Bioterrorism Threat Reappears

DR. DOUG HANSON

It's been a while since we have heard much about it, but, bioterrorism has once aging reared it ugly head. On December 3rd the Commission on Prevention of WMD Proliferation and Terrorism released its report: World at Risk. While the report deals a lot with the threat of a nuclear attack it also presents the conclusions of the expert panel on the threat of a bioterrorism attack on U.S. soil. The major conclusion of the study is that the World faces the likelihood of a bioterrorist attack sometime between now and the year 2013. It is quite likely that such an attack would occur somewhere in this country or at a U.S. facility in some other country.

The recent episode of letters sent thru the mail with white powder in them reaffirmed how easy such an attack might be carried out. While these envelopes were a hoax the episode in 2001 where envelopes laced with anthrax were sent to various Congressman and news commentators demonstrates that a biological agent can be transmitted in a relatively unsophisticated manner.

We think of biological warfare as something that the military carries out with organisms genetically groomed to do a specific, deadly job. These organisms are combined with a very sophisticated system for delivery a process called weaponization. Indeed, the U.S. Military, and the militaries of many countries, have had programs to develop biological weapons. The U.S. Military presumably abandoned it program in 1969 because these weapons were too hard to handle and deliver safely. However, for a terrorist group like Al-Qaeda or others personal safety is not necessarily a major issue.

Anthrax:
The U.S. Government has focused a great deal of time and money on developing a defense system against an attack using the bacteria, Bacillus anthracis. Training programs for medical personnel and first responders have stressed how to recognize and treat anthrax infections. The Strategic National Stockpile (SNS) of Drugs (mainly Cipro) and other medical supplies for an anthrax attack is maintained at the CDC in Atlanta, GA. It is set up to be able to deliver drugs and supplies to any state in the country within 12 hours of an attack. The problem with this program is that an attack might not come from anthrax but from any one of a number of other organisms listed on the CDC's rostrum of Potential Bioterrorism organisms. These include organisms producing diseases like Plague, Tularemia, hemorrhagic fever, Brucellosis, Psittacosis and others. The bacteria and viruses causing these diseases vary widely in species and properties.

But What If It's Not Anthrax?
With so much emphasis placed on anthrax it is not unlikely that a terrorism group would choose to develop one of these other agents to use in an attack. The problem with any biological attack is that unlike a suicide bomber or car bomb the effects of the attack will not be apparent for some period of time after the initial events. This period called the incubation period can be as short as 24 hours or as long as a week to 10 days depending on the organism and the route of exposure. The most likely route of exposure would be by inhalation of an aerosol of the organism.

So unless there is an eye witness to someone releasing a biological agent the results would not become evident until large numbers of people begin showing up at hospital ERs or walk-in clinics exhibiting the signs of some unusual infection. One positive result of the Development of the Office of Homeland Security is an initiative that has lead to better reporting between hospitals of the occurrence of unusual cases. This will lead to a quicker realization that something unusual has occurred. For many of the potential biological agents the initial symptoms are hard to distinguish from other more common conditions like the flu. This can add one or more days until a definite diagnosis of and agent infection might occur. The exceptions are diseases like those caused by RNA viruses like the viral hemorrhagic fever (VHF) viruses. In these cases the patient often shows sign of bleeding under the skin or from body orifices at very early stages.

Home Grown Bugs
It is widely believed that production of biological agents requires very sophisticated equipment and expertise to develop. While this is true if you want to develop military grade, weaponized material it is not quite so true if you simply want to develop some material that can be delivered to and kill a large number of people. Terrorist would rarely be too concerned about the purity of a culture used for a biological attack if they were to initiate one. After all, the suicide bomber rarely dress up in their best Sunday suit and tie (or more likely Thobe or Jibab) and goes out to bomb a market.

Any facility that has the means to grow a bacterial organism could be capable of growing a biological agent. This could include an abandoned bakery, a brewery including a small micro-brewery, pharmaceutical or biotechnology company, and many food processing plants. You simply need a means to culture a large quantity of the organism in some type of metal chamber that can be kept relatively sterile while the temperature and aeration process can be controlled. Once the large volume of culture is grown you simply need a way to concentrate it and then a delivery system that will produce an aerosol.

Delivering the Goods
A crude aerosol spray could be delivered into the air conditioning system of an office building or a large shopping mall or even released at some sporting or entertainment event where a large group of people are assembled. Once infected these individual would not show symptoms until the incubation period was complete. In the mean time they would have left the site of exposure and traveled to their homes in different parts of the city or different surrounding town. There if the biological agent was capable of being transmitted to others they might spread the disease to other members of their family, friends or even people at a drug store or local super market.

Mass Panic
When it is realized that a biological attack has taken place either by official announcement or more likely by a leak to the press it is likely that there will be a wide spread panic on the part of the public. While police will have to work with other responders to ensure any potential attack site is secure law enforcements biggest problem will be with crowd control. As news account of the attack spread across the city potentially thousands of people will descend on hospitals all believing they have been exposed. As they try to get medical help and antibiotics the hospitals and clinics will be overwhelmed. Fights will break out in crowds and pharmacies and even veterinary hospitals will be broken into as people attempt to get antibiotics.

For the first several days it may not be possible to determine who is actually infected and who is not. Everyone will believe that they have been exposed and this can lead to mass hysteria. In the 1995 Sarin chemical agent attack on a Tokyo subway over five thousand people descended on medical facilities claiming to have been exposed. In reality, only twelve people died and about five hundred suffered some non-lasting affects from the attack. Keeping order in a mass situation like this will be a daunting task for law enforcement officers.