Guarding against Biological Agents
Pennachio, Dorothy L., Medical Economics
Vigilance is the key. Here are steps you can take right now.
Bernd A. Wollschlaeger learned firsthand about bioterrorism preparedness as a physician with the Israel Defense Forces during the Gulf war. Part or his duty was to see that civilians, including doctors, were prepared to cope with the worst possible scenarios.
"We made sure everyone had gas masks and decontamination kits, and that they knew how to use them," he says. "Because people knew how to protect themselves, there was surprisingly little panic during Scud missile attacks."
Wollschlaeger is now a family physician in North Miami Beach, FL, the state where the first anthrax death due to terrorism occurred a year ago. "The anthrax attack triggered a surge of physician interest in bioterrorism," he says. "But we live in an event-driven society." Interest in the medical aspects of weaponizing disease dropped off over the months following the axtthrax attacks. Then, the Centers for Disease Control and Prevention last month presented new guidelines for smallpox preparedness.
Patients are concerned, too. Many ask what they should be doing to prepare for the unthinkable. What advice can you give unexposed patients who ask to be vaccinated against smallpox? What if they ask for Cipro or other prophylactic therapy? What about testing? What vaccines are available?
The one thing we've learned for sure since the first case of inhalational anthrax was diagnosed in the offices of a supermarket tabloid in Florida is that we're not adequately prepared, says James Hughes, director of the CDC's National Center for Infectious Diseases. Wollschlaeger, too, says he's concerned that massive panic would occur here if we were to experience anything akin to the 1995 sarin nerve-gas attacks in Japanese subways.
Primary care physicians would be on the front lines in the event of an attack-- the first to see patients with vague symptoms that could signal a disease caused by intentional dissemination. Now's the time to ready yourself.
Look for zebras, not horses
"The first step in preparedness is breaking through the denial that we have nothing to worry about," says Rex Archer, director of the Kansas City, MO, Health Department. Take very seriously the anthrax letters of a year ago, even though few victims died.
"Maintain a high degree of suspicion," says Archer. "We can no longer presume everyday conditions. And if something seems miss, we have to act rapidly." Terrorists can use fast-acting agents as weapons, so that by the time symptomatic patients are diagnosed, it's probably too late to treat them. The time from onset of symptoms toll death can be as short as three days for in anthrax, for example.
"Look for things out of season, out of context, out of sequence, out of range-influenza in July, for instance," says Jonathan L. Temte, a family physician and chairman of the Executive Committee for the Wisconsin Influenza Pandemic Plan.
Since knowledge is your best defense, familiarize yourself with symptoms that differentiate bioterror-related disease from common illnesses. If a disease that mimics pneumonia occurs in a previously healthy patient when there's no epidemic, that should make you suspicious. So should unusual clusters of disease or unusual levels of disease-associated morbidity and mortality.
You'll need to be aware of classic symptoms and early warning signs of the six diseases that the CDC has identified as Category A: anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fever. The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) Web site contains information about each of these diseases, as well as some decision support tools-interactive question-and-answer modules to aid in diagnosis. Also learn the clinical aspects of each agent and available diagnostic tests. You'll find links to articles on all the agents at www. …