If an Anthrax Attack Should Happen ...Study outlines best strategies to limit deaths< March 18, 2003 > It is a nightmare scenario that would have been unthinkable in the pre-September 11th world: Terrorists have released more than two pounds of anthrax upwind of a densely populated metropolitan area in the United States. A plume of deadly anthrax spores is enveloping the area. The lives of all 11.5 million people living in the region are in danger, because inhaling just a minute number of anthrax spores can be fatal unless there is quick antibiotic treatment. What should the federal government do? A detailed answer to that question is provided in a paper published in a recent issue of Proceedings of the National Academy of Sciences, one that comes from an unexpected source—the Stanford University Graduate School of Business. But Lawrence M. Wein, a professor of operations information and technology at the school and the lead author of the paper, sees no incongruity in business experts devising a bioterror attack scenario, and what should be done if one occurs. "I see this as a service operation," Wein says. "Just as McDonald's needs to get hamburgers out as fast as possible, so we need to get anthrax vaccine and antibiotics out as quickly as possible." As the paper notes, right now "detailed guidelines ... specifying who needs treatment and how those people are prioritized do not appear to be in place." The paper is designed to offer such guidelines. The scenario continues with a chilling statistic: Just under 1.5 million people are infected with the anthrax bacteria spores. Then it asks: Given a number of different treatment strategies, how many will die? The answer revolves around the distribution of the antibiotics, most frequently Cipro, that are used against anthrax. The researchers estimate that :
But in the whirlwind of events, what is the best overall strategy? Wein says there are four critical points. The first would be to act at once, even if there were uncertainties about whether an attack was occurring. The cost of a false alarm is "just panic and out-of-pocket expenses," Wein says. "If you wait, the cost could be many lives." Second, treat people as quickly as possible—about 10,000 lives would be lost for every hour of waiting. Third, make sure people keep taking the antibiotics after the initial panic ebbs. In the only case of anthrax poisoning in the United States, only 40 percent of the postal workers given antibiotics in the fall of 2001 adhered to the regimen, Wein says. Finally, ensure that hospitals have adequate "surge capacity" to handle the sudden inflow of patients, just as a McDonald's must be ready for the crush of students that appears when school lets out. There is a critical need for trained personnel to respond to a bioterror attack, Wein says, because, in cold mathematical terms, "it takes one person per 700 in the population to save 1,000 lives." There should be a national volunteer system set up to provide those trained people, he adds. Wein is critical of the federal government's establishment of a "Bio-Watch" surveillance system, with sensors designed to pick up signs of airborne anthrax as early as possible. Money for that system would be better spent on distributing packages of Cipro and other antibiotics to the public and hospitals, to be used only if an attack occurs, Wein contends. Antibiotics can always be used in medicine, while "biosensors are of no benefit if there is no attack," he says. The US government should also consider a mass anthrax vaccination program, Wein says. There is a federal effort to vaccinate a large number of Americans against smallpox, but no such effort is being made against anthrax. It may seem odd for a mathematician to be evaluating a medical model developed in a business school, Webb acknowledges. But it makes sense because "this is a mathematical model that is open to scientific interpretation, and I have some background in the subject of biomathematical problems," he says. Glenn F. Webb, a professor of mathematics at Vanderbilt University and author of an accompanying editorial, says the study fills a "critical gap by providing quantitative assessment of the deaths resultant to a civilian population from an airborne attack of weaponized anthrax on a large city." A spokesman for the Centers of Disease Control and Prevention (CDC), which has a program with the Federal Bureau of Investigation (FBI) to respond to anthrax and other biological weapons, says it is agency policy not to comment on research done elsewhere. Meanwhile, the American College of Healthcare Executives has just completed a survey of hospital chief executive officers on the status of programs related to bioterrorism preparedness. The survey found:
Always consult your physician for more information. Online Resources(Our Organization is not responsible for the content of Internet sites.) American College of Healthcare Executives Centers of Disease Control and Prevention (CDC) Proceedings of the National Academy of SciencesUS Department of Health and Human Services |
For more information on infectious disease, please visit the Infectious Diseases health information module on this Web site. For more information on travel medicine, please visit the Travel Medicine health information module on this Web site. In Other News About Your Health:Global, US Health Alerts Go Out for Mystery Respiratory IllnessWHO issues emergency travel advisory; CDC alerts state and local health officials World Health Organization (WHO) officials issued an emergency global travel advisory Saturday and the US Centers for Disease Control and Prevention (CDC) issued its own health alert as the number of nations hit by a mysterious respiratory illness continued to climb. The illness, now being called Severe Acute Respiratory Syndrome (SARS) and described as an "atypical pneumonia," has killed at least eight people, including an American businessman in Hong Kong and a mother and son in Toronto, Canada. It has left most of the others, many of them hospital workers, with severe breathing difficulties, according to news reports. The latest case appears to involve a Singapore surgeon who was hospitalized in Germany Saturday after flying out of New York City. The WHO advisory, sent to all airlines, warned that the illness, which apparently is impervious to antibiotics and antiviral drugs, was becoming "a worldwide health threat." "Until we can get a grip on it, I don't see how it will slow down," WHO spokesman Dick Thompson said at the agency's headquarters in Geneva. "People are not responding to antibiotics or antivirals; it's a highly contagious disease, and it's moving around by jet. It's bad." The CDC moved into emergency mode to alert health authorities at state and local levels Saturday. "The emergence of two clusters of this illness on the North American continent indicates the potential for travelers who have been in the affected areas of Southeast Asia to have been exposed to this serious syndrome," CDC director Dr. Julie L. Gerberding said in a statement issued in Atlanta. "Therefore, we are instituting measures aimed at identifying potential cases among travelers returning to the United States and protecting the people with whom they may come into contact." Among other things, the agency is now investigating any illness among travelers who may have passed through the United States after having potential exposure to the virus. It is also preparing health alert cards to give to travelers returning from southeast Asia. Cases of SARS have also been reported in mainland China, Indonesia, the Philippines, Singapore, Thailand, and Vietnam. WHO officials said the agency had received reports just in the last week of more than 150 suspected new cases. WHO officials urged all countries to help in the outbreaks. Scientists do not know whether SARS is a virus or even an infectious agent. As a result, they are focusing on the possibility that it is a previously unknown infectious agent. The WHO travel advisory, while not calling for restrictions on travel, urged that travelers who may have come in contact with someone infected should watch for such symptoms as high fever, coughing, and shortness of breath. People who suspect they may have the illness should seek medical attention and should not travel until they recover. Always consult your physician for more information. |