They'd better hurry up. This is scary.
Posted on 11/05/2001 11:32:26 AM PST by Magician
Officials at the Centers for Disease Control and Prevention are training doctors to recognize the disease and vaccinating small teams of experts.
ATLANTA, Nov. 3 The government has begun taking steps to cope with the possibility of a terrorist attack involving smallpox by training doctors to recognize the disease and by vaccinating small teams of experts who would rush to any part of the country to contain and treat a suspected outbreak.
Officials at the Centers for Disease Control and Prevention, which is taking the steps, say they have no evidence that anyone is readying a terrorist attack using smallpox, a disease that was eradicated worldwide 21 years ago. But they say smallpox is so deadly that it is important to prepare for any attack.
The smallpox virus is known to exist only in laboratories in the United States and Russia. But germ warfare experts suspect that other countries, including North Korea and Iraq, may have secretly obtained stocks. It is greatly feared as a weapon because it is contagious and has a high death rate. And much of the world's population is susceptible.
Last week, the disease centers vaccinated about 140 members of epidemiologic teams that can be summoned at a moment's notice to examine a suspected case anywhere in the country.
This week, the centers will begin a series of training courses in smallpox for certain of its own employees and state and local health workers. Additional courses will be held over the next several weeks at the federal agency's headquarters here.
The vaccinations and course are part of a broader effort by health officials to respond quickly to any new bioterrorism threats that might follow the recent deliberate spread of anthrax through the mail.
"Our concerns are not limited to anthrax," said Dr. James M. Hughes, who directs the agency's center for infectious diseases. Those concerns include diseases like botulism, plague, tularemia and smallpox.
Smallpox is of particular concern because it can spread quickly. In a military exercise last summer called Dark Winter, researchers simulated a smallpox attack on Oklahoma City. The epidemic quickly soared out of control, spreading to 25 states and millions of people.
Tens of millions of Americans younger than 30 are susceptible to smallpox because they were never vaccinated; the United States stopped smallpox immunizations in 1972. Tens of millions of people vaccinated decades ago are thought to have decreased protection because the vaccine may have worn off.
Another concern is that generations of American doctors have never seen a case of smallpox. The only doctors who have are a few hundred who participated in the World Health Organization's smallpox eradication program decades ago.
Smallpox patients are usually quite sick. The infection is characterized by a rash and a fever of at least 102 degrees.
The rash and symptoms begin to develop 11 or 12 days after a person is exposed to the virus. The characteristic lesions can occur anywhere on the body, but they usually appear on the face first, and they tend to appear more on the arms and legs and less on the chest, abdomen and back. Palms and soles are favorite areas. The earliest lesions tend to appear as raised bumps that often contain fluid.
Over a period that can last as long as 19 days, the lesions become firm, filled with pus, and form scabs. The illness can scar and blind its victims.
Smallpox can be confused with chickenpox. In making the diagnosis, a doctor touches the skin. Smallpox lesions tend to feel as if they are deep in the skin, in contrast to the lesions of chickenpox, which feel superficial. Chickenpox itches; smallpox lesions can be very painful.
But because the earliest stage of smallpox can resemble rashes caused by many other diseases besides chickenpox, identification can be difficult without laboratory tests.
Since smallpox was eradicated, the centers have sent epidemiologists to investigate suspect illnesses a few times a year. Dr. Hughes said that the centers had already dispatched smallpox experts on short notice three times in the last month to evaluate specific cases.
None of the patients had smallpox. Instead, they had problems like allergic rashes or shingles, an illness in adults that is caused by the same virus that caused chickenpox early in life.
Dr. Jeffrey P. Koplan, the director of the disease centers, said that his agency expected a number of false alarms as a necessary part of the efforts to encourage doctors to heighten their suspicion of anthrax, smallpox and other so-called exotic diseases.
Dr. Koplan likened the extra caution to programs that encourage patients with chest pain to seek medical attention to determine if they are having heart attacks. Many patients admitted to coronary care units turn out not to have had heart attacks.
Even doctors who have seen smallpox cases have been wrong. Doctors at the disease centers misdiagnosed a case of chickenpox as smallpox in Washington in the mid-1960's. And earlier this year, epidemiologists at the centers responded to a call from health officials in a Central American country where a missionary doctor who had seen smallpox became suspicious about several cases of rash and fever in a remote village. But the rash turned out to be from something else.
Dr. Stanley O. Foster and Dr. J. Michael Lane, two former disease centers employees who are smallpox experts, are helping with the centers's course on the disease. They said in interviews that they would show course participants pictures of smallpox lesions at various stages of development.
The course leaders are also trying to find ways to put photographs of smallpox lesions on the Internet so that doctors anywhere will recognize it if they see a real or suspected case.
Participants will also learn how to use the special two-pronged needle required to administer smallpox vaccine.
