mailed to New York Times reporter Judith Miller, it certainly was contained in a letter mailed to a Microsoft subsidiary in Reno, Nev. Investigators are attempting to determine if the attack in Reno was linked to the anthrax attack in New York and to the anthrax attack which occurred at the American Media building in Boca Raton, Fla. earlier this month.
This certainly appears to be a coordinated campaign of biological warfare, albeit with crude weapons. Indeed, those who perpetuated this series of outrages appear to have been aiming at mass disruption rather than mass destruction. They seem to have been counting on the lightning-like responses of the 24-hour news cycle to arouse terror across America. It is a maddening operational concept -- two anthrax infections are all that is needed to strike fear into the hearts of millions of Americans.
Unfortunately, the FBI must bear some blame for not acting more quickly. According to The New York Times, the bureau was notified the day that the suspicious letter was received at NBC studios (Sept. 25), and yet, it did nothing for two weeks -- refusing to test either the letter or the powdery substance within. It only deigned to notice the smoking gun in front of its face after a private doctor notified city public-health officials about Miss O'Connor's skin condition.
Despite Miss O'Connor's infection, it is worth remembering that the skin is merely one part of the multi-layered defenses that the body has against disease-causing bacteria. Moreover, part of what made bacteria-caused diseases (such as the bubonic plague) so devastating in the past is that the germ theory of disease, and the antibiotics used to fight those germs, have been in use for little more than a century.
Many of those antibiotics were discovered by Americans, and the terrorists who sealed anthrax-filled envelopes seem to have forgotten what an inventive, resilient people Americans are. While some are buying gas masks and filling up on antibiotics, most are remaining calm and going about their business, albeit with an even deeper sense of outrage.
Besides, envelopes of anthrax are certainly frightening. But so are plenty of other things that come in the mail. Most Americans probably find their monthly credit-card statements far more terrifying than anything a terrorist could send through the postal service.
In closing his Friday night broadcast of NBC Nightly News, Tom Brokaw said it best, "This is so outrageous and so maddening, it's beyond my ability to express it in socially acceptable terms. So we'll just reserve our thoughts and our prayers for our friend (Miss O'Connor) and her family." So will we.
Isn't it time you bought yourself a gas mask -- and asked your doctor for a bottle of those fancy antibiotics? If the surging anthrax scare makes you think so, you'll have to get in line. Terrified of bioterrorism, a swelling mob is buying up pills and protective gear as fast as the sellers can sell. It turns out there aren't enough masks and meds for everyone right now, but don't worry: It wouldn't help if there were.
In fact, it might hurt. Counting on a gas mask as a shield against bioterrorism is the height of foolhardy optimism. The same goes for hoarding antibiotics to ward off a man-made plague. Such seemingly self-protective deeds oversimplify the threat they seek to address, granting groundless confidence to the fretful. What good is a gas mask, after all, unless it's worn 'round the clock? What use is Cipro, the anthrax fighter, if a terrorist's preferred pathogen is the hemorrhage-inducing Ebola virus?
Little good and no use, it's sad to say. The resolute bioterrorist has a stunning array of poisons and plagues to choose from, and no individual can prepare for them all. That's what governments are for: to anticipate and contain public-health disasters. Surely a premeditated epidemic threatening hundreds of thousands is one disaster worth anticipating. That kind of terrorism could make the Sept. 11 tragedy look like a warmup exercise. The prospect has worried public-health experts for years.
Has it worried U.S. officials? Not enough. Though Health and Human Services Secretary Tommy Thompson claims his department is ready to handle anything bioterrorists can dish out, there's reason to doubt him. According to a draft report by the General Accounting Office, the federal bioterrorism plan is an underfunded jumble of programs spanning 20 departments. The government is shamefully short on crucial vaccines. It has no clear game plan for containing an incipient epidemic. Moreover, its prevention efforts are feeble; federal inspectors examine only 2 percent of shipping containers arriving from overseas, and just 1 percent of imported food.
That's just the trouble at the top. States and cities aren't in much better shape. Most of the country's cops and firefighters aren't really prepared to respond to bioterrorism. Neither are hospitals, most of which stock supplies sufficient for a few days of ordinary patient flow.
These findings drive home a lesson Americans have been slow to learn: The United States is vulnerable to its unseen enemies, and poorly prepared to cope if they attack. This was true long before Sept. 11, and could remain so if the gas-mask craze continues. What the country really needs is a very different kind of craze -- in favor of a strong public-health system equipped to prevent, detect, monitor and treat epidemics before they run out of control. Such a system is the surest shield against bioterrorism. Congress should rush to forge it.
(Compiled by United Press International)
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