DC to Get Bio-Attack Warning System

August 27, 2002
By Pamela Hess

WASHINGTON (UPI) -- Washington, Albuquerque, N.M., and two other cities will get an experimental "medical surveillance system" this fall and winter to track diseases in hopes of identifying a biological attack before it reaches epidemic proportions, Pentagon officials told United Press International Tuesday.

The system will cobble together environmental monitors that will sample the air for biological agents, and software to collect data from pharmacies, hospitals and doctors' offices and send it to a central system that will search for "spikes" of unusual symptoms.

For instance, a jump in sales of cold and flu medicine during the summer could suggest a manmade outbreak of a respiratory disease.

The $300 million, two-year pilot program is sponsored by the Defense Department and is being designed to determine exactly what kind of monitoring and reporting systems can quickly identify outbreaks.

"Our goal is not to protect the cities. Our goal is to find out how to do it," said Ron Yoho with the Defense Threat Reduction Agency.

No such system was in place in Washington last year when it suffered an anthrax attack that killed two postal workers. Five people total were killed in the United States by last fall's anthrax attacks.

"We all recognize this is something we need to do," said Anna Johnson Winegar, deputy assistant to the defense secretary for chemical and biological defense. "It has been less than robustly supported. It's a matter of competing priorities. A lot of people had put a biological terrorist attack in the hypothetical category until last fall. Shame on us."

It is unclear whether the biodefense system contemplated now would make any difference in the event of a small-scale attack, the officials acknowledged. However, it might have improved the chances that hospitals would have recognized the symptoms of anthrax earlier.

"It certainly would have been more probable," Winegar told UPI. "We are trying to synthesize (the information) so that it would have been like all those people were seen by the same doctor."

Presumably, had the victims gone to the same doctor, a pattern would have been noticed and investigated. Two of them did, in fact, and both survived.

At least one of the postal workers who was killed last fall from anthrax in the Washington area was treated for flu and released from a hospital without the anthrax infection being detected.

"In this game, 12 hours, 24 hours or 48 hours can make a big difference in treating people," said Paul Bergeron, an analyst on the Pentagon's chemical and biological defense program.

Medical surveillance is not a new concept; the Centers for Disease Control and Prevention regularly tracks outbreaks of diseases, including an ongoing monitoring of the progress of the West Nile Virus. The system relies on doctors and hospitals to report infectious diseases to a central database where anomalies and suspicious clusters are identified.

The Pentagon bio-defense pilot program, however, is designed to leverage that reporting network and yield a suite of sensors and technologies that cities can buy and deploy.

To that end, the Defense Department will hold a "competition" in December during which cities can nominate themselves to be test facilities; the winners would be announced in early 2003, and environmental samplers and software distributed by mid-year.

The cities with best chances of being selected would have mass transit, including a subway system, a major airport, and possibly be on the coast, the officials suggested.

Most of the biological detection projects tend to be "point detection," that is, machines that suck in air samples to check for the presence of certain agents. Those systems are limited, however, by their range, how often they are checked, and by the organisms and chemicals they are programmed to recognize.

Nationwide, federal, state and local organizations already have more than 100 information systems designed for health surveillance, the National Association of County and City Health Officials says. The Pentagon's software, based on the existing Army program known as "ESSENCE," requires no additional inputs from overtaxed healthcare professionals. It merely mines data off records already kept by hospitals and pharmacies.

That information is scrubbed for privacy concerns by the healthcare provider; patients' names and personal data will not be available to the government.

"No data will ever come to us that haven't already passed through filters," Yoho said.

Acting on the data will also be the responsibility of health officials, Yoho said: if a biological event is detected, the most likely scenario for response is that hospitals will be notified and they will contact patients and other potential victims.

Biological attacks -- as Palm Beach County and the Washington area know only too well from their experience last fall with anthrax -- are often slow to be noticed. Many diseases present early symptoms similar to common viruses until it is too late to treat them and they have already spread.

Anthrax is not communicable, but a host of other agents believed to be in the arsenals of several countries are, including plague, (Yersinia pestis ), smallpox (variola major) and Ebola and Marburg hemorrhagic fever. CDC also identifies botulism (Clostridium botulinum toxin), tularemia (Francisella tularensis), and Lassa fever, Junin fever, and related arenaviruses as posing potential biological threats.

Many infectious diseases incubate for a week or more, during which time the patient feels healthy but is capable of infecting others. That is why a medical surveillance system is critical -- to pool the individual cases into a central sample and determine quickly whether a terrorist has released a biological agent.

"Only a short window of opportunity will exist between the time the first cases are identified and a second wave of the population becomes ill," CDC warned in an April 2000 report. "During that brief period, public health officials will need to determine that an attack has occurred, identify the organism, and prevent more casualties through prevention strategies (e.g., mass vaccination or prophylactic treatment).

"As person-to-person contact continues, successive waves of transmission could carry infection to other worldwide localities."

The Pentagon will also spend another $120 million to set up a "virtual" biological terrorism research facility, tying together the multitude of researchers working on various aspects of biological defense.

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