But disease centers officials are not planning mass smallpox vaccinations at this time. One reason is that not enough vaccine exists. Another is that the risks of mass vaccination could outweigh any benefits, particularly if no smallpox case ever appears.
Smallpox vaccine, made from a different virus, has risks that are difficult to quantify for today's population. Among the 5.5 million Americans who received their first smallpox vaccination in 1968, Dr. Lane said, eight died as a result. About two people per million who were vaccinated had an often fatal reaction known as vaccinia necrosum, which destroyed flesh and muscle. About four per million developed encephalitis, or inflammation of the brain.
Today, a particular concern is the hundreds of thousands of Americans with weakened immune systems from H.I.V. and other viruses, as well as drugs used to treat cancer and prevent rejection of organ transplants. The danger is that such people can become ill from the vaccine itself, and transmit the vaccine virus to other people, including those with impaired immune systems.
The standard epidemiologic response to smallpox is to identify the disease, isolate cases, vaccinate everyone known to have had direct contact with infected people since the first week of symptoms and then monitor their state of health.
Mass vaccination is not considered the appropriate medical response to an outbreak of smallpox. But if epidemiologic information determines that the virus was introduced widely through the air at a public gathering, for instance then mass vaccination might be required.
If smallpox had been ERADICATED, we wouldn't be having this discussion. The very reason there was no threat from smallpox was because everybody was vaccinated. How can they call a disease "eradicated" if half the government laboratories in the world have the stuff? HOMEGROWN VACCINES
They'd better hurry up. This is scary.
Step One. Announce that its an Isolated Incident.
Step Two: If someone got exposed at a Mall, DO NOT RUN TESTS ON MALL AIR. WAIT ONE WEEK. THEN CHECK MALL FOR CONTAMINATION.
Step Three: Repeat Step One
Thank you for the honor and privilege of addressing you. I have spent the past six years researching and writing about viruses and biological weapons, first for my nonfiction book The Hot Zone, which was about an outbreak of Ebola virus near Washington, D.C., then for my fact-based novel The Cobra Event, which describes a bioterrorism event in New York City, and which I understand President Clinton, Defense Secretary William Cohen, and Speaker Newt Gingrich have all read with interest, and finally a recent New Yorker article, "The Bioweaponeers." In the course of learning from a wide range of experts, I have become an expert myself.
Biological weapons are among the most dangerous weapons in the world today. They are infectious diseases, living organisms. Some are very contagious. Unlike any other weapons, biological weapons are alive and know how to replicate. They can make copies of themselves inside the human body. A bioweapon can copy itself endlessly in people. A nuclear bomb can't make copies of itself. From a small point of release, a bioweapon can jump from person to person in a explosive chain of lethal infection. A bioweapon makes no distinction between soldier and civilian, rich and poor, ordinary people or national leaders: we are all equally vulnerable.
The Soviet biological-weapons program was known as Biopreparat, or "The System" by the scientists who worked in it. Biopreparat was founded in 1974 by a special state directive to carry on with a clandestine bioweapons program, shortly after the Soviet Union signed the Biological Weapons Convention, which bans the development, stockpiling, and use of bioweapons.
Biopreparat was like an egg. The outside part was devoted to peaceful medical research. The hidden inner part, the yolk, was devoted to the creation and production of sophisticated bioweapons powders-smallpox, black plague, anthrax, tularemia, the Marburg virus, and certain brain viruses.
At its height in the late 1980s, Biopreparat employed around 32,000 scientists and staff. It was scattered in about fifteen major biowarfare facilities across the Former Soviet Union. The sites included a huge virus-research facility called Vector, in Siberia. Biopreparat was staffed by scientists, but it was controlled and funded by the Soviet Ministry of Defense. The military was responsible for developing the weapons delivery systems, while Biopreparat made the hot warhead material. The scientists and military people didn't get along with each other, and there was a lot of mutual suspicion and dislike. Biopreparat was an inefficient bureaucracy. It resembled the Soviet space program or the Soviet hydrogen-bomb project. The system was flawed, but it had some very definite successes.
For example, Soviet scientists developed in an airborne, powdered form of the Marburg virus-a close cousin of the Ebola virus, which causes people to die by hemorrhage from the openings of the body. The weaponized Marburg virus was reportedly so potent that monkeys (and presumably people) would die after exposure to a single particle trapped in the lungs. They also discovered a way to mass-produce Marburg virus using a simple technology that is available to any country.
