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Bracing for Bioterror

Health correspondent Susan Dentzer reports on how a simulated plague outbreak helped health care providers and officials prepare for a bioterrorism threat.

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  • JIM LEHRER:

    On bio-terrorism: Just a year ago, this nation was in a full-fledged scare over anthrax. Since then, many health experts and communities have been preparing for future bio-terror threats. We have a report from Susan Dentzer of our health unit, a partnership with the Henry J. Kaiser Family Foundation.

  • ACTOR:

    Why aren't you telling us anything?

  • ACTOR:

    We don't even know if it's smallpox!

  • ACTOR:

    Then give us masks.

  • ACTOR:

    You don't need masks. You've already been exposed.

  • SUSAN DENTZER:

    The popular television show "E.R." recently featured these chaotic scenes of a hospital responding to a potential smallpox bio-terrorist attack. The show featured crowds out of control, frenzied doctors and nurses, and panicked victims and their families.

  • ACTOR:

    Clear.

  • ACTRESS:

    Call someone. Get someone. I want somebody with more experience.

  • ACTOR:

    There isn't anyone.

  • ACTOR:

    Because nobody's seen this disease for 50 years. Clear.

  • ACTOR:

    Let's see what we've got here.

  • SUSAN DENTZER:

    Now cut to real life, and to a hospital in suburban Montgomery County, Maryland. A bioterrorism preparedness exercise was under way there earlier this fall.

  • SIMULATED PATIENT:

    I've got severe diarrhea and I just can't take it anymore.

  • SIMULATED PATIENT:

    We'll get you seen by a doctor. I realize you're sick.

  • SUSAN DENTZER:

    In direct contrast to the scenes from "ER," this training effort was far more subdued. And organizers said that was just the point, to find ways to keep things from spinning out of control in the wake of a bio-terrorist attack.

  • DOCTOR:

    Were you on the metro yesterday when the symptoms happened?

  • SIMULATED PATIENT:

    Yeah, that's how I get home from work.

  • DOCTOR:

    From work, okay. And how do you feel now?

  • SIMULATED PATIENT:

    Pretty bad.

  • DOCTOR:

    Okay. (Siren)

  • SUSAN DENTZER:

    It's been a year since America got its first good look at bio-terrorism, in the form of the anthrax attacks in Florida, New York, and metropolitan Washington, D.C. Those attacks left 17 people seriously ill and five dead. After a year of intense investigation, law enforcement officials still don't have a suspect in the anthrax attacks.

    But in the meantime, federal, state, and local officials, as well as health systems, are still trying to digest last year's lessons and anticipate what could happen in the face of an even deadlier attack. In the process, they're laying the groundwork for a vastly improved bio-terrorism response in the future. Few regions of the country have as much at stake in doing that as the area in and around Washington, D.C. Dr. Michael Richardson is interim medical director of the District of Columbia Department of Health.

  • DR. MICHAEL RICHARDSON:

    The Washington metropolitan region very much, I think, is sort of the Petri dish of preparedness, because here you have all elements of local, state, regional, federal, and international coming together, and you have all the threats and all the risks intensified here.

  • SUSAN DENTZER:

    So one technique officials have used to enhance preparedness is to simulate bioterrorist events, as Montgomery County recently did. The county is just outside Washington, and gained notoriety as the site of six of the recent sniper shootings in the Washington area.

  • OFFICIAL:

    First of all, ladies and gentlemen, we do know that we had a biological agent introduced into the population of Montgomery County.

  • SUSAN DENTZER:

    The county's recent day-long exercise simulated a bio-terrorist event that, on paper, unfolded over six days. A total of 500 people participated, including multiple county government agencies and five area hospitals. Only a small group of people knew in advance about the exercise, since part of the goal was to test how quickly the system would recognize that an attack had occurred. So at 7:00 AM on a sunny September morning, day one of the scenario, dozens of volunteers acting out the symptoms of illness began to show up in emergency rooms, like the one here at Holy Cross Hospital in Silver Spring, Maryland.

  • OFFICIAL:

    We're going to get you to the hospital, put you on INC — where we'll be watching you over night.

  • SUSAN DENTZER:

    On this day, a critical test was to see whether hospital personnel would recognize quickly that an emergency was unfolding and take appropriate steps to cope. At Holy Cross, that didn't take long. After roughly 70 sick patients streamed into the emergency room, a hospital command center was quickly set up.

  • DENNIS MESAROS, Holy Cross Hospital:

    We've maxed out at 50 to 70 patients of which we've seen at one time. We have them dispersed into three areas. We still have an emergency department. We have a short stay unit. We now are going to use the PAC-U as a holding area.

  • SUSAN DENTZER:

    At the same time, hospital staff faced the challenge of identifying what had caused the victims' illness. The anthrax attacks showed that's not always easy, says Maryland's top health official, Dr. Georges Benjamin.

