CEO SUMMARY: America’s clinical laboratories are soon to be enlisted in the war against terrorism. Concerns about chemical and biological terrorist attacks have reached high levels following the death of a Florida man from pulmonary anthrax and the discovery of letters containing anthrax mailed to Tom Brokaw of NBC News and Senator Tom Daschle of North Dakota. Authorities are working to link these events to terrorists.
THE DEATH OF ONE MAN from anthrax in Florida and the discovery of a growing number people either infected or exposed to anthrax triggered a media frenzy over the Spector of terrorist attacks using biological agents.
As THE DARK REPORT goes to press today, at least 12 people, primarily in New York and Florida, have tested positive for anthrax. Government investigators are treating all episodes as crimes and believe the anthrax was intentionally introduced.
Regardless of what this investigation concludes, heightened media attention on the subject of chemical and biological terror in the United States is forcing government authorities to take serious steps to prepare for such attacks. As they do, clinical laboratories throughout the country will become involved and begin developing plans for how their organization will detect these types of attacks and what they will do in response to them.
Already, long-standing efforts to formally organize a response plan among selected regional laboratories are accelerating. Increased funding from Congress to support such preparations in hospitals is a given. The only question is how much money will be earmarked to support this program.
The thought of biochemical attacks is horrifying to most Americans. Indeed, many in the media and some in the government have painted gruesome pictures of how such attacks could wreak mayhem upon the population.
However, most laboratorians understand enough about the dynamics of disease and diagnosis to know that the existing system may already be positioned to do a better job of detection and response than the public perceives.
Pulmonary Anthrax Victim
Case in point is the death of Bob Stevens on October 5, the unlucky victim of pulmonary anthrax. Stevens was brought to JFK Medical Center in Miami mid-week, showing a variety of symptoms.
Although authorities have not publicly disclosed specific details of how the disease was diagnosed, laboratorians with connections to JFK Medical Center tell THE DARK REPORT that the story circulating there is this: the attending physician, after viewing the chest x-rays, knew the disease was not pneumonia and referred the x-rays and case work-up to the Florida Department of Health. The Department of Health made the diagnosis of pulmonary anthrax and referred the case to the Center for Disease Control(CDC) in Atlanta, which confirmed the diagnosis.
This all happened within a day or two of the patient’s admission. It was the first case of pulmonary anthrax in the United States since 1972 and only the eighteenth reported case in the country since 1900.
Fast, Accurate Diagnosis
Certainly it is a fact that the medical establishment is now paying attention to the potential for biochemical attacks since the events of September 11. But the rapid identification of a seldom- seen disease by JFK Medical Center’s physicians in the Bob Stevens case is reassuring. THE DARK REPORT believes it is representative of how emergency room physicians and their supporting laboratories throughout the country utilize the reference and esoteric testing resources to rapidly identify unfamiliar or unusual diseases.
For the clinical laboratory profession, a variety of changes will be implemented by government authorities and legislators. In Congress, Senators Edward Kennedy (D-Mass.) and Bill Frist (R-Tenn.) introduced legislation calling for an increase of $1.4 billion in spending to prepare for biological and chemical attacks. At least $295 million would be directed toward “improving hospital response capabilities.”
The federal Center for Disease Control and Prevention (CDCP) are helping state and local health departments acquire and deploy automated equipment that will run molecular tests for antibodies and DNA probes. The goal is to perform more sensitive and accurate testing as fast as possible, and do it closer to the site of possible biological or chemical incidents. Currently it takes two or three days to confirm a diagnosis. The goal is to cut that down to hours.
Tighter Controls On Labs
Another change on the way is tighter controls over infectious agents in clinical and research labs. For example, it is estimated that at least 5,000 labs in the United States hold quantities of 42 agents listed by the CDCP as dangerous pathogens. Upwards of 150,000 labs in the United States hold small amounts of microbes for “reference cultures.” These are used to aid in identifying suspected pathogens following an outbreak or environmental release.
These examples demonstrate that elected officials and government regulators have begun to pay closer attention to the way laboratories operate, and their role in the early and accurate detection of biochemical attacks. Expect more changes in the months ahead.
Biological Warfare Has Important Limits That Make It Most Difficult to Employ
ONE EXPERT BELIEVES BIOLOGICAL WARFARE is not the ready weapon of mass destruction that many perceive it to be.
“It’s important to remember that guerilla warfare and terrorist action operates from three principles,” said Henry I. Miller, M.D., Fellow at the Hoover Institution at Stanford University and an official at the Food and Drug Administration between 1979 and 1994.
“Successful operations must be: 1) simple to execute; 2) offer the terrorists a high degree of security before and during the attack; and 3) provide surprise to those attacked,” he explained. “Biological warfare is a complex undertaking, and fails on at least the first two of these principals. It is not a trivial undertaking to grow and weaponize biological agents.”
In an exclusive interview with THE DARK REPORT, Dr. Miller emphasized an overlooked fact that would affect biological warfare. “Over the past half-century, university and government research labs working with infectious agents have, unintentionally, performed what amounts to small-scale biological warfare ‘experiments’,” he said. “In other words, there were laboratory accidents in which organisms were released.
“The outcomes of these incidents are revealing and somewhat reassuring,” continued Dr. Miller. “The U.S. Center for Disease Control in Atlanta, which used to monitor these mishaps, recorded 109 laboratory-associated infections during the period 1948-1973, but not a single secondary case—that is, of a patient’s family member or community contact— was reported.”
Dr. Miller says a review of medical literature will show a similar pattern of limited secondary infections involving expo- sure to infectious diseases. His conclusion? “Although a future lethal epidemic caused by progressive person-to-person spread of infectious agents is unlikely, their widespread dispersion—throughout a subway system or in the ventilating system of an office building, for example—potentially could infect thousands of people,” he noted.
Dr. Miller observed that diseases, to spread throughout a population, need an efficient vector. “Bubonic plague killed on a wide scale in the Middle Ages because the vector, fleas, went unrecognized. Also, the incubation period for most diseases requires days, creating an opportunity for medical intervention.
“In theory, I believe smallpox has the most destructive potential,” he continued. “But it is a challenging and complex process to grow smallpox and convert it into a weapon. Also, there is residual immunity among those previously vaccinated.”
Dr. Miller advocates a reasoned approach to biological warfare. He believes that the existing medical system in the United States has a great capacity to detect and identify disease. “Think about what happens when an international traveler becomes sick in the United States,” he said. “Whether it is West Nile Fever or some other disease not often seen in this country, an accurate diagnosis is made rather quickly.”
Because of this existing capability, Dr. Miller says “the prospect of exposure to biological weapons should elicit not hysteria, but vigilance and planning. Louis Pasteur, the father or bacteriology, was correct that ‘chance favors only the prepared mind’.”
