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Strategies & Market Trends : Rande Is . . . HOME -- Ignore unavailable to you. Want to Upgrade?


To: Rande Is who wrote (55205)10/18/2001 8:44:43 AM
From: U Up U Down  Respond to of 57584
 
POSTEXPOSURE INFECTION CONTROL
Vol. 281 No. 22,
June 9, 1999
POSTEXPOSURE INFECTION CONTROL

A smallpox outbreak poses difficult public health problems because of
the ability of the virus to continue to spread throughout the population
unless checked by vaccination and/or isolation of patients and their
close contacts.

A clandestine aerosol release of smallpox, even if it infected only 50
to 100 persons to produce the first generation of cases, would rapidly
spread in a now highly susceptible population, expanding by a factor
of 10 to 20 times or more with each generation of cases.2, 10, 38
Between the time of an aerosol release of smallpox virus and
diagnosis of the first cases, an interval as long as 2 weeks or more is
apt to occur because of the average incubation period of 12 to 14
days and the lapse of several additional days before a rash was
sufficiently distinct to suggest the diagnosis of smallpox. By that
time, there would be no risk of further environmental exposure from
the original aerosol release because the virus is fully inactivated within
2 days.

As soon as the diagnosis of smallpox is made, all individuals in whom
smallpox is suspected should be isolated immediately and all
household and other face-to-face contacts should be vaccinated and
placed under surveillance. Because the widespread dissemination of
smallpox virus by aerosol poses a serious threat in hospitals, patients
should be isolated in the home or other nonhospital facility whenever
possible. Home care for most patients is a reasonable approach,
given the fact that little can be done for a patient other than to offer
supportive therapy.

In the event of an aerosol release of smallpox and a subsequent
outbreak, the rationale for vaccinating patients suspected to have
smallpox at this time is to ensure that some with a mistaken
diagnosis are not placed at risk of acquiring smallpox. Vaccination
administered within the first few days after exposure and perhaps as
late as 4 days may prevent or significantly ameliorate subsequent
illness.39 An emergency vaccination program is also indicated that
would include all health care workers at clinics or hospitals that might
receive patients; all other essential disaster response personnel, such
as police, firefighters, transit workers, public health staff, and
emergency management staff; and mortuary staff who might have to
handle bodies. The working group recommends that all such
personnel for whom vaccination is not contraindicated should be
vaccinated immediately irrespective of prior vaccination status.

Vaccination administered within 4 days of first exposure has been
shown to offer some protection against acquiring infection and
significant protection against a fatal outcome.15 Those who have been
vaccinated at some time in the past will normally exhibit an
accelerated immune response. Thus, it would be prudent, when
possible, to assign those who had been previously vaccinated to
duties involving close patient contact.

It is important that discretion be used in identifying contacts of
patients to ensure, to the extent that is possible, that vaccination and
adequate surveillance measures are focused on those at greatest
risk. Specifically, it is recommended that contacts be defined as
persons who have been in the same household as the infected
individual or who have been in face-to-face contact with the patient
after the onset of fever. Experience during the smallpox global
eradication program showed that patients did not transmit infection
until after the prodromal fever had given way to the rash stage of
illness.17, 18

Isolation of all contacts of exposed patients would be logistically
difficult and, in practice, should not be necessary. Because contacts,
even if infected, are not contagious until onset of rash, a practical
strategy calls for all contacts to have temperatures checked at least
once each day, preferably in the evening. Any increase in temperature
higher than 38°C (101°F) during the 17-day period following last
exposure to the case would suggest the possible development of
smallpox2 and be cause for isolating the patient immediately,
preferably at home, until it could be determined clinically and/or by
laboratory examination whether the contact had smallpox. All close
contacts of the patients should be promptly vaccinated.

Although cooperation by most patients and contacts in observing
isolation could be ensured through counseling and persuasion, there
may be some for whom forcible quarantine will be required. Some
states and cities in the United States, but not all, confer broad
discretionary powers on health authorities to ensure the safety of the
public's health and, at one time, this included powers to quarantine.
Under epidemic circumstances, this could be an important power to
have. Thus, each state and city should review its statutes as part of
its preparedness activities.

