Magazine article The American Enterprise

Wake Up and Smell the Bio Threat

Magazine article The American Enterprise

Wake Up and Smell the Bio Threat

Article excerpt

In August 1999, four New York City residents showed up at hospital emergency rooms complaining of headaches and dizziness. A few became paralyzed. Doctors were stumped. Botulism? A rare nerve inflammation? Scans eventually revealed that the patients all had encephalitis--an inflammation of the brain.

Eight cases and another two weeks later, the Centers for Disease Control came up with a diagnosis: St. Louis Encephalitis, a viral disease transmitted by mosquitoes. Publicly, the CDC and local health agencies stuck with their diagnosis. Privately, scientists were skeptical: They tested mostly for standard diseases, not rare ones.

CDC scientists continued their research. Doctors didn't crack the case until birds started to die at the Bronx Zoo. An astute veterinarian sent a few bird brains to a friend at the Department of Agriculture. The samples ended up at CDC headquarters in Atlanta, where scientists used genetic fingerprinting to discover that it was West Nile Virus--never before detected in North America--that was making people sick. By autumn, a total of 62 people had been diagnosed with the virus, and six had died.

But less than one of every 100 people infected with West Nile actually becomes seriously ill. Only mosquitoes can spread it. America's next viral outbreak, whether natural or an act of bio-terrorism, may not be so easy on us. The official response to West Nile instills little confidence that disaster could be avoided in the case of a bio-terror attack. Right now, everything America has that was designed specifically to counter bio-terrorism is old, expensive, and slow.

The greatest threat probably comes from viruses: They are relatively easy to engineer into designer bio-weapons. Technicians can produce viruses from a rather small collection of DNA. (In July of last year, scientists reported they had created the polio virus from recipes available on the Internet.) Many viruses can also survive for long periods of time outside living cells, especially in a dry state, where they can easily become airborne. There are no antiviral drugs that have the same striking effectiveness and broad attack range that antibiotics do.

Indeed, we might not even know that an attack had occurred for some time. Most bio-terror experts worry about the silent release of an infectious agent of which we have no hint until the incubation period has passed and the terrorists have fled. Then people would come to emergency rooms with non-specific symptoms that may not immediately trigger the right medical diagnoses. So what's required is a good early warning system. Right now, disease surveillance comes in two principal forms. Passive surveillance usually calls on doctors to take the initiative to report suspicious medical cases to state health authorities. Active surveillance asks public health officials to contact doctors directly to gather the data. Both methods share one inherent handicap: By the time people go to the hospital, an epidemic could have already broken out.

Except for food- and water-borne diseases, the U.S. has no comprehensive system for detecting outbreaks of infectious diseases before people start to get ill. Each state decides which diseases to report to the state health department and which information to pass on to the CDC. Often, chaos results. "There's so much noise, we can hardly pick up the signal," says Frederick Burkle of the Defense Threat Reduction Agency at Johns Hopkins University. Even worse, we don't even have the needed technology: About half of state labs can't do the type of genetic testing that ultimately unearthed West Nile.

A bit of progress has been made: The CDC is encouraging local public health leaders to develop systems for surveying the public for worrisome signs such as unusual diagnoses or spikes in doctor visits--a practice public health officials call syndromic surveillance. New York City has such a system in place: Emergency rooms feed data into a central computer system; software alerts public health officials when it finds clusters of symptoms in one geographic area, unusual combinations of symptoms, or inordinately high numbers of symptoms reported by a particular hospital. …

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