Be prepared?

Taking precautions against bioterrorism may not be as futile as you think.

Published October 3, 2001 10:15PM (EDT)

On Sept. 11, hours after New York's twin towers crumbled to the ground, the state Department of Health and the national Centers for Disease Control and Prevention (CDC) were on the scene sampling the rubble and the air. While officials expressed concern over exposure to asbestos, acidic gas and other contaminated dust and debris, their greater fear was that the crashing planes might have discharged weaponized anthrax, smallpox or plague. They were relieved to find no evidence of biological attack. Some were also surprised.

Three weeks later, with lower Manhattan a war zone, Americans face a new reality: Police vehicles barricade reservoirs against acts of biological and chemical terror. Crop dusters and hazardous waste trucks, allegedly targeted by terrorists for delivery of killer cargo, are under 24-hour surveillance. And talking TV heads invoke nightmare scenarios of bioterrorism, which they say could claim millions of lives.

In case of an actual germ attack, what should we, individually, do? A recent New York Times story reported a sudden flurry of prescriptions for the antibiotic ciprofloxacin -- shown in peer-reviewed medical literature to be superior in treating anthrax and other weapons of biological war. The doctors the story cited labeled the effort misguided, and, said the Times, felt that "Cipro would probably be useless in treating anthrax."

Other media outlets have tended to agree. When a listener to a recent radio call-in show asked the physician-host how he might protect himself from the biological threat, he was told, "It's being addressed by the government. It's a public health issue, and individuals need not be concerned."

As a society, our best hope for long-term survival is, of course, collective security. We must fight terrorism at its source, and create a rapid response system for civilian defense so that any bioweapon making it through the safeguards can be halted at once.

But you don't have to be chairman of the Pentagon's Defense Science Board, like William Schneider Jr., say, to realize we may still be a tad unprepared. "Our healthcare system already operates at 95 percent capacity," says Schneider, and would be "unable to accommodate a mass-casualty event."

So what is a citizen to do? There's the conventional wisdom: If and when a weaponized germ is deployed near your office or home, cross your fingers and pray. This might be acceptable if, in fact, there were no means of self-defense. But a reading of peer-reviewed literature in august publications from the Journal of the American Medical Association to the CDC's Morbidity and Mortality Report, and interviews with experts in the field, suggest a host of specific preparations that we, as individual civilians, can take. From small private stashes of inexpensive antibiotics like tetracycline to a store of supplies, including electrolyte, paper masks and latex gloves, there are some simple steps that could give us the edge in surviving the first chaotic days of a bioterrorist attack.

Take, for instance, the issue of cipro. While it's true it won't help once symptoms set in, a source as authoritative as the Journal of the American Medical Association (JAMA) points out that the symptoms may start anywhere from two days to eight weeks after exposure, depending how close you are to ground zero and how much anthrax you have inhaled. So while the unlucky victims to get sick first and set off the alarm are beyond help, the rest of us -- those blocks or miles away from the release -- will have a fighting chance with a week or two of cipro or another antibiotic, doxycycline, on hand.

Here's the advice of the "Consensus Statement" of the working group gathered by JAMA to produce a May, 1999 article entitled "Anthrax as a Biological Weapon: Medical and Public Health Management": 60 days of treatment with antibiotic, to commence before symptoms begin. "A delay of antibiotic treatment for patients with anthrax infection even by hours may substantially lessen chances for survival," the Journal states. Given the state of our emergency pipeline, I'll keep a bottle of Doxy or Cipro in the medicine cabinet, thank you very much, no matter what the New York Times says.

Going through the potential weapons of biological terror, in fact, I've found at least some means of self-defense in each and every case.

Smallpox: Considered by many the most threatening of all biological weapons because of its extreme contagion and its power to kill a third of those afflicted, smallpox is a virus and, therefore, unresponsive to antibiotic treatment at any point. Nonetheless, there are things you can do to try and improve your chances. One suggestion from experts is the purchase of electrolyte for any infected individual who becomes dehydrated. You may also wish to purchase latex gloves, paper surgical masks and paper gowns to promote cleanliness and ward off contagion in case anyone is infected in your home. Natural immune boosters like the beta carotene found in carrot juice are worth a shot as well. But the most potent form of protection, even after exposure, according to the American Medical Association, is the vaccine itself -- if you can get your hands on it. "Vaccination administered within the first few days after exposure and perhaps as late as 4 days may prevent or significantly ameliorate subsequent illness," according to a 1999 article in the Association's journal.

Plague: As with anthrax, you'd be wise to have a small personal stash of antibiotics on hand. According to the Center for the Study of Bioterrorism and Emerging Infections, a division of St. Louis University School of Public Health, alternatives here include doxycycline, tetracycline, ciprofloxacin and, especially in cases of meningitis, Chloramphenicol -- although this is to be avoided at all cost by pregnant or lactating women.

Tularemia: In weaponized form, say researchers at the Center for the Study of Bioterrorism, this bacterial infection can kill about a third of those who remain untreated. Thankfully, common antibiotics, including doxycyline, tetracycline and cipro, reduce that number to 2 percent. Because it might be difficult to count on a prescription, let alone supplies at the pharmacy, in the face of a mass epidemic, it could be wise to have a week or two of your own supply on hand.

Cholera: It's not a pretty death, but without treatment, sometimes an unavoidable one. Yet a few simple supplies can shift the odds in your favor. These include the right kind of rehydration fluids -- World Health Organization solution, Ricelyte or Rehydralyte are recommended. Also advisable: Tetracycline, docycycline or ampicillin, among other antibiotics proven effective in fighting this disease.

There's no need to be alarmist here, just intelligent; no need to hide in a bunker or spend large sums of money. Certainly, it's downright dangerous to use antibiotics unless there's an actual attack, lest you inadvertently breed resistant forms of the very microbes you want to kill. All you need to do is take some modest precautions and, most important, think: Are your personal decisions driven by your own reading and analysis of the peer-reviewed literature, or by radio doctors and TV talking heads?

To continue your education, try the links below:

"Consensus Statement: Anthrax as a biological weapon, medical and public health management," from the Journal of the American Medical Association, May 12, 1999

"Consensus Statement: Smallpox as a biological weapon, medical and public health management," from the Journal of the American Medical Association, June 9, 1999

"Consensus Statement: Plague as a biological weapon, medical and public health management," from the Journal of the American Medical Association, May 3, 2000

"Consensus Statement: Tularemia as a biological weapon, medical and public health management, from the Journal of the American Medical Association, June 6, 2001

"Consensus Statement: Botulinum Toxin as a biological weapon, medical and public health management," from the Journal of the American Medical Association, February 28, 2001

Center for the Study of Bioterrorism and Emerging Infection, St. Louis University School of Public Health

Johns Hopkins Center for Civilian Biodefense Studies

The CDC's Bioterrorism Links

By Pamela Weintraub


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