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By Avram Goldstein
Public health officials say the Washington
area is relatively well prepared to respond to a biological
or chemical attack, but they acknowledge that gaps remain
in the medical safety shield -- gaps they have begun to address.
Every day, by fax or in person, epidemiologists, nurses and
environmental health specialists from the District, Maryland
and Virginia pore over hospital emergency room logs looking
for disease patterns.
In regular conference calls, they share their findings with
neighboring jurisdictions and federal authorities. Other officials
meet almost daily to coordinate responses and to improve the
way the region tracks diseases that could be related to an
outbreak.
Since the Sept. 11 attacks on New York and Washington, the
area's government and hospital
officials say they have been consumed with bioterrorism,
fueled by public concern and administration warnings about
possible additional attacks.
Congress has moved to distribute $1.4 billion to state and
local public health authorities, and governments are focused
on the problem as never before.
"Bioterrorism is all
anyone [in public health] is doing," said Georges C.
Benjamin, Maryland's health secretary.
The D.C. Health Department is proposing to beef up its emergency
health and medical services office from five to 64 people
and to expand its ability to distribute emergency drugs. That
will be one subject today at a DC Council hearing.
Washington Hospital Center has accelerated work under a $2.2
million federal contract to design a prototype emergency room
that can shift rapidly to caring for mass casualties.
Virginia is putting the finishing touches on a secure satellite
communications television conference link to share disease
reports and instructions with its health officers.
A regional bioterrorism task force at the Metropolitan Washington
Council of Governments completed a plan Sept. 6 and remains
an active forum for updating plans and coordinating responses.
Unknowable facts such as what biological agent might be used,
its target and conditions under which it would be dispersed
leave residents uneasy. But Mark Smith, chairman of the emergency
department at Washington Hospital Center, said the fear can
be overdone.
"It's important to demystify the bioterrorism threat,"
he said. "These agents are not new, and they have a clear
clinical spectrum and clear [prevention] and treatment regimens.
Most of the bacterial diseases that can be weaponized can
actually be treated during the incubation period with oral
medications."
Anne Peterson, Virginia's health commissioner, counseled calm.
"We have to find a careful balance between recognizing
it's a very serious problem we need to do more about and the
reassurance that much is in place and the risks are quite
low," she said. "We're not saying everything can
be taken care of, but the panicked response is not necessary."
A successful attack, though, could be overwhelming. "We
could be talking about tens of thousands of victims,"
said Joe Zelinka, public safety program coordinator at the
Council of Governments. "That would absolutely crush
our medical system."
Peterson said the challenges in the Washington area are great.
"The DC area is unique," she said. "It's a
high-risk area, and it has all these boundaries. But we have
started to work out ways to share."
One of the first steps taken after Sept. 11 was to educate
the private health establishment. Last week, DC Health Director
Ivan C.A. Walks faxed a memo to every District doctor, nurse,
clinic and hospital mandating immediate reports of patients
with certain unusual or suspicious conditions. Similar advice
circulated in Virginia and Maryland.
Walks said he wants to be notified of any such conditions
and asked doctors to refrain from prescribing unnecessary
antibiotics.
DC Medical Society President Stuart Seides said doctors are
comfortable with the guidelines.
"They want their patients to feel that if, God forbid,
they come down with anthrax, their doctor isn't going to scratch
his head and say, 'I've never seen this and don't know what
to do about it,' " Seides said.
Walks said CDC officials suggested the wide alerts so epidemiologists
get the earliest warning of suspicious cases, clusters or
outbreaks.
Syndromes caused by likely biological agents could initially
resemble flu symptoms a day or more after exposure -- long
after victims might disperse.
The sooner epidemiologists know what they are dealing with,
the sooner officials can begin treatments.
Some drugs are on hand now, officials say, and additional
supplies are in a national pharmaceutical stockpile.
The Council of Governments' bioterrorism task force catalogued
actions necessary to meet a large-scale crisis.
Federal officials would deliver 50 tons of prepackaged medical
supplies to the area within 12 hours and, within 36 hours,
follow up with a supply of drugs to treat or prevent the specific
illness. They could send as many as 7,000 medical workers
to an area if necessary.
Victims would be told to assemble at casualty collection points
or other makeshift outpatient sites for triage, and only the
sickest would be transported to hospitals.
To make room for the influx, hospitals would discharge every
patient possible. Once the hallways, chairs and other areas
were filled with patients, officials would set up operations
at nearby schools or hotels for access to hospital laboratory,
X-ray, food and other facilities.
If the number of patients continued to grow, military field
hospitals could be set up within 72 hours. If needed, officials
could impose quarantines and restrict treatment to those patients
most likely to survive.
It is all unimaginable, but
calm and continued planning is the only option,
said Benjamin, the Maryland health secretary.
"Disasters overwhelm systems," he said. "You
can't prepare for everything, so you do the best you can to
shorten the time from absolute chaos to controlled disorder.
By training and pre-positioning supplies and equipment, you
try to give yourself an edge."
Washington Post October
5, 2001; Page B01
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