ANTHRAX THREAT
October 15 , 2001

Susan Dentzer provides an update on the anthrax outbreaks, then Gwen Ifill discusses the public health threat with Senator Bill Frist(R-TN) and U.S. Surgeon General David Satcher. The NewsHour Health Unit is funded by a grant from The Henry J. Kaiser Family Foundation. Background: Discussion:

 

Online NewsHour Special Report: The Bioterrorism Threat Oct. 12, 2001: New concerns surrounding the anthrax threat. Oct. 12, 2001: Examining the anthrax cases in Florida and New York. The NewsHour's Health Spotlight.   Centers for Disease Control and Prevention U.S. Health and Human Services	SUSAN DENTZER: Senate Majority Leader Tom Daschle confirmed today that his personal office near the capitol had received a letter this morning containing suspicious powder. Preliminary field tests indicated that the powder contained anthrax. SEN. TOM DASCHLE: I did contact each of the other members of leadership just to warn them that something may occur in their offices as it has in mine. At this point the office is quarantined. Staff are not leaving the offices. The office is officially closed until all of the procedures have been satisfactorily addressed. SUSAN DENTZER: Daschle said that staffers in his office who were exposed to the letter were being treated preventively with antibiotics. They'll also be monitored closely for any signs of disease. To date, just two people have been confirmed to have full- blown anthrax infections. One case was at NBC News in New York, where an assistant to anchor Tom Brokaw tested positive for anthrax. She is being treated with antibiotics and is expected to recover fully. And in Florida, Robert Stevens, a photo editor for The Sun tabloid newspaper, died of the results of an anthrax infection on October 5. At the same time, nearly a dozen other individuals across the country have been exposed to the anthrax bacteria, but without becoming sick. In the case involving NBC News at Rockefeller Center, New York city officials confirmed over the weekend that a police officer and two laboratory workers had been accidentally exposed to tiny amounts of anthrax while they were handling the letter sent to NBC. And in Reno, Nevada, health officials said four people who might have been exposed to anthrax that may have been contained in a letter sent to Microsoft, did not test positive for exposure this weekend. At the White House today, President Bush was asked about a possible relationship between terrorist Osama bin Laden and the anthrax scares. PRESIDENT GEORGE W. BUSH: There may be some possible link. We have no hard data yet. But it's clear that Mr. bin laden is a man who is... an evil man. He and his spokesmen are openly bragging about how they hope to inflict more pain on our country. So we're watching every piece of evidence. We're making sure that we connect any dots that we have to find out who's doing this. And I wouldn't put it past him. But we don't have hard evidence yet. SUSAN DENTZER: As the anthrax scare intensified, Health and Human Services Secretary Tommy Thompson said that the government would ask for an additional $1.5 billion to fight bioterrorism this fiscal year-that's more than five times what is currently in HHS's budget for bioterrorism. Among other things, the money would be used to accelerate production of vaccine to fight smallpox, generally considered a far more dangerous threat than anthrax. Grants would be channeled to state and local agencies to beef up hospitals' ability to respond to bioterrorism, and to improve training of emergency personnel. And some of the funds would be used to beef up the government's stockpile of antibiotics, which currently could treat up to two million people for about 60 days. HEALTH AND HUMAN SERVICES SPOKESMAN: And we are going up on Capitol Hill this week and requesting an additional billion dollars to increase that to 12 million. So that we could handle 12 million individuals in America for up to 60 days. So I'm telling people, you don't need to hoard ciprofloxacin or dyno or penicillin. SUSAN DENTZER: One piece of information investigators were focusing on today was the fact that both the letter to Daschle's office and one of two suspect letters received at NBC were postmarked in Trenton, New Jersey. By late today, the fear had turned global with anthrax scares erupting in countries from Australia to Czechoslovakia. In France police evacuated people from several government and private offices after packages containing suspicious powder arrived in the mail.