During the smallpox epidemics in the 1960s and 1970s in Europe,
there was considerable public alarm whenever outbreaks occurred
and, often, a demand for mass vaccination throughout a very
widespread area, even when the vaccination coverage of the
population was high.2 In the United States, where few people now
have protective levels of immunity, such levels of concern must be
anticipated. However, the US vaccine supply is limited at present;
thus, vaccine would have to be carefully conserved and used in
conjunction with measures to implement rapid isolation of smallpox
patients.

---------
The working group recommends that an emergency stockpile of at
least 40 million doses of vaccine and a standby manufacturing
capacity to produce more is a critical need. At a minimum, this
quantity of vaccine would be needed in the control of an epidemic
during the first 4 to 8 weeks after an attack.
--------
SUMMARY

The specter of resurgent smallpox is ominous, especially given the
enormous efforts that have been made to eradicate what has been
characterized as the most devastating of all the pestilential diseases.
Unfortunately, the threat of an aerosol release of smallpox is real and
the potential for a catastrophic scenario is great unless effective
control measures can quickly be brought to bear.

Early detection, isolation of infected individuals, surveillance of
contacts, and a focused selective vaccination program are the
essential items of a control program. Educating health care
professionals about the diagnostic features of smallpox should permit
early detection; advance regionwide planning for isolation and care of
infected individuals in their homes as appropriate and in hospitals
when home care is not an option will be critical to deter spread.
Ultimately, success in controlling a burgeoning epidemic will depend
on the availability of adequate supplies of vaccine and VIG. An
adequate stockpile of those commodities would offer a relatively
inexpensive safeguard against tragedy.

jama.ama-assn.org
Bet our brave congressmen/women and their families get vaccinated so that they can take care of Americas business of burying the dead.



To: Rande Is who wrote (55205)10/18/2001 10:03:29 AM
From: Bucky Katt  Respond to of 57584
 
Rande, real old play, TTN, says their machines can "zap" mail, on a big scale, thus killing anthrax spores, same technology they use to irradiate meat, etc.
Just an idea, it is down 2 bucks today..

I should have kept XOXO, it spiked again...I thought 300% was good enough...



To: Rande Is who wrote (55205)10/18/2001 12:10:08 PM
From: Frederick Langford  Read Replies (1) | Respond to of 57584
 
Rande,

Experts Say Spores Won't Spread in Ventilation System [NYT]
nytimes.com

October 18, 2001

THE STRUCTURES

By JAMES GLANZ and DAVID E. ROSENBAUM

Experts on biological warfare and building design said yesterday that it was extremely unlikely that the anthrax spores mailed to Senator Tom Daschle could have been spread in dangerous amounts to the rest of the Hart Senate Office Building through the ventilation system.

Even what were apparently finely ground, weapons-grade spores containing anthrax would be quickly diluted in any ordinary office building and at least partly filtered by a standard office ventilation system, as long as it was up to current standards, the experts said. And once contaminated air left the building through its exhaust pipes, the concentrations of the spores would be far too low to cause infection.

"Once it goes to the outside, it'll quickly be diluted so that it's not a hazard," said Richard Spertzel, a former weapons inspector and senior biologist for the United Nations Special Commission on Iraq.

Government investigators quickly shut down the Hart Building's ventilation system to eliminate any chance that the disease could be spread farther, and Mr. Spertzel said they acted properly. But he added that weapons-grade anthrax, which wafts in the air and seldom sticks to surfaces, would have been cleared from the area by the ventilation system, often called H.V.A.C. for heating, ventilation and air conditioning.

"If you left the H.V.A.C. on," he said, "you could walk in there in two to two and a half hours and be perfectly safe."

Still, the experts said the incident would bring attention to recommendations that have long been put forward to reduce the damage that bioterror attacks — whether from outside a building or, as in this case, inside — are likely to cause.

Those recommendations include keeping the air pressure in office buildings at a slightly higher pressure than the outdoors, carefully monitoring all intake vents and adding high-efficiency filters to all heating and air conditioning systems. For anyone who is particularly worried about the threat, mobile filters, available commercially, will more quickly cleanse the air in individual offices.

But even without those measures, the likelihood of mass exposures through air circulation within a building is minute, said James E. Woods, founding director of the HP- Woods Research Institute in Herndon, Va.

"There's a huge fear factor, but when we stop and think about it, the probability of getting exposed is pretty low," said Mr. Woods, who is also chairman of the environmental health committee of the American Society of Heating, Refrigerating and Air Conditioning Engineers, which sets standards for the field.

