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Improving Preparedness
 he following approaches
could improve the nation's preparedness to manage the consequences of
a bioterrorist attack.
Early
Detection of a Biological Attack
Advanced technologies
for detecting the release of biological agents into the atmosphere are
currently being developed. The BioWatch initiative was launched in
2003, installing devices in a handful of major U.S. cities to detect rapidly the presence
of select BW agents in the air. It operates as a network of sample
collection facilities, coupled to the network of pollution sensors
deployed by the Environmental Protection
Agency. BioWatch monitors operate around-the-clock. BioWatch has been
criticized for it high cost ($53 million in the first year of
operation), limited coverage, and choice of sensor location. As part of
a new Bio-Surveillance Program Initiative announced by the Bush
administration for FY 2005, the Department of Homeland Security
announced an overhaul of BioWatch to modernize its detectors, extend
coverage, and begin to network the sensors and integrate them with other
monitoring mechanisms.
Infectious
Disease Surveillance and Response
FBI and EPA personnel working to
identify anthrax-contaminated mail
In the event of a major outbreak of infectious disease caused by
bioterrorism,
the U.S. public health system would be the nation's first line of defense,
backed up by the Centers
for Disease Control (CDC), the
National Institutes of Health (NIH),
and other federal agencies. Because of the incubation period between
infection and the onset of symptoms, a covert biological attack would
not be detected immediately, but only after a delay of several days. One of the first indications of an unusual disease
outbreak would be when the initial victims became ill and sought treatment
in emergency rooms and doctors' offices. Detection and containment of
the outbreak would entail four basic steps:
- Recognition
and Diagnosis: Medical clinicians
would identify potential cases of an unusual infectious disease or syndrome
(an undiagnosed cluster of symptoms). Clinical laboratories would
then identify the disease agent from patient blood, urine,
or other specimens.
- Communication
of Surveillance Information to Public Health Authorities: Health care professionals and laboratories that detect an unusual pattern
of disease, such as several patients with the same symptoms or a non-endemic disease,
would report their observations to local or state public health departments.
- Epidemiological
Analysis of the Surveillance Data: Epidemiologists working for
the health department would interpret the surveillance data to make
a tentative determination of the source of the outbreak, the mode of
transmission, and the extent of exposure. They would then make recommendations
for appropriate treatment and public health measures to contain the
outbreak.
- Delivery
of the Appropriate Medical Treatment and Public Health Measures:
Patients seriously affected by the disease would be admitted to hospitals
for treatment. Those infected with contagious agents would be isolated
and all of their potential contacts vaccinated (if a suitable vaccine
is available) to prevent the disease from spreading. In some circumstances,
it may be necessary to quarantine exposed persons in an effort to
reduce transmission of the disease. Hospitals currently lack sufficient
"surge capacity" to treat a large influx of infectious disease patients.
Because the U.S.
public health infrastructure has weakened in recent decades, it is essential
to remedy serious deficiencies in city, county, and state health departments.
For example, electronic communication systems and coordination mechanisms
are needed so that local, state, and federal public health officials
can be linked together into a seamless web. Some federal civilian biodefense monies have been spent to improve communications and laboratory capabilities, but considerable deficiencies in the public health system's ability to handle a regional or nationwide pandemic remain. Improving epidemiological surveillance and response capabilities
around the country would make the nation better prepared for a full
range of infectious disease threats, of which bioterrorism is only one.
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