The powders were stockpiled by the ton for quick loading into ICBM missiles and special weapons systems. Biopreparat was required to stockpile no less than 20 tons of freeze-dried smallpox powder, which was stored in bunkers near missile-launching silos. The smallpox was targeted on the United States. We were a so-called "deep target." This means that since the United States was in a different continent, it was presumed that smallpox would rage in North America but not get back to Russia. The smallpox and the other agents were produced to be loaded into special MIRV biological warheads designed to be mounted intercontinental ballistic missiles. Twenty tons of smallpox would fill a large number of strategic bio-warheads. The capacity of these biowarheads was roughly 100 pounds of dry smallpox. This implies the Soviets had perhaps 100 to 400 smallpox warheads. They probably had an equal number of Black Death warheads. The Soviets could have easily hit the 100 largest cities in the United States with devastating combined outbreaks of strategic smallpox and Black Death-an attack that could easily kill as many people as a major nuclear war.
At the time, there was a general belief among leading American scientists that biological weapons were not a problem and would not even work effectively as weapons. I say that no country would deploy strategic warheads without thorough testing. Those warheads worked. Furthermore, some very influential American experts in biological weapons were insisting that the Soviet Union was not and could not be violating the Biological Weapons Convention. Today, few leading American biologists know anything about biological weapons, and many still seem to believe that bioweapons don't really work and are not much of a problem. I leave you to conclude whether the American scientific leadership has served the public and its government well in this matter.
I have no idea where those biowarheads are now. I don't know if they're still launchable. Are any of them still targeted on the United States? Who knows. The Russian government has never admitted to having them in the first place. Russian military people have never said these warheads were destroyed. One can wonder if other countries, such as Iran or Iraq, have obtained examples of the biowarheads, for use as study models for their own missile programs.
The biowarhead had special cooling systems to keep a virus alive during the heat of re-entry. It was meant to drop down over a city on a parachute. When the warhead reached a certain height over the ground, it burst apart, and bomblets full of smallpox would fly off all directions. The bomblets were egg-shaped and made of aluminum, and were about the size of small melons. They would pop open with soft sound, and powdered smallpox (or Marburg, or Black Death) would disperse in the air over the city, almost instantly becoming invisible. The powder is very fine. It's treated with plastics and resins to increase its potency and longevity in the air.
A weaponized bioparticle is very small, about 1 to 5 microns across. That's the size that lodges best in the human lung. To get an idea of the size of a weaponized particle, you could think about fifty of them lined up side by side: they'd span the thickness of a human hair.
They are invisible in the air, and they can travel for miles.
I'll give you a demonstration using harmless baby powder. This illustrates what a bioweapon really looks like in the air-it disperses and becomes invisible and undetectable.
There is a time lag after the release-people have become infected, and now they're incubating the virus-and then people start to die. Respectfully, I want to show you some photographs of real human victims of natural smallpox virus. These photographs were taken in the 1970s by doctors fighting natural outbreaks. Bear in mind that smallpox is fantastically contagious-it spreads through coughing and droplet infection, like the common cold, and one human with smallpox can infect 20 or 30 more people. Most of the human population of the earth has little or no immunity to it today, because the vaccine wears off. Even those of us who've had shots are no longer immune.
I know that these photographs are shocking, but many people have the mistaken idea that smallpox is like an exaggerated form of chicken pox. It isn't. There's a bloody, hemorrhagic form of smallpox which looks like the crash and bleed-out that happens with Ebola virus. Blistering and bleeding occur inside the body, in the stomach and intestines. As you can see, the skin seems to blacken and shrivel. This is called blackpox. In a military release of smallpox, the victims would be receiving extremely high doses of smallpox, far higher than in a natural outbreak, and we can suspect that many of the victims would be developing blackpox and having smallpox bleedouts. Blackpox is even more contagious than so-called ordinary smallpox.
Smallpox virus is easy to make in large quantities. I'm not going say exactly how to do it, but basically you can grow it in glass bottles the size of wine bottles. A room full of these bottles constitutes a national biological-weapons laboratory. Virtually any nation can have such a facility, and hide it easily. All you need is a master seed strain and a few Ph.D. scientists and perhaps $200,000 worth of equipment, which can be bought on the open market.
Have scientists left Russia bringing their expertise and master seed strains of smallpox with them, or other bioweapon seed strains? We would be foolish not to presume so. In 1990, about 4,500 scientists and researchers worked at Vektor. Today, only about 1,000 to 1,500 people work there. The rest have gone elsewhere: into other jobs, other labs, or they're unemployed. Some, I do believe, have left Russia. I have been told by American scientists who've visited Vektor that the security around the smallpox storage area is pathetic- "one pimply-faced kid holding a Kalashnikov that may not have any bullets in it," in the words of one American scientist.
This underlines the need for the United States to stockpile the smallpox vaccine. There are currently only 7 million usable doses on hand. Experts believe that in any terrorist release of smallpox, even a small one, the virus is so contagious that it would be necessary to vaccinate at least 20 to 30 million Americans to stop the outbreak. The U.S. Army has a new way to make smallpox vaccine very cheaply and in large quantities, but it needs to be tested and approved. Enough smallpox vaccine for every citizen-270 million doses-could be stored in a small building the size of a garage, and the vaccine would remain potent for decades. By having plenty of vaccine ready, we effectively remove smallpox as a good weapon from the arsenal of a would-be terrorist. It would also take smallpox out of the hands of Saddam Hussein far more effectively (and cheaply) than bombing his laboratories-for the American vaccine could be offered to any country threatened by smallpox, thus making the virus much less credible as a menace or a weapon.
