"Be Prepared" and "The Invisible Nightmare"

Readers respond to stories on bio-terrorism by Pamela Weintraub and Andrew Leonard.

Published October 4, 2001 7:30PM (EDT)

Read "Be Prepared," by Pamela Weintraub.

This article thoughtlessly suggests an irresponsible approach to a serious problem. Public health officials I know fear that hoarding of antibiotics will create a shortage in the event of an attack, with people under-treating themselves or treating themselves when they don't need to. The potential for waste, adverse reactions, class disparities in treatment, half-treated people walking around spreading disease, etc. is mind boggling. It's sad that, after eroding the public health system for decades out as part of a general retreat from shared responsibility for common needs, people react to this potential for crisis with "I'll get mine, I don't care who else needs it."

Maybe people just figure there's an infinite supply of doxy, cipro, etc., since it's plentiful for current non-bioterrorism needs. The recent series of vaccine shortages (flu last year, current shortage of tetanus vaccine) make it clear that we can't take availability of medical supplies for granted. I thought about having some cipro on hand to reduce anxiety about an early response to exposure. But when I learned that anthrax exposure requires two months of therapy, I realized that everybody keeping a dozen pills in their medicine cabinet was a problematic response. What we need is to be educated about safety precautions, make sure our public health systems have staff and funding to respond to a crisis, and maybe start thinking about working together for the common good.

-- Joan M. Bedinghaus

As a biologist, I couldn't disagree with Ms. Weintraub more. How will the public know that an attack has taken place? How will the individuals decide which disease has been released and which antibiotic is appropriate? And exactly how should individuals obtain and manage such a large variety of drugs as she suggests? Does Ms. Weintraub understand how ridiculous her suggestions are? Perhaps we should each have an arsenal of drugs in our medicine cabinets, "just in case!"

What sort of doctor would provide this arsenal? And with an arsenal of various antibiotics, people would be likely to use them, perhaps for a cold, an undiagnosed infection, acne, whatever is bothersome at the moment. Antibiotics are valuable, and becoming increasingly so as microbes adapt to them and render them ineffective. It is imperative that we reduce our dependency on these drugs as they have limited usage before they are permanently ineffective. Does Ms. Weintraub realize that a calculated biological attack is not at all like a minor cold or infection being passed around? A calculated attack would likely incorporate antibiotic resistant microbes, the fastest, the deadliest, the most contagious microbes. Most likely, viruses.

Containment and aggressive treatment by experts (the CDC, the Army, WHO) are keys to limiting the death toll in a biological attack, not medicine cabinet cure-alls. I see no fault in Ms. Weintraub's suggestions of keeping gloves, masks, and electrolytes as these are good precautions for routine and natural illnesses anyway. And if she wants to rely on her stash of antibiotics in the face of the end of the world, fine. (You might as well advocate hiding under a desk during a nuclear attack.) As for me, I will cooperate with professionals trained for this situation.

-- Erin Dobrinen

Obviously, survival will come down to who can afford to buy these antibiotics (assuming that doctors will hand out prescriptions). I've taken every one of these antibiotics at one time or another -- they're not cheap. Those who can't afford to buy the meds that they need now are going to be left out in the cold. Somehow, knowing that one's survival may depend on the pharmaceutical industry is less than reassuring.

-- Jennifer Kemmer

I think it's great that Pamela Weintraub's article gives alternatives to the "sit around and wait to die" advice that most sources provide, but where am I going to find a doctor willing to write a prescription for a disease I don't have yet? I've had a hard time getting effective antibiotics when I have a provable infection. I suspect that even if I had the article in hand, the doctor would simply chuckle condescendingly and send me on my way. Is there a directory of doctors who actually give a damn?

-- Linda Miller

As well informed as Pamela Weintraub's article "Be prepared?" was on the medical treatment aspects of biological warfare, it was devoid of common sense.

While she mentions six of the bio-weapons considered likely for use by terrorists, the Australia Group (a coalition regulating trade in potential bio-weapons technologies) specifies 20 viruses, 13 bacteria, and 4 Rickettsiae with an additional 8 viruses and 5 bacteria on a "warning list". None of the bacteria on the list will react in the exact same way to any one antibiotic prophylaxis. "Getting your hands on" the smallpox vaccine (or any of the other virus vaccines) is not something that is readily accomplished at the neighborhood pharmacy.

The discussion of cipro and anthrax is particularly un-enlightening. "While the unlucky victims get sick first and set off the alarm ... the rest of us ... will have a fighting chance with a week or two of cipro or another antibiotic, doxycycline, on hand." Notwithstanding the fact that antibiotics have a shelf life, never mind that the bio-weapon may be engineered for antibiotic resistance, there are some major flaws with this argument.

The very first of the "unlucky victims" who "set of the alarm" will present with flu-like symptoms, potentially undiagnosed as a bio-attack by the medical community, two days after the resulting attack. There will be no sirens that go off the moment a bio-attack occurs. A biological agent release isn't as obvious as an explosion. The armed forces have several systems such as the BIDS and JPBDS systems which can detect the presence of biological agents, but these are relatively few and far between. A stealthy release of an agent would most likely go unnoticed. The victims appearing two days later WILL BE the alarm.

That said, it is important to note that anthrax is not communicable from person to person. The infection spreads as secondary infections due to anthrax spores carried from place to place by a victim, so once the victim has changed clothes and showered, their potential to spread disease is drastically reduced. Once the alarm is out, wearing an improvised dust mask and washing your hands regularly will be infinitely more effective than gulping down your hoarded cipro.

