Bioterrorism without paranoia OR complacency
Here's an excellent series of questions and answers from a specialist:
"Dr. Nass Replies to Frequently Asked Questions Regarding a Bioterrorism Response, September 26,
2001
Q: What antibiotic should I obtain?
A: Although ciprofloxacin has been licensed for use by FDA for anthrax, and doxycycline was very effective in monkey
studies, nearly all common antibiotics, except cephalosporins, are effective against anthrax when it occurs naturally. The
problem is that when developed as a bioweapon, bacteria can have antibiotic resistance genes introduced, rather simply. Since
cipro and doxycycline have been advocated for anthrax since before the Gulf War, an adversary might specifically try to
overcome those antibiotics. So it is impossible to know for sure what antibiotics will work, in advance of an attack.
If there is an anthrax release, the organism will be cultured and we will know within 48 hours what antibiotics to use.
Q: How can I get antibiotics?
A: Obviously, you can only get them from a physician. If everyone obtains their own "stash" of antibiotics, there will not be
enough for those who are actually exposed. The government does have some antibiotic stockpiles stored around the country.
Q: What is the risk of anthrax to me?
A: Anthrax is only deadly when you inhale a huge number of spores. Once the spores hit the ground, they stay there, so the
risk from re-aerosolization is miniscule. In Sverdlovsk (now Ekaterinburg) there was a large release of anthrax spores from a
bioweapons factory, due to a faulty or missing filter, in 1979. Only 66 people in a town of more than 1 million died from
anthrax, although the citizens were not notified of the release, and therefore did not receive prompt antibiotics or optimal
medical therapy.
Anthrax does NOT spread from person to person. When it travels with the wind, it follows a narrow path, and does NOT
spread out widely over long distances. That is why there were so few cases in Sverdlovsk. Workers in American factories
that were grossly contaminated with anthrax spores, who inhaled hundreds of spores each day, almost never developed
inhalation anthrax, the most deadly form of the disease.
Therefore, if anthrax is used, it will affect only a limited area, and relatively small numbers of people. It is a good terrorist
weapon, as any use will strike terror in millions or billions of people. But it is a BAD weapon if you are trying to inflict a
massive amount of casualties.
Q: But I heard that 50 kilograms released over NYC could kill millions?
A: You could only achieve massive casualties if you had a plane going back and forth over NYC, making multiple loops over
the city, with the wind exactly right. This would require that we lose control of the air space over our cities.
Q: But couldn't anthrax be released without detection, and we would have no warning until people started dying?
A: Sensors have been developed, and have been deployed, to detect such releases. There are relatively simple devices that
can tell if unusual numbers of organisms are in the air. Hopefully these devices will be put in the right places and provide us
adequate warning of an attack.
Q: If there is a release of anthrax, what is the treatment?
A: In animal studies, antibiotics given for one or two months prevented anthrax in exposed animals while on antibiotics. Some
of the animals did develop anthrax after the antibiotics were stopped, due to spores that remained in their lungs but had never
germinated, so the antibiotics were unable to be effective against them. It was hypothesized that 6 months of antibiotics might
suffice to prevent this. Since humans need to inhale a lot more anthrax than lab animals, before they become affected, this may
not be as big a concern as we think.
Q: Are there safe vaccines anywhere?
A: The British (killed) anthrax vaccine has had similar criticisms as the American vaccine, and is not necessarily any safer. The
Russian (actually from Tblisi, Georgia) live anthrax vaccine safety profile is uncertain. The live animal anthrax vaccine routinely
kills llamas and some goats, so I would not use it on humans without a lot of study first.
Q: What about other threats, like smallpox or plague?
A: Smallpox is a virus that might respond to antivirals. There is a stockpile of several million doses of freeze dried vaccine
maintained by CDC, which is approximately 30 years old. It was tested on humans last year. New vaccine will be available in
2004. Smallpox is highly contagious. Those born before 1980 in the US received smallpox vaccine as infants, and will have
some level of protection.
Plague is a bacterial disease that can spread person to person, but not that easily. The existing plague vaccine is not thought to
be effective against the inhaled form of the disease. Many antibiotics work for naturally occurring plague, but if bioengineered
for virulence, as in the case of anthrax, effective antibiotics cannot be predicted.
The fatality rates for these diseases are lower than for anthrax.
Q: What about gas masks and protective equipment?
A: If you are in the vicinity of an attack, the best protection is to get inside and close all windows and doors. As long as you
do not breathe in the tens of thousands or more spores required to induce illness, you will be fine. If you insist on a mask, you
will need one that prevents inhalation of particles greater than one micron.
Q: What about chemical weapons?
A: In general, they are like anthrax. Yes, they can kill you (1 milligram of VX on your skin is a lethal dose). But they will only
affect a relatively small area, and, like anthrax, will spread following a narrow plume of wind, not a wide area. They dissipate in
a relatively short time. They are only good for attacking dense concentrations of people."
anthraxvaccine.org |
