Letters to the Editor

The Nation Needs to Face the Possibility of Bioterrorism

October 1, 2001

The nation must prepare to deal with the threat of bio-terrorism, since recent events have proved that anti-American terrorists will sacrifice any number of innocent lives to advance their goals.

Biological weapons cause disease through dissemination of bacteria, virus, or microbial toxin. Some of the most feared biological agents include small pox, anthrax and plague. Bio-terrorism experts estimate that at least 10 nations, and possibly 17, possess biological warfare weapons. Many of these countries are declared enemies of the United States, including Iraq, Libya and North Korea.

The World Health Organization estimates that fifty kilograms of aerosolized anthrax spores dispensed by a source two kilometers upwind of a population center of 500,000 unprotected people would, in ideal meteorological conditions, travel greater than 25 miles downwind and kill or incapacitate an estimated 125,000 people.

Prevention against attacks-through better intelligence and enhanced homeland security-is the first line of defense. Should prevention fail, the country must also possess a preparedness plan to respond quickly to an attack and take measures to limit the spread of disease.

Role of Primary Care Physicians

Planning and training to deal with bioterrorism must emphasize the role of primary care physicians. Internists and primary care physicians would be the first health care providers to recognize that an attack may have occurred and who could work to contain the epidemic.

Covert dissemination of a biological agent in a public place will not have an immediate impact because of the delay between exposure and onset of illness (i.e., the incubation period). For example, in the event of a covert release of smallpox, patients will appear in doctors' offices and emergency rooms during the first or second week complaining of what appears to be an ordinary viral infection. By the time health officials discover the problem's true dimensions, it may already have been widely spread by person-to-person contact.

The key elements of a bioterrorism preparedness plan include early detection by primary care physicians of suspicious illnesses, an effective and rapid system for reporting such illnesses, a plan to quarantine and when possible treat affected persons, and adequate supplies of vaccinations.

Government Commitment

The 115,000 physician-members of the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) are doing their part. The College has provided its members with a special Web site (www.acponline.org/bioterro) with links to resources from the Center for Disease Control and Prevention and other sources concerning the physician's role in addressing a bioterrorism emergency

The education should encompass programs that:

1) teach physicians how to detect biological infections, reduce the risk of the disease spreading to others, and when possible, provide treatment to those who are infected.

2) educate health care providers on whom to contact if they suspect a bio-terrorist attack. An effective communication channel must be established to assure that senior health officials in the federal government get quick notification. Federal officials should have the power to immediately take action to reduce the spread of disease working in cooperation with local authorities.

The federal government needs to assure that physicians have access to vaccines to prevent further infection. Health care providers need information on how potentially infected patients should be treated and quarantined to prevent additional infections. Doctors need guidance on how they can protect themselves and other health care workers from infection, so the whole health care system is maintained.

Responding to the threats of bioterrorism will be costly, but as is always the case in health care, prevention is more life-saving and cost-effective than treatment.

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