Definitely got a chill down my spine when Dr. Julie Gerberding, head of CDC, spoke today about the sleepless nights she's had worrying about a particular pathogen, or vulnerable population, or vulnerable target. She specifically mentioned anthrax a couple of times, and still speaks of the '01 anthrax attacks in the kind of tone most educated people reserve for discussions of the Holocaust.
You can seperate the public health people who are really dialed in from those who aren't pretty easily - those who are dialed in look like hell nowadays, and are a lot less patient with the leftist bunk their colleagues sometimes spew. Just about slapped a public health manager today, who started ranting about how Dubya is deploying weapons of mass destruction against minorities, weapons like socioeconomic disparities. It's scary to realize that plenty of the people drafting the bioterror emergency response plans either think like this, or are close friends with those (like this woman) who do.
AND…
The lack of media coverage of anthrax is odd. I think it’s about more than laziness, sloppy reporting, or even carefully considered attempts to avoid public panic. I think it’s because the story somehow triggers a fear response, a reluctance to acknowledge a looming threat that can’t be avoided. Something deep in many people’s psyches is preventing them from truly wrapping their mind around this story.
I was at a major public health conference the week the postal workers died from anthrax. It was very instructive to see the immediate, unscripted reaction of folks like Tommy Thompson and David Satcher. It was even more instructive to see the reactions of their underlings. To this day, at any gathering of public health professionals – especially those involved in infectious disease work – you’ll find a dedicated core readily talking of the anthrax attacks as more significant than 9/11.
It is this core that I was thinking of earlier when I wrote of those who are “dialed in”. I don’t think these people are privy to secret knowledge. It’s just that they understand the implications of what’s going on. The public health community is being asked to undergo an epic transition – to become a wing of the civil defense system, and the key element in defending against bioterrorism. You have to work with these folks to understand the kind of people we’re talking about. These aren’t military people. These aren’t even hospital staff, or EMS personnel. It’s the people who create marketing campaigns telling you to eat 7 pieces of fruit a day and wear a bike helmet, or who write impossibly dense research papers on topics like the impact of flu vaccines on immigrant mothers who have been incarcerated (seriously). Many are, to be kind, nerds. Liberal, socially-sensitive nerds.
If anyone in this country, outside of the federal leadership or justice department, was going to seriously push the issue of bioterrorism it would have to be these people, because coping with it is their job. But, due to temperament, they won’t do it. Most are not comfortable with the media. Most, to be honest, are very uncomfortable with anything vaguely connected to the military or national defense.
But these are the people who have been feverishly working for the past year on developing emergency response plans to a bioterrorism attack, building stockpiles of antibiotics and other supplies, and building communications plans where none before existed. One tiny example. If a year ago, 10 people went to 10 different city hospitals with symptoms of anthrax, it would have been days before anyone would have seen the pattern. Precious days lost. Hospitals aren’t set up to talk to each other, or to track incidents of disease across the general population. That’s the job of the public health departments. Today, though, an outbreak is much more likely to be caught early because for the first time the city health department staff knows the hospital staff, and they talk to each other. And they’re spending boatloads of money on computerized tracking and hotlines to have an early warning of an outbreak. And they’re drilling on plans that tell everyone what they need to do in the event of an emergency. It’s pretty impressive, all the more so because of the kind of work these people are used to doing.
The CDC is one of the lead agencies for this, establishing best practices and providing funding and guidance to state and local public health leaders. But, it’s up to the states to execute.
But even in this context, anthrax is talked about with hesitation. Smallpox is more likely to be discussed. That’s because of the brilliance of anthrax as a weapon – the almost instant death toll. You can plan for smallpox. Vaccination, quarantine, post-exposure vaccination, and so on. You can’t plan for anthrax. You can’t vaccinate. If it’s weaponized to be anti-biotic resistant (an easy step for a bioweaponeer, although mysteriously not done to the 2001 anthrax) you can’t do much to treat it. And, since it’s stable and easily spread, a bad guy could target a lot more folks than with smallpox. With smallpox, you’re dependent on it being spread virally. With anthrax, you can go for maximum initial exposure. Nasty. But at least all the talk about smallpox has gotten people talking seriously about bioterrorism.
A lot of research has been done on anthrax in general, and is available over the web. Including at CDC. When you couple the common general knowledge about anthrax, with the short list of details we know about the degree of weaponization of the 2001 anthrax, you get a doomsday weapon. Dr. Gerberding got huffy today at one woman, who made a little speech about the difference in the care that those on Capitol Hill received and those in the post offices received. Julie G. said that CDC hadn’t realized that the anthrax could be spread through the sorting machines, but they sure do now. It was eventually dismissed, but at one point there was serious consideration of the possibility that the old woman in CT who died of anthrax was infected by spores that FLOATED all the way from NYC or Jersey. Just the fact that this was entertained should tell you something about the degree to which this stuff could be dispersed in a city. Yes, it would be more effective inside – a mall, an office building, the subway. But it doesn’t have to be inside. And the stuff doesn’t die. It’ll get tracked all over the place, sticking to people’s clothes and everything else. A mason jar tossed on the subway tracks, another opened and stashed in a plant at the mall, and a third covertly sprinkled throughout the airport lobby – and no warning letters. By the time we knew what hit us, we’d be looking at anywhere from a 100,000 to a million dead.
If you want to learn more, I'd recommend one of the good books on bioweapons. I hear Ken Alibek's Demon in the Freezer is a good place to start. We live in interesting times.
The Demon in the Freezer is by Richard Preston, author of The Hot Zone
A chunk of "Demon" was excerpted in the New Yorker. It is an unsettling read.
You may also be thinking of Biohazard by Ken Alibek, which details his bioweapons research and production in the old Soviet Union. At one point, Biopreparat was manufacturing some ten tons of weaponized smallpox per year.
We live in interesting times.
Yes, I tend to agree.