To this day, the Russian government and leading Russian biologists have never clearly admitted to the world that they had a large bioweapons program. They have not disclosed its extent or its basic work. They've never owned up to what they did. Instead, to this day, we continue to hear evasions, doublespeak, and outright lies. American experts who've been to Russia and inspected the biowarfare facilities have nagging suspicions that bioweapons research and development still continues in Russia. Biological weapons are an ethical and scientific abomination, a disgrace to biology. Leading American scientists should come out and say so, loudly and clearly. It's time for our scientific leadership to makes its voice heard.
Biological weapons are exceedingly dangerous, but some sharp thinking and some wise planning right now can make us much safer. As a citizen and a parent of children, I thank you for this hearing and for your concern.
In a technical sense it was true that the exiting 184 year-old (in 1980) vaccine did have too high risk of complications given the lack of smallpox in the wild. There are complications including encephalitis, and even death. Although these occur at low levels, innoculating everyone in a population in order to protect against an extinct disease will produce a number of injured people. The solution should be to develop new vaccines that are safer than the existing live vaccina vaccine. The technology for vaccines has improved greatly since 1796 when Jenner introduced vaccination.
An example of the tradeoffs between risks and benefits of different vaccines for one disease are the two vaccines for polio. The first vaccine (1955) was the killed Salk vaccine. The second (1961) was attenuated live Sabin vaccine. There was a vicious academic debate about which vaccine is safer or effective. It is often said that academic politics are viscious because the stakes are so low but in this case, the stakes were extremely high. Theoretically the killed vaccine should not cause the disease, but an early batch made by a licensee who did not completely follow Dr. Salk's protocol for killing the virus, caused an outbreak. The Sabin vaccine was tested in Africa with the assistance of the Soviet Union. There were some serious questions about the methodology of the study. The Soviets did not count any case of polio contracted less than 14 days after receiving the vaccine as being caused by the vaccine. Dr. Sabin was awarded the Nobel prize for medicine, but Dr. Salk did not share in it.
It was believed that the live oral vaccine is more effective in creating a life long immunity to polio. It is cheaper to manufacture, acts faster, and also has the ability to secondarily innoculate others who may come into contact with feces or water cominated by the feces of the recipient. Because of the ability to spread the effect of the vaccine beyond the person being inoculated, it was believed to be better for stopping outbreaks especially in less developed countries. The major problem is that about once in every 2.4 million cases the virus reverts back to pathogenic form and causes polio in the recipient. It also can cause the disease in others who may come in contact with the feces of the recipient. The last case of wild polio in the US occurred in 1979. After the 1980s almost every case of polio in the US was caused by the live vaccine; the others were aquired outside the US. There were several lawsuits in the 1980s and the protocols were changed so that the first two doses would be the inactivated or killed vaccine followed by two doses of the live vaccine.
The CDC's website says that the new protocol for 2000 is for four doses of an improved inactivated vaccine. The purpose of of this protocol is to totally eliminate the possibility of vaccine-caused polio. This is especially important since the wild virus does not exist in this country! The WHO is now in the process of eradicating polio from the world!
There are two major points I want to make about this digression about polio. First the safety of a vaccine for an extinct disease or at least extinct in this country has to be much higher than for a disease that is endemic or epidemic. Second, if a disease is eradicated in the wild, there is absolutely no way to verify that there are no undocumented samples of that disease in a laboratory. If we stop vaccinating, then future generations will become vulnerable to the use of polio as a biolgical weapon. I doubt very seriously after this scare about smallpox that citizens of the US would let the WHO and CDC stop the manufacture of polio vaccine when polio is eradicated in the wild. The WHO hopes to eradicate other diseases such as measles. This is a great thing for humanity, but we should never again make our population vulnerable to extinct diseases that could be used as biological weapons. We need to have research into producing vaccines that are much safer than the currently availabe ones for diseases that are targeted for extinction. This way we can justify vaccinating almost all the population against these diseases. If the overwhelming majority of people in this country and other highly developed countries were immune to smallpox, there would be no incentive for terrorists to use it.
This tells me that the gov't thinks there has already been an attack. Maybe that was what Ashcroft's warning was about.
No that's step two...step one is to send Tommy Thompson out to tell us that the victim caught whatever he has by drinking from a mountain stream in NC.
The incubation period for smallpox is a very consistent 12 days.
Assume deployment Oct.30, then we'll see starting this weekend.
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