If
an Anthrax Attack Should Happen ...
Study
outlines best strategies to limit deaths
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March 18, 2003 > It is a nightmare scenario
that would have been unthinkable in the pre-September 11th world:
Terrorists
have released more than two pounds of anthrax upwind of a densely
populated metropolitan area in the United States. A plume of deadly
anthrax spores is enveloping the area. The lives of all 11.5 million
people living in the region are in danger, because inhaling just a
minute number of anthrax spores can be fatal unless there is quick
antibiotic treatment.
What
should the federal government do?
A
detailed answer to that question is provided in a paper published
in a recent issue of Proceedings of the National Academy of
Sciences, one that comes from an unexpected source—the
Stanford University Graduate School of Business.
But
Lawrence M. Wein, a professor of operations information and technology
at the school and the lead author of the paper, sees no incongruity
in business experts devising a bioterror attack scenario, and what
should be done if one occurs.
"I
see this as a service operation," Wein says. "Just as McDonald's needs
to get hamburgers out as fast as possible, so we need to get anthrax
vaccine and antibiotics out as quickly as possible."
As
the paper notes, right now "detailed guidelines ... specifying who
needs treatment and how those people are prioritized do not appear
to be in place." The paper is designed to offer such guidelines.
The
scenario continues with a chilling statistic: Just under 1.5 million
people are infected with the anthrax bacteria spores. Then it asks:
Given a number of different treatment strategies, how many will die?
The
answer revolves around the distribution of the antibiotics, most frequently
Cipro, that are used against anthrax. The researchers estimate that
:
- If everyone
who showed up at a hospital were given Cipro, there would be 123,400
deaths.
- If antibiotic
treatment were reserved for those with symptoms, the number of
deaths would be reduced by 4.3 percent, or approximately 118,000
fatalities.
- If treatment
were limited to those showing early signs of sickness, the reduction
would be 4.9 percent, or 117,350 deaths.
- And if treatment
were reserved for those with acute symptoms, the reduction in
deaths would be 7.1 percent, or 114,800 fatalities.
But
in the whirlwind of events, what is the best overall strategy?
Wein
says there are four critical points.
The
first would be to act at once, even if there were uncertainties about
whether an attack was occurring. The cost of a false alarm is "just
panic and out-of-pocket expenses," Wein says. "If you wait, the cost
could be many lives."
Second,
treat people as quickly as possible—about 10,000 lives would
be lost for every hour of waiting.
Third,
make sure people keep taking the antibiotics after the initial panic
ebbs. In the only case of anthrax poisoning in the United States,
only 40 percent of the postal workers given antibiotics in the fall
of 2001 adhered to the regimen, Wein says.
Finally,
ensure that hospitals have adequate "surge capacity" to handle the
sudden inflow of patients, just as a McDonald's must be ready for
the crush of students that appears when school lets out.
There
is a critical need for trained personnel to respond to a bioterror
attack, Wein says, because, in cold mathematical terms, "it takes
one person per 700 in the population to save 1,000 lives."
There
should be a national volunteer system set up to provide those trained
people, he adds.
Wein
is critical of the federal government's establishment of a "Bio-Watch"
surveillance system, with sensors designed to pick up signs of airborne
anthrax as early as possible. Money for that system would be better
spent on distributing packages of Cipro and other antibiotics to the
public and hospitals, to be used only if an attack occurs, Wein contends.
Antibiotics
can always be used in medicine, while "biosensors are of no benefit
if there is no attack," he says.
The
US government should also consider a mass anthrax vaccination program,
Wein says. There is a federal effort to vaccinate a large number of
Americans against smallpox, but no such effort is being made against
anthrax.
It
may seem odd for a mathematician to be evaluating a medical model
developed in a business school, Webb acknowledges. But it makes sense
because "this is a mathematical model that is open to scientific interpretation,
and I have some background in the subject of biomathematical problems,"
he says.
Glenn
F. Webb, a professor of mathematics at Vanderbilt University and author
of an accompanying editorial, says the study fills a "critical gap
by providing quantitative assessment of the deaths resultant to a
civilian population from an airborne attack of weaponized anthrax
on a large city."
A
spokesman for the Centers of Disease Control and Prevention
(CDC), which has a program with the Federal Bureau of Investigation
(FBI) to respond to anthrax and other biological weapons, says
it is agency policy not to comment on research done elsewhere.
Meanwhile,
the American College of Healthcare Executives has
just completed a survey of hospital chief executive officers on the
status of programs related to bioterrorism preparedness. The survey
found:
- Ninety-five percent
of the CEOs say their hospitals already have, or will have within
six months, a bioterrorism disaster plan in place, developed in
coordination with local emergency or health agencies.
- As a result
of initiatives taken since 9/11, 69 percent of the CEOs believe
their hospitals have become safer places.
- Sixty percent
say their hospitals have decontamination units in place. Of the
hospitals without decontamination units, 70 percent plan to purchase
them within the next year.
Always
consult your physician for more information.
Online
Resources
American
College of Healthcare Executives
Centers
of Disease Control and Prevention (CDC)
US
Department of Health and Human Services
US
Food and Drug Administration (FDA)