	Educate, not vaccinate
	GWEN IFILL: Joining me now are Republican Senator Bill Frist of Tennessee, a physician and member of the Health Education and Labor Committee. And U.S. Surgeon General David Satcher. Dr. Satcher, we have heard everything, we have heard about planes being grounded and cathedrals being evacuated. People everywhere seem to be very jittery about this. About today's events particularly including the positive anthrax case at the Capitol and also what we've heard coming out of New York. What should Americans be doing? U.S. SURGEON GENERAL DAVID SATCHER: Well, I'm delighted to be on with Senator Frist. I think one major issue is the public health infrastructure. The best defense against bioterrorism, we believe, is a very strong public health infrastructure. That requires cooperation with the criminal justice system, but a strong public health infrastructure means not only a very strong CDC-- and I think it's probably the strongest public health agency in the world but needs a lot of work-- it also means strong state and local health departments. It means very well trained and alert health professionals on the front line, alert to unusual findings. But the thing that we don't talk about a lot is that it requires an informed public, not a public that's panicking but a public that's informed about the reality of the risk and how to minimize it. And certainly I think CDC has issued guidelines about how to look at mail and how to identify unusual mail that you should be very careful about opening, and if you happen to open an envelope and to find powder, that you cover it immediately, you try to close off that area so that more people are not exposed and so it can be investigated. I think we need to make this system work. I think if we do we will minimize the risk even though we're sort of under attack, we can minimize the risk of that attack. GWEN IFILL: Senator Frist, are we prepared to minimize the risk? SEN. BILL FRIST: Well, we are. And I think your question as to what individuals can do is a very important one. From a federal standpoint, we have heavily invested today in fighting bioterrorism. As in the opening piece was said, there is more on the way. I think we're equipped from a federal level in terms of stockpiling, getting antibiotics to people in an appropriate, timely manner. But there are things that individuals can do. In this war-- and I think at this point, this is war on anthrax, on biological weapons, and it's evolved into that over the last several days. But knowledge is power. It means that individuals today do need to take a little bit of time to learn how to handle mail, to go to those sites, whether it's the CDC site or even on my own Web site, I've listed how to best handle mail on my Web site today because I've gotten thousands of questions or inquiries over the last week I even put the images of what the skin lesions should look like. At this standpoint individuals do need to have a lower bar, a lower threshold for being suspicious. They need to be vigilant but at the same time they should be assured that we can respond in an appropriate way. But the system has not yet and I don't think will be stressed because we have the very best public health people out there identifying and communicating. Yes we can improve and we're going to do that with further funding. That's coming soon.
	Hoaxes and paranoia
	GWEN IFILL: Senator, is it possible for people to be too aware? There are so many hoaxes out there right now about talcum powder, baby powder or other things. Is it possible for people to be too worried? Doctors are reporting that people are being sent to the FBI when they have a case of the flu. SEN. BILL FRIST: No, as you've heard and reported here on the Capitol, all over the Capitol today in the office buildings there's been report of powders all over the country. At this point I don't think we can be too vigilant. You have to use common sense and good judgment. But because there is this terrorist activity out there, you can't be too vigilant. You do need to know the facts. The fact is that anthrax is not contagious. It can't be spread from person to person. To inhale it you have to have almost a huge cloud of anthrax. Of course, you have to have 10,000 spores just to get the infection. The little skin lesions generally have to enter through an open cut, and they're imminently treatable. You can start antibiotics days later. It's not just cipro, penicillin. People need to know you don't want to start antibiotics in advance. They're dangerous to that in terms of resistance to microorganisms, in terms of the side effects. And you don't need gas masks and the like. We need to have people reach out, be educated, talk to people about what is appropriate in terms of vigilance. With that we're going to get through this just fine.
	Building the public health defense
	GWEN IFILL: Dr. Satcher, let's talk about the Centers for Disease Control, which you used to run. You alluded a few minutes ago to the fact that it needs some work. Is this $1.5 billion going to be enough? Is this stockpile we're talking about, increasing the stockpile I think to 12 million doses that Tommy Thompson was talking about, will that be enough? Is that realistic? U.S. SURGEON GENERAL DAVID SATCHER: I think it's realistic. I don't think anybody can say ultimately what will be needed. But I think it's realistic in terms of expectation that when it comes to really responding-- and that's what the CDC has demonstrated the ability to do so well, even in these recent events -- it's an outstanding organization. It needs support. Senator Frist has been very supportive of the CDC and of strengthening the public health infrastructure. We need to continue that. That's what Secretary Thompson is asking for: Funds to continue that, to increase the stockpile in terms antibiotics and vaccines, smallpox vaccines, et cetera. So I think it does need some help. We need to continue to strengthen it so that we can respond to things that we can't predict. But nobody can say how big of an attack we might ultimately experience. But realistically I think we're taking the right approach. GWEN IFILL: But let me ask you a practical question. There are four cities now where there have been reported confirmed cases of anthrax circulated through the mail, circulated mostly as far as we know. How can weaponable anthrax be ground into a powder so fine that it actually causes the disease to occur, and how does the person doing it, assuming that it is a deliberate planting, how does that person not contract the disease him or herself? U.S. SURGEON GENERAL DAVID SATCHER: