Bioterrorism a real threat; are we ready?
Seattle Times staff reporters
This state is no exception to that vulnerability.
Yet amid the anxiety, there is hope — and, more significantly, action. Both hinge largely on how much we're willing to pay, and how fast the bureaucracy can move.
Washington has a head start on many states. And while there now is little protection here against a well-executed attack with plague or poison, opportunities abound to increase our security, especially against smaller-scale bioterror.
Options include buying portable germ detectors ($10,000-$50,000 apiece), equipping more emergency workers with protective gear ($23 million), covering Seattle's nine open water reservoirs (as much as $45 million), and adding hospital beds, staff, ventilators, vaccines and antibiotics across the region (billions of dollars).
Gov. Gary Locke set up a Committee on Terrorism two years ago. Its bioterror response plan — kept secret to avoid alerting the enemy — deals with such issues as leadership in a crisis and distribution of precious drugs.
State Secretary of Health Mary Selecky will meet with county and local health officials in Yakima tomorrow. She says, "We really are ramping up information and action" on the threat of bioterror.
And none too soon. A single case of highly contagious smallpox would lead to a declaration of emergency nationwide, and could kill tens of millions.
A national exercise in June started with one case of smallpox in Oklahoma City and spread to 25 states and 15 countries, with several million hypothetical deaths. A test run of Denver's preparedness for pneumonic plague fell apart after four days, with thousands dead and hospitals overrun.
Other substances seen as potential dangers by security and health experts include:
• Anthrax, a deadly bacterium that can travel through the air. A government study estimated that 200 pounds released upwind from Washington, D.C., could kill as many as 3 million people.
• Botulism, the most toxic biological substance known. Although it typically contaminates food, it could be developed as an aerosol weapon.
• Plague, a contagious disease that wiped out a third of Europe's population in the 14th century.
• Nerve gases such as sarin and tabun, which can kill within minutes.
But while such prospects are terrifying, the challenges for terrorists are steep. Nobody has seriously hurt more than a handful of people in an actual chemical or biological terror attack. Many of the substances that could be used are scarce and/or difficult to handle.
The only known biological-terror attack in U.S. history was in The Dalles, Ore., in 1984, when members of the Rajneesh cult poisoned 751 people with salmonella. No one died.
The largest known chemical-terror attack anywhere was in Tokyo in 1995, when the Aum Shinri Kyo cult released sarin gas into subways, killing 12.
Those isolated events, as well as preparations for the 1999 World Trade Organization meetings in Seattle, have given state and local officials here a start in fortifying our defenses against what some experts call "the poor man's atomic bomb."
Here is a look at what has been done, what needs to be done — and what cannot be done to defend against biological and chemical terrorism.
In dealing with bioterror, an ounce of prevention is worth 6 billion doses of cure.
The first defense is intelligence. The events of Sept. 11 showed the consequences of failure.
Some government proposals seek to better share intelligence information; others seek to restrict it to avoid leaks.
Meanwhile, security has been tightened at the U.S.-Canada border. Troops are on alert at the U.S. Army's Umatilla Chemical Depot in Eastern Oregon and at the Hanford Nuclear Reservation in Eastern Washington.
The Washington Department of Health has advised managers of 16,000 public drinking-water systems to improve security by locking doors, setting alarms and questioning any strangers.
Crop-dusting companies, with planes that could be used in attacks, are also on alert.
If the security is breached, there is one other possible barrier for protection, at least against biological weapons: vaccines.
Before Sept. 11, vaccines were a low priority for drug companies because of liability lawsuits, low profit margins and little public concern about such an attack.
That means only two small companies in the United States are manufacturing vaccines for anthrax and smallpox.
BioPort of Lansing, Mich., is the nation's sole maker of anthrax vaccine. Its plant, closed for modernization, is expected to be running again within six weeks under National Guard protection. So far, BioPort has produced enough to vaccinate fewer than 20 percent of the 2.4 million American troops. The vaccine is not available to the public; the company in recent weeks turned away more than 1,000 people asking for it.
Acambis, a British company with operations in Cambridge, Mass., last year signed a 20-year, $343 million contract to boost America's stockpile of smallpox vaccine. In his book "Scourge," bioterrorism expert Jonathan Tucker said the government has 7.5 million doses of smallpox vaccine on hand — not enough to handle even a mild outbreak.
Acambis' contract calls for it to produce 40 million more doses. Last week, government officials pushed the company to make its first batches by late 2002 instead of 2004.
Vaccine production could be ramped up quickly if the government pushes — and pays for it. Pointing to massive production of penicillin in World War II, Dr. Bert Spilker of the Pharmaceutical Research and Manufacturers Association of America says drug companies could spring to action again quickly, and that there is excess manufacturing capacity.
If there's an outbreak of disease, expect a scramble for vaccine. The state's secret preparedness plans say who will get priority: law-enforcement, emergency and medical workers.
Chemical attacks would likely be obvious, but not so for biological terror.
