September 2002

BIOTERRORISM FEARS
TEXAS PREPARES FOR AN ATTACK THAT COULD KILL THOUSANDS
By Ken Ortolon

In the 1997 Tom Clancy novel Executive Orders, Arab terrorists unleash the deadly Ebola virus on an unsuspecting America. Distributed via aerosol devices set off in crowded convention halls, shopping malls, and other public places, the virus sickens or kills tens of thousands before the outbreak can be contained. That was fiction, and some might have said the entire scenario was far-fetched. But that was before Sept. 11, 2001. In the aftermath of the suicide jetliner attacks that day and the deaths and illnesses caused by the anthrax-tainted letters that appeared in New York, Washington, D.C., and Florida a month later, physicians and public health officials across the country are rapidly gearing up to respond to just that type of bioterrorist event. While experts say Ebola is not the likely weapon a bioterrorist would choose, there is a real threat that anthrax, smallpox, or one of several other deadly biological agents could be used against the United States.

I think it's very likely that there will be biologic agents used against us by our enemies, said Ronald R. Blanck, DO, president of the University of North Texas Health Science Center at Fort Worth and chair of Texas Medical Association's Task Force on Bioterrorism. Is it going to happen? Yes. What's the organism going to be? I don't know.

On the fast track

Convinced the threat of biological weapons is real, the federal government is helping states prepare for a bioterrorist event and pushing a very aggressive schedule for preparedness planning. The Texas Department of Health (TDH) has received two federal grants of nearly $60 million to improve hospital preparedness and to beef up state and local health department laboratory facilities, disease surveillance capability, and other public health functions.

The first grant of $8.4 million came from the Health Resources and Services Administration (HRSA) to measure hospitals readiness to deal with mass illnesses resulting from a bioterrorist event. Ron Hilliard, RN, coordinator of the TDH Bioterrorism Hospital Preparedness Program, says the first phase of the project surveyed all 570 hospitals in Texas to determine their level of preparedness. About $1.7 million of the grant was earmarked for carrying out that survey.

The remaining money will help hospitals improve their planning for bioterrorism response.

"I think it's very likely that there will be biological agents used against us by our enemies."

Ronald R. Blanck, DO

"While the need for prevention efforts is increasing, the actual commitment by states and localities to terrorism prevention is declining."

Saul B. Wilen, MD

"A reassessment of how government agencies are expending their resources on antiterrorism efforts is needed."

Saul B. Wilen, MD

Dr. Blanck says physician education is critical. Most physicians have never seen smallpox, anthrax, pneumonic plague.

The prevention basket

While millions of dollars and months of effort have gone into preparing to react to a bioterrorism attack, at least one Texas physician says too little attention has been paid to efforts to prevent it. Saul B. Wilen, MD, president of International Horizons Unlimited, a San Antonio-based terrorism prevention think tank, says efforts to prevent terrorism have actually declined since Sept. 11.

While the need for prevention efforts is increasing, the actual commitment by states and localities to terrorism prevention is declining, Dr. Wilen said. A reassessment of how government agencies are expending their resources on antiterrorism efforts is needed.

Between Oct. 1, 2001, and May 31, 2002, International Horizons analyzed state and local antiterrorism efforts of four states and eight localities across the country. The analysis looked at all actions taken or proposed relating to terrorism, emergency management, effective communication, education efforts for staff and the public, resources management, and crisis response.

The data, presented to the U.S. Secret Service Task Force on Electronic Crimes and Terrorism in April, show that as of March 31, 80 percent of all efforts were solely reactive in nature. Only 5 percent of all efforts were directed at prevention. By May 31, reactive efforts had increased to 81 percent, while prevention efforts had dropped to 2 percent.

Should we be responsive? Should we know how to treat if there is a treatment? Should we know how to isolate? Yes, yes, yes, Dr. Wilen said. But we're putting all our eggs into one basket, and that's the responsiveness basket. We need to be putting half of our efforts into prevention.

That, Dr. Wilen says, is because our hospitals and public health departments don¹t have the capabilities to respond to a massive outbreak of a disease like smallpox.

In Bexar County, serving 1.5 million people, Metropolitan Health District Director Fernando Guerra says his surge potential is 50 per day, said Dr. Wilen. What good is that if you have 100,000 cases of smallpox? What if you have to quarantine 40,000 people in San Antonio? How are you going to do it?

Dr. Wilen, who also recently spoke about terrorism prevention to the Western Governors Association and the National Governors Association, says prevention must include information, effective communication, education, and resources management.

"You prevent terrorism by optimally using education and developing systems to detect information as the trends are being made, and then acting upon those trends, communicating them effectively," he said. "And the education must apply to all levels including the community. They must be players."

Reprinted permission of Texas Medicine magazine and the Texas Medical Association.