The over-prescription of antibiotics is already enough of a problem without having every person with self-diagnosed tularemia self-prescribing Tetracycline or Doxycycline. This will only dull the effectiveness of medicine's "front line" antibiotics for the rest of us suffering real, non-terrorist induced infections.

Everyone hates to feel powerless, and everyone hates to be scared, but there really IS nothing that any one person can do, other than to use their vote and their voice to influence community, state and federal policy. We need to reinforce our healthcare system for mass casualty events, we need to pour money into bio-weapons detection and mitigation technology, we need to make sure that our leaders are prepared to make the right moves at the right time to react to bioterrorism. We do not need to dig a bioterrorist bunker. "There is no need to be alarmist here, just intelligent ..." Ms. Weintraub needs to take her own advice.

-- Bernard Froman


Read "The Invisible Nightmare," by Andrew Leonard.

In the current climate of the nation, I found this article exploitative, sensational and misleading. The possibility of this happening is nearly nil. Your article does not challenge the ideas presented in any meaningful way. Shame on you. And shame on Salon as well. I hear you are becoming all pay-per-read. This article gives me little reason to regret missing out on the pay articles.

-- Peter Mareno

Leonard's review on "Germs: Biological Weapons and America's Secret War" is correct in saying there is schizophrenia in the arms-control community over the likelihood of an biological attack. Until one happens it is difficult to assess the risks without access to highly classified information.

However, it is because the technical skills are fairly easy to obtain that international treaties, such as the biological and chemical weapon conventions, should be supported. The U.S. really has to understand that the dangers involved in NOT having these treaties in place and ratified are unthinkable. If it means that biotechnology companies [who are afraid of industrial espionage and have basically killed attempts to ratify the BWC in the U.S.] are unhappy, so be it.

I would be the first to agree that there are risks and problems associated with arms control treaties. But a lot of these risks depend on how much funding you can give the verification regime. For example, the current funding on verification given to organizations such as the IAEA is pitiful, and many national projects have had funding cuts in the past few years.

There are also some small low-cost projects that could give you some early warnings of interest in weapons of mass destruction. A few years ago, I carried out a small survey to see however many of the clandestine nuclear weapons programs had scientists who had previously worked on the verification teams of the International Atomic Energy Agency. Usually an inspector will stay with the IAEA for about 5-10 years before moving back to his or her country. Surprisingly, the IAEA does not track what happens to their employees after they leave the IAEA. Even with the scarcity of information available, I did managed to find out that Pakistan, India, South Africa, Brazil and Iraq all employed ex-IAEA inspectors in quite influential positions in their weapons programs. Tracking the employment of individuals working in these fields would not cost much (on a yearly basis) and may be a good indicator of any large-scale hidden programs underway. Creating a similar scheme for biological research would probably cost a bit more (as you're dealing with a bigger scientific population), but it would still be doable.

With the Russian scientists who used to work on biological weapons I think you have to look to the success of the Nuclear Cities Initiative, which has probably one of the most cost-effective programs the U.S. has ever deployed in reducing the risk of nuclear proliferation. Most Russian scientists don't want to leave their country as long as they are paid a reasonable salary. Helping them do that, through supporting schemes such as the NCI, would be a wise investment in U.S. funding resources. Its just a pity that before 11 September, the U.S. was going to cut funding for it by 80 percent.

-- Paul Guinnessy

I believe that your approach to this topic, along with many journalists, is fueling the fear generated by the September 11th attacks. You may see your responsibility as one of an educator -- letting the people know. DID we need to know what you just put out, was it driven by a need to help people, or was it just an opportune piece of journalism that seemed like a good idea at the time?

Yes -- its always within my range of choices to stop reading these sorts of articles.

I am going to stop looking at your Web site.

Please stop spreading the terror.

-- Jon Stuart

While it's easy to imagine all of the ghastly possibilities of bioterrorist attacks, science and history can teach us that the chances of a large-scale successful bioterrorist attack is rather slim. In reading the following report from the Center for International and Security Studies, I think I have a much better perspective on the bioterrorist issue. http://www.fas.org/bwc/papers/dartmthb.htm

We seem to be suffering from too much hyperbole, too many "12 Monkeys" swimming in our subconsciousness, and too many people (politicians) expressing their fears about bioterrorism but not having much scientific and medical knowledge.

There is more to learn from the failures of attempted bioterrorist attacks than there is to learn from the few and far between successes. For instance: an infamous terrorist group in Japan that had unlimited resources, cultivated anthrax and other weapons and tried to spread it all over Tokyo. While on a small scale people have been killed in the infamous Tokyo subway attacks, all of this talk about millions of people only makes people feel unsafe when the chances of dying in a bioterrorist attack is very low.

I can't believe I'm saying this, but Tommy Thompson is right. There is nothing the average person can do, except maybe move to a remote part of Montana and cease all contact with other humans.

I live in D.C., I commute to work every day by bus, metro and walking. I know I'm more likely to get run over by some guy talking on his cell phone while driving his SUV and running a red light than I am to die of anthrax poisoning. The fact is everyone has a birthday and a date of death, but it's up to you how you want to spend all those days in between ... and in my opinion worrying about when/how you're going to die is a waste of energy.

-- Hedda Kniess

I think this is an important story. but at what point does reporting on biological warfare and its simple execution become a self-fulfilling prophecy? We might as well buy the wackos a wipe-out-the-population-in-3-easy-steps kit. Again I'm not asserting that this isn't a valid story nor am I advocating censorship. but i do think public safety ought to be taken into account when publishing these kind of stories. remember the hijackers were trained in part by US flight schools. Who needs bin Laden when all the education a vicious attacker needs is right here ...

-- Laura Plaut

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