Smallpox has a 12-day incubation period of high contagion, and anthrax symptoms can't be diagnosed until one to six days after exposure. The delayed reaction of biological agents makes early detection crucial. Smallpox is 30 percent fatal; anthrax, 90 percent fatal.
Family doctors and internal-medicine physicians are key to detection. The national Centers for Disease Control (CDC) issued three alerts in the first 24 hours after the Sept. 11 terrorist attacks, asking doctors nationwide to look for unusual patterns of illness.
That's a major challenge: Several of the biological agents start out looking like the flu, with symptoms such as fever, headache, chills, fatigue and muscle aches.
"We want docs to have increased suspicion for the possibility of a bioterrorism attack," said Dr. Jeff Duchin, director of communicable-disease control for King County and coordinator of the county's response to biological attack. "We want them to have this in the back of their minds."
About a dozen Seattle-area hospitals have had or will have special training on detection and response.
"The problem is that the symptoms are not specific to the illnesses," says Dr. Harry Pepe III, a Redmond family-practice doctor. "We'll be missing some cases initially until we see more specific signs."
Also on heightened alert are county coroners, emergency medical workers and poison-control centers.
Meanwhile, Drs. Bill Lober and Bryant Thomas Karras of the University of Washington are speeding up their work on an automated data-collection system designed to detect suspicious patterns of illness. The system, which is not yet ready, will take and process information from hospitals, clinics, laboratories, ambulances, doctors and the public.
Someday we may have germ detectors as cheap and plentiful as smoke detectors, but experts say that is at least 10 years away. Some early-detection devices do exist, including portable "sniffers" to sample and detect airborne germs.
Eastern Washington University recently built a prototype for laser analysis to continuously sample and identify biological weapons in the air. It cost $100,000 and weighs 45-50 pounds.
The State Department of Health laboratory is equipped to identify any biological agent.
"It's state of the art," says Duchin.
And it's fast: The lab takes only one day to identify E. coli bacteria, for instance, compared with the five days it took during the Jack In The Box outbreak in 1993.
Every minute counts. The CDC has eight 50-ton "push packages" of drugs and medical supplies stashed around the country, deliverable to any site within 12 hours, backed up by a National Pharmaceutical Stockpile with enough antibiotics for 2 million cases of anthrax. The government wants antibiotics for 10 million.
If the real thing hits, then, they do have a plan — or more realistically, thousands of plans they hope will work together.
Congress' watchdog agency, the General Accounting Office (GAO), last week said the bioterror-response system is still fragmented and uncoordinated.
"That is definitely a problem," says Dr. Mark Oberle, a former CDC officer who is now associate dean for Public Health Practice at the University of Washington. He adds, "Washington state is actually a little farther ahead than many other states in dealing with outbreak responses."
It was only five years ago that the Pentagon wrote America's first plan for homeland response to terrorist weapons of mass destruction. Four years ago, training began; Seattle-area agencies and the Washington National Guard were some of the first to be certified ready.
Later, the Pentagon stepped aside and gave homeland control to the Department of Justice and Federal Emergency Management Agency, which sometimes battled over turf.
The new Office of Homeland Security is expected to improve matters, helping coordinate more than 40 federal agencies.
Washington was the second state after Georgia to connect all its county health departments over the Internet, in what is called the Health Alert Network.
In the event of an attack by chemicals or germs, hospitals would likely be inundated. And officials are concerned about their ability to handle that.
Over the past decade, the number of hospital beds in the Puget Sound region dropped by 10 percent to 4,012, according to the Washington State Hospital Association. Nurses are in short supply. And the University of Washington School of Medicine trains new physicians at the rate of about 150 a year, barely enough to keep up with retiring doctors in Washington, Alaska, Montana and Idaho.
"The hospitals are doing a lot with (bioterrorism) preparedness, but if there is one thing we're worried about, it's not beds, but staffing levels," says Cassie Sauer, spokeswoman for the State Hospital Association.
Equipment and drugs are also an issue. The Denver plague test in May 2000 also showed a great need for more ventilators and antibiotics to save patients with severe respiratory problems.
The traumatic events here in late 1999 — the WTO riots and the cancellation of Seattle's millennium celebration after the arrest of a terrorist at the border — provide a good foundation for terrorism planning.
While the state held just one exercise focusing on terrorist attacks in 1997, and just two in 1998, there were 12 in 1999 and 13 in 2000. Clifton Spruill, lead investigator on a March 2001 GAO report on combating terrorism, says Washington's cities and counties had "surprisingly" more exercises than many other areas.
And there's a bonus: "All the preparations we have done on the terrorist side make us much better prepared for a naturally occurring event or accident," such as an earthquake, said Seattle Deputy Fire Chief A.D. Vickery.
However, these exercises have focused on attacks by chemicals or explosives, with none on biological terror.
Seattle and state officials planned a big test of medical-supply distribution in a mock bioterror attack Sept. 20-21.
It was postponed by real life-and-death events.
Duff Wilson can be reached at 206-464-2288 or firstname.lastname@example.org.