The Canton Repository

October 10, 2001

America unprepared for biological assault 

Copley News Service

WASHINGTON — The nation’s public health system is unprepared to respond to a biological attack, four bioterrorism experts told a Senate panel Tuesday. Bringing it up to speed will require millions of dollars in federal spending, they added.

“A wide-scale bioterrorism attack would create mass panic and overwhelm most existing state and local systems within a few days,” said Michael T.
Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

Osterholm is co-author of a book published last year, “Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe.” It warned that a bioterrorist offensive is inevitable.

The lack of readiness extends from thousands of hospitals, state and local health departments to the federal Centers for Disease Control, the experts
told a panel of the Senate Committee on Health, Education, Labor and Pensions.

“It is difficult to exaggerate the deficiencies of our present public health capacities,” said Donald A. Henderson, a physician and director of the Johns
Hopkins Center for Civilian Biodefense Studies. “It is inaccurate to even call the varied public health structures at state, city and county level a public
health system, since many of these units are not connected or coordinated in any meaningful way.”

While the experts acknowledged that steps have been taken to strengthen the response, they continue to see gaping holes.

“We are better positioned than we were several months ago, indeed several weeks ago, but much remains to be done,” Henderson said.

For example, doctors and nurses are in a position to be the first to recognize possible symptoms of a biological assault. Most, however, “have never seen cases of certain diseases, such as smallpox or plague,” said Janet Heinrich, director of health care-public health issues at the U.S. General Accounting Office. “And some biological agents initially produce symptoms that can be easily confused with influenza or other, less virulent illnesses, leading to a delay in diagnosis or identification.”

Medical laboratories similarly lack experience in identifying biological agents such as anthrax, she said.

Another weak area is communications.

“If we are to detect and rapidly identify a new health problem, public health officials must be available 24 hours a day, seven days a week, to take calls from clinicians reporting cases which may be suggestive of ... a bioweapons related disease,” said Henderson, recently tapped to chair a bioterrorism advisory panel for U.S. Secretary of Health and Human Services Tommy Thompson. “This is not possible in most areas of the country.”

One out of 10 public health departments “do not even have e-mail,” added Mohammed N. Akhter, a physician and executive director of the American Public Health Association. “If a bioterrorist attack occurred on a Friday afternoon, there would be no report of it until Monday morning under the current staffing profile of most health departments.”

Few hospitals have enough “surge capacity” to accommodate all who would be infected by a biological assault, the experts said.

Over the past decade, hospitals have eliminated excess capacity in response to intense financial pressure. As a result, “no hospital or geographically contiguous group of hospitals could effectively manage even 500 patients demanding sophisticated medical care, such as would be required in an outbreak of anthrax, for example,” Henderson said.

Akhter added that “emergency rooms can barely address current needs.”

The federal role also has to be strengthened, the critics said.

Henderson advocated a “single, centralized medical and public health strategy for preparing the nation to detect and respond to bioterrorist attacks.” He said the effort should be managed by the Department of Health and Human Services and coordinated with state and local authorities.

The Centers for Disease Control has little capacity to “fight on many fronts” and needs to be expanded, Akhter said.

Even the relatively small outbreak of the West Nile virus in New York City two years ago taxed local, state and federal resources.

“Both the New York State and the Centers for Disease Control laboratories were inundated with requests for tests, and the Centers for Disease Control laboratory handled the bulk of the testing because of the limited capacity at the New York laboratories,” Heinrich said.

She added that the Centers for Disease Control “would have been unable to respond to another outbreak had one occurred at the same time.”

Senate committees are considering requests for up to $1.6 billion in funding to develop a bioterrorist response.