Well, you know, it's not really easy to develop the weapon of anthrax to affect a lot of people. And I don't know if there's ever been a successful attack with the weapon as such for large numbers of people. There was the accident in Russia in which the anthrax organism seeped out and I believe about 80 people were infected, at least came down with anthrax. And about 70 of them died. That was not an attack. That was an accident. There have been attempts, like in Japan, to build large weapons to attack large numbers of people -- to date, no successful attempts. It is not easy. Let me just say that. I think anthrax is too accessible. I know that there are a lot of laboratories doing research on anthrax. We're trying very hard to do a better job. SEN. BILL FRIST: Let me.... DAVID SATCHER: Of controlling that. GWEN IFILL: Senator Frist. SEN. BILL FRIST: Let me jump in and say both regard to the funding and also the focus on anthrax, it is very important that we develop a coherent, comprehensive strategy to fight bio weapons. The focus today is on anthrax, but people should be aware that there are all sorts of other bio weapons that we need to target, that we know are in the hands of people that we don't want to have. That's things like smallpox. It's tularemia; it is pneumonic plague; it's the botulism toxins; therefore, we can focus on the vaccines and we should put emphasis there on stockpiling but it is absolutely critical that we address this from the prevention standpoint, from the preparedness standpoint and from the response standpoint. If you just had 10 million or 20 million doses of vaccine, you still have to address the overall comprehensive aspects where there are gaps. That's why it's critical to support the overall public health infrastructure, which addresses surveillance for all of these, communication amongst the various entities who need to communicate to report it quickly and have the laboratory support to make the diagnosis so you can treat. GWEN IFILL: Senator, how big are those gaps now? Dr. Satcher just alluded to the fact that there are pretty big ones. SEN. BILL FRIST: There are pretty big ones. And, again, the idea of putting $1.4-$1.5 billion fills most of the gaps. We do need to make sure that it's distributed in such a way that you look at intelligence and prevention and responsiveness, look at state and local preparedness. I spent all this morning back in Nashville, Tennessee, with people from all across the state, the experts. And they basically say, yes, stockpile and make sure you have plenty of antibiotics. But in truth what we need is help at the state and local level to make sure that physicians are trained to recognize these systems that we have the Internet capability to communicate one to another. We need to make sure that the $1.5 billion is appropriately distributed for preparedness and appropriate response and prevention and doesn't all just go to a single vaccine or a single stockpile. U.S. SURGEON GENERAL DAVID SATCHER: Some of the money is for strengthening the health alert network which has been developed.... SEN. BILL FRIST: Fantastic. U.S. SURGEON GENERAL DAVID SATCHER: CDC supporting state and local health departments, strengthening laboratories. So we've tried to develop a very strong network. Some of this money could go to further strengthen that network.
	An educated response
	GWEN IFILL: As we've been hearing all these stories about different sightings of potential anthrax around the country one of the questions that comes up is how do you know it's really anthrax? How do these tests work and how do we know that a false positive isn't really a false positive? I mean how do we begin to... When you talk about informing the public and the public being informed. U.S. SURGEON GENERAL DAVID SATCHER: We have to rely on the laboratories to make that... I don't think we can prepare people to determine whether powder is anthrax. We rely upon the laboratories. People must consult their local health departments if they have suspicions about products. So we're not asking people to be able to recognize anthrax. I think a high index of suspicion is very important. SEN. BILL FRIST: Let me just add that there are a number of tests, more than a handful of tests from looking at it under a microscope all the way to the DNA examination. So when you hear like the serology out in Arizona, which is another type of test and even another one, the enzyme laying - or ELIZA -- there's a range of tests, some preliminary diagnoses come back but they all have to be confirmed at the end of the day. We've only seen two cases by the way as pointed out in your piece. Those two cases one tragic the other imminently treatable. All the others have been measures not of disease but an environmental test. They're just swabs; they are not disease. GWEN IFILL: What should people do who have been tested for this? What are the first practical steps they should take aside from getting out of the room and turning it over to law enforcement authorities, what does an individual do? SEN. BILL FRIST: First of all I think for a more lengthy sort of explanation, go to the CDC Web site or my Web site. After initial exposure or suspected exposure where you want to lock down the room, wash your hands with soap and water, not chlorine or other things but soap and water. Isolate yourself from other people. Relax. Don't panic. All of this is treatable, imminently treatable. You will have a nasal swab; you will probably a blood test. Preliminary results will be back within six hours and final results in 48 hours. You'll likely be started on antibiotics, probably penicillin in the meantime. It is 100 percent treatable or curable at that standpoint. GWEN IFILL: Dr. Satcher, do you want to add anything to that? U.S. SURGEON GENERAL DAVID SATCHER: No. I think this is something that can be managed if people are alert and aware and respond appropriately. It really does get back to what is a strong public health infrastructure and what is the role of individuals and communities in maintaining like regular hand washing or cooking food appropriately, reporting things that are unusual. But I want to say we haven't talked a lot about physicians and others on the front line who must be a major part of this too and must not only report but also must counsel patients. The appropriate response is not to write a prescription for ciprol because somebody is worried. The appropriate response is to educate them and to support them. GWEN IFILL: Dr. Satcher and Senator Frist, thank you both very much. U.S. SURGEON GENERAL DAVID SATCHER: Thank you. SEN. BILL FRIST: Thank you.