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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Saturday, September 28, 2002

    Bioterror Preparedness Update: A perusal of local newspapers from throughout the country confirms that the state of smallpox preparedness is mostly dismal. One community in Michigan equates infectious disease with toxic chemicals and has armed themselves with committees:

    University Hospitals are equipped with a hazardous materials team trained to investigate and isolate toxic exposures before they spread.

    In addition, UHS organized a terrorism task force shortly after the terrorist attacks last September to help make decisions about the proper course of action in the event of exposure to smallpox, Winfield said.

    Reedy said the Washtenaw County Public Health Department has been keeping on top of the smallpox risk with a committee of health professionals who rigorously investigate bioterrorism issues.

    No word on whether they’ve actually come up with any plans.

    In Ohio, they’ve been distracted by West Nile virus hysteria:

    But state and local officials are still wrestling with how and where to quarantine victims who come in contact with the virus and which hospitals to designate as isolation units for people who become sick.

    Most local health departments have been too overwhelmed with West Nile virus this summer to spend much time on smallpox. And with winter approaching, their attention has turned to influenza.

    There’s not much health departments can do about West Nile, other than recommend mosquito control, and all they can do about influenza is give their routine immunization clinics - clinics so longstanding that they should be able to function on autopilot. They hardly require the full attention of the public health authorities.

    In West Virginia, and many other places, they aren’t sure whether to vaccinate their heatlhcare responders before or after the event:

    As with federal officials, determinations also need to be made as to whether some individuals should receive precautionary vaccinations and if so, who those might be, Mercer said.

    They’re also a little hazy on the natural history of smallpox infection:

    Despite the long incubation period for smallpox, Mercer said patients do not become contagious until the lesions occur. But at that point, there is an opportunity to slow the spread of the disease. Patients, he said, are extremely ill and not likely to be out in public.

    Huh? The US Army’s handbook of Handbook of Medical Management of Biological Casualties describes the onset of smallpox as similar to the flu with “malaise, fever, rigors, vomiting, headache, and backache. Two to three days later lesions appear..” And here’s what JAMA’s Consensus Statement of the Working Group on Civilian Biodefense says about the infectious period of the disease:

    Virus titers in saliva are highest during the first week of illness,corresponding with the period during which patients are most infectious.

    That means that there’s a two to three day period when people are infectious but don’t have the tell-tale rash. It’s excessively optimistic to think that everyone with fever and malaise would stay home. The reality is that people push themselves all the time to work through their illnesses, especially if they think it’s just the “flu”.

    In North Carolina, things are even worse. They’re planning to rely on the pretty much discredited “ring vaccination theory” :

    For someone who hasn't been exposed to smallpox, "the risks of the vaccine outweigh the benefits," said Dr. James Kirkpatrick, bioterrorism coordinator for the state of North Carolina.

    The first response to any smallpox outbreak would be "ring vaccination," or vaccination of family members and close contacts, Kirkpatrick said.

    Many health officials believe the vaccine can protect those who have been exposed to the virus if the vaccine is given four to five days after exposure.

    Looks like Surgeon General Carmona is right to be “concerned because America isn't quite prepared for anything, at least not yet.”

    There is one county in Maryland , however, that’s been working hard on preparedness:

    In a simulation of what public health experts and government leaders fear could be a real-life nightmare, a woman walked into a Frederick emergency room yesterday displaying symptoms of history's most virulent disease: smallpox.

    About 2 p.m., actress Amanda Strand told doctors in the fake emergency room that she had a rash and a 103-degree fever. Within 20 minutes, a SWAT team in dark-blue body armor had stormed in, barred the doors, and duct-taped the vents.

    A helmeted doctor with a pistol strapped to his thigh informed everyone they would be unable to leave for eight to 10 hours and would then be quarantined or monitored by health officials for at least 17 days.

    The pistol-toting may be a bit much, but at least the county has thought things through and run a mock emergency to discover their deficiencies:

    “They were amazed at the scope of the undertaking -- isolating the initial victim and all those potentially exposed, creating vaccination and quarantine centers, closing off roads, communicating with the press and with state and federal officials.

    ..."You'll be amazed at what you discover when you practice, silly little things that just blow your plans to shreds," said state health Secretary Dr. Georges Benjamin.

    ..County officials said the planning and drill have helped identify several potential problems.

    The county did not have enough protective suits for workers who would have to treat the infected or enough respirators for patients.

    Potential quarantine sites had improper ventilation. The county also had no written plans to provide linens or food to quarantined patients. Vitarello and friends have solved those problems.

    It also became apparent that the county's public health staff, with only a few doctors and about 50 nurses, would not be able to run both quarantine and vaccination centers.

    So Frederick officials included plans to shift scores of doctors from Frederick Memorial to the centers and to enlist hoards of retired nurses, doctors and veterinarians to give vaccinations and monitor the potentially infected.

    The most dismaying thing about this story is that the efforts at preparedness weren’t initiated by the public health department, but by a local cardiologist who was concerned enough to devote his time and energy to organizing a plan. Luckily, his public health officials were willing to work with him. I have the feeling that there are a lot of public health departments out there who aren’t taking the threat of bioterrism seriously.

    posted by Sydney on 9/28/2002 08:53:00 AM 0 comments


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