HEALTH & SCIENCE

Physicians are early warning system against bioterrorism

Reporting suspicious disease clusters to public health agencies is a critical part of the nation's ability to combat an attack involving a biological pathogen.

By Susan J. Landers, AMNews staff. Oct. 15, 2001. Additional information

Washington -- All physicians will be on the front lines if a bioterrorism event occurs.

After the Sept. 11 attacks in New York City and Washington, D.C., the threat of an assault with a lethal virus or other pathogen, already considered a very real possibility by many in the medical community, has moved to the top of the public's fears.

"It's not that the risk is greater now," said J. Chris Hawk III, MD, a member of the AMA's bioterrorism subcommittee and a surgeon in Charleston, S.C. "It's just that a lot more people realize that terrorism is real."

Smallpox, for example, is one of the most feared biological agents. It could kill thousands of people and result in the re-establishment of a disease now considered eradicated -- representing a major setback for modern medicine. It also would represent a different kind of challenge for health care professionals confronting such a disaster situation.

Emergency physicians in New York and Washington knew precisely what they had to do when terrorists crashed their hijacked aircraft into the World Trade Center and the Pentagon. But what could office-based physicians do if terrorists unleash this virus, or another deadly scourge, in their communities?

As it turns out, they can do plenty.

Physicians serve as the nation's early warning system by being alert to unusual illnesses or questioning the severity of symptoms in patients.

For one thing, physicians should be suspicious of unusual disease clusters, said Timothy Flaherty, MD, chair of the AMA Board of Trustees. The AMA Council on Scientific Affairs began studying terrorism in 1999 and has established a subcommittee on bioterrorism. There will be a session on bioterrorism at the AMA Interim Meeting in December.

"The most important issue for the office-based physician is the role we will play in the early detection of a bioterrorist attack," said Melvyn Sterling, MD, an internist in Orange, Calif., and a member of the AMA bioterrorism subcommittee.

"Our public health system cannot respond until it is aware that an attack has occurred," he noted. And physicians should get used to the idea that they will need to call their city or county health officer whenever they suspect something unusual, Dr. Sterling said. And if it turns out to be a false alarm, that's fine.

A question of preparedness

Meanwhile, health departments are gearing up for this potential barrage of phone calls, said Donald Henderson, MD, director of the Johns Hopkins Center for Civilian Biodefense Studies.

In addition, he said, the federal government is stockpiling medications and medical supplies that can be airlifted to an affected area of the country on short notice.

But much of the training conducted since 1995 has focused on police, firefighters and emergency medical technicians and the threat of a chemical attack, Dr. Henderson said.

Only recently have hospitals and the public health system been involved, he said, and shortcomings are evident. Hospitals are being operated at full capacity for economic reasons, he noted, and even an outbreak of influenza may tax them. "We are also short of nurses and support personnel," Dr. Henderson said. And isolation rooms are rare.

But all public health departments are gearing up to be ready around the clock, said Mohammad Akhter, MD, PhD, executive director of the American Public Health Assn.

In addition, "Every physician should have the phone number of the Centers for Disease Control and Prevention," Dr. Akhter said. "That's where you can get the information that will be beneficial to the management of the case."

And the difficulties perpetrators of such an attack would face mean that there likely would be time to prepare, according to bioterrorism expert Jonathan Tucker, PhD, a director at the Monterey Institute's Chemical and Biological Weapons Nonproliferation Program.

Terrorists would have to overcome some very significant technical hurdles before they could stage a widespread attack on the United States using deadly biological pathogens, he said in a recent presentation.

Terrorists would have to obtain samples of the agent and determine how to disperse it effectively, explained Dr. Tucker, who is also the author of Scourge: The Once and Future Threat of Smallpox.

The Japanese terrorist group Aum Shinrikyo that released nerve gas in the Tokyo subway in 1995 failed in at least two earlier attempts to release biological agents, despite the fact that they were sophisticated and well-funded, Dr. Sterling said. "So this is something that is not going to be a backyard operation," he said. "But it can happen."

Patients' needs

And what about worried patients seeking answers on how best to protect themselves and their families? Or those patients for whom the horrific televised scenes of the disasters have revived painful memories or resulted in sleepless nights and depression?

Mary Anne McCaffree, MD, an Oklahoma City neonatologist and member of the AMA bioterrorism subcommittee, advises physicians to allow some extra time to listen to patients for whom a posttraumatic stress disorder may have been rekindled. "It might be worth it to ask patients, 'What can I help you with?' " she said.

One physician in Ohio has taken matters into his own hands by prescribing the antibiotic ciprofloxacin, which is thought to be effective against anthrax, to his patients.

"I found out that if we do get an anthrax attack, you have four hours to get prophylactic antibiotics or you're dead," said A. Hugh McLaughlin, DO, a family practice physician in Cuyahoga Falls, Ohio.

So far, about 100 patients have accepted Dr. McLaughlin's offer.

But not all physicians agree that arming patients with a prescription for antibiotics is the proper way to go. Ciprofloxacin is valuable for treating a range of infections. A run on the drug, as has been seen in New York City, could cause shortages in other parts of the country, and patients who need the medication now may not be able to obtain it, Dr. Sterling noted.

In addition, antibiotic resistance has caused an enormous international problem, he said. "If we were to give prescriptions to large numbers of people, they would probably not only keep it for emergencies, but a lot would use it when they get a cold, and that would further spread resistance to the antibiotic."

Back to top.