The nine-story Hart Building is built in the shape of a cross as seen from above; inside, at the center of the cross, is a dramatic 100-foot atrium. The building houses the offices of about 50 senators and is connected through open corridors to the Dirksen Building, which also contains Senate offices.

The letter to Mr. Daschle, the Senate majority leader, was opened in his office, in the building's southeast quadrant. That quadrant has now been closed off. Government officials said its ventilation system was not connected to the rest of the building.

"Those ventilation systems have been off since shortly after the letter was opened, to minimize any further spread," said Robert Gibbs, program manager of the Defense Advanced Research Projects Agency, at a news conference with Senator Daschle and others this afternoon.

To become infected with inhalational anthrax, the deadliest form of the disease, a person would have to inhale 8,000 to 10,000 spores no larger than about five microns. The filters in the systems of newer office buildings should remove about 90 percent of particles of that size in a single pass, said Mr. Woods, of the heating engineers' society.

More advanced filters, called HEPA for high-efficiency particulate air filter, take out at least 99.97 percent of such particles in a single pass, Mr. Woods said. But those filters are often 5 to 10 times as expensive and require more powerful air- circulation systems, and so are not used in many buildings. Officials refused to comment on the ventilation systems used in federal buildings in Washington.

Experts cautioned that a ventilation system could be used to spread lethal quantities of anthrax. An attack with the potential to cause much larger numbers of casualties would involve infusing huge amounts of anthrax into one of the building's intake vents. The best solution, Mr. Spertzel said, is to "guard it so nobody has access to it."

About the possibility that anthrax or some other biological weapon could be released into the outside air, Dr. Richard L. Garwin, a physicist who is an authority on weaponry at the Council on Foreign Relations in New York, suggested a way to protect people who stay inside: use the ventilation system to keep the building's air pressure slightly higher than that of the surroundings, so that contaminants do not enter through windows and doors.

There are even measures for reducing the threat of a bioweapon already inside a building.

Dr. Thomas J. Johnson, director of the division of respiratory care on the Brooklyn campus of Long Island University, said emergency rooms had long taken measures to protect against small, lethal particles — in their case, drug-resistant tuberculosis bacteria on the droplets released when patients cough.

The emergency rooms use mobile HEPA filters with their own fans, he said. Another bioweapons expert, Dr. Matthew S. Meselson, said that such units sell commercially and that he keeps one in his office at Harvard, where he is a professor of biology.

Both Dr. Johnson and Dr. Meselson said that those filters could not eliminate the danger of anthrax infection in a contaminated building, and that the best defense was to stop the attacks from occurring in the first place. But they said the filters showed that other protections were available.

"We know we can do some good, basic protection of individuals using the same methodology we used for multidrug-resistant TB," Dr. Johnson said.

Fred



To: Rande Is who wrote (55205)10/18/2001 8:25:28 PM
From: Libbyt  Read Replies (1) | Respond to of 57584
 
