U.S. Totally Unprepared for Bioterrorism

Speaking in Washington at the Center for Strategic and International Studies, Dr. Tara O'Toole, deputy director of the Johns Hopkins University Center for Civilian Biodefense Studies, said, "100 grams of anthrax properly dispersed downwind over Washington, D.C., for example, could kill between 150,000 and three million people in the surrounding areas.

"This would produce fear and panic all over the country as millions rush to doctors' offices to be checked out."

Ten grams of anthrax is the equivalent of one ton of chemical nerve agents, Dr. O'Toole explained.

Most frightening of all, Dr. O'Toole said "is the ever faster pace of technological advance, which has made the know-how for creating, manufacturing and dispersing these agents of mass destruction widely available through open literature."

The National Academy of Sciences recently published a research paper that was a roadmap for the manufacture of a virulent strain of the 'flu. Today, she said, the 1918 'flu that killed some 25 million in Europe in four months and infected 25 percent of the U.S. population -- with almost 700,000 deaths -- can easily be replicated and produced. AIDS in Africa is a glimpse of the horror that may lie ahead.

In addition to Russian stores of former Soviet bio-weapons of mass destruction, there are "a dozen countries, including all states named by the State Department as sponsors of terrorism, that have developed bio-warfare capability," according to Dr. O'Tara.

"These weapons of mass destruction are potentially a way around U.S. military power," she said. "They could, for example, destroy overseas bases during a U.S. forward deployment" such as Kosovo in 1999.

"This is the age of big biology, of unbelievable breakthroughs in the search for medical miracles," Dr. O'Toole explained, "but this goes hand in hand with the tools to make ever more virulent weapons."

No U.S. city has the capacity for a mass casualty situation, she said. Johns Hopkins, for example, only has five isolation wards for infectious diseases. Out of 5,000 hospitals in the United States, 30 percent are losing money. A thousand hospitals have closed in recent years as they went broke.

"Emergency rooms are also losing money" strained as they are by poor people without medical insurance. Most ERs resort to just-in-time staffing procedures, she said, "and very few nurses are hospital employees.

In the case of an epidemic, security staffs and cafeteria employees would take off in droves, just as was the case in 1994 during the plague outbreak in Surat, India. The U.S. Public Health system is woefully understaffed, under-funded and not part of an integrated system. There are no beepers or computers or even fax machines in many places. Public Health-wise we are simply not wired."

Dr. O'Toole also said that a recent exercise in Denver, codenamed "TOPOFF," postulated the release of bubonic plague in a bio-terrorist attack.

"It was called off after four days from sheer exhaustion of the participants and the epidemic was still expanding," she said. "One must contain an epidemic from the very beginning or it is quickly out of control through mass travel to the rest of the country and the world. How does one restrict travel in such a crisis and impose curfews? Voluntarily or with guns?"

Dr. O'Toole concluded by saying there is an urgent need of some $3 billion a year over 10 years for research and development in bio defense. These funds would be designed to produce more definitive rapid diagnostics of an epidemic (smallpox incubation period is 14 days during which time one person infects 15 others); microchips that could decipher the problem immediately; better and more vaccines; an immune response with an all-purpose way to limit our vulnerability; hospital training and an electronically linked hospital system (to eliminate the now autonomous and competitive system between hospitals); incentives for getting hospitals involved.

The U.S. Public Health system, she said, "must identify critical capacities to detect, track and contain." This would have to include a new triage ethic because in biological attack "the sickest don't get handled first. They are left to die."

Additional points made by Dr. Tara O'Toole:

* Bio-war can push nations beyond the point of recovery.

* A bio-weapons attack is not likely to stay "local"; it will spread very quickly.

* Bio-weapons are strategic population destroying weapons which sets them apart from other weapons of mass destruction.

* It is not easy to hide a nuclear reactor, but very easy to hide a fermenter.

* There is no clear line between civilian and military targets.

* Genetic engineered pathogens may well confuse diagnosis making it very difficult for doctors to respond in time.

* Most American doctors would not be able to recognize smallpox or anthrax.

* Pharmaceutical companies do not possess surge capabilities in case of an incident; they are entirely geared to just on time deliveries.

*These days one can play Lego with the DNA of a bug and make it more virulent and resistant to antibiotics.