  • DR. GEORGES BENJAMIN:

    You know, almost all of these threat agents initially look like a non-specific syndrome, which presents as the flu– so fever, chills, headache, muscle aches. A lot of these diseases: Anthrax looks that way initially; plague looks that way initially; smallpox can look that way initially.

  • SUSAN DENTZER:

    In this simulated attack, the patients described the same general symptoms.

  • WOMAN:

    I'm still coughing, my throat hurts and my head hurts and my muscles hurt. Everything hurts.

  • MAN:

    Everything hurts right now?

  • WOMAN:

    Yeah.

  • MAN:

    Are your eyes watering. Is your nose running?

  • SUSAN DENTZER:

    The hospital staff performed lab tests and x-rays to pinpoint the cause. Although those tests were not conclusive, they did help to rule out some types of bacteria. Based on that information and patients' symptoms, the staff suspected that the agent was pneumonic plague. That's caused by a bacterium that can be aerosolized to disperse through the air. The disease can spread rapidly from one person to another via droplets from the mouth or nose. Doctors told patients that the disease's progression can be slowed or halted with antibiotics. But if patients are not treated in time, the mortality rate is extremely high. A key concern about bioterrorism is whether hospitals could handle unexpected crowds of patients who showed up after an attack. At Holy Cross that morning, it seemed initially as if the hospital had enough staff and supplies to cope.

  • MAN:

    We have enough treatment for the patients that we have, plus we have enough antibiotics– both doxycycline and ciprofloxacin– to prophylax our staff.

  • SUSAN DENTZER:

    But as the patient load built, many of the institution's resources were exhausted. A call went out to other area hospitals for supplies and personnel.

  • MAN:

    In terms of medical supplies, do we have enough masks, and where are we in terms of gloves? We had a count of 3,000. What are we at?

  • SUSAN DENTZER:

    But those institutions were also taking part in the exercise and were similarly overwhelmed. The call for help was rebuffed. An hour later, it was day two of the exercise. At the county government offices in Rockville, Maryland, a so-called incident command structure was set up to coordinate the county's overall response. That, too, was partly based on lessons learned from the anthrax attacks.

  • DR. MICHAEL RICHARDSON:

    I think the thing that we also learned from the anthrax is that the relationships that we form and the relationships that we practice are the ones that actually work when an event happens.

  • SUSAN DENTZER:

    So Montgomery County gathered together staff from all key county departments, including transportation and schools. Representatives were also on hand from federal agencies, like the Centers for Disease Control. The county's fire administrator, Gordon Aoyagi, was in charge of the command.

  • GORDON AOYAGI:

    We believe, based upon the information that was presented to us by the epidemiologist from public health, that the agent was introduced at a metro station, probably Bethesda Metro.

  • SUSAN DENTZER:

    Officials calculated that 50,000 people had been exposed on the metro, and then in turn had infected friends and family, for a total exposure of 400,000. That meant mass casualties were probably at hand. By day three, the declaration of an emergency had triggered a call to draw upon the federal stockpile of medications known as the National Pharmaceutical Supply. The drugs arrived and were dispatched to eight central distribution sites around the county. But at the five local hospitals, officials grew confused about whom to call at the county's incident command to find out how to get the drugs. By day four, the toll was growing. At least 200 deaths had already occurred. But the pattern of illness and mortality seemed at odds with the theory that the agent had been dispersed at the Bethesda Metro.

  • MAN:

    If, in fact, we believe that it was introduced at the Bethesda Metro Center, the number of people who are presenting themselves at hospitals is different than the infection site. And we are finding a larger number of people who are presenting themselves at hospitals on the Silver Spring side of the line, not the Shady Grove side of the line.

  • SUSAN DENTZER:

    By the end of the exercise, the grim tally stood at more than 2,000 dead. At a quick wrap-up session afterwards, participants learned that the scenario's script ended with the arrest of six individuals accused of releasing the aerosolized bacteria. The mystery behind the strange pattern of deaths was also solved. It turned out that the bioterrorists had released the agent not just at the Bethesda Metro stop, but throughout the entire tri-state metro system, making it a true region-wide disaster.

    After the exercise, Montgomery County officials undertook an extensive review to determine what lessons they had learned. One was the need to create a separate public health incident command to coordinate the many health-related aspects of the response. They say that would help to lessen the confusion that cropped up during the exercise as health providers and local officials struggled to find out what was going on. Other officials throughout the region say identifying just those sorts of problems is key to improving bioterrorism response.

  • DR. GEORGES BENJAMIN:

    We're better than we were a year ago, but we really need to continue to improve that preparedness. And we're moving in that direction, it's just got to move a lot quicker.

  • SUSAN DENTZER:

    So if the unthinkable does occur again, the Washington area, as well as other regions across the country, will stand a far better chance of being ready.

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