First We Cripple the CIA, Then We Blame It

By Tom Clancy, a novelist.
September 18, 2001
Commentary

The Wall Street Journal

We know now that America has been the victim of a large, well-planned, and well-executed terrorist act. The parameters are yet to be fully explored, but that won't stop the usual suspects from pontificating (and, yes, that includes me) on what happened and what needs to be done as a result. A few modest observations:
As I write this we only know the rough outlines of what has taken place. We do not know exactly who the perpetrators were, though we have heard from Vice President Dick Cheney that there is "no question" that Osama bin Laden had a role. But many groups may have been involved, and we do not know their motivation, or for whom or for what particular objective they worked.
"Don't know" means "don't know" and nothing more. Absent hard information, talking about who it must have been and what we need to do about it is a waste of air and energy. To discern the important facts, we have the Federal Bureau of Investigation as our principal investigative agency, and the Central Intelligence Agency (along with National Security Agency and the Defense Intelligence Agency) as our principal foreign-intelligence services. Getting the most important information is their job, not the job of the news media, which will only repeat what they are told. Gathering this information will take time, because we need to get it right.
Terrorism is a political act, performed for political objectives. The general aim of terrorism is to force changes in the targeted society through the shock value of the crime committed. Therefore, if we make radical changes in how our country operates, the bad guys win. We do not want that to happen. Whoever planned this operation is watching us right now, and they are probably having a pretty good laugh. We can't stop that. What we can do is to maintain that which they most hate, which is a free society. We've worked too hard to become what we are, and we can't allow a few savages to change it for us. Next, our job is to take a step back, take a deep breath and get to work finding out who it was, where they are, and what to do about it.
Terrorism is a crime under the civil law when committed by domestic terrorists; it can be an act of war when committed by foreigners. For domestic criminals we have the FBI and police. For acts of war we have our intelligence community and the military. In either case we have well-trained people to do the work. If we let them do their job, and give them the support they need, the job will get done as reliably as gravity.
The foreign-source option seems the most likely at this time. The first line of defense in such a case is the intelligence community. The CIA is an agency of about 18,000 employees, of whom perhaps 800 are field-intelligence officers -- that is, the people who go out on the street and learn what people are thinking, not how many tanks they have parked outside (we have satellites to photograph those).
I've been saying for a lot of years that this number is too small. American society doesn't love its CIA, for the same reason that it doesn't always love its cops. We too often regard them as a threat to ourselves rather than our enemies. Perhaps these incidents will make us rethink that.
The best defense against terrorist incidents is to prevent them from happening. You do that by finding out what a potential enemy is thinking before he is able to act. What the field intelligence officers do is no different from what Special Agent Joe Pistone of the FBI did when he infiltrated the mafia under the cover name of Donnie Brasco. The purpose of these operations is to find out what people are thinking and talking about. However good your satellites are, they cannot see inside a human head. Only people can go and do that.
But America, and especially the American news media, does not love the CIA in general and the field spooks in particular. As recently as two weeks ago, CBS's "60 Minutes" regaled us with the hoary old chestnut about how the CIA undermined the leftist government of Chile three decades ago. The effect of this media coverage, always solicitous to leftist governments, is to brand the CIA an antiprogressive agency that does Bad Things.
In fact, the CIA is a government agency, subject to the political whims of whoever sits in the White House and Congress. The CIA does what the government of which it is a part tells it to do. Whatever evil the CIA may have done was the result of orders from above.
The Chilean event and others (for example, attempts to remove Fidel Castro from the land of the living, undertaken during the presidency of JFK, rather more rarely reported because only good came from Camelot) caused the late Sen. Frank Church to help gut the CIA's Directorate of Operations in the 1970s. What he carelessly left undisturbed then fell afoul of the Carter administration's hit man, Stansfield Turner. That capability has never been replaced.
It is a lamentably common practice in Washington and elsewhere to shoot people in the back and then complain when they fail to win the race. The loss of so many lives in New York and Washington is now called an "intelligence failure," mostly by those who crippled the CIA in the first place, and by those who celebrated the loss of its invaluable capabilities.
What a pity that they cannot stand up like adults now and say: "See, we gutted our intelligence agencies because we don't much like them, and now we can bury thousands of American citizens as an indirect result." This, of course, will not happen, because those who inflict their aesthetic on the rest of us are never around to clean up the resulting mess, though they seem to enjoy further assaulting those whom they crippled to begin with.
Call it the law of unintended consequences. The intelligence community was successfully assaulted for actions taken under constitutionally mandated orders, and with nothing left to replace what was smashed, warnings we might have had to prevent this horrid event never came. Of course, neither I nor anyone else can prove that the warnings would have come, and I will not invoke the rhetoric of the political left on so sad an occasion as this.

But the next time America is in a fight, it is well to remember that tying one's own arm is unlikely to assist in preserving, protecting and defending what is ours.

************

IMO, the same headline for this article also applies to the FBI. The new funds approved on an emergency basis to fight terrorism have enabled the FBI and other agencies to go into "high gear" with their war on terrorism. Some of the laws have also been changed to enable the FBI to have further less restricted wiretap abilities as well as being allowed to search the hard drive of various computers. (They were denied these privileges before 9/11/01) These new changes in the law only occurred after the events of 9/11.

FBI, CIA and DEA agents IMO have been severely underpaid for the services they provide for our country. Until this recent crisis, I believe that many FBI agents were never paid for overtime work...but having additional funds available will hopefully remedy that situation.

Our FBI agents have been working non-stop...many, with very few hours off, since 9/11. IMO your criticism of the